Catheterisation for peripheral diagnostic and interventional procedures

Summary

Noninvasive imaging modalities have almost entirely replaced diagnostic peripheral angiography in everyday clinical practice. However, catheter-based angiography remains the gold standard if imaging results are inconclusive or as a foundation for endovascular revascularization. Patient’s history of previous endovascular or surgical revascularization procedures, as well as clinical presentation and non-invasive imaging results, should be integrated in the planning of an angiographic study with respect to choice of access site, sheath size, and catheters. The specific technicalities of catheterisation for each peripheral territory – lower extremities, visceral arteries, supra-aortic vessels and upper extremities – are described. Complications of peripheral diagnostic angiography are rare and mainly related to access site management, inappropriate manipulation of wires or catheters, and use of nephrotoxic iodinated contrast agents.

Introduction

The purpose of this chapter is to provide an overview of the technical aspects of catheterisation of the peripheral vasculature, including the supra-aortic vessels, the visceral organs (i.e., renal arteries, coeliac trunk and mesenteric arteries), and the upper and lower extremities. General aspects of catheterisation of the peripheral vasculature as well as the vessel anatomy are described in the chapter on Contrast agents and renal protection. Thanks to the good performance of noninvasive imaging modalities, such as...