245 transaxillary arteriograms in arteriopathic patients: success rate and complications.

Two hundred and forty-five transaxillary arteriograms were attempted at Charing Cross Hospital between 1982 and 1991 on 195 arteriopathic patients (mean age 64 years) in whom the femoral route was contra-indicated due to absent pulses (94), previous surgery (108), femoral artery aneurysm (5), severe aorto-iliac disease (8) or previous failure by the femoral route (30). Most arteriograms (211) were carried out to investigate peripheral vascular disease, the others were carried out to perform transluminal angioplasty (16) to assess cerebrovascular disease (10) and to investigate arterial insufficiency of the kidneys, alimentary tract and upper limb (8). There were two (0.8%) technical failures where the axillary artery could not be punctured. Selective catheterization of the carotid, vertebral, axillary, lumbar, renal, superior mesenteric, inferior mesenteric, iliac, femoral or popliteal arteries was performed in the course of 38 procedures. There were three (1.2%) serious complications related to the puncture site, a large haematoma followed by a prolonged neurological deficit of the brachial plexus in a hypertensive patient receiving haemodialysis, and thrombosis of the axillary artery in two other patients both of whom responded to surgical thrombectomy. There were three (1.2%) serious systemic complications, two patients had a cardiac arrest and although both were successfully resuscitated one became anuric and died from renal failure and septicaemia 4 weeks later. One patient with a history of transient ischaemic attacks developed a similar transient episode at the end of the procedure. Compared with six series of 290 attempted brachial artery catheterizations in patients where the femoral route was contra-indicated which have been reported since 1986, our series of 245 attempted axillary artery catheterizations had a significantly higher incidence of technical success at the first attempt (P = 0.021) and a lower incidence of vascular complications requiring surgery or angioplasty which was not statistically significant. Our conclusion is that transaxillary arterial catheterization has a high rate of technical success (99%) and should be considered in patients where the femoral route is contra-indicated due to arterial disease.

Hyponatraemia following transurethral resection of the prostate.

In a prospective study of 100 patients undergoing transurethral resection, changes in serum sodium were estimated during the per-operative and post-operative periods. The weight of prostate resected and the volume of irrigant fluid used influenced the changes in serum sodium. In 93 patients these changes were not statistically significant. In only seven patients were significant falls in serum sodium recorded, in one case to a level of 103 mmol/l. All seven exhibited the clinical features of the transurethral syndrome and there was one post-operative death which we attributed to it. The TUR syndrome undoubtedly exists and its incidence in this series was 7%. Its pathogenesis and clinical management are discussed.