Angiographic evaluation of injury to the great vessels.

Angiography prior to surgery can provide vital information for the management of injuries to the brachiocephalic vessels. The angiographic examination precisely localizes active bleeding sites, accurately positions foreign bodies, and defines the nature of posttraumatic complications, such as thrombosis or arteriovenous fistula formation. A series of cases illustrative of the varied uses of preoperative angiography will demonstrate its value. Methods Suitable diagnostic examinations of the brachiocephalic vessels are readily obtained. In each of the studies in this report, a curved, multiholed catheter was introduced into the right femoral artery using the Seldinger technique. 1 An approach via the right axillary artery can also be used. The catheter is advanced into the ascending aorta and the patient is placed in the right posterior oblique position. Serial roentgenograms of the brachiocephalic vessels are obtained during the rapid injection of 50 ml of diatrizoate sodium (Hypaque-M) 75% or diatrizoate meglumine (Renografin 76). If