Pulmonary angiography in a non-teaching hospital over a 12-year period

OBJECTIVE: To report the safety of pulmonary angiography in a non-teaching hospital and discuss the place of this investigation in the diagnosis of pulmonary embolism. DESIGN AND SETTING: A retrospective review of all patients undergoing pulmonary angiography over a 12-year period, November 1979 to October 1991, at Dandenong Hospital, Melbourne. A protocol was established whereby each procedure was performed with the assistance of staff and equipment from the intensive care unit to provide haemodynamic monitoring and measurement of pulmonary artery pressures. PATIENTS: During the review period 114 patients underwent pulmonary angiography, most (108) for suspected pulmonary embolism. RESULTS: One hundred and fifteen pulmonary angiograms were performed, and no deaths related to the procedure occurred. Complications included perforation of the right atrium in three patients, with no sequelae. Cardiac arrhythmias were common but self-limiting. CONCLUSION: In our series, pulmonary angiography was a safe procedure if undertaken with the appropriate monitoring measures. A protocol which includes the participation of the intensive care unit has proved helpful. In addition, it was found that clinical symptoms and signs were unreliable and in 24 patients who also had ventilation-perfusion (V/Q) scans, only seven scans were accurate. A review of the literature indicates that V/Q scans lack specificity and that pulmonary angiography may be performed safely. The latter investigation should be more frequently performed.