Translumbar Catheterization of the Abdominal Aorta

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Abstract
The purpose of this communication is to describe a simple translumbar aortic catheterization technic which has proved helpful as an alternative approach in patients in whom transfemoral catheterization was considered hazardous. Technic The procedure is done under local anesthesia with slight barbiturate sedation. The previously described Teflon catheter-needle combination is used for the introduction of an 8-inch Teflon catheter by direct puncture of the aorta with an 18-gauge needle (1–3). Ideally, the puncture is made above the level of the renal arteries by a classical high translumbar approach (4–7). The twelfth rib is identified (Fig. 1), and the skin is infiltrated with a local anesthetic approximately 5 fingerbreadths (8 to 10 cm.) lateral to the midline and one fingerbreadth below the twelfth rib (Fig. 1). A small “nick” with a No. 11 knife blade is made through the skin to facilitate introduction of the needle. The latter is directed obliquely ventrad and cephalad toward T-12 until the vertebral body is identified with the needle tip, then the catheter needle is withdrawn at least 5 cm. and directed more laterally to bypass the vertebral body. The needle is advanced slowly until the vigorously pulsating abdominal aorta is identified by gently placing the palpating thumb against the needle hub (Fig. 2, A). The aortic wall is penetrated with a short, controlled stabbing motion by advancing the needle 1 cm. into the aortic lumen. Correct intra-aortic position is evidenced by free pulsatile blood flow obtained, following removal of the stylus (Fig. 2, B). The inner needle is now removed and only the Teflon catheter remains in place. To advance the catheter, an especially flexible and sharply curved guide wire is gently introduced with the tip pointing upward (Fig. 2, C). If the guide cannot be introduced easily, the Teflon catheter has to be somewhat withdrawn, as resistance is usually due to the close proximity of the catheter tip to the aortic wall. The guide wire is advanced approximately 10 cm. into the aorta and the fairly stiff Teflon catheter can now be pushed over the guide eliminating damage to the aortic wall. A plastic pressure tubing is connected to the catheter (Fig. 2, C) and its correct intra-aortic position is verified by a small test injection of contrast medium under fluoroscopic control. Thirty to forty-five cubic centimeters of 75 per cent Diatrizoate solution is delivered by a power injector (8) in approximately 2.5 seconds with a one-hundred pound per square inch pressure using a 60 c.c. syringe (Fig. 3). Comments In recent years, the transfemoral percutaneous catheterization technic (9) has largely replaced translumbar aortography. The transfemoral approach is more flexible and allows repositioning of the catheter and selective catheterization of the abdominal arterial branches.

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