WSHIMA
WSHIMA – Case 15: Embolization hepatic artery PROCEDURE: visceral angiography and embolizatioPREPROCEDURE DX: upper GI bleeding, suspected duodenal bulb regionPOSTPROCEDURE DX: samePROCEDURE FINDINGS: No active extravasation seen. Empiric embolization of GDA with metal coils. Manual hemostasis.CLINICAL HISTORY: 88-year-old man with recurrent GI bleeding. Endoscopydemonstrates visible vessel in the duodenal bulb. Angiography isrequested to evaluate for bleeding site with potential for empiricembolization.DIAGNOSIS: End stage renal disease [N18.6]; Gastrointestinal hemorrhage,unspecified [K92.2]; Hypotension, unspecified [I95.9]; Gastrointestinalhemorrhage, unspecified [K92.2]; Acute posthemorrhagic anemia [D62];Shock, unspecified [R57.9]CONTRAST: IOPAMIDOL 61 % INTRAVENOUS SOLUTION 145 mLFLUORO TIME: 14.41min The patient was positioned supine on the fluoroscopy table.Right groin was sterilelyprepped and draped. After admission of localanesthesia with 1% lidocaine, a micropuncture needle was guided into theright common femoral artery, over the femoral head. A wire was placedusing standard guidewire technique, a 5 French vascular sheath wasplaced. The sheath was intermittently flushed throughout the procedure. A 4 French pigtail catheter was placed in the suprarenal aorta and aortogram obtained. Next, a Simmons one catheter was placed into the aorta, however the reverse curve could not be formed. This was then exchanged for a Cobra C2catheter. The catheter was initiated into theceliac trunk. Celiac angiography was obtained. Next, the superior mesenteric artery was selected. Superior mesenteric angiogram wasobtained. The celiac artery was again selected. A Progreat microcatheterwas advanced into the common hepatic artery. Common hepatic angiographywas obtained. Next, the microcatheter was advanced into thegastroduodenal artery. Gastroduodenal angiography was obtained. Next, thegastroduodenal artery was embolized with five Tornado 5mm -2 mmmicrocoils and one Nester 3 mm coil. Follow-up angiography of the commonhepatic artery was performed. Microcatheter and base catheter removed.Right common femoral angiogram was performed. The vascular sheath wasremoved with manual pressure for 15 minutes to achieve hemostasis.FINDINGS: Aortogram: Essentially conventional mesenteric anatomy seen. No active extravasation identified. Celiac arteriogram: Essentially conventional anatomy. No activeextravasation identified.Superior mesenteric arteriogram: No active extravasation mon hepatic arteriogram: No active extravasation seen.Gastroduodenal arteriogram: No active extravasation seen.Follow-up common hepatic arteriogram: Successful coil embolization of gastroduodenal artery.Right common femoral arteriogram: Vascular sheath in the common femoralartery over the bottom half of the femoral head. Atherosclerotic diseaseof the common femoral artery and proximal superficial femoral arterynoted.Impression:IMPRESSION:1. Visceral angiography demonstrating no active extravasation or othervascular abnormalities to explain the patient's recurrent bleeding.2. Empiric coil embolization of the gastroduodenal artery based on thebleeding site identified on endoscopy. ................
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