Protocols and Results of Resident Neurosurgeon's Transfemoral Catheter Angiography Training Supervised by Neuroendovascular Specialists

Abstract

Objective: Transfemoral catheter angiography (TFCA) is a basic procedure in neurovascular surgery with increasing importance in surgical and non-invasive treatments. Unfortunately, resident neurosurgeons have relatively few opportunities to perform TFCA in most institutions. We report a method developed in our hospital for training resident neurosurgeons to perform TFCA and evaluate the efficacy of this training.

Methods: From May 2011 to September 2011, a total of 112 consecutive patients underwent TFCA by one resident neurosurgeon supervised by two neuroendovascular specialists. Patients who underwent elective diagnostic procedures were included in this study. Patients who underwent endovascular treatment were excluded. Demographic data, indications for TFCA, side of approach, number of selected arteries, and complications were analyzed.

Results: This study included 64 males and 48 females with a mean age of 51.6 (12-81) years. All procedures were performed in the angiography suite. Common indications for procedures were as follows: stroke-induced symptoms in 61 patients (54.5%), Moyamoya disease and arteriovenous malformation in 13 patients (11.6%), and unruptured intracranial aneurysm in eight patients (7.1%). Right and left femoral puncture was performed in 98.2% and 1.8% of patients, respectively. A total of 465 selective angiographies were performed without complications. Angiographic examination was performed on 4.15 vessels per patient.

Conclusion: TFCA can be performed safely by resident neurosurgeons based on anatomical study and a meticulous protocol under the careful supervision of neuroendovascular specialists.

Keywords: Cerebral angiography; Residency; Training.

Fig. 1

Cerebral angiography report rorm. The resident neurosurgeon must confirm the diagnostic angiography result after the procedure. This form contains the patient's basic information, diagnosis, operator information, amount of dye used, puncture site, complications, type of sheath, type of catheter, examination of vessel locations, location of three-dimensional rotation angiography, brief patient history, angiographic findings, final diagnosis after angiography, report date, and signatures.

Fig. 2

Number of catheters used according to patient age. The number of catheters used increased with age. The age range was 50 to 59 years. In 30 patients, a Davis catheter was used. In one patient, Davis, Headhunter, and Simons catheters were used. Among patients >60 years of age, a Davis catheter was used in 28 patients; Davis and Headhunter catheters were used in three patients; and Davis, Headhunter, and Simons catheters were used in one patient.

Fig. 3

Number of vessels used in angiography. Selected vessels included the femoral artery, common carotid artery in the neck, intracranial carotid artery, external carotid artery, vertebral artery, subclavian artery, and aorta. Femoral artery angiography was performed in all patients.