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Page 1

(6) Frontiers in
(Q) European Radiology

Editors-in-Ch ief

A. L. Baert . F. H.W Heuck

Editorial Board

L.Dalla-Palma· P.Dawson· L.Diankov· G. duBoulay
R. Gunther· G. Kalifa . 1. Lammer . M. Laval-leantet
R. Passariello . C. Pedrosa· H. Pokieser . M. Reiser
1. Remy . W Semmler· U. Speck
C. Standertskj6Id-Nordenstam· H.Thomsen
A.Valavanis . D. Vanel . P. F. G. M. van Waes . P. Vock

Founding Editors

Albert L. Baert . Erik Boijsen
Walter A. Fuchs· Friedrich H.W Heuck

Berlin Heidelberg New York
London Paris Tokyo
HongKong Barcelona

Page 2

Professor Dr. A.L. Baert
Katholieke Universiteit Leuven,
Universitaire Ziekenhuizen Gasthuisberg,
Dienst Radiologie, B-3000 Leuven

Professor Dr. F.H.W. Heuck
Director emeritus, Radiologisches Institut,
Katharinenhospital Stuttgart
Private address:
Hermann-Kurz-StraBe 5, D-7000 Stuttgart 1

Founding Editors:
Albert L. Baert . Erik Boijsen
Walter A. Fuchs . Friedrich H. W. Heuck

With 49 Figures and 9 Tables

ISBN-13:978-3-642-76101-0 e-ISBN-13:978-3-642-76099-0
DOl: 10.1007/978-3-642-76099-0

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned,
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© Springer-Verlag Berlin Heidelberg 1991
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Page 59

58 P. Dawson

in any obvious way in actual clinical angiography. Some of the recent literature
in this field is not only confusing but positively misleading.

On the subject of catheter materials, we may say that the thrombogenicity of
some of the newer catheter materials warrants investigation and more thought
should be given to the development of better catheter materials and to surface
morphology by the companies involved.

In the case of angioplasty it may be best to reserve judgement on the relative
merits of different contrast agents. No data are available but it seems reasonable
to hypothesise that the special environment created in angioplasty as a result of a
grossly injured endothelium and periods of relative and absolute stasis-sometimes
for prolonged periods-may warrant the use of both systemic heparinization and
the most anticoagulant contrast agents available.

As for systemic heparinization, there is general feeling that it is helpful but
that large-scale trials are needed to establish this. Even if heparinization were
proven to be useful it would be necessary to establish meaningful methods of
controlling its effectiveness during procedures-determining activated whole blood
clotting time, for example.

Non-ionic contrast agents are better tolerated than their ionic counterparts
and are, on the basis of first principles, to be preferred in general. They are costly
and therefore some discrimination in their use is not unreasonable, but to deprive
those patients who would benefit from them because of some poorly founded
concern that they are somehow pro-coagulant would seem unjustified.

Perhaps we can do no better than to quote Bettmann [36]: "experience suggests
that these differences in clotting (between ionics and non-ionics) are far less
important than the combination of training, judgement and careful adherence to
optimal technique".

The key to safe angiography is good technique, not bad contrast agents.


1. Winding 0 (1987) Contaminants in contrast media and catheters. In: Ansell G, Wilkins RA (eds)
Complications in diagnostic imaging, 2nd edn. Blackwell, Oxford, pp 430~439

2. Adams DF, Olin TB, Kose KJ (1965) Cotton fibre embolisation during angiography. Radiology

3. Kay JM, Wilkins RA (1969) Cotton fibre embolisation during angiography. Clin RadioI20:410~413
4. Ramirez G, O'Neill WM, Lambert R, Bloom MA (1978) Cholesterol embolisation: a complication

of angiography. Arch Int Med \38: 1430~ 1432
5. Perdue GD, Smith RB (1969) Atheromatous microemboli. Ann Surgery 169:954~959
6. Formanek G, Frech RS, Amplatz K (1970) Arterial thrombus formation during clinical percutaneous

catheterisation. Circulation 41: 833~839
7. Green GS, McKinnon CM, Roech j (1972) Complications of selective percutaneous coronary

arteriography and their prevention. A review of 445 consecutive examinations. Circulation

