ROUTINE CEREBRAL ANGIOGRAPHY BY THE FEMORAL CATHETER APPROACH

The senior author has extensive experience using percutaneous carotid and brachial techniques and can unequivocally state that the femoral cerebral approach is easier, faster, quicker and a more satisfactory method of reaching the cerebral vessels in the routine patient population. A cataloging of the relative advantages and disadvantages of cerebral angiography might be useful to those considering using this technique.

Advantages of Femoral Cerebral Angiography.

1. Ease of injecting multiple vessels! It is frequently possible within 1 hour to inject both internal carotid arteries and a vertebral artery and have angiograms of all 3 vessels.

2. Readily allows subselective injection (external carotid artery, for example).

3. Allows selection of the right vertebral artery when it is larger than the left (20 per cent).

4. During femoral vertebral artery injections, reflux is routinely obtained down the opposite vertebral artery. This is an immense advantage in aneurysm studies, since, in other techniques, the right posterior inferior cerebellar artery is frequently not studied.

Disadvantages of Femoral Cerebral Angiography.

1. More equipment is required (catheter, needle, wire, dilator).

2. More expense to the patient, especially if the catheters and wires are disposed of after each procedure as recommended by manufacturers (in our department, the catheters are re-used).

3. Requires fluoroscopy and a floating-top table.

4. Possible thrombosis of the femoral artery in the leg.

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