481
TECHNICAL NOTES
Vol. 117
Technic al Noles
•
Modification of a Serial Film Changer for Frontal Magnification Angiography 1 Robert M. Spitzer, M.D., Harold E. Olsson, M.D., and Bernard J. Gibson, R.T.
A movable carriage was designed and built for a Franklin film changer to facilitate routine serial 2X magnification. This simple device permits magnification angiography without ma jor equipment purchases or room alterations. IN DEX TERM :
Angiography, apparatus and equ ipment
Radiology 117: 481 , November 1975
• Frontal magnification requires a special elevating table top in order to achieve the proper subject-to-fum distance. We wish to describe a simple modification of a standard Franklin film changer which facilitates serial frontal magnification without an elevating table top. DESCRIPTION
Our department has three Franklin film changers, one of which is an older unit which has been reconditioned to act as a reserve unit . This changer was removed from its stand and placed on a movable carriage built in the hospital shop (Figs. 1 and 2). The wheel height was adjusted to provide a 50 .8-cm (20-in.) subject-ta-film distance for 2X magnification. When frontal magnification is desired, this standby unit is rolled into place. The unit can easily be returned to its original stand if it is needed to replace one of the routinely used changers.
Catheter Exchange in Tortuous Vessels During Selective Cerebral Angiography 1
•
Lawrence Goldberger, M.D., Marc N. Coel, M.D., and Folke J. Brahme, M.D. Inability to advance double-curved catheters beyond the origin of tortuou s arch vess els is a common problem in femorocerebral angiography in the aged or hypertensive pat ien t. The authors describe a simple techn ique involving the use of an exchange guide wire and stra ight catheter which has proved to be safe and successful in such Circumstances. INDEX TERMS :
Catheters and Cath eterization. Cerebral Angiography, tech-
nique Radiology 117:481 -482, November 1975
•
•
Selective catheterization for femorocerebral angiography is frequently difficult in the elderly or hypertensive patient with a tortuous aortic arch and branch vessels . Double-curved catheters simplify the task of selecting the desired arch ves-
Fig. 1. Movable carriage constructed with a wheel he ight designed for 2X magnification. A tripod arrangement of the wheels facilitates leveling of the changer. Wheel locks reduce changer movement. Fig. 2. The mod ified film changer may be rolled into posi tion as required. ACKNOWLEDGMENT: We wish to express our appreciation to Waiter Ward and Herschel Hotaling for their help in design ing and constructing the carriage . 1
From the Department of Radiology, Rochester General Hospital,
1425 Portland Ave ., Rochester. N. Y. 14 6 2 1. Accepted for publication in July 1975. sjh
sel; however, it Is often impossible to advance the catheter beyond the origin of the vessel due to the shape and sometimes the stiffness of the material. particularly in the left common carotid artery. We wish to describe a technique which overcomes this problem and permits further selective catheterization of the internal or external carotid artery. TECHNIQUE
An appropriately shaped double-curved polyethylene catheter (Fig. 1, A-D) is used to engage the origin of the selected arch vessel. A straight guide wire w ith a floppy tip is introduced to an appropriate level beyond the orifice. If initial attempts to advance the catheter fail , the guide wire is removed and replaced with a 260-cm exchange guide wire 0.089 mm (0 .035 in.) in diameter with a straight floppy tip ,2 following which the double-curved catheter is removed and replaced with a soft straight polyethylene catheter of the same diameter (Fig. 1, E). The soft catheter easily negotiates the course of the guide wire already in place in the selected vessel. A gentle preformed curve at the distal end of the catheter enables further selection of the internal or external carotid artery (Fig. 2).
482
November 1975
TECHNICAL NOTES
c
B
o
the abnormal area, makes this technique hazardous. The technique described here has been used successfully for some time in superselective visceral angiography. Emboli produced by clots carried on the tip of the exchange catheter have been minimized or eliminated by treating all catheters and gUide wires with the benzalkonium-heparin solution described by Amplatz (1). This technique has been used successfully in selective catheterization of the left carotid artery when the doublecurved catheter could not be advanced beyond the orifice of the selected vessel. The gentle distal curve of the catheter permits selective catheterization of the internal or external carotid artery. No complications have occurred and no significant increase in time has been required, since the exchange is made over a guide wire which is already in place. This same technique has also been successful in catheterization of the vertebral artery and other branches of a tortuous subclavian artery. Here the guide wire can be pinned in the axilla or upper arm by external compression to facilitate exchange of preshaped superselective catheters.
