J.Jpn. Surg. Soc.. 79(3): 188-202, 1978

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Original article

CLINICAL AND EXPERIMENTAL STUDY OF THE SELECTIVE VISCERAL ANGIOGRAPHY IN BILIARY DISEASES (First report)

It is widely accepted the angiographic study of the abdominal organs is very useful tool for diagnostic purpose in biliary diseases. In this paper, the indication of angiography with obstructive jaundice patient and radiological changes of blood vessels are discussed. For preoperative analysis of blood vesels and biliary duct, selective visceral angiography and percutaneous cholecystography (PTC) are simultaneously performed.
On the basis of study of clinical patient with biliary disease and experimental animals, the following conclusions are drawn :
1. In 20 out of 579 cases without jaundice (3.4%), some reaction to contrast medium was observed. In 2 out of 87 with jaundice (2.3%), schowed vomiting and oliguria but none of them were fatal.
Clitical analysis of 87 jaundice patients and 9 experimental jaundice dogs concluded that less than 2.5ml/kg of 76% diatrizoate is safty amount of contrast media for angiographic study.
2. The radiological changes of hepatic blood vessels were measured and analysed. The diameter of proper hepatic artery was 4.71 ± 0.94 mm in 25 control cases. In jaundice cases, it was 5.84 ± 0.95 mm. In the cases performed PTC-drainage, the proper hepatic artery was 6.02 ± 0.97 mm in diameter preoperatively but after this procedure was performed, it was decreased to 4.97 ± 0.66 mm. Bilateral hepatic arteries showed almost same tendensy, but the splenic artery and the portal vein schowed no change.
In the experimental dogs, common and bilateral hepatic arteries schowed dilatation 11.7-29.2% after the ligation of the common bile duct. After releasing the ligation, the diameter decreased in 4.1~17.4% compared with a state of experimental jaundice.
3. In 42 cases negative of gallbladder by PTC, it was visuarized in 80% by routine visceral angiography.
But 92% was visuarized by the superselective hepatic angiography.
4. Preoperative diagnosis of peri-cholecystitis was done in 99 cases and all were confirmed surgically. The characteristic finding on angiogramm was the right gastroepiproic artery and its branches and gastroduodenal artery were retracted toward the gallbladder. This was found 63% in 36 cases with severe adhesion around galblader.

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