Ultralow-contrast stepping digital subtraction angiography for whole-limb arterial evaluation: A case report.
- 1Department of Radiology, Shimane University Faculty of Medicine, 89-1 Enya cho, Izumo, Shimane, 00693-8501, Japan.
Abstract
Stepping digital subtraction angiography (DSA) enables whole-limb arterial assessment with a single contrast injection, and diluted contrast medium may further reduce iodine exposure. A patient in their 80s with an abdominal aortic aneurysm and bilateral common iliac artery aneurysms was scheduled for staged internal iliac artery embolization before endovascular aneurysm repair (EVAR). Due to a mural thrombus in the left common iliac artery aneurysm, right internal iliac artery embolization was performed via an ipsilateral approach. Severe right external iliac artery stenosis prompted stepping DSA before and after embolization to evaluate distal embolization. Sevenfold- and tenfold-diluted stepping DSA examinations were performed before and after embolization, respectively, using identical injection parameters (3 mL/s; 30 mL). These required 4.29 and 3.0 mL of undiluted contrast medium, respectively. Although pedal artery enhancement was reduced with tenfold dilution, image quality remained acceptable, and no obvious distal embolization was identified in the visualized arteries; however, small emboli in poorly opacified pedal branches could not be excluded with tenfold dilution. Because internal iliac artery embolization was not expected to significantly alter lower-extremity arterial perfusion, the observed difference in image quality was considered to primarily reflect the difference between the two dilution protocols rather than changes in arterial hemodynamics. Ultralow-contrast stepping DSA may be a contrast-saving technique in selected cases when repeated whole-limb arterial evaluation is required.
Related
- Photon-counting CT-angiography in comparison to digital subtraction angiography and MR-angiography for assessing intra-aneurysmal flow disrupting devices
- PRISM: Phase-Resolved Isotropic Subtraction Mapping for Automated Multi-Phase CT Digital Subtraction Angiography
- Diameter measurement of tubular structures on CT angiography, 3D rotational angiography, and 2D digital subtraction angiography against caliper ground truth: A phantom study of surrogates for intracranial vessels.
- Territory-based ultrasound assessment for extracranial and vertebrobasilar arterial stenosis and carotid plaque vulnerability: a multicentre comparison with digital subtraction angiography and histopathology
- Persistent Hypoperfusion on Post‐Recanalization Digital Subtraction Angiography Perfusion Maps in Anterior Circulation Large Vessel Occlusion
BibTeX
@article{maruyama2026ultralowcontrast,
title = {{Ultralow-contrast stepping digital subtraction angiography for whole-limb arterial evaluation: A case report.}},
author = {Mitsunari Maruyama and Yuki Kimura and Megumi Nakamura},
journal = {Radiology case reports},
year = {2026},
month = oct,
doi = {10.1016/j.radcr.2026.09.064},
url = {https://europepmc.org/article/MED/42910077},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Ultralow-contrast stepping digital subtraction angiography for whole-limb arterial evaluation: A case report.
AU - Mitsunari Maruyama
AU - Yuki Kimura
AU - Megumi Nakamura
PY - 2026
DA - 2026/10/13
JO - Radiology case reports
DO - 10.1016/j.radcr.2026.09.064
UR - https://europepmc.org/article/MED/42910077
AB - Stepping digital subtraction angiography (DSA) enables whole-limb arterial assessment with a single contrast injection, and diluted contrast medium may further reduce iodine exposure. A patient in their 80s with an abdominal aortic aneurysm and bilateral common iliac artery aneurysms was scheduled for staged internal iliac artery embolization before endovascular aneurysm repair (EVAR). Due to a mural thrombus in the left common iliac artery aneurysm, right internal iliac artery embolization was performed via an ipsilateral approach. Severe right external iliac artery stenosis prompted stepping DSA before and after embolization to evaluate distal embolization. Sevenfold- and tenfold-diluted stepping DSA examinations were performed before and after embolization, respectively, using identical injection parameters (3 mL/s; 30 mL). These required 4.29 and 3.0 mL of undiluted contrast medium, respectively. Although pedal artery enhancement was reduced with tenfold dilution, image quality remained acceptable, and no obvious distal embolization was identified in the visualized arteries; however, small emboli in poorly opacified pedal branches could not be excluded with tenfold dilution. Because internal iliac artery embolization was not expected to significantly alter lower-extremity arterial perfusion, the observed difference in image quality was considered to primarily reflect the difference between the two dilution protocols rather than changes in arterial hemodynamics. Ultralow-contrast stepping DSA may be a contrast-saving technique in selected cases when repeated whole-limb arterial evaluation is required.
SN - 1930-0433
ER -