Transfemoral Catheter Aortography in Dissecting Aneurysm

Abstract

Summary The several methods available for aortography in dissecting aneurysm are reviewed critically with reference to the diagnostic information provided and to patient safety. The trans‐femoral catheter technique found satisfactory on both of these counts in a majority of 18 personal cases is described in detail. Particular emphasis is laid on why the abdominal portion of the aorta should usually be examined as well as the thoracic and on why accidental catheterization and injection of the dissection sac need not be hazardous in experienced hands. An explanation is given for the occasional necessity in the series to catheterize the aorta from an upper limb artery and a preference is expressed for the left transaxillary route as an alternative to the transfemoral in such circumstances.

Branch Involvement at Aortography in Dissecting Aneurysm, With Particular Reference to the Lower Intercostal and Renal Arteries

“…Cases of the previously reported series (Syme, 1971) were included only if an arterial catheter study had been made of both thoracic and abdominal aorta; to this group of 13 patients have been added four more examined since September, 1970. The aortographic diagnosis of dissecting aneurysm, made on criteria already outlined (Syme, 1971), was supported clinically in all 17 and later verified at autopsy in six; none was operated. FIGURE l.-Male, 44 years, long-standing unsuspected dissection.…”

“…The method of aortography has been described fully elsewhere (Syme, 1971). In 16 cases contrast was injected in the true lumen, usually first in the ascending aorta and then at the thoracolumbar junction; however, in two the sac was also injected inadvertently adjacent to the ascending aorta or arch.…”

“…Three cases of dissecting aneurysm apparently confined to the thoracic (a) Injection in narrowed true lumen at thoracolumbar junction shows its left border more distinct, though unopacified sac on left. (Reprinted from Syme, 1971. ) aorta warrant no further mention here, beyond noting that in one the left lower intercostal arteries were involved in the position of the unopacified sac.…”

“…The transfemoral catheter approach preferred by the author for aortography in dissecting aneurysm has already been noted to facilitate the recognition of major branch involvement in both thorax and abdomen (Syme, 1971). The potential diagnostic value of such observations and their bearing on the feasibility of surgical treatment have been remarked upon, but not considered in depth.…”

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INTRODUC~IONThe transfemoral catheter approach preferred by the author for aortography in dissecting aneurysm has already been noted to facilitate the recognition of major branch involvement in both thorax and abdomen (Syme, 1971). The potential diagnostic value of such observations and their bearing on the feasibility of surgical treatment have been remarked upon, but not considered in depth.The aortographic findings in branch arteries in a personal series of 17 patients with aortic dissection will now be reviewed and compared with those in the aorta itself The mechanisms for their production will be indicated.

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