Comparative Efficacy of Stepping vs. Segmental Digital Subtraction Angiography for Lower Limb Venography: A Prospective Observational Study
DOI:
https://doi.org/10.55640/irjmshc-v02i09-01Keywords:
Stepping Angiography, Lower Limb Venography, Digital Subtraction Angiography (DSA)Abstract
Background: Accurate imaging of the lower limb venous system is critical for diagnosing and managing chronic venous disease. Traditional segmental anterograde venography, the historical standard, is associated with procedural inefficiencies and potential risks. Stepping digital subtraction angiography (DSA) has emerged as a promising alternative, but direct comparative data are lacking. This study aimed to compare the diagnostic efficacy, procedural efficiency, and safety of stepping DSA versus the traditional segmental technique for lower limb venography.
Methods: We conducted a prospective, single-center comparative study of patients undergoing lower limb anterograde venography. Patients were allocated to either the stepping DSA group (single contrast injection with automated table movement) or the traditional segmental angiography group (multiple injections for distinct venous segments). The primary outcome was diagnostic image quality of the iliac vein and inferior vena cava (IVC), assessed by blinded radiologists. Secondary outcomes included total angiography time, radiation dose (Dose Area Product), contrast agent volume, and the incidence of imaging artifacts.
Results: A total of [Number] patients were included. The stepping DSA technique demonstrated significantly superior image quality, with a 26.9% improvement in iliac vein clarity and a 62.2% improvement in IVC clarity (p<0.001 for both). Procedurally, stepping DSA was substantially more efficient, reducing the mean angiography time by 63.3% (from approx. 28 min to 10 min; p<0.001). Furthermore, it conferred a significant safety advantage, reducing the mean radiation dose by 24.1% and contrast agent volume by 31.6% (p<0.01). Imaging artifacts from residual contrast were present in 38% of traditional procedures but were absent in all stepping DSA procedures (p<0.001).
Conclusion: Stepping DSA is superior to traditional segmental angiography, offering enhanced diagnostic visualization, particularly of central veins, while significantly reducing procedure time, radiation exposure, and contrast burden. Given these clear advantages, stepping DSA should be considered the preferred technique for routine lower limb venography.
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Copyright (c) 2025 Dr. Rohan S. Patel, Prof. Anjali V. Mehta (Author)
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