Percutaneous Transaxillary Selective Coronary Angiography

Abstract

The basic premise of optimal angiography is to deliver the contrast material selectively to the arterial bed under investigation. This applies to the coronary arterial bed as well as other areas of the body. In 1959, Mason Sones reported his technic of selective catheterization of the coronary arteries with a specially designed catheter (9). The coronary angiograms Sones produced are of such excellence that all other methods must be compared and evaluated with reference to his results. We have modified his basic technic (7–9) by omitting the surgical exposure of the brachial artery and open arteriotomy and substituting instead the percutaneous transaxillary Seldinger approach (2, 6). Advantages of the percutaneous transaxillary approach include those of the Seldinger technic versus open arteriotomy: the ability to re-examine the patient via the same artery, if necessary, after review of the angiogram and on an annual basis to evaluate therapeutic programs. A technical advantage is the fact that the axillary artery is approximately 20 cm closer to the coronary arteries, facilitating catheterization of the ostia. A Seldinger type guide wire also facilitates catheterization of tortuous innominate arteries. The purpose of this report is to describe our technic of percutaneous transaxillary coronary angiography and to report observations which may assist others in embarking upon selective coronary angiography. Technic The most direct route to the coronary arteries is via the right axillary artery, subclavian and innominate arteries to the root of the aorta. Manipulation of the catheter and selective catheterization of the coronary ostia are greatly facilitated by this direct route. With the patient recumbent on the catheterization table, the right arm is externally rotated and abducted. A proper position is attained by asking the patient to cup the back of his head with the right hand. This throws the axillary artery into optimal position for percutaneous puncture. The axilla is scrubbed with an antiseptic solution and draped, and percutaneous puncture of the axillary artery is accomplished under local anesthesia. The optimal site for the arterial puncture is just distal to the palpable fold of the pectoralis major muscle.