The percutaneous femoral artery approach to selective coronary arteriography.

SUMMARY Experience in performing 267 selective coronary arteriograms by both the exposed brachial artery and percutaneous femoral artery techniques has proved the latter to be the technique of choice. The percutaneous femoral artery approach obviates the need for performing a cutdown over the small caliber brachial artery with the associated difficulties of catheter manipulation from this vessel. We have been able to intubate the left coronary artery with ease in all of 122 patients in whom this approach was attempted. The right coronary has been selectively entered in approximately 90% of these patients. The stability of the position of the catheter in the coronary ostia during manipulation of the patient, coughing, and deep breathing is an outstanding feature of this technique. SELECTIVE coronary arteriography is the method of choice of visualizing the coronary arterial tree in the living human. The Sones technique, performed by approaching the coronary arteries from the exposed right brachial artery, was introduced in 1959.1, 2 Weidner and associates3 subsequently described a percutaneous axillary artery approach to the coronaries, which at least obviated the need for performing open ar-teriotomy but has the disadvantages of difficult catheter manipulation and potential trauma to the brachial plexus. In 1962, Rick-etts and Abrams4 reported experience in performing selective coronary studies by means of percutaneous femoral artery punctures in animals and a small number of patients. The purpose of this paper is to relate our experiences with the percutaneous fem-oral artery approach. We have performed 267 selective coronary arteriograms in the Cardio-pulmonary Department of St. Mary's Hospital by means 730 Arterial catheterization of both the exposed brachial artery and per-cutaneous femoral artery techniques. During our earlier experiences with the Sones technique , we frequently encountered the following difficulties: (1) inability to advance the catheter beyond the innominate artery, (2) failure to intubate the left coronary artery, particularly in the patient with a dilated aorta, (3) thrombosis or dissection of the brachial artery at the site of the arteriotomy, and (4) painful spasm of the small caliber brachial artery. On the other hand, we were impressed by the ease with which the left coronary artery could be entered inadvertently or intentionally during retrograde left heart catheteriza-tion via the femoral artery. For this reason, we attempted to design catheters which would allow selective intubation of both the left and right coronary arteries from the leg. Method Catheters for a "left coronary" and a "right …