margaret fahy
Guru
Hi Guys,
Can you please give me some input on the Angiographies done prior to Embolization procedure below.
Thanks so much.
Margie
1. Ultrasound guided access of the right common femoral artery.
2. Abdominal aortogram.
3. Selective catheterization of left L3 intersegmental lumbar
artery and angiogram.
4. Selective catheterization of 2 third order branches of left L3
lumbar intersegmental artery and angiogram.
5. Embolization of 2 branches of the left L3 intersegmental
lumbar artery using detachable coils.
6. Post embolization angiogram
7. Hemostasis with manual compression.
8. Double-lumen PICC line placement into the right upper
extremity.
PROCEDURE IN DETAILS:
The skin of the right groin was prepped and draped in sterile
fashion. Using US guidance a 21 gauge needle was inserted in the
right common femoral artery. Once arterial blood return was
obtained a .018" Nitrex wire was placed into the artery and
advanced to the distal abdominal aorta. The needle was removed
and replaced with a 5 French micropuncture sheath/dilator set.
The wire was sized up to a .035" Newton wire, and a 5F vascular
sheath was placed into the artery. Over the wire, a 5-French
pigtail catheter was advanced into the abdominal aorta . Contrast
was injected and angiogram was obtained. The catheter was
exchanged for a 5 French HS1 catheter. Then selective
catheterization of the left L3 intersegmental artery was
performed. Contrast was injected and angiography was obtained.
FINDINGS:
ABDOMINAL AORTA: The visualized portions of abdominal aorta and
its branches are unremarkable. There is increased vascularity in
the region of left renal mass inferior to the left kidney. The
main feeding arteries are coming from left L3 lumbar
intersegmental artery which is mildly enlarged. The main renal
arteries appear grossly normal.
LEFT L3 LUMBAR INTERSEGMENTAL ARTERY: The artery is slightly
enlarged. The left renal mass is primarily supplied by 3 main
branches of this artery with anastomosis to smaller left renal
cortical vessels. The radiculomedullary artery supplying the
anterior spinal artery (artery of Adamkiewicz) is is seen
originating from left L3 lumbar intersegmental artery.
LEFT L3 LUMBAR INTERSEGMENTAL ARTERY EMBOLIZATION: Selective
catheterization of the inferior branch of left L3 lumbar
intersegmental artery was performed using 2.8 Fr Renegade
microcatheter. Contrast was injected, confirming catheter tip
location. Embolization of this branch was performed using 2
detachable Penumbra coils under fluoroscopic monitoring. Post
embolization angiogram demonstrated cessation of blood flow
through this artery.
Then selective catheterization of the superior branch of left L3
lumbar intersegmental artery was performed using 2.8 Fr (high
flow) Renegade microcatheter. Contrast was injected, confirming
catheter tip location. The 3mm 15cm detachable coil was
prematurely deployed in the proximal portion of the artery in an
area of very spasmed vessel with tortuosity. Multiple attempts
were made to adjust the coil position post intra-arterial
nitroglycerin administration, and the coil was finally advanced
into the most proximal portion of the target artery just distal
to the anterior spinal artery origin. Initial post embolization
angiogram demonstrated the spinal artery but subsequent selective
angiography did not. 5000 units of systemic bolus of Heparin and
local IV nitroglycerin was the given and a repeat angiogram still
failed to demonstrate the spinal artery but did demonstrate
increased occlusion of additional feeders to the tumor. The
microcatheter was removed and motor and sensory evoked potentials
demonstrated normal lower spinal cord function.
POST EMBOLIZATION AORTOGRAM:
A 5-French pigtail catheter was reinserted into the abdominal
aorta for a post procedure final non selective angiogram.
Contrast was injected which demonstrated almost complete
obliteration of the arterial blood supply to the tumor and again
no filling of the anterior spinal artery from this level.
Additionally some visualization of small branches off the left
inferior epigastric artery to the tumor were now noted.
The catheter and sheath were then removed and manual compression
was applied until hemostasis was achieved. A sterile occlusive
dressing was applied at the site. The patient left the IR Suite
in stable condition. Dr. was present for the entire
procedure.
