Malpractice in invasive cardiology: is angiography of abdominal aorta or subclavian artery appropriate in patients undergoing coronary angiography? A meta analysis.
BACKGROUND
Identification of peripheral vascular disease by angiography in patients undergoing coronary angiography may be considered as malpractice but sometimes seems to be justified under clear entry criteria. The present mata-analysis is aimed to analyze the appropriateness and results of screening angiography of subclavian or abdominal aorta performed at the time of coronary angiography.


METHODS
A search of published literature for peripheral angiography in patients undergoing coronary angiography over the last 10 years was performed using the MEDLINE database. No language restriction was employed. Only studies enrolling more than 100 patients for abdominal aortography and 50 patients for subclavian/internal mammary artery angiography were considered. Reference lists from identified studies were also reviewed to identify other potentially relevant references.


RESULTS
Twenty-nine studies were retrieved: 8 articles about subclavian artery (SA) and internal mammary (IMA) angiography and 21 about renal (RA) and aortoiliac (AOI) angiography. The total number of patients enrolled was 27,936. Nine studies out of 29 were prospective. Defined entry criteria were reported in 24 out of 29 studies. Significant SA and IMA stenosis were reported in 5.5 and 9% of patients, respectively. RA stenosis >50% was present in 12.7% of patients with CAD. Finally, undetected AOI disease was reported in 35.5% of patients undergoing coronary angiography. Mean complication rate was 0.8 +/- 0.6%. Predictors of SA and IMA stenosis were unclear. Age, multi-risk profile, multi-vessel CAD, history of PVD or carotid disease, severe hypertension, unexplained renal dysfunction or decreased creatinine clearance have been reported most frequently as predictors of RA and AOI disease in patients undergoing coronary angiography.


CONCLUSIONS
Consistent evidence of appropriateness of renal angiography in selected patients undergoing coronary angiography have been produced in literature. IMA and AOI angiography seem to be not justified unless they are part of SA in patients scheduled for arterial conduit with brachial differential pressure, thoracic irradiation or surgery, or of abdominal angiography to detect RA stenosis in laboratories with radiological digital peripheral equipment.
Rigatelli
Gianluca
G
Interventional Cardiology Unit, Rovigo General Hospital, Rovigo, Italy. jackyheart@hotmail.com
Rigatelli
Giorgio
G
D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D002309:Cardiology / Q000592:standards*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D006801:Humans; D008318:Malpractice; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging; D012077:Renal Artery / Q000000981:diagnostic imaging; D013348:Subclavian Artery / Q000000981:diagnostic imaging*