Balloon occlusion femoral angiography prior to in-situ saphenous vein bypass

The advent of the in situ saphenous vein bypass procedure for peripheral lower extremity ischemic disease has placed new demands on the angiographer. It is imperative that the small runoff arteries of the calf be seen beyond the level of the ankle to include evaluation of the patency of the plantar arch. Balloon occlusion femoral angiography (BOFA) has been used in 45 consecutive lower extremities in 40 patients referred for proposed in situ saphenous vein bypass; excellent visualization of the plantar arch on the first run was obtained in 40 of 45 extremities (88.9%). The patients included 35 (87.5%) insulin-dependent diabetics with severe proximal arterial disease. Initially, in situ candidates were studied using conventional “runoff” methods; it was rarely possible to visualize the upper trifurcation vessels let alone the plantar arch by this conventional method. The BOFA method was used to provide excellent visualization of the plantar arch and foot arteries. It permits use of smaller contrast medium volumes, provides all the arteriographic anatomy on one 51 inch long film, and is safe.