Selective Bronchial Arteriography in Man

Abstract

Since 1963 we have successfully accomplished selective bronchial arteriography in man with percutaneous transfemoral technic and the aid of a specially designed and locally constructed catheter.3 This catheter has extreme maneuverability and controllable deflection of the tip by reason of a deflector assembly. Technic A cannula-trocar set, guide, catheter, and deflector assembly, all locally constructed, are used.3 Following percutaneous transfemoral catheterization of the aorta, the tip of the catheter is positioned just distal to the origin of the left subclavian artery. The patient lies comfortably on a motorized remotely controlled rotating cradle which permits rotation of the patient from 0 to 90° to either side at variable speeds any time during the procedure. The wire of the deflector assembly is retracted, and this allows bending of the preformed curved tip. The tip of the catheter has no side-holes and an outer diameter of 1 mm.; its body has an outer diameter equivalent to that of a No. 7 French. At the end of the catheter are two curves, the proximal one adapting the tip to any size aorta. These curves can be varied by advancing or withdrawing the deflector wire. The catheter tip should always be perpendicular to the aortic wall. Rotation of the patient aids in the identification of the origin and course of the opacified vessels. In searching for the orifice of the bronchial arteries, the catheter is slowly rotated during its advancement and retraction. Cannulation of a vessel orifice is detected visually on the fluoroscopic or television screen and also conveyed to the operator's hand by a “catching sensation.”Hand injection of radiopaque medium permits confirmation of the position of the catheter tip. There are two outlets in the deflector assembly, and to each of these a modified one-way valve is attached. Heparinized saline solution is intermittently infused through one outlet and a 5-ml. syringe containing radiopaque material is connected to the other. Injection through either outlet will not cause reflux into the other. If an intercostal artery is injected, ipsi-lateral back pain is a usual complaint. The pain disappears when the catheter tip is withdrawn from the orifice of the intercostal artery or after flushing with diluted procaine solution. Fluoroscopi-cally, the intercostal arteries are seen to course horizontally, parallel to the ribs, except for the proximal aortic intercostals which initially flow cranially. The bronchial arteries usually flow toward the hilar regions, and when one is injected, it will be seen coursing obliquely and caudal-ward. The right intercostobronchial trunk has been the most constantly seen in our studies (Fig. 1). At its injection coughing, in addition to pain, is often elicited. When the injected bronchial artery arises independently from the aorta, pain is not. usually experienced, but coughing may occur.