Again, any suggestions?:
PROCEDURE: EMBOLIZATION OF LEFT GASTRIC ARTERY BRANCHES
HISTORY: History of gastric carcinoma. Patient required blood transfusion. Despite conservative management, patient continued to bleed. Patient had an upper endoscopy on 09/04/2010. Oozing blood was documented on previous endoscopy. In addition, patient has severe jaundice, elevation of bilirubin. CT revealed obstruction of the common bile duct due to metastatic disease. Patient had previous GI bleeding embolization in the past.
CONSENT: The procedure, risks, and benefits are explained to the patient. Informed consent was obtained.
Moderate sedation was initiated with Versed and Fentanyl.
Using ultrasound guidance, right common femoral artery was evaluated. Appeared compressible. The right common femoral artery was accessed without difficulty.
Then, selective catheterization of the celiac artery was performed with a 5-French Cobra catheter. Contrast was injected and hepatic artery angiogram was performed.
No definite extravasation of contrast is noted.
Then, selective catheterization of multiple branches of the left gastric artery arising from the left hepatic artery and directly from the celiac trunk was performed. At least 3 branches feeding into the stomach were identified and were embolized empirically using 700 microns particles. Stasis was achieved.
(Selective catheterization of the 3rd order branch of the hepatic artery was performed.)
Selective catheterization of the gastroepiploic artery was performed as a branch of the gastroduodenal artery. The gastroepiploic artery was not embolized. If oozing from the gastric carcinoma persists, then embolization of the gastroepiploic artery should be considered.
IMPRESSION:
1. SELECTIVE EMBOLIZATION OF MULTIPLE BRANCHES OF LEFT GASTRIC ARTERY ARISING FROM LEFT HEPATIC ARTERY AND DIRECTLY FROM THE CELIAC TRUNK (THIRD ORDER BRANCH). THE GASTROEPIPLOIC ARTERY EMBOLIZED.
2. IF OOZING AND BLEEDING PERSIST FOLLOWING LEFT GASTRIC ARTERY EMBOLIZATION, THEN EMBOLIZATION OF THE GASTROEPIPLOIC ARTERY SHOULD BE CONSIDERED.
DATE OF STUDY: 10/29/2010
PROCEDURE: PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAM WITH PLACEMENT OF COMMON BILE DUCT STENT
HISTORY: Common bile duct obstruction due to metastatic gastric carcinoma, jaundice, biliary duct dilatation.
CONSENT: The procedure, risks, and benefits are explained to the patient. Informed consent was obtained.
The abdomen was prepped and draped in the usual manner. Two percent lidocaine was used for local anesthesia.
Using ultrasound guidance, left biliary ducts were accessed without difficulty. Contrast was injected and percutaneous transhepatic cholangiogram was obtained through the needle and revealed obstruction of the common bile duct. The hepatic duct, left and right intrahepatic ducts are patent. Then, using a 5-French catheter, a Glidewire was manipulated through the obstruction into the duodenum. A 5-French measuring pigtail catheter was placed in the common bile duct. The obstruction measured approximately 8 cm in length.
A PTFE-covered metallic stent was then advanced over the wire and positioned at the obstruction site. The stent measured 8 mm x 10 cm in length. The stent was deployed in the common bile duct. A second noncovered stent was deployed proximally in the common hepatic duct.
Immediate flow was reestablished in the common bile duct into the duodenum. The patient tolerated the procedure well.
IMPRESSION: SUCCESSFUL PLACEMENT OF A PTFE-COVERED METALLIC STENT INTO THE COMMON BILE DUCT FOR TREATMENT OF COMMON BILE DUCT OBSTRUCTION DUE TO METASTATIC GASTRIC CARCINOMA
Thanks so much for any help
PROCEDURE: EMBOLIZATION OF LEFT GASTRIC ARTERY BRANCHES
HISTORY: History of gastric carcinoma. Patient required blood transfusion. Despite conservative management, patient continued to bleed. Patient had an upper endoscopy on 09/04/2010. Oozing blood was documented on previous endoscopy. In addition, patient has severe jaundice, elevation of bilirubin. CT revealed obstruction of the common bile duct due to metastatic disease. Patient had previous GI bleeding embolization in the past.
CONSENT: The procedure, risks, and benefits are explained to the patient. Informed consent was obtained.
Moderate sedation was initiated with Versed and Fentanyl.
Using ultrasound guidance, right common femoral artery was evaluated. Appeared compressible. The right common femoral artery was accessed without difficulty.
Then, selective catheterization of the celiac artery was performed with a 5-French Cobra catheter. Contrast was injected and hepatic artery angiogram was performed.
No definite extravasation of contrast is noted.
Then, selective catheterization of multiple branches of the left gastric artery arising from the left hepatic artery and directly from the celiac trunk was performed. At least 3 branches feeding into the stomach were identified and were embolized empirically using 700 microns particles. Stasis was achieved.
(Selective catheterization of the 3rd order branch of the hepatic artery was performed.)
Selective catheterization of the gastroepiploic artery was performed as a branch of the gastroduodenal artery. The gastroepiploic artery was not embolized. If oozing from the gastric carcinoma persists, then embolization of the gastroepiploic artery should be considered.
IMPRESSION:
1. SELECTIVE EMBOLIZATION OF MULTIPLE BRANCHES OF LEFT GASTRIC ARTERY ARISING FROM LEFT HEPATIC ARTERY AND DIRECTLY FROM THE CELIAC TRUNK (THIRD ORDER BRANCH). THE GASTROEPIPLOIC ARTERY EMBOLIZED.
2. IF OOZING AND BLEEDING PERSIST FOLLOWING LEFT GASTRIC ARTERY EMBOLIZATION, THEN EMBOLIZATION OF THE GASTROEPIPLOIC ARTERY SHOULD BE CONSIDERED.
DATE OF STUDY: 10/29/2010
PROCEDURE: PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAM WITH PLACEMENT OF COMMON BILE DUCT STENT
HISTORY: Common bile duct obstruction due to metastatic gastric carcinoma, jaundice, biliary duct dilatation.
CONSENT: The procedure, risks, and benefits are explained to the patient. Informed consent was obtained.
The abdomen was prepped and draped in the usual manner. Two percent lidocaine was used for local anesthesia.
Using ultrasound guidance, left biliary ducts were accessed without difficulty. Contrast was injected and percutaneous transhepatic cholangiogram was obtained through the needle and revealed obstruction of the common bile duct. The hepatic duct, left and right intrahepatic ducts are patent. Then, using a 5-French catheter, a Glidewire was manipulated through the obstruction into the duodenum. A 5-French measuring pigtail catheter was placed in the common bile duct. The obstruction measured approximately 8 cm in length.
A PTFE-covered metallic stent was then advanced over the wire and positioned at the obstruction site. The stent measured 8 mm x 10 cm in length. The stent was deployed in the common bile duct. A second noncovered stent was deployed proximally in the common hepatic duct.
Immediate flow was reestablished in the common bile duct into the duodenum. The patient tolerated the procedure well.
IMPRESSION: SUCCESSFUL PLACEMENT OF A PTFE-COVERED METALLIC STENT INTO THE COMMON BILE DUCT FOR TREATMENT OF COMMON BILE DUCT OBSTRUCTION DUE TO METASTATIC GASTRIC CARCINOMA
Thanks so much for any help