Arteriography: The State of the Art

Abstract

The papers on the subject of angiography which appear in this issue of Radiology are illustrative of the many approaches to the opacification of the arterial tree of the human body that are now available. The extent of local disease processes and anatomic variations may limit any given approach to a particular artery, with the possible exception of the direct percutaneous needle puncture of the vessel in question. In some instances direct percutaneous puncture of the left carotid artery is necessary for its opacification, regardless of the status of adjacent vessels. The generalization that optimal visualization of an artery is obtained when the contrast material is injected as close as possible to the area of interest still holds. In many situations, however, the desired information can be obtained by an intravenous injection by way of the arm veins or by utilizing the next compartment in the system, the right atrium. The right atrium is an elastic chamber which is vented in three directions and can tolerate a forceful injection of a large amount of contrast material. Right ventricular injection and introduction of the catheter tip into the pulmonary artery are also in common usage. With these approaches smaller volumes of contrast medium are employed than for right atrial injection. The veins most commonly used for percutaneous needle punctures are those of the upper extremity. Catheters may be introduced into various arm veins or into the femoral veins. Turning to arterial approaches, the arteries of the head and neck may be opacified by introduction of a needle into the brachial artery, which, with the axillary and subclavian arteries, serves as an extension catheter, or actual tubing may be percutaneously or surgically introduced into the brachial artery and advanced to an appropriate level. The axillary artery and subclavian artery have been used as puncture sites for the introduction of contrast material either by needle or by tubing. Percutaneous arterial catheters may be introduced into the femoral artery, also, and advanced to or into the mouth of any aortic branch. Direct needle puncture of the carotid, vertebral, and abdominal aortic vessels is still common practice. In the event of severe obstruction in proximal branches or in a branch through which the catheter would pass, direct needle puncture may become necessary. Contrast material can be introduced, on occasion, into the left side of the circulation by passage of a venous catheter through an intracardiac or great vessel communication, as well as by transatrial septal injection using the Ross needle. The use of an injector capable of introducing the material at a pressure of several hundred pounds per square inch is mandatory for catheter injection of any type requiring retrograde flow, such as brachial injection for opacification of vessels in the head and neck and for catheter aortography where a large volume of flow requires rapid delivery.