Can anyone help me out with this procedure????
Clinical history: Patient is a 38-year-old gentleman with history
of TB in the past now with significant hemoptysis. Patient status
post bronchoscopy demonstrating bleeding from the right mid an
lower lobe. Request for bronchial artery embolization.
Embolization particles: 500 to 700-mu. Embospheres, one vial
Fluoroscopy time: 20 minutes
Contrast: 150 cc of Isovue-300
Procedure:
The patient was placed on
the angiography table in the supine position. The right groin was
prepped and draped in the usual sterile fashion. Local anesthesia
was obtained with 1% lidocaine. There was continuous physiologic
monitoring of the patient throughout the procedure. Utilizing
single wall puncture technique the right common femoral artery was
entered. Utilizing exchange technique a 5-French last was sheath
was placed. Over a Bentson wire an omni-flush catheter was
advanced into the ascending thoracic aorta. Digital subtraction
angiography of the thoracic aorta was performed. The Omni flush
catheter was then exchanged initially for a 5 french MicKesson
catheter which was unsuccessful at cannulating the orifice of the
bronchial artery. This was then exchanged for a 5 french Cobra 3
catheter with successful catheterization of multiple intercostal
arteries on the right and left. These demonstrated only very
small bronchial branches without any significant abnormality or
evidence of extravasation. Selective catheterization was obtained
of a prominent enlarged right bronchial artery with tortuosity and
extensive branch formation. No direct extravasation of contrast
material was identified. Given abnormality of this branch vessel
embolization was performed. This was performed utilizing 500 to
700-mu embosphere particles. This was performed until adequate
stasis was obtained without evidence of significant reflux.
Post-embolization selective angiogram of this vessel demonstrated
adequate embolization. Selective catheterization of a left
bronchial artery demonstrated normal vascular appearance. The
catheter was removed over wire. The sheath was removed and
compression applied until hemostasis was obtained. The patient
tolerated these procedures well.
Interpretation:
Evaluation of thoracic aortogram demonstrates normal great
vessels. The thoracic aorta was of normal caliber. Filling of
multiple intercostal branches were demonstrated.
Selective catheterization was performed of 5 separate intercostal
branches on the left which failed to demonstrate abnormalities or
filling of abnormal bronchial artery vessels. Selective
catheterization of a left bronchial artery failed to demonstrate
abnormal caliber or lesional vasculature. Selective
catheterization of 3 separate right intercostal vessels fail to
demonstrate abnormalities or abnormal bronchial arteries.
Selective catheterization of the right bronchial artery
demonstrated significant enlargement of the bronchial artery with
lesional vessels. Successful embolization was performed of this
vessel utilizing Embosphere's with post embolization angiogram
demonstrating successful embolization.
Impression: Successful embolization of abnormal right bronchial
artery.
Clinical history: Patient is a 38-year-old gentleman with history
of TB in the past now with significant hemoptysis. Patient status
post bronchoscopy demonstrating bleeding from the right mid an
lower lobe. Request for bronchial artery embolization.
Embolization particles: 500 to 700-mu. Embospheres, one vial
Fluoroscopy time: 20 minutes
Contrast: 150 cc of Isovue-300
Procedure:
The patient was placed on
the angiography table in the supine position. The right groin was
prepped and draped in the usual sterile fashion. Local anesthesia
was obtained with 1% lidocaine. There was continuous physiologic
monitoring of the patient throughout the procedure. Utilizing
single wall puncture technique the right common femoral artery was
entered. Utilizing exchange technique a 5-French last was sheath
was placed. Over a Bentson wire an omni-flush catheter was
advanced into the ascending thoracic aorta. Digital subtraction
angiography of the thoracic aorta was performed. The Omni flush
catheter was then exchanged initially for a 5 french MicKesson
catheter which was unsuccessful at cannulating the orifice of the
bronchial artery. This was then exchanged for a 5 french Cobra 3
catheter with successful catheterization of multiple intercostal
arteries on the right and left. These demonstrated only very
small bronchial branches without any significant abnormality or
evidence of extravasation. Selective catheterization was obtained
of a prominent enlarged right bronchial artery with tortuosity and
extensive branch formation. No direct extravasation of contrast
material was identified. Given abnormality of this branch vessel
embolization was performed. This was performed utilizing 500 to
700-mu embosphere particles. This was performed until adequate
stasis was obtained without evidence of significant reflux.
Post-embolization selective angiogram of this vessel demonstrated
adequate embolization. Selective catheterization of a left
bronchial artery demonstrated normal vascular appearance. The
catheter was removed over wire. The sheath was removed and
compression applied until hemostasis was obtained. The patient
tolerated these procedures well.
Interpretation:
Evaluation of thoracic aortogram demonstrates normal great
vessels. The thoracic aorta was of normal caliber. Filling of
multiple intercostal branches were demonstrated.
Selective catheterization was performed of 5 separate intercostal
branches on the left which failed to demonstrate abnormalities or
filling of abnormal bronchial artery vessels. Selective
catheterization of a left bronchial artery failed to demonstrate
abnormal caliber or lesional vasculature. Selective
catheterization of 3 separate right intercostal vessels fail to
demonstrate abnormalities or abnormal bronchial arteries.
Selective catheterization of the right bronchial artery
demonstrated significant enlargement of the bronchial artery with
lesional vessels. Successful embolization was performed of this
vessel utilizing Embosphere's with post embolization angiogram
demonstrating successful embolization.
Impression: Successful embolization of abnormal right bronchial
artery.