The Seldinger technique, which forms the basis of modern vascular interventional radiology, involves the following sequence:

• A Surgical cut-down → direct arteriotomy → catheter insertion → direct closure
• B Direct trocar puncture → sheath insertion without guidewire → catheter placement
• C Needle puncture of vessel → guidewire insertion through needle → needle removal → sheath/catheter passage over guidewire ✓
• D Ultrasound-guided venous puncture → balloon dilation → stent deployment without guidewire

Explanation

The Seldinger technique (described by Sven-Ivar Seldinger in 1953) is the cornerstone of percutaneous vascular access: (1) arterial/venous puncture with a needle; (2) guidewire insertion through the needle lumen into the vessel; (3) needle removal while maintaining guidewire position; (4) passage of a dilator and/or sheath over the guidewire into the vessel; (5) catheter/device insertion over the guidewire. This approach revolutionized vascular access by eliminating the need for surgical cut-down. Modified Seldinger technique uses a micropuncture set (21G needle + 0.018-inch wire) for safer initial access in high-risk patients. All modern PICC, central line, arterial line, and drain placements use this principle.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.