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i 79

Technical ,..

Catheter Femoral Yashwant

:

.

,

for Conversion of Retrograde Artery Catheterization

Note 1

,..,

to Antegrade

D. PateI1

Antegrade femoropopliteal catheterization may be required for diagnostic angiography, angioplasty, thrombolytic therapy, or chemotherapeutic infusions. Several needles [i 2] and catheters [3, 4] have been described for this purpose. We designed a catheter that allows easy conversion of a retrograde puncture to antegrade catheterization. This catheter was used successfully in i 8 patients.

direction

into

the

external

sheath/catheterthen

iliac

artery.

can be passed

This

catheter

or

into the superficialfemoral

any

other

artery.

,

Materials The

Results

and Methods

catheter

has a double curve and is triangular (Cook Inc., IN). The primary curve is about 135#{176} and the secondary curve is about 30#{176} (Fig. 1). The common femoral artery is punctured in the retrograde direction at a 70#{176} angle with a Seldinger needle. The catheter is introduced over a guidewire into the abdominal aorta. The tip of the catheter is then engaged into a visceral artery and by a rotational and pushing motion ofthe catheter at the groin, the triangular shape ofthe catheter is re-formed. The catheter is then brought down into the common and external iliac arteries with its tip facing the lateral wall. This avoids opening the catheter loop at the aortic bifurcation or catheterization of the ipsilateral hypogastric artery. In the external iliac artery, the catheter is rotated so as to direct the tip medially. The catheter is then pulled at the groin to engage the secondary curve at the puncture site in the common femoral artery. A test injection of contrast medium usually delineates the distal common femoral artery and the superficial and deep femoral arteries. Road mapping facilitates subsequent

Bloomington,

passage of a guidewire

into the superficial

femoral artery. The use of

a tapered guidewire decreases the risk of dislodging the catheter out of the femoral artery or pushing the catheter in the retrograde

Received April 1 7, 1 989; accepted 1 Department of Radiology, Albert AJR 154:179-180,

January

after revision May 30, 1989. Einstein College of Medicine and Bronx

1990 0361-803X/90/1541-0179

© American

This maneuver was performed in 18 patients between the ages of i 4 and 70 years. Thirteen patients had diagnostic antegrade angiography. Three patients had superficial femoral and popliteal angioplasty, and one patient had thrombolytic therapy for a distal superficial femoral artery thrombosis. In one patient, the procedure was initially unsuccessful because of a horizontal retrograde puncture. A second retrograde puncture at approximately 70#{176} was successful in converting and catheterizing the superficial femoral artery. In three patients blood oozed around the catheter in the groin after the conversion. This was controlled by exchanging for a larger catheter in two patients and by direct compression in the third patient.

Discussion The triangular catheter is useful when access to the superficial femoral artery is necessary after retrograde femoral catheterization. As compared with a sidewinder catheter [3], the curve is easily re-formed in the abdominal aorta without the need of a tip-deflecting guidewire. Once the curve is formed, there is little or no tendency for this loop to reopen at the aortic bifurcation or in the iliac arteries. This technique

Municipal Roentgen

Hospital Ray Society

Corp.,

Bronx,

NV 1 0461

.

Address reprint requests to V. D. Patel.

PATEL

i 80

AJR:154, January 1990

The

technique decreases direct radiation exposure to the hands as compared with the antegrade technique. In obese patients, it may allow easier access to the superficial femoral artery compared with the antegrade technique.

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operator’s

REFERENCES 1 . Kikkawa K. A new antegrade femoral artery catheter needle set. Radiology 1984;151

Fig. 1.-Double-curve

triangular

catheter.

also may be used as an alternative to direct antegrade femoral puncture and catheterization of the superficial femoral artery.

:798

2. Hawkins JS, Coryell LW, Miles SG, Giovannet MJ, Siragusa RJ, Hawkins IF Jr. Directional needle for antegrade guidewire placement with vertical arterial puncture. Radiology 1989;168:27i-272 3. Shenoy S5. Sidewinder catheter for conversion of retrograde into antegrade catheterization. Cardiovasc Intervent Radiol 1983;6: 112-113 4. Miles SG, Siragusa R, Hawkins IF Jr. New directional accordian catheter for converting a retrograde puncture into an antegrade catheter placement. AJR 1988;151

:197-199