Objectives and clinical significance of the procedure
The procedure is used in surgical and diagnostic practice to deliver instruments to major vessels.
The main objective of the technique is to introduce a catheter into the aorta and arterial trunks branching from it.
The procedure is performed for the following purposes:
- Angiography — injection of a contrast agent to visualize the aorta and its branches.
- Cardiac chamber catheterization — diagnostic advancement of a catheter into the heart chambers.
Required instruments
A specialized set of instruments is used for successful catheterization via the Seldinger technique:
- Puncture needle — has an inner diameter of 1.5 mm for the free passage of the guidewire.
- Guidewire — a flexible element inserted through the needle lumen into the arterial bed.
- Polyethylene catheter — a cannula with an outer diameter of 1.2–1.5 mm, placed over the guidewire.
- Syringe with contrast agent — connected to the catheter at the final stage of the procedure.
Step-by-step execution technique
The procedure is performed in a strict sequence:
- Needle insertion: the needle is inserted directly below the inguinal ligament (lig. inguinale) precisely along the projection of the femoral artery.
- Guidewire introduction: a guidewire is advanced into the artery through the inner lumen of the puncture needle.
- Replacing the needle with a catheter: the needle is withdrawn from the tissues, leaving the guidewire in the vessel. The polyethylene catheter is threaded over the guidewire from above.
- Advancement: the catheter along with the guidewire is advanced proximally through the femoral and iliac arteries into the aorta to the desired level.
- Final step: the guidewire is removed from the catheter, after which the syringe with the contrast agent is connected to the catheter.
Instrument dimensions
| Tool | Dimensional characteristics | Purpose |
|---|---|---|
| Puncture needle | Inner diameter 1.5 mm | Femoral artery puncture |
| Guidewire | Matched to the 1.5 mm needle | Guide for the catheter |
| Polyethylene catheter | Outer diameter 1.2–1.5 mm | Delivery of contrast into the aorta |
Briefly: answers to topical questions
How is the projection line of the femoral artery determined?
The projection line of the femoral artery is known as Keen's line. It is defined by a line drawn from the midpoint of the inguinal ligament to the medial epicondyle of the femur, provided that the leg is slightly flexed at the knee joint and abducted outwardly.
What complications can occur during femoral artery puncture?
Complications of the intervention may include a hematoma at the puncture site in the groin; with antegrade puncture above the inguinal ligament, there is a risk of retroperitoneal hematoma.
Which anatomical structures are located medially and laterically to the femoral artery within the vascular lacuna?
Medial to the femoral artery lies the femoral vein. Within the vascular lacuna, the femoral artery is the most lateral of the listed structures; no separate structure directly lateral to the artery is specified in the sources.
Remember the sequence of steps using the key elements N-G-C: first the Needle, then the Guidewire, then the Catheter.
Class and exam questions
At what site is the needle inserted during femoral artery puncture?
The needle is inserted directly below the inguinal ligament (lig. inguinale) strictly along the projection of the femoral artery.
What is the purpose of inserting a catheter into the femoral artery via the Seldinger technique?
The catheter is advanced into the aorta and its branches to perform angiography (contrast imaging) or cardiac chamber catheterization.
Through which vessels is the catheter advanced to the aorta?
The catheter along with the guidewire is advanced sequentially through the femoral and iliac arteries.
What are the dimensions of the needle and catheter for this procedure?
The inner diameter of the puncture needle is 1.5 mm, and the outer diameter of the polyethylene catheter is 1.2–1.5 mm.
What else to study on this topic
- Topographic anatomy of the femoral artery and its projection relative to lig. inguinale
- Anatomical course of the femoral and iliac arteries to the aorta
- Ratio of inner and outer diameters of the needle (1.5 mm) and catheter (1.2–1.5 mm)
- Rules for guidewire removal and connecting the syringe with the contrast agent
- Methodology of cardiac chamber catheterization via arterial access
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