8. Adams DF, Fraser DB, Abrams HC (1973) The complication of coronary arteriography. Circulation

9. Takaro T, Pifarre R, Wuertlein RD (1972) Acute coronary occlusion following coronary
arteriography. Mechanism and surgical relief. Surgery 72:1018~1029

10. Takaro T, Hultgren HH, Littman D (1973) An analysis of deaths occurring in association with
coronary arteriography. Am Heart J 86:587~597

Page 60

Contrast Agents in Clinical Angiography 59

11. De la Torre, Jacobs D, Aleman J Anderson GA (1973) Embolic coronary artery occlusion in
percutaneous transfemoral coronnary arteriography. Am Heart J 86:467473

12. Judkins MP, Gander MP (1974) Complications of coronary arteriography. Circulation 49: 599-602
13. Robertson HJF (1987) Blood clot formation in angiographic syringes containing non-ionic contrast

media. Radiology 162: 621-622
14. Robertson HJF (1988) Non-ionic contrast media in radiology. Procedural considerations. Invest

15. Miller DL (1989) Heparin in angiography: current patterns of use. Radiology 172:1007-1011
16. Adams DF, Abrams HL (1979) Complications of coronary arteriography: a follow-up report.

Cardiovasc Radiol 2:89-92
17. Davis K, Kennedy JW, Kemp MG, Judkins MP (1979) Complications of coronary arteriography

from the collaborative study of coronary artery surgery (CASS). Circulation 59: 1105-1112
18. Kennedy JW (1982) Mortality related to cardiac catheterisation and angiography. Cathet

Cardiovasc Diagn 8:323-327
19. Kennedy JW (1982) Complications associated with cardiac catheterisation and angiography. Cathet

Cardiovasc Diagn 8:5-9
20. Bjork L (1972) Heparin coating of catheter against thromboembolism in percutaneous catheter-

isation for angiography. Acta Radiol [Diagn] 12:576-578
21. McCarty RJ, Glasser SP (1973) Thrombogenicity of guidewires. Am J Cardiol 32:943-946
22. Duitt TW, Durst S, Moore R, Amplatz K (1974) Guidewire thrombogenicity and its reduction.

Radiology 111 :43-46
23. Durst S, Johnson BS, Amplatz K (1974) The effect of silicone coatings on thrombogenicity. Am J

Reontgenol 120:904-906
24. Eldh P, Jacobsson B (1974) Heparinised vascular catheters. A clinical trial. Radiology 111 :289-292
25. Bourassa M G, Cantin M, Sandborn EB, Pederson E (1976) Scanning electron microscopy of surface

irregularities and thrombogenesis of polyurethane and polyethylene coronary catheters. Circulation

26. Wilner GD, Casarella WJ, Baier R (1978) Thrombogenicity of angiographic catheters. Circ Res

27. Kido DK, Paulin S, Aienghat JA, Wafernaux C, Riley LD (1982) Thrombogenicity of heparin and
non-heparin coated catheter: clinical trial. Am J Roentgenol 139:957-961

28. Judkins MP, Hinck VC, Dotter CT (1968) Teflon-coated safety guides. An adjunct to the use of
polyurethane catheters. Am J Roentgenol 104:223-224

29. Hawkins IF, Herbert L (1974) Contrast material used as catheter flushing agent: a method to
reduce clot formation during angiography. Radiology 110:351-352

30. Dawson P, Pitfield J, Grainger RG (1983) The low osmolality contrast agents. A simple guide.
Clin Radiol 34:221-226

31. Raininko R, Ylinen SL (1987) Effect of ionic and non-ionic contrast media on aggregation of red
blood cells in vitro. Acta Radiol [Diagn] 28:87-92

