Technical considerations of selective arteriography.

Abstract

Elective visualization of branches of the aorta can be obtained by injecting contrast substance through a catheter placed in or near the selected artery. We began our experimental work with available intracardiac catheters. Using dogs, we promptly convinced ourselves that success hinges upon fluoroscopic visualization of a catheter tip having the proper curve. Moulded radiopaque catheters met these requirements. Preparation of Catheter: Catheter design needs to be individualized. Disposable catheters (KIFA) may be bent, punched, and sealed to meet the anticipated needs (4). The proper bend is obtained by heating the catheter containing the stylet over a steam bath (176° F.) and cooling in running water while maintaining the arc. Slight heating of the adaptor end will cause it to curl, facilitating the development of the collar. The flanging tool will finish the seat for the Luer-Lok adaptor. Sterilization may be accomplished by immersion in germicidal solutions or fumigation at 140° F. for three hours in ethylene oxide. Before the introduction of the catheter it should be thoroughly irrigated with sterile saline as well as rinsed externally. Lubrication with sterile mineral oil may facilitate its passage. Introduction of Catheter: The essential features for open exposure were developed by one of us (J. D.) following the observation that large needle punctures of arteries produced complications. Ödman's (2) report of 58 per cent incidence of minor complications with the percutaneous femoral route reinforced our determination to continue this method. The artery is exposed under local anesthesia and the adventitia stripped. Umbilical tape is looped about the vessel above and below the site for introduction of the catheter to regulate bleeding. It is important to exclude collaterals. The distal artery is injected with 0.2 per cent heparin solution. A short transverse incision is then made in the artery, the proximal tape is loosened, and the catheter containing the stainless steel stylet is advanced gently to the approximate origin of the desired vessel. With removal of the stylet, the curve at the tip is largely restored. A 30-c.c. syringe containing normal saline with 0.2 per cent heparin is attached to the catheter. It is usually fairly easy to control the bent tip with external rotation and to visualize fluoroscopically entry into the selected vessel. During injection the tip should not be in the artery. When the catheter is removed, continuous suction is maintained to insure removal of any tiny clots. The artery is repaired with 6–0 arterial silk. Visualization of Vertebral and Carotid Arteries: The catheter may be introduced through the brachial artery and placed near the origin of the vertebral and common carotid so that visualization of these vessels is distinct. Fluoroscopic control of the catheter is highly recommended.