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Catheter angiography through aortofemoral grafts: prevention of catheter separation during withdrawal.

In our experience, catheter angiography through aortofemoral grafts is a safe procedure. One of us (R. L. Mani) recently reported a series of 30 consecutive angiograms performed through a graft with a negligible complication rate involving the punctured limb I 1 1. Following publication of these data, we experienced our first complication. The catheter became fixed during withdrawal at the termination of the procedure and, after vigorous traction by the operator, separated at the puncture site. Since this was our only complication, we questioned local angiographers who had performed similar graft punctures. We discovered that ( 1 ) an identical complication had occurred 2 years earlier and (2) the insertion of a guide wire into the catheter prior to withdrawal was not a common practice. In fact, among our present angiography staff of seven, only one (R. L. Mani) employed this procedure routinely. We subsequently developed a set of guidelines for catheter withdrawal following aortofemoral graft puncture to prevent this complication. In 20 further cases performed with this technique, we encountered no complications. In one case the catheter became fixed during withdrawal but was easily reinserted, freed, and withdrawn in the manner described below. Our present complication rate is one in 53 (2%). We are confident that these figures will improve with experience. We report two cases of complications in which the catheter broke off during withdrawal following graft angiography and describe a technique that can preclude such complications.