Permanent fluoroscopic, and US images were obtained and stored in
the PACS system
Can you please give me some input on the Angiographies done prior to Embolization procedure below.
Thanks so much.
Margie
1. Ultrasound guided access of the right common femoral artery.
2. Abdominal aortogram.
3. Selective catheterization of left L3 intersegmental lumbar
artery and angiogram.
4. Selective catheterization of 2 third order branches of left L3
lumbar intersegmental artery and angiogram.
5. Embolization of 2 branches of the left L3 intersegmental
lumbar artery using detachable coils.
6. Post embolization angiogram
7. Hemostasis with manual compression.
8. Double-lumen PICC line placement into the right upper
extremity.
PROCEDURE IN DETAILS:
The skin of the right groin was prepped and draped in sterile
fashion. Using US guidance a 21 gauge needle was inserted in the
right common femoral artery. Once arterial blood return was
obtained a .018" Nitrex wire was placed into the artery and
advanced to the distal abdominal aorta. The needle was removed
and replaced with a 5 French micropuncture sheath/dilator set.
The wire was sized up to a .035" Newton wire, and a 5F vascular
sheath was placed into the artery. Over the wire, a 5-French
pigtail catheter was advanced into the abdominal aorta . Contrast
was injected and angiogram was obtained. The catheter was
exchanged for a 5 French HS1 catheter. Then selective
catheterization of the left L3 intersegmental artery was
performed. Contrast was injected and angiography was obtained.
FINDINGS:
ABDOMINAL AORTA: The visualized portions of abdominal aorta and
its branches are unremarkable. There is increased vascularity in
the region of left renal mass inferior to the left kidney. The
main feeding arteries are coming from left L3 lumbar
intersegmental artery which is mildly enlarged. The main renal
arteries appear grossly normal.
LEFT L3 LUMBAR INTERSEGMENTAL ARTERY: The artery is slightly
enlarged. The left renal mass is primarily supplied by 3 main
branches of this artery with anastomosis to smaller left renal
cortical vessels. The radiculomedullary artery supplying the
anterior spinal artery (artery of Adamkiewicz) is is seen
originating from left L3 lumbar intersegmental artery.
LEFT L3 LUMBAR INTERSEGMENTAL ARTERY EMBOLIZATION: Selective
catheterization of the inferior branch of left L3 lumbar
intersegmental artery was performed using 2.8 Fr Renegade
microcatheter. Contrast was injected, confirming catheter tip
location. Embolization of this branch was performed using 2
detachable Penumbra coils under fluoroscopic monitoring. Post
embolization angiogram demonstrated cessation of blood flow
through this artery.
Then selective catheterization of the superior branch of left L3
lumbar intersegmental artery was performed using 2.8 Fr (high
flow) Renegade microcatheter. Contrast was injected, confirming
catheter tip location. The 3mm 15cm detachable coil was
prematurely deployed in the proximal portion of the artery in an
area of very spasmed vessel with tortuosity. Multiple attempts
were made to adjust the coil position post intra-arterial
nitroglycerin administration, and the coil was finally advanced
into the most proximal portion of the target artery just distal
to the anterior spinal artery origin. Initial post embolization
angiogram demonstrated the spinal artery but subsequent selective
angiography did not. 5000 units of systemic bolus of Heparin and
local IV nitroglycerin was the given and a repeat angiogram still
failed to demonstrate the spinal artery but did demonstrate
increased occlusion of additional feeders to the tumor. The
microcatheter was removed and motor and sensory evoked potentials
demonstrated normal lower spinal cord function.
POST EMBOLIZATION AORTOGRAM:
A 5-French pigtail catheter was reinserted into the abdominal
aorta for a post procedure final non selective angiogram.
Contrast was injected which demonstrated almost complete
obliteration of the arterial blood supply to the tumor and again
no filling of the anterior spinal artery from this level.
Additionally some visualization of small branches off the left
inferior epigastric artery to the tumor were now noted.
The catheter and sheath were then removed and manual compression
was applied until hemostasis was achieved. A sterile occlusive
dressing was applied at the site. The patient left the IR Suite
in stable condition. Dr. was present for the entire
procedure.
Permanent fluoroscopic, and US images were obtained and stored in
the PACS system