Translumbar aortography: experience with a steerable pigtail catheter

The authors have designed a new coaxial system for translumbar aortography and studies of the pelvis and the legs from low or high aortic puncture sites. A no. 4 French pigtail catheter with a maximum flow rate of 18 mL/s is mounted coaxially on a 32-cm-long, 20-gauge, thin-walled, two-part needle. The needle cannula accepts a guide wire of diameter 0.021 in (0.53 mm), over which the catheter can be advanced craniad for aortography or caudad for arteriography of the leg. After the first injection of contrast agent, the catheter can usually be easily redirected to complete the study. Such studies were successfully completed in 73 of 79 consecutive patients; the aorta could not be cannulated in 2, and the catheter could not be redirected in 4. The sole complications were asymptomatic extravasation of the contrast agent in one patient and moderately severe back pain that resolved spontaneously in another. The authors describe the technique, as well as variations that have been developed to overcome aortic abnormalities.