eISSN: 3087-405X editor@aimjournals.com
All Journals
Submit your article

International Research Journal of Medical Sciences and Health Care

Open Access Peer Review International
Open Access

Comparative Efficacy of Stepping vs. Segmental Digital Subtraction Angiography for Lower Limb Venography: A Prospective Observational Study

DOI https://doi.org/10.55640/irjmshc-v02i09-01
PDF
Dr. Rohan S. Patel 1 , Prof. Anjali V. Mehta 1 ,
4 Department of Interventional Radiology, Advanced Medical Institute of Central India, Indore, India
4 Department of Vascular and Endovascular Surgery, Advanced Medical Institute of Central India, Indore, India

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.

Keywords

Stepping Angiography, Lower Limb Venography, Digital Subtraction Angiography (DSA)

References

Martinez FO, Montero GC, Lahoz GMA, et al. Evidence of inflammatory network disruption in chronic venous disease: an analysis of circulating cytokines and chemokines. Biomedicines 2025; 13: 150.
Diaz AJ, Gianesini S, Khalil AR. Glycocalyx disruption, endothelial dysfunction and vascular remodeling as underlying mechanisms and treatment targets of chronic venous disease. Int Angiol 2024; 43: 563-590.
Fukaya E, Kolluri R. Nonsurgical management of chronic venous insufficiency. N Engl J Med 2024; 391: 2350-2359.
Ming T, Weijian F, Jianwei C, et al. Diagnostic value of lower extremity venous duplication via digital subtraction angiography guided venography. Vasc Endovascular Surg 2023; 58: 166-171.
Yingjiang X, Jian W, Yongjia C, et al. Evaluation of 3-dimensional rotational venography for the diagnosis of non-thrombotic iliac venous lesion. Front Cardiovasc Med 2023; 10:1088224.
Arnoldussen CWKP. Imaging of deep venous pathology. Cardiovasc Intervent Radiol 2024; 47: 1580-1594.
Maki JH, Wilson GJ, Cartright SD, et al. Patient-specific timing for bolus-chase peripheral MR angiography. J Magn Reson Imaging 2016; 43: 249-260.
Çildağ MB, Ertuğrul MB, Köseoğlu ÖFK. Charcot neuroarthropathy and a new sign: "soft tissue contamination sign of foot or ankle" on bolus chase 3-dimensional magnetic resonance imaging. J Foot Ankle Surg 2020; 59: 643-644.
Hanrahan JC, Lindley DM, Mueller M, et al. Diagnostic accuracy of noncontrast MR angiography protocols at 3T for the detection and characterization of lower extremity peripheral arterial disease. J Vasc Interv Radiol 2018; 29: 1585-1594.e2.
Von Elm E, Altman DG, Egger M; STROBE Initiativeet al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573-577.
Chen Q, Chen Y, Dai X, et al. Analysis of hot issues in venous surgery. Chinese Journal of Practical Surgery 2022; 42: 1321-1342.
Liao M, Yang Y, Chen Y, et al. Personalized contrast agent dosing to prevent contrast induced nephropathy in high risk populations in Guangdong, China. Sci Rep 2025; 15: 6938.
Montminy ML, Thomasson JD, Tanaka GJ, et al. A comparison between intravascular ultrasound and venography in identifying key parameters essential for iliac vein stenting. J Vasc Surg Venous Lymphat Disord 2019; 7: 801-807.
Dwivedi A, Singh NS, Sharma A, et al. A systematic review of radiological diagnosis and management of May-Thurner syndrome. J Pharm Bioallied Sci 2024; 16: S1012-S1016..

Most read articles by the same author(s)

<< < 1 2 3 4 5 6 > >> 

Similar Articles

You may also start an advanced similarity search for this article.