E
Fig. 1. A-D. Double-curved catheters used for selective catheterization of an aortic arch vessel. E. Exchange catheters for more distal catheterization of the common carotid or internal carotid artery.
REFERENCES DISCUSSION
1. Amplatz K: A simple non-thrombogenic coating. Invest RadioI6:280-289, Jul-Aug 1971 2. Ayella RJ: A new method of catheterizing the great vessels arising from the aortic arch. Radiology 110:714-715, Mar 1974 3. Riddervold HO, Craddock WE: An improved technique for selective femorocerebral angiography. Radiology 101:701-702, Dec 1971
Several methods of catheterizing tortuous vessels arising from an already tortuous aortic arch have been described. Ayella (2) recommended a soft straight polyethylene catheter with a deflector guide and pointed out the potential traumatic complications associated with the use of a deflecting system. Riddervold and Craddock (3) suggested that external compression be applied to the guide wire in the proximal carotid artery to permit advancement of the catheter without backing out the guide wire . The potential hazard of carotid compression alone, as well as possible dislodgement of emboli from soft ulcerated plaques by pressure of the guide wire against
.~ .
1 From Veterans Administration Hospital, 3350 La Jolla Village Drive, San Diego, Calif. 92161 , and the Department of Radiology, University of California-San Diego, San Diego, Calif. Accepted for publication in June 1975. Supported in part by grant GM-02023-05 from the NIH, USPHS. 2 Type TSF, Cook, Inc., Bloomington, Ind. sjh
"
f", ,
:;
A A
,;/
-:
1
'
·· '~i
e,
\;~ . .
,
\,.:t.~.;;·;': .>.:.
8
~~$': '
··~t\1, . "'A"1' ,:~,,\:
Fig. 2. A. Attempts to advance the double-curved catheter beyond the orifice result in a vector force that backs the tip of the catheter out of the selected vessel. B. With the 240-cm exchange guide wire in place, the course of the double-curved catheter is straightened following its removal. C. The straight catheter is advanced over the guide wire and well into the selected vessel.
TECHNICAL NOTES
Vol. 117
Technic al Noles
•
Modification of a Serial Film Changer for Frontal Magnification Angiography 1 Robert M. Spitzer, M.D., Harold E. Olsson, M.D., and Bernard J. Gibson, R.T.
A movable carriage was designed and built for a Franklin film changer to facilitate routine serial 2X magnification. This simple device permits magnification angiography without ma jor equipment purchases or room alterations. IN DEX TERM :
Angiography, apparatus and equ ipment
Radiology 117: 481 , November 1975
• Frontal magnification requires a special elevating table top in order to achieve the proper subject-to-fum distance. We wish to describe a simple modification of a standard Franklin film changer which facilitates serial frontal magnification without an elevating table top. DESCRIPTION
Our department has three Franklin film changers, one of which is an older unit which has been reconditioned to act as a reserve unit . This changer was removed from its stand and placed on a movable carriage built in the hospital shop (Figs. 1 and 2). The wheel height was adjusted to provide a 50 .8-cm (20-in.) subject-ta-film distance for 2X magnification. When frontal magnification is desired, this standby unit is rolled into place. The unit can easily be returned to its original stand if it is needed to replace one of the routinely used changers.
