Transfemoral internal thoracic (mammary) arteriography.

Abstract

The use of arteriography in the evaluation of myocardial implants and coronary arteries is increasing. Transbrachial selective catheterization of the internal thoracic (mammary) artery (4), first described by Arner (1), has been used to evaluate internal thoracic arterial implants in the myocardium (2, 3). Ödman (6) demonstrated that percutaneous catheterization of the main branches of the aorta is feasible, and recently Judkins (5) reported this modification of Seldinger's technic (7) for transfemoral coronary arteriography. This paper presents a method of selectively catheterizing both internal thoracic arteries and the coronary arteries at one examination, using the transfemoral Seldinger technic. This procedure was developed for a number of reasons: (a) the need for arteriographic evaluation of bilateral internal thoracic arterial implantation in the myocardium; (b) the difficulty in using the left brachial retrograde approach for left internal thoracic arteriography following arteriographic or local arterial complications; (c) the belief that evaluation of myocardial revascularization is incomplete without concomitant assessment of coronary arterial disease by coronary arteriography; and (d) the ease of performing coronary arteriography by the Judkins technic, in contrast to the Sones technic (8) of selective coronary arteriography from the left brachial artery. Materials Fifty consecutive patients with internal thoracic arterial implantations in the myocardium were studied one to five years after the revascularization procedure. In 49, the implantation was single on the left side; in 1, it was double. The catheters and technic of coronary arteriography employed were essentially those utilized by Judkins (5) and Takaro (9). The right Judkins coronary catheter was used in three-fourths of the internal thoracic procedures, and a modified arteriographic catheter2 in one-fourth (Fig. 1). The modified internal thoracic catheter is a 100-cm-long No. 7 French Ducor Catheter3 which accommodates a wire 0.035 inch in diameter. The curves are similar to those of the right Judkins catheter, with the exception of the distal angulation. The internal thoracic catheter has two angulations, which are 60° at 0.5 cm from the tip and 30° at 2 cm from the tip. These angulations and the smaller catheter size allow the catheter to be manipulated somewhat more easily in the subclavian arteries. Method At catheterization, with the patient in the supine position on the x-ray table, a guide wire was inserted through a No. 18 thin-walled needle into the femoral artery and then into the abdominal aorta. A No. 7 Gensini Teflon catheter was used to dilate the puncture site in the femoral artery, after which the right Judkins catheter was inserted over the wire. The left internal thoracic artery was first catheterized by placing the catheter in a neutral position in the aortic arch as shown in Figure 2, A.