title: Comparison of the vasodilating effect of nitroglycerin, verapamil, and tolazoline in hand angiography.
abstract: OBJECTIVE
  To compare the vasodilating effect and safety of intraarterial verapamil with the long-accepted standard vasodilators nitroglycerin and tolazoline in hand angiography.
  
  
  METHODS
  The authors studied 25 patients who underwent brachial artery angiography. In 22 cases, there was poor or moderate visualization of the forearm and hand vasculature. To improve blood flow to the periphery, subsequent angiograms with intraarterial vasodilating agents were obtained. First, nitroglycerin was administered (n = 22). In cases of continuous poor or moderate visualization of the forearm and hand vasculature, another angiogram was obtained with verapamil (n = 21). If opacification remained poor or moderate, eventually tolazoline was injected (n = 20). To avoid pharmacologic interactions of the different vasodilating drugs, a minimum 15-minute interval between series was observed. The degree of opacification of the forearm and hand arteries was graded on a scale from 1 to 5: visualization of the forearm arteries only was defined as 1, of the forearm arteries and superficial/deep palmar arch as 2, of the forearm arteries, superficial/deep palmar arch, and digital arteries to the level of the metacarpophalangeal joints as 3, to the level of the proximal interphalangeal joints as 4, and to the distal interphalangeal joints as 5.
  
  
  RESULTS
  All three vasodilating agents demonstrated highly significant improvement in blood flow; verapamil and tolazoline showed statistically greater effects than nitroglycerin. Verapamil caused the fewest and least severe adverse effects.
  
  
  CONCLUSIONS
  Intraarterial verapamil and tolazoline are comparable in terms of vasodilatory efficacy in hand arteries. However, because of its favorable adverse effect profile, verapamil is recommended for optimizing visualization of the peripheral arterial vascular system.
authors.affiliation: Department of Radiology, Universitätsklinikum Lübeck der Medizinischen Universität zu Lübeck, Germany. stoeckel@medinf.mu-luebeck.de
authors.forename: Beate Maria
authors.initials: BM
authors.lastname: Stoeckelhuber
authors.forename: Ingo
authors.initials: I
authors.lastname: Suttmann
authors.forename: Mechthild
authors.initials: M
authors.lastname: Stoeckelhuber
authors.forename: Georg
authors.initials: G
authors.lastname: Kueffer
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D003287:Contrast Media / Q000494:pharmacology; D004890:Erythema / Q000139:chemically induced; D005260:Female; D006225:Hand / Q000098:blood supply / Q000000981:diagnostic imaging*; D006261:Headache / Q000139:chemically induced; D006358:Hot Temperature; D006801:Humans; D006941:Hyperesthesia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000009:adverse effects / Q000494:pharmacology*; D012039:Regional Blood Flow / Q000187:drug effects; D012720:Severity of Illness Index; D014043:Tolazoline / Q000009:adverse effects / Q000494:pharmacology*; D014665:Vasodilator Agents / Q000009:adverse effects / Q000494:pharmacology*; D014700:Verapamil / Q000009:adverse effects / Q000494:pharmacology*
chemical_list: D003287:Contrast Media; D014665:Vasodilator Agents; D014043:Tolazoline; D014700:Verapamil; D005996:Nitroglycerin