A New Subclavian Artery Catheterization Technic

Abstract

HomeRadiologyVol. 78, No. 6 PreviousNext ArticlesA New Subclavian Artery Catheterization TechnicPreliminary Report1Kurt Amplatz, Richard HarnerKurt Amplatz, Richard HarnerKurt AmplatzRichard HarnerPublished Online:Jun 1 1962https://doi.org/10.1148/78.6.963MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractAngiographic demonstration of the carotid and vertebrobasilar arterial system has become of increasing interest to neurologists and neurosurgeons. In order to demonstrate these vessels in their entire course and avoid the hazards of direct puncture, more attention is being paid to indirect methods of cerebral angiography via the aortic or subclavian artery.Subclavian angiography by any of the percutaneous supraclavicular routes (1–3) is not wholly satisfactory for several reasons: 1.Punctures of the first and second portions of the subclavian artery are technically difficult because they have to be performed without the guidance of a palpable pulse.2.Pneumothorax is a not uncommon complication because of the close apposition of the first and second portions of the subclavian artery to the apical pleura.3.Intravascular advancement of the needle or catheterization of the artery is difficult, resulting in perivascular injections.Subclavian angiography via percutaneous retrograde catheterization of the brachial artery (4) proved to be a valuable procedure, but in the presence of arterial spasm this technic is difficult. Thrombosis of the brachial artery has been observed in 4 of our patients.Recently one of us (R. H.) developed a simple method of infraclavicular subclavian artery puncture, which proved to be safe in a large group of patients (5). A needle is passed through the skin at a point just lateral to the midclavicular line and inferior to a line passing transversely through the sternal notch toward the third portion of the subclavian artery. The artery is palpated in the supraclavicular fossa with the index finger of the free hand. Since by this infraclavicular route the puncture is made almost parallel to the artery, the needle can be advanced into its second portion close to the origin of the vertebral artery. Recently Pouyanne et al. (6) independently described a similar infraclavicular approach for vertebral angiography.Though infraclavicular needle puncture of the third portion of the subclavian artery proved useful for demonstration of the vertebrobasilar system, filling of the right carotid artery was inconstant, and extravasation of contrast medium occurred. These drawbacks were overcome by a simple intravascular catheterization technic, still using the infraclavicular artery approach, allowing satisfactory visualization of the right carotid and even the aortic arch.METHODThe catheter is made of thin-walled Teflon spaghetti tubing fitting snugly over a 6-inch, wide-lumen, 18 gauge needle (Fig. 1, A). The end of the tubing is machined to a smooth taper, to minimize fraying. A plastic tubing adaptor is attached to the other end, allowing connection to an injection apparatus (7). Teflon is employed since it is a low-friction, heat-resistant plastic permitting autoclaving and re-use of the needle-catheter combination.Mild sedation is achieved with barbiturates. The skin is infiltrated with a local anesthetic approximately one finger width lateral to the midclavicular line and about one finger width below a line passing transversely through the jugular notch, as shown in Figure 2. The index finger of the free hand is placed in the supraclavicular fossa, where the subclavian artery is palpated at the level of the first rib. The skin and subcutaneous tissues are pierced with a No. 11 knife blade, eliminating binding of the catheter-needle. Following deep infiltration with a local anesthetic, the needle and catheter are advanced medially, upward and posteriorly beneath the clavicle toward the palpable subclavian artery.Article HistoryPublished in print: June 1962 FiguresReferencesRelatedDetailsCited By, Vol. 92Neuroradiology, Vol. 5, No. 3, Vol. 10 / 1Journal of Chronic Diseases, Vol. 21, No. 8New England Journal of Medicine, Vol. 276, No. 25Acta Radiologica. Diagnosis, Vol. 5, No. P1The British Journal of Radiology, Vol. 39, No. 458Zur Darstellung der infratentoriellen Gefäße mit der GegenstromarteriographieActa Neurochirurgica, Vol. 13, No. 3-4Circulation, Vol. 32, No. 5New England Journal of Medicine, Vol. 271, No. 6Angiology, Vol. 15, No. 6Journal of Neurosurgery, Vol. 20, No. 5Journal of Neurosurgery, Vol. 20, No. 3American Heart Journal, Vol. 64, No. 4Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 78, No. 6 Metrics Altmetric Score PDF download