Cath Procedure: After discussing the risk-benefit ratio of the procedure
and obtaining signed informed consent, the patient is brought to the cardiac
or heart catheterization laboratory and placed on the table. Mild conscious
sedation is commonly used and varies according to the preference of the
cardiologist. Intravenous sedation may also be used intermittently during
the case, as needed. Oxygen saturation is constantly monitored.
The x-ray tube is attached to one end (on top) and the image intensifier
(II)/camera assembly (below) is attached to the other end of a mobile
arm that can be rotated left and right plus cranially and caudally (towards
and away from the patient's head). This ability allows the patient's coronary
angiograms to be reviewed from various angles. The vascular access site (groin in
the majority of cases) is cleansed with an antibacterial solution and
covered with surgical drapes. Before proceeding any further, many cardiologists
who use the femoral artery approach will confirm bony landmarks before
accessing the artery. This is accomplished by placing a needle or hemostat
on top of the groin at the anticipated puncture site and fluroscopically
evaluating the position of the tip as it relates to the femoral head.
The inguinal ligament usually crosses
the superior edge of the femoral head. In the majority of cases, the common
femoral artery usually bifurcates into the profunda and superficial branches
below the mid portion of the femoral head. The target entry site of the
needle is the superior half of the femoral head and is achieved by controlling
the entrance point, the insertion angle of the needle, and taking into
account the anticipated depth of the artery.
sites may result in entering one of the bifurcation branches of the common
femoral artery. In such cases, compression, post removal of the sheath
is more difficult. Also, the incidence of a pseudo-aneurysm and femoral
artery thrombosis is slightly increased. Puncture at the arterial bifurcation
point may make it more difficult to secure hemostasis with compression
or a sealing device, In some cases surgical repair may be needed. A high
puncture should be avoided, if possible, because it then becomes difficult
to compress the artery against a bony structure and the risk of a retro-peritoneal
hematoma is increased.