Seldinger technique

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

Uses

• digital subtraction angiography

• insertion of central venous catheters

• insertion of chest drains

• insertion of pacemaker leads or implantable cardioverter-defibrillators

• 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. desired vessel or cavity is punctured using a trocar (hollow needle)

2. soft curved tip guide wire is then inserted through the trocar and advanced into the lumen

3. guidewire is held secured in place whilst the introducer trocar is removed

4. large-bore sheath/cannula/catheter is passed over the guidewire into the lumen/cavity

5. guidewire is withdrawn leaving the introducer sheath in situ through which catheters and other medical devices can be introduced

Complications

• failed access

• haemorrhage

• infection

• perforation of viscus

• guidewire embolus

• pseudoaneurysm formation

History and etymology

The Seldinger technique was first described in 1953 by Sven-Ivar Seldinger(1921-1998), a pioneering Swedish interventional radiologist (a rare example of Stigler's law of eponymy being being wrong).

Seldinger technique was often incorrectlly attributed to "double-wall puncture" (DWP) technique possibly due to the use of two-part needle (Cournard needle, that commonly used for DWP at that time) in the procedure. A DWP involves the blind puncture of anterior and posterior walls of the artery and then withdrawal of the needle to posiition its tip correctly into the lumen. With the advent of image guidance, DWP is not longer relevant as it can cause complications such as haematoma, arteriovenous fistula, or retroperitoneal haemorrhage ³.

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 hollow 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.