ARTERIAL

After the first intra-arterial cannula was introduced to measure blood pressure in 1856, it wasn't until the 1920s that significant advancements in arterial access emerged. In 1929, the German physician Forssmann, after administering local anesthesia, successfully guided a urinary catheter through his cephalic vein into his own heart. He later repeated this cardiac catheterization on a terminally ill woman, an act that cost him his position at the Berliner Charité Hospital but ultimately led to him receiving the Nobel Prize in Physiology or Medicine in 1959. At the Karolinska Hospital in Stockholm, Sweden, a young assistant worked on perfecting the technique developed by Cournand, now known as the Seldinger technique.

Presentation

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Anatomy

Target Zone

Indications

Iliac procedures
Large devices in retrograde directions
Distal procedures, too far for radial access

Contra Indications

Infection at the puncture site
Severe coagulopathy
Obesity
Vascular disease
Previous surgical procedures

Workup

CTA
Sometimes doppler/duplex

Preproduceral

DRUGS TO STOP

Allergy check
Anticoagulation management
If needed antibiotics

Material

Essentials

Standard angiography set

Non Essentials

Positioning

Depending on the planned procedure

Steps

Classic Seldinger technique

Ultrasound guided puncture (standard short-axis)
Wire introduction
Exchange needle for sheath
Flush with heparinised NaCl
Administer 5000 IU Heparin if needed

Tips & Tricks

Use of a safety wire to prevent access loss

Retrograde access
* In case of resistance use fluoroscopy (the wire might dissect or be in a non-target vessel)
* In case of antegrade puncture use the ultrasound to direct the wire in the SFA
* If the latter fails, use a safety wire under the attempt to redirect the wire

Antegrade access
* When the wire enters the deep femoral artery, use a safety wire to prevent access loss when retracting the sheath
* Use ipsilateral oblique projection