Catheter Exchange in Tortuous Vessels During Selective Cerebral Angiography 1
•
Lawrence Goldberger, M.D., Marc N. Coel, M.D., and Folke J. Brahme, M.D. Inability to advance double-curved catheters beyond the origin of tortuou s arch vess els is a common problem in femorocerebral angiography in the aged or hypertensive pat ien t. The authors describe a simple techn ique involving the use of an exchange guide wire and stra ight catheter which has proved to be safe and successful in such Circumstances. INDEX TERMS :
Catheters and Cath eterization. Cerebral Angiography, tech-
nique Radiology 117:481 -482, November 1975
•
•
Selective catheterization for femorocerebral angiography is frequently difficult in the elderly or hypertensive patient with a tortuous aortic arch and branch vessels . Double-curved catheters simplify the task of selecting the desired arch ves-
Fig. 1. Movable carriage constructed with a wheel he ight designed for 2X magnification. A tripod arrangement of the wheels facilitates leveling of the changer. Wheel locks reduce changer movement. Fig. 2. The mod ified film changer may be rolled into posi tion as required. ACKNOWLEDGMENT: We wish to express our appreciation to Waiter Ward and Herschel Hotaling for their help in design ing and constructing the carriage . 1
From the Department of Radiology, Rochester General Hospital,
1425 Portland Ave ., Rochester. N. Y. 14 6 2 1. Accepted for publication in July 1975. sjh
sel; however, it Is often impossible to advance the catheter beyond the origin of the vessel due to the shape and sometimes the stiffness of the material. particularly in the left common carotid artery. We wish to describe a technique which overcomes this problem and permits further selective catheterization of the internal or external carotid artery. TECHNIQUE
An appropriately shaped double-curved polyethylene catheter (Fig. 1, A-D) is used to engage the origin of the selected arch vessel. A straight guide wire w ith a floppy tip is introduced to an appropriate level beyond the orifice. If initial attempts to advance the catheter fail , the guide wire is removed and replaced with a 260-cm exchange guide wire 0.089 mm (0 .035 in.) in diameter with a straight floppy tip ,2 following which the double-curved catheter is removed and replaced with a soft straight polyethylene catheter of the same diameter (Fig. 1, E). The soft catheter easily negotiates the course of the guide wire already in place in the selected vessel. A gentle preformed curve at the distal end of the catheter enables further selection of the internal or external carotid artery (Fig. 2).
482
November 1975
TECHNICAL NOTES
c
B
o
the abnormal area, makes this technique hazardous. The technique described here has been used successfully for some time in superselective visceral angiography. Emboli produced by clots carried on the tip of the exchange catheter have been minimized or eliminated by treating all catheters and gUide wires with the benzalkonium-heparin solution described by Amplatz (1). This technique has been used successfully in selective catheterization of the left carotid artery when the doublecurved catheter could not be advanced beyond the orifice of the selected vessel. The gentle distal curve of the catheter permits selective catheterization of the internal or external carotid artery. No complications have occurred and no significant increase in time has been required, since the exchange is made over a guide wire which is already in place. This same technique has also been successful in catheterization of the vertebral artery and other branches of a tortuous subclavian artery. Here the guide wire can be pinned in the axilla or upper arm by external compression to facilitate exchange of preshaped superselective catheters.
E
Fig. 1. A-D. Double-curved catheters used for selective catheterization of an aortic arch vessel. E. Exchange catheters for more distal catheterization of the common carotid or internal carotid artery.
REFERENCES DISCUSSION
1. Amplatz K: A simple non-thrombogenic coating. Invest RadioI6:280-289, Jul-Aug 1971 2. Ayella RJ: A new method of catheterizing the great vessels arising from the aortic arch. Radiology 110:714-715, Mar 1974 3. Riddervold HO, Craddock WE: An improved technique for selective femorocerebral angiography. Radiology 101:701-702, Dec 1971
Several methods of catheterizing tortuous vessels arising from an already tortuous aortic arch have been described. Ayella (2) recommended a soft straight polyethylene catheter with a deflector guide and pointed out the potential traumatic complications associated with the use of a deflecting system. Riddervold and Craddock (3) suggested that external compression be applied to the guide wire in the proximal carotid artery to permit advancement of the catheter without backing out the guide wire . The potential hazard of carotid compression alone, as well as possible dislodgement of emboli from soft ulcerated plaques by pressure of the guide wire against
.~ .
1 From Veterans Administration Hospital, 3350 La Jolla Village Drive, San Diego, Calif. 92161 , and the Department of Radiology, University of California-San Diego, San Diego, Calif. Accepted for publication in June 1975. Supported in part by grant GM-02023-05 from the NIH, USPHS. 2 Type TSF, Cook, Inc., Bloomington, Ind. sjh
"
f", ,
:;
A A
,;/
-:
1
'
·· '~i
e,
\;~ . .
,
\,.:t.~.;;·;': .>.:.
8
~~$': '
··~t\1, . "'A"1' ,:~,,\:
Fig. 2. A. Attempts to advance the double-curved catheter beyond the orifice result in a vector force that backs the tip of the catheter out of the selected vessel. B. With the 240-cm exchange guide wire in place, the course of the double-curved catheter is straightened following its removal. C. The straight catheter is advanced over the guide wire and well into the selected vessel.
