PROCEDURE REQUESTED - EMBOLIZATION-TRANSCATHETER
CLINICAL HISTORY: ABDOMINAL ABCESS
COMMENTS:
PROCEDURE:
1. Pelvic arteriography with selective arteriograms of the left internal
iliac artery, the anterior division of the left internal iliac artery,
and left internal pudendal artery.
2. Coil embolization of a branch of the left internal pudendal artery.
INDICATION: Arterial injury.
MEDICATIONS: Sedation provided by the anesthesia department.
CONTRAST: 68 ml Omnipaque 300
FLUOROSCOPY TIME: 8.7 minutes.
COMPLICATIONS: None.
TECHNIQUE: The procedure was performed under emergent conditions. The
patient was placed supine on the fluoroscopy table and the right groin
was prepped and draped in a sterile fashion. A timeout was performed.
The right common femoral artery was accessed with a micropuncture needle
and guidewire under direct sonographic guidance. A 5 French vascular
sheath was placed over a Bentson guidewire. A 5 French Contra flush
catheter was advanced over the guidewire and positioned in the lower
abdominal aorta. Pelvic arteriography ensued. The catheter was used to
advance a Bentson guidewire to the left common femoral artery. The
catheter was exchanged over the guidewire for a 5 French Kumpe catheter.
The Kumpe catheter was then withdrawn and positioned into the left
internal iliac artery. Arteriography was performed.
Using a renegade microcatheter in coaxial fashion, the anterior division
of the left internal iliac artery was selected and arteriography was
performed. The next, the left internal pudendal artery was selected and
further arteriography was performed. Vascular injury was demonstrated
involving a branch arising from the internal pudendal artery. This branch
vessel was embolized with a 2 mm x 3 mm 0.018" Tornado microcoil and
three 5 mm straight microcoils. Postembolization arteriography
demonstrated occlusion of this branch vessel.
The catheters were removed. The sheath was removed and hemostasis was
achieved with manual compression. The patient tolerated the procedure
well without immediate complication and was dismissed after a period of
observation.
FINDINGS:
1. High-grade stenosis of the origin of the left internal iliac artery.
Mild scattered atherosclerotic stenoses are demonstrated throughout the
bilateral iliac and common femoral arterial systems.
2. Arterial irregularity was identified involving a branch vessel of the
left internal pudendal artery consistent with vascular injury.
IMPRESSION:
Successful coil embolization of a branch vessel of the left internal
pudendal artery.
CLINICAL HISTORY: ABDOMINAL ABCESS
COMMENTS:
PROCEDURE:
1. Pelvic arteriography with selective arteriograms of the left internal
iliac artery, the anterior division of the left internal iliac artery,
and left internal pudendal artery.
2. Coil embolization of a branch of the left internal pudendal artery.
INDICATION: Arterial injury.
MEDICATIONS: Sedation provided by the anesthesia department.
CONTRAST: 68 ml Omnipaque 300
FLUOROSCOPY TIME: 8.7 minutes.
COMPLICATIONS: None.
TECHNIQUE: The procedure was performed under emergent conditions. The
patient was placed supine on the fluoroscopy table and the right groin
was prepped and draped in a sterile fashion. A timeout was performed.
The right common femoral artery was accessed with a micropuncture needle
and guidewire under direct sonographic guidance. A 5 French vascular
sheath was placed over a Bentson guidewire. A 5 French Contra flush
catheter was advanced over the guidewire and positioned in the lower
abdominal aorta. Pelvic arteriography ensued. The catheter was used to
advance a Bentson guidewire to the left common femoral artery. The
catheter was exchanged over the guidewire for a 5 French Kumpe catheter.
The Kumpe catheter was then withdrawn and positioned into the left
internal iliac artery. Arteriography was performed.
Using a renegade microcatheter in coaxial fashion, the anterior division
of the left internal iliac artery was selected and arteriography was
performed. The next, the left internal pudendal artery was selected and
further arteriography was performed. Vascular injury was demonstrated
involving a branch arising from the internal pudendal artery. This branch
vessel was embolized with a 2 mm x 3 mm 0.018" Tornado microcoil and
three 5 mm straight microcoils. Postembolization arteriography
demonstrated occlusion of this branch vessel.
The catheters were removed. The sheath was removed and hemostasis was
achieved with manual compression. The patient tolerated the procedure
well without immediate complication and was dismissed after a period of
observation.
FINDINGS:
1. High-grade stenosis of the origin of the left internal iliac artery.
Mild scattered atherosclerotic stenoses are demonstrated throughout the
bilateral iliac and common femoral arterial systems.
2. Arterial irregularity was identified involving a branch vessel of the
left internal pudendal artery consistent with vascular injury.
IMPRESSION:
Successful coil embolization of a branch vessel of the left internal
pudendal artery.
