October 21, 1968

Tortuosity of Subclavian And Innominate Arteries

Author Affiliations

Los Angeles

JAMA. 1968;206(4):895. doi:10.1001/jama.1968.03150040107030

To the Editor:—  As Bousvaros and Sandler report (205:466, 1968), tortuosity of the subclavian and innominate arteries is commonly encountered in catheterization of the thoracic aorta. Prolonged manipulation in order to pass a catheter beyond this area is undesirable and may lead to intimal dissection. Unfortunately, the only alternative recorded by the authors is to desist and use the femoral route. Since one cannot predict the presence of such a condition, a method that would not necessitate a new approach would be helpful. Radiologists are frequently called on to perform, percutaneously via the axillary approach,1 studies in older patients with considerable vascular disease and hypertension in whom this problem is more often encountered. Indeed, Roy noted that in 396 patients, tortuosity and/or atheromatous disease prevented successful percutaneous transaxillary catheterization in 5.8% and resulted in arterial damage in 2.6%.2Since introduction of the safety "J" wire by Judkins