Seldinger technique

The Seldinger technique is the mainstay of vascular and other luminal access in interventional radiology. 

History

The Seldinger technique was first described in 1953 by Dr Sven Ivar-Ivar Seldinger (1921-1998), a Swedish radiologist who pioneered the field of interventional radiology. Prior to this procedure, sharp large bore trocars were employed to gain arterial access, resulting in a high rate of complications and limiting its use to larger arteries. While working at the Karolinska Hospital he introduced a novel method of gaining vascular access using a needle, exchange wire, and catheter, which enabled radiologists to perform angiography in a relatively risk-free manner and thus lead to the emergence of minimally invasive procedures.

Uses

• digital subtraction angiography
• insertion of central venous catheters
• insertion of chest drain
• insertion of pacemaker leads or implantable cardioverter-defibrillator
• insertion of PEG tubes

Practically speaking, the majority of interventional diagnostic and therapeutic radiological procedures employ the Seldinger technique for initial vascular access.

Technique

1. The desired vessel or cavity is punctured using a sharp hollow needle (trocar).
2. A soft curved tip guide wire is then inserted through the hollow needle and advanced into the lumen.
3. The guidewire is held secured in its place while the introducer needle is removed.
4. A large bore sheath (or cannula or alternatively a drainage tube) is then railroaded over the guidewire and introduced into the lumen/cavity.
5. The guidewire is withdrawn leaving the introducer sheath in situ through which catheters and other medical devices can be introduced without surgical exposure.

Complications

• failed access
• haemorrhage
• infection
• perforation of viscus
• guidewire embolus
• pseudoaneurysm formation