Abdominal Aortography: A New Catheter Tip Closing Obturator for Percutaneous Technic

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Abstract
Renal angiography is of recognized clinical importance in the etiological diagnosis of hypertension, the differentiation of renal, retroperitoneal, and other abdominal masses, and the study of a variety of other acquired and congenital renal lesions. While renal arterial opacification can be achieved by intra-aortic injection or selective renal catheterization (1), the latter technic has distinct disadvantages: (a) It imposes a choice between the added risk, inconvenience, and cost of multiple injections and the even more hazardous alternative of incomplete, potentially misleading diagnostic information. (b) The selective technic is more difficult and re-requires fluoroscopy, preferably with an image intensifier. This “premium” on skill, experience, and special equipment is generally not warranted by advantages to the patient, institution, or physician. Despite its drawbacks, however, direct renal arterial injection has the advantage that it does not cause opacification of superimposed mesenteric arteries, and to this extent it is graphically superior to un-selective abdominal aortography. Similar considerations apply to pelvic arteriography, where neither renal nor mesenteric filling is desired. In order to gain the graphic advantages and eliminate the drawbacks of selective branch artery catheterization, we had used an obturator stylus to control the distribution of contrast substances injected by catheter into the aorta. Williams (6) has employed a specially shaped “loop-end” catheter for this purpose, and Porstmann (2, 3) has described a similar instrument used for other purposes. Our instrument consists of a conical metal plug 7 mm. long and 1.6 mm. in diameter, which is attached at its base to the end of a thin stainless steel wire running the length of the catheter employed. The catheter tip is tapered in such a manner that the conical obturator plug, when fully advanced through the lumen, will seat itself snugly and completely occlude the end orifice. If thermoplastic tubing such as polyethylene is used, the catheter tip is readily formed by drawing it out over the tip of the obturator while heating with an alcohol flame. The length of the tube must be consistent with the length of the stylus wire in order that the obturator plug will wedge into and occlude the tapered catheter tip. If the stylus is just slightly longer than the catheter, the resulting buckling tends to keep the plug seated. For abdominal aortography we have found it convenient to use a polyethylene catheter (PE 260) 23 inches long. Following its percutaneous spring-guided introduction into a femoral artery (4), the catheter is advanced to a point slightly above the level of origin of the renal arteries.

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