AXILLARY ARTERY APPROACH TO CAROTID, VERTEBRAL, ABDOMINAL AORTA, AND CORONARY ANGIOGRAPHY.

Abstract

Considerable attention has been directed recently to the angiographic demonstration of occlusive disease in the arteries to the brain and in the coronary arteries. These patients have generalized arterial disease so that frequently severe involvement of the iliac makes transfemoral catheterization technically difficult or even prohibitively dangerous. The axillary artery is a convenient alternative approach because it is part of the brachiocephalic trunk. In addition, on the right side, beyond the subclavian and distal innominate, the proximal innominate artery and ascending aorta form a straight line approach to the root of the aorta and coronary arteries. Others (1, 5, 11) have chosen the upper extremity as a site of entrance into the arterial tree. Peirce (7) tried and abandoned the axillary artery approach. He had one case of thrombosis, one of neuritis, and two unsuccessful studies out of five examinations. Because of frequent severe hemorrhages at the puncture site and unsuccessful examination, Sutton (13) makes only limited use of the transaxillary route. By slight modification of guide wires, needle, and catheters, however, we find this approach most useful and in some instances the one to be preferred. The artery is superficially located and relatively fixed by the axillary sheath. This aids in efficient local anesthesia and easy puncture. Material Since August 1961 we have employed the transaxillary approach in approximately 200 vascular examinations. The ages of the patients have ranged from six to seventy-three years. Because of our interest in coronary angiography, the greatest number have been in the fourth and fifth decades. In addition to coronary angiography, the axillary approach is the preferred method for vertebral angiography (Fig. 1). In some selected cases the catheter is passed into the abdominal aorta for study of the renal arteries and even the bifurcation of the abdominal aorta and arteries of the lower extremities. Equipment The necessary equipment may be broken down into two categories: x-ray apparatus and catheter accessories. Some type of image intensification is absolutely essential and television is desirable. A rapid serial changer capable of two films per second for cerebral studies and six films per second for cardiac work is needed. Selective coronary angiography requires not only cinefluorography but also an oscilloscope for constant monitoring of pressure at the catheter tip and for electrocardiography. Polaroid films are helpful for final delineation of catheter position but cannot be used as a substitute for fluoroscopy during the actual maneuvering of the catheter. The guide wires and catheters require some modification over the conventional Seldinger technics when the axillary approach is employed. Guide wires of the P90 caliber that are 150 cm. long3 have been one of the best assets to the axillary approach.