32. Wilson H (1950) Aqueous dextrose solutions. A hazard in transfusion. Am J Clin PathoI20:667-669
33. Dawson P (1985) Chemotoxicity of contrast agents and clinical adverse effects. Invest Radiol

34. Dawson P (1988) Non-ionic contrast agents and coagulation. Invest Radiol 23:S310-S317
35. Dawson P, McCarthy P, Allison DJ, Bradshaw A, Garvey B (1988) Non-ionic contrast agents,

red cell aggregation and coagulation. Br J Radiol 61 :963-965
36. Bettman MA (1989) Guidelines for use oflow osmolality contrast agents. Radiology 172:901-903

Page 117

Frontiers in European Radiology
Editors-in-Chief: A.L.Baert, F.H. W.Heuck

Volume 7
1990. III, 128 pp. 62 figs. 13 tabs.
Hardcover DM 98,- ISBN 3-540-52515-7

A. P. G. van GUs et al.: Non-invasive Imaging of Functioning Paragangli-
omas (Including Phaeochromocytomas). - WA. Kaiser: Dynamic Mag-
netic Resonance Breast Imaging Using a Double Breast Coil: An Impor-
tant Step Towards Routine Examination of the Breast. - H.Bosmans
et al.: Magnetic Resonance Angiography: Techniques, Prospects, and
Limitations. - C. Delcour et al.: Angiographic Evaluation of Impotent
Men. - G. Wilms et al.: Laser-Assisted Angioplasty: State of the Art and
Future Developments. - C. Masciocchi et al.: The Painful Shoulder:
Magnetic Resonance Imaging Findings.

Volume 6
1989. III, 87 pp. 43 figs. in 100 sep. illus. 15 tabs.
Hardcover DM 118,- ISBN 3-540-50466-4

Magnetic Resonance Imaging of Focal Lesions of Liver and Spleen
Using Gradient-Echo Sequences at 1.5 Tesla:
A Comparison with Ultrasound and Sequential
Computerized Tomography. J. Griebel,
C.F.Hess, and B.Kurtz. - Analysis of the Signal
Intensity of FLASH and FISP Fast-Imaging
Pulse Sequences. S. H. Heywang,
G. Kroebrunner, and M. W Bauer. - Ultrasound
of the Hip Joint: Experimental and Clinical
Studies. R. Langer. - Defecography: A Supple-
mentary Diagnostic Asset in the Study of the
Disorders of Defecation. P.H. G.Mahieu.

Page 118

Frontiers in European Radiology
Editors-in-Chief: A.L.Baert, F.H. W.Heuck

Volume 5
1987. III, 176 pp. 120 figs. in 215 sep. illus. 33 tabs.
Hardcover DM 180,- ISBN 3-540-17636-5

Angiocinedensitometry of Renal Blood Circulation by Electrocardio-
gram-Controlled Injection and Computer-Assisted Evaluation. 1. Buck. -
Experimental Basis of Percutaneous Transluminal Angioplasty.
Ch. L. Zolliko/er. - Ultrasound Examination of the Breast - Diagnostic
Information Related to Mammography. 1. Pirschel. - Computerized
Tomography in Pituitary Microadenoma. D. Poos and P. Capesius.

Volume 4
1984. I, 158 pp. 82 figs. in 144 sep. illus.
Hardcover DM 86,- ISBN 3-540-13410-7

Therapeutic Angiography in Neuroradiology: Clinical Objectives and
Results. P. Lasjaunias, P. Halim, and L. Lopez-Ibor. - Densitometric
Investigations of Renal Perfusion by Dynamic
X-Ray Computed Tomography. U. Reiser,
1.Buck, and F.H W.Heuck. - Percutaneous
Transhepatic Drainage: Technique, Results,
and Special Applications. R. Koster. - Video-
densitometric Measurements of the Blood
Flow in the Model Circulation and in the Iliac
Arteries: Methodological Investigations.

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