Technique for implantation of chronic indwelling aortic access catheters

Introduction For chronic, repeated cardiovascular studies in trained, conscious dogs, we describe a technique for implantation of an arterial vascular access catheter in the aorta. In comparison to previous techniques, our technique enables arterial catheter implantation without interrupting the systemic circulation or compromising peripheral arterial flow, requires only a single penetration of the aortic wall, and results in a catheter facing downstream in the aorta. The catheter is usable for both arterial blood sampling and intra-arterial injection of pharmacologic agents. Methods After thoracotomy, two purse-string sutures were set in the aortic wall at the catheter entry-site. A Debakey-Satinsky vena cava clamp was used to partially clamp and isolate a 3-cm portion of aorta surrounding the pursestring sutures. The catheter was prepared by inserting a 0.35 mm guide wire, curve tip end first, into a 7 French silicone Access Technologies catheter. This caused a slight bend at the tip of the catheter, which later facilitated entry into the aorta and prevented damage to the intima of the aortic wall. Catheters were tunneled from the thorax to the nape of the neck, attached to a subcutaneous vascular access port (VAP), and buried in the fascia. Catheters were locked with 2 mL heparinized saline (20 IU/mL). With this technique, we implanted 16 aortic vascular access catheters in 16 dogs. Results Of the 16 animals, 8 are being maintained for long-term study, 7 were sacrificed for histopathological examination, and 1 died due to improper catheter implantation without the aid of the curved-tip guide-wire technique. VAPs have remained bidirectionally patent in all long-term animals (n = 8) ongoing for 7.5 +/- 1.4 months (mean +/- SEM), with an ongoing maximum of 14 months. In these long-term animals, VAPs were used 5.88 +/- 1.34 times. Postmortem examinations were performed on short-term animals (n = 8) sacrificed at 2.85 +/- 1.29 months. The catheters have remained bidirectionally patent in all but the one animal that died. In the short- term animals, the 7 patent VAPs were used 12.71 +/- 1.64 times. Histopathological examination of hematoxylin and eosin (H&E) slides from the catheter entry site revealed only minimal chronic inflammation. No evidence of tissue over-growth around any of the intravascular segments of these silicone catheters was noted in any animal. Conclusions Thus, this dependable subcutaneous arterial access system provides a means for examining acute and long-term effects of environmental and pathophysiological influences in conscious dogs. These catheters have remained bidirectionally patent ongoing for more than 1 year and allowed infusion of agents and withdrawal of central arterial blood samples.