Digital Subtraction Angiography

Despite the continued refinement of vascular ultrasound and noninvasive cross-sectional imaging studies (computed tomography angiography [CTA] and magnetic resonance angiography [MRA]) in the diagnosis of vascular pathologies, digital subtraction angiography (DSA) remains the “workhorse” imaging modality for the diagnosis and management of peripheral arterial disease. Despite its inherent invasiveness, catheter-based DSA provides excellent spatial resolution of vascular pathology in a time-resolved fashion, allowing for detailed anatomic assessments and direct visualization of “flow” within a given vessel. The ability of DSA studies to capture high-resolution anatomic and physiologic information within relatively large two-dimensional anatomic fields of view (FOV) provides the basis for DSA being considered the “gold standard” diagnostic imaging modality for many vascular pathologies. Additionally, in the nearly six decades since Charles Dotter performed the first percutaneous transluminal angioplasty, the development of image-guided catheter-based interventions has revolutionized medicine and spawned the advent of the following specialties: interventional radiology, neurointerventional surgery, interventional cardiology, and endovascular surgery. DSA, along with intra-procedural fluoroscopic guidance, is the imaging modality that allows these catheter-based interventional specialties to see, diagnose, and treat an ever-expanding number of vascular and nonvascular pathologies. To adequately intervene, however, a solid foundation in DSA “basics” is of paramount importance.