Double puncture of single common femoral artery for CT hepatic arteriography and CT arterial portography

To evaluate the safety and efficacy of double puncture of a single common femoral artery for CT hepatic arteriography (CTHA) and CT arterial portography (CTAP) in patients with hepatocellular carcinoma. Between October and December 1995, 35 patients with hepatocellular carcinoma underwent double puncture of a single common femoral artery for combined CTHA and CTAP. Preangiographic laboratory data were as follows:platelet count from 28,000 to 250,000/mm3 (average, 124,500/mm3);prothrombin time from 45.8% to 100% (average, 85.3%). In the inguinal area, a pair of 21G puncture needles were used unilaterally for the first two femoral punctures, at a distance of 5-7mm;a 0.018'' guidewire for the insertion of a 4-F sheath in a coaxial micropuncture introducer set;and a 0.035'' guidewire and 4F check-flo sheath for the insertion of 4-F catheters. After being moved to the CT room, patients then underwent spiral CTHA and CTAP for further detection of hepatocellular carcinoma nodules. Transarterial chemoembolization followed, and the punctured site was then compressed by the usual finger compression method. After initial compression and one day later, we observed the puncture site for complications such as hematoma formation, thromboembolization or arteriovenous fistula, etc. Except for the formation of two mild hematomas, no remarkable severe complications were noted. Fifteen patients who had previously undergone combined spiral CTHA and CTAP using the bilateral femoral puncture method (with a 5-F check-flo sheath) felt more comfortable than when an earlier method was uded. For combined CTHA and CTAP, double puncture of a single common femoral artery is safer and more comfortable than the bilateral femoral puncture method.=20