Coronary Arteriography: Prevention of Thromboembolic Complications Using a Pressure‐Drip Flushing Technique

Abstract

All selective coronary arteriographic examinations (1,833) performed in the authors' laboratory during a five-year period (1/1/70 to 12/31/74) were analyzed for mortality and total morbidity according to method used. During the first two years, the control period, the classic brachial artery cutdown (Sones) and percutaneous femoral artery puncture (Judkins) techniques were utilized. Mortality rate for the total 589 patients was 1.01%. This included a mortality of 0.26% (1/386) for the brachial arteriotomy method, and 2.5% (5/203) for the percutaneous femoral puncture approach. After introduction of the pressure-drip flushing technique, the subsequent three-year mortality rate for a total of 1,244 patients was 0.16%. This included an incidence of 0.17% (1/585) for brachial arteriotomy and 0.15% (1/659) for modified percutaneous puncture techniques. The morbidity incidence during the initial two-year period was 3.0% (18/589). This included an incidence of 2.0% for brachial arteriotomy and 5.0% for percutaneous puncture techniques. After institution of the new pressure-drip flushing technique the total incidence fell to 1.2% equally divided between arteriotomy and percutaneous techniques. Modification of the classic percutaneous femoral artery puncture techniques has resulted in major reduction of mortality and morbidity complications which are chiefly thromboembolic in nature. It has not significantly influenced local thrombotic complications of arteriotomy.

Coronary arteriography by the percutaneous transfemoral technique in patients on intraaortic counterpulsation

“…The early evaluations of the transfemoral approach revealed a relatively high rate of complications which were mainly thromboembolic (7,8,9). However, improvements in the technique prompted recent reports emphasizing the safety of the transfemoral route when either systemic heparinization (10) or careful cleansing was done during the procedure (2,11). Many catheterizers are less facile with the Sones than the Judkins technique; the characteristics of the Judkins are those of simplicity and quickness of execution, as well as a good stabilization of the catheter, allowing a good resolution in the cine films.…”