An audit of the procedural aspects, post-operative complications, and outcomes of cerebrovascular digital subtraction angiography
Digital subtraction angiography (DSA) is an invasive technique used to visualise the cerebral vascular anatomy in selected patients. Indications include aneurysm detection, when non-invasive imaging has been negative, or to delineate arteriovenous malformation anatomy prior to treatment. The Society of Interventional Radiology, American Society of Neuroradiology and Society of NeuroInterventional Surgery have published joint quality thresholds for quality assurance from which these audit standards have been derived.
The Cycle
All performed procedures should be in keeping with local indication guidelines
All patients should have written consent documented in the notes
Complication rates should not be in excess of that within the published literature
Diagnostic success rates should be in keeping with that within the published literature
100% in line with local guidelines
100% written consent
Diagnostic success rate ≥ 98%
Neurological complications
Reversible neurological deficit ≤2%
Permanent neurological deficit ≤1%
Access site complications
Hematoma (requiring transfusion, surgery, or delayed discharge) ≤3%
Occlusion ≤1%
Pseudoaneurysm/av fistula ≤1%*
Systemic complications
Contrast-induced nephropathy ≤5%
Major contrast reaction ≤5%
Catheter-induced complications
Arterial dissection/subintimal passage ≤1%
Subintimal injection contrast ≤1%
Assess local practice
Each component of the target outcomes
Radiologists’ reports from the procedure, with indication and diagnostic outcome
Collect patient notes for review of consent and post-operative complications
100 cases, or all procedures over one year
Review of departmental acceptable indications
Review of the assessment of patient fitness for procedure
Consideration of whether number of cases performed is sufficient to maintain skill base / low complication rate
Consideration of further specialist refresher training
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Wojak, J. C. et al. Quality Improvement Guidelines for Adult Diagnostic Cervicocerebral Angiography: Update Cooperative Study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS). Journal of Vascular and Interventional Radiology 26, 1596–1608 (2015) https://www.ncbi.nlm.nih.gov/pubmed/26372000