1

Lateral Sacral Artery

Figure 16.7. Continued. (E) Left internal iliac artery angiogram shows the tumor supply through lateral sacral arteries (black arrow) and the iliolumbar artery (open arrow). (F) Control pelvic angiogram shows a complete tumor de-vascularization. Fibered coils were used to protect normal distal branches of the iliolum-bar arteries (see artifacts superimposing on both internal iliac arteries).

Figure 16.7. Continued. (E) Left internal iliac artery angiogram shows the tumor supply through lateral sacral arteries (black arrow) and the iliolumbar artery (open arrow). (F) Control pelvic angiogram shows a complete tumor de-vascularization. Fibered coils were used to protect normal distal branches of the iliolum-bar arteries (see artifacts superimposing on both internal iliac arteries).

Sidewinder Shaped Catheter
f

Selective catheterization of intercostal or lumbar arteries is done by means of a 4-Fr or, on rare occasions, a 5-Fr H-1 catheter. Other catheters used are C-1 and C-2 catheters, Sidewinder I or II catheters, or, by some experts, a steam-shaped 4-Fr catheter with a distal hook-shaped tip. An amount of 2 to 4 mL is injected within a second, and the angiogram is acquired in anterior-posterior projection. To reduce the time involved in placing the catheter and switching the contrast-filled syringe back and forth, it is recommended to have an assistant inject the contrast if an injector pump is not available. If injection by hand is preferred, the small syringe should be attached to a three-way stopcock, while another attached syringe, filled with 20 mL of contrast material, serves as a reservoir. The digitally subtracted angiographic run (acquisition) should be long enough to capture both the arterial and venous phases. This is especially true in the evaluation of spinal vascular malformations.

If an intervention is planned and a 6-Fr guide catheter is preferred for the coaxial microcatheter placement, it may be helpful to place a 6-Fr femoral sheath or, if the region of interest is located higher, a long femoral sheath bypassing the often tortuous aortic-iliac system. Infrequently, the guide catheter may require to be changed over an exchange wire for a stable position within the intercostal or lumbar artery. It is easier and less traumatic to use hydrophilic-coated exchange guide wires for straightening the proximal part of the segmental arteries. With the introduction of 5-Fr guide catheters with larger lumina, a larger catheter may not be required.

A range of microcatheters, including flow-guided catheters and micro-wires, are available for interventional procedures. The selection must be tailored to the size of the vessel and the embolic material used. For diagnostic purposes, heparin is not given. Heparin may be given for inter-ventional procedures, but only on rare occasions to prevent inadvertent thrombosis, especially if catheters are navigated within the spinal cord vasculature. In selected cases of high-flow AVMs that have blood supply from anterior or posterior spinal arteries, we put the patient on aspirin and/or Plavix to prevent a retrograde thrombosis after embolization.

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  • Sofia
    What is the orgin of the medial sacral artery?
    8 years ago

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