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The International Journal of Cardiovascular Imaging (2005) 21: 591598
DOI 10.1007/s10554-005-3753-y Springer 2005
Received 25 February 2005; accepted in revised form 15 March 2005Background: Identication of peripheral vascular disease by angiography in patients undergoing coronary
angiography may be considered as malpractice but sometimes seems to be justied 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 identied 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. Dened entry criteria were reported in 24 out of 29 studies. Signicant 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
prole, 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 justied unless they are part of SA in patients scheduled for arterial
conduit with brachial dierential pressure, thoracic irradiation or surgery, or of abdominal angiography to
detect RA stenosis in laboratories with radiological digital peripheral equipment.Malpractice in invasive cardiology: is angiography of abdominal aorta
or subclavian artery appropriate in patients undergoing coronary
angiography?A meta-analysisGianluca Rigatelli1,2 & Giorgio Rigatelli2,31Interventional Cardiology Unit, Rovigo General Hospital, Rovigo, Italy; 2Endo Cardio...