A J-Shaped Catheter for Retrograde Catheterization of Tortuous Vessels

It has been estimated that 10 to 20 per cent of patients over forty years of age exhibit arterial tortuosity which prevents successful retrograde catheterization of the abdominal and thoracic aorta. Attempts at forcing the catheter frequently result in intramural passage and subsequent dissection. The purpose of the present communication is to describe a modification of the Seldinger technic and a special catheter which have permitted successful retrograde catheterization in such situations. Technic The tip of a No. 205 polyethylene catheter is formed over a thin Kifa leader. The distal 1.5 cm. is then curved in a sharp arc so that the resulting catheter resembles the letter “J.” The Seldinger technic of percutaneous arterial puncture is carried out in a conventional manner, and the metallic guide wire is inserted. If the flexible tip of the guide wire does not pass smoothly through the iliac or subclavian artery into the thoracic or abdominal aorta, the leader is replaced by the J-shaped catheter. The smooth convexity of the J allows for easy advancement, and this catheter will frequently “turn corners” when a straight catheter is stopped by engagement of the tip in the wall of the vessel. After the J catheter has successfully maneuvered the tortuous vessels, the metallic guide wire is reinserted. While the tip of the guide wire remains in the aorta the J-shaped catheter is removed. A larger angiographic catheter can now be easily inserted over the metallic guide without fear of intramural passage as is illustrated in Figure 1. Application This technic has now been employed in a series of 400 consecutive patients, 75 per cent of whom were over forty years of age. In 45 of these patients, the vessel conformation was such that the conventional Seldinger technic did not allow passage of the metal guide wire into the aorta, but the J-shaped catheter permitted successful catheterization and angiographic study. In 2 cases, the successful passage from the femoral artery to the abdominal aorta could not be accomplished, utilizing the J catheter. Although the major usefulness of this catheter is in the approach to the abdominal aorta from the femoral arteries, it has also proved highly serviceable in approaching the aortic arch following axillary artery puncture. The angle at the junction of the subclavian artery and the carotid has been difficult to pass in some patients with the conventional guide wire or the conventional catheter. In such instances the J-shaped catheter has been useful in attaining smooth and successful entry into the thoracic aorta. It has also been successfully used when difficulties arise in passing catheters into the inferior vena cava, because of either tortuosity of the iliac veins or repeated entrance of a straight catheter into an ascending lumbar vein. No complications have arisen as a result of the additional step of having to insert two separate catheters.