Hi Diane,
Following is the report.
Procedure: Abdominal aortogram, bilateral extremity arteriogram, and
embolization of muscular branch of the left superficial femoral artery
and the right profunda femoris.
Clinical indication: Massive bleeding from both lower extremities status
post blunt trauma with open fracture involving the left lower extremity
and closed fracture involving the right lower extremity.
Procedure: The patient was under general anesthesia when I was asked to
come to the Operating Room to performed intraoperative arteriography and
embolization as indicated.
Following the above procedures, after waiting approximately 1.5 to 2
hours, we initiated our procedure. The arterial line was exchanged from
the right common femoral artery for a #5 French vascular sheath through
which a #5 French pigtail catheter was placed at the level of the
abdominal aorta and an abdominal aortogram performed using C-arm.
Multiple injections were necessary due to the small field of view. No
active extravasation was identified with particular attention to the
lumbar arteries as there had been extravasation identified on CT scan
into the right retroperitoneum. This was not evident on this portion of
the examination.
Pelvic arteriography was performed and again no extravasation was
identified.
Following this, the catheter was exchanged for a #5 French RIM catheter
which was used to selectively catheterize the left common femoral artery.
Digital subtraction arteriography of the left lower extremity was
performed. This revealed active extravasation from a muscular branch of
the distal left superficial femoral artery. After consultation with the
consulting vascular surgeon, a decision was made to perform embolization.
This was performed using a #5 French Davis catheter which was used to
selectively catheterize the bleeding vessel. Via this catheter, a
Tracker microcatheter was placed and five 2 mm in diameter by 20 mm in
length microcoils deployed to result in complete cessation of flow
through the injured artery. Repeat arteriography revealed excellent flow
down to the level of the foot with no further extravasation identified.
Following this portion of the procedure, the left common femoral artery
was punctured with ultrasound guidance with a micropuncture needle.
Using Seldinger technique, a #5 French vascular sheath was placed.
Previously performed right lower extremity arteriography through the
right femoral sheath had revealed active extravasation from branches of
the right profunda femoris. This was selectively catheterized with a #5
French RIM catheter. 3 mm, 5 mm, and 8 mm coils with Gelfoam slurry were
used to completely occlude flow through the profunda femoris. This
resulted in effective cessation of flow. Good flow was maintained within
the right common femoral artery with distal flow identified to the level
of the foot.
Following the procedure, the sheaths were left in place and placed to
arterial lines to maintain patency.
IMPRESSION: Status post embolization of muscular branch of the left
superficial femoral artery and right profunda femoris as described above.