Inferior Mesenteric Artery Occlusion Following Lumbar Aortography

Abstract

The patient was a male aged 40 years, admitted to Royal Victoria Hospital, Belfast, in August, 1954, with the clinical diagnosis of Leriche's syndrome. A translumbar aortogram was done to help assess the suitability of the patient for an arterial graft. Before commencing the aortogram the patient was tested for sensitivity to diodone. There was no evidence of aortic calcification or aneurysm in a plain radiograph of the abdomen. A test film during injection of 5 ml. of contrast medium showed the needle tip to be in the lumen of the aorta and all the contrast medium was seen in the aorta and none in its branches. For the aortogram two separate injections, each of 30 ml. of 70 per cent diodone, were given into the lumbar aorta at the level of the 3rd lumbar vertebra. The syringe was emptied as rapidly as possible by hand. The aortogram resulting from the first injection (Fig. 1) revealed evidence of a thrombus at the aortic bifurcation with complete blockage of the left common iliac artery. There was considerable retrograde filling of the aorta with contrast medium, some of which had entered the inferior mesenteric artery. Some contrast medium had entered the right common iliac artery but had not progressed far enough to give adequate details of the circulation to the right leg. A second injection was given with delayed exposure to allow for the slowed circulation.