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Technical
Improved
Technique
MICHAEL
D. MILLER,’
Note
for Transcatheter
Embolization
IRWIN
AND
S. JOHNSRUDE,
Tnanscatheten embolization of arteries to control bleeding and to infarct tumors has been widely described in the nadiologic literature during the last 5 years. The process of introducing the emboli into the catheter hub can be cumbersome, requiring repeated removal of the syringe from the catheter, so that the small pieces of Gelfoam, autologous clot, Silastic spheres, or other material a simple
may
be individually
modification
injected.
We
of a two-way
have
stopcock
developed to facilitate
Method The complete
apparatus
is shown
in
modified consists
stopcock of drilling
two-way
stopcock.
the
housing
way
stopcock
two-way
valve
used
figure
1
,
in detail. a tapered The
to avoid
in transcatheter emboliand figure 2 shows the The entire modification side hole in a Luer-Lok
rotor
is removed
damaging
it.
already
has
is preferred
the
before
Although
necessary
for two
side
reasons:
drilling the
three-
hole,
(1) the
C. JACKSON
Gelfoam approximately 1 .5 x 1 .5 x 5 mm which has been soaking in normal saline can easily be inserted through the open side hole into the valve using mosquito forceps. The valve is then notated to the open position (fig. 2A). The side hole is now closed and, in closing, has sheared off any Gelfoam not fully inserted, leaving it clearly visible outside the system. Pressure on the syninge plunger easily pushes the embolus into a clear connecting tube, where its presence may be visually confirmed; from theme it is further advanced into the artery. The procedure is repeated until the desired mesuIts are obtained. Emboli are prepared from commercially available strips or blocks of Gelfoam by the device shown in figure 3. This is simply a stack of five to 10 doubleedged razor blades separated by Lucite or stainless steel spacers 1 .6 mm thick. The spacers coven one cutting edge and both ends of the blades, leaving the working edge exposed to a depth of about 5 mm. The blades are easily replaced by removing the two bolts. Best results are obtained with a combined downward pressure and short slicing motion. This system has shortened the time required to embo-
this process.
zation
DONALD
of Arteries
the
former
has a fitting which, unless removed, interferes with insertion of the embolus; and (2) the three-way stopcock has a T-shaped passage through the rotor which results in a dead space which might trap the embolus. In figure 2B, the modified stopcock is shown in the closed position. In this position the catheter is closed off, preventing back flow of blood. A single piece of
lize
arteries,
reduced
catheter
damage
produced
by me-
peated clamping or kinking, minimized trapping of Gelfoam in dead space between the catheter and syringe, and decreased the chance of introducing air emboli.
Modifi#{176}dstopcock
Catheter
Fig. 1 -Assembled
3”Iong c/ear connecting
apparatus
introducing emboli into catheter. Flushing syringe is attached.
tube
Injecting
syriflge
containing
30%
Renogrofin
Received July 15, 1977; accepted October 5, 1977. All authors: Department of Radiology, Duke University
1
Am J Ro.ntg#{149}nol 130:183-184,
C 1978 American
Roentgen
January Ray Society
1978
Medical
Center,
Durham,
183
North Carolina
27710. Address
0361
reprint
-803X/78/01
requests
to I. 5. Johnsrude.
00-01
83 $02.00
for
Downloaded from www.ajronline.org by 177.104.15.179 on 11/08/15 from IP address 177.104.15.179. Copyright ARRS. For personal use only; all rights reserved
184
TECHNICAL
NOTE
Fig. 3.-Gelfoam cutter consisting alternating with Lucite or stainless steel
B
Fig. 2.-Detail of modified two-way stopcock. A, Side hole closed. In this position emboli are flushed into catheter. B, Side hole open for insertion of emboli. In this position arterial line is not open through side hole as it would be with conventional three-way stopcock.
of double-edged spacers.
razor
blades
Technical
Improved
Technique
MICHAEL
D. MILLER,’
Note
for Transcatheter
Embolization
IRWIN
AND
S. JOHNSRUDE,
Tnanscatheten embolization of arteries to control bleeding and to infarct tumors has been widely described in the nadiologic literature during the last 5 years. The process of introducing the emboli into the catheter hub can be cumbersome, requiring repeated removal of the syringe from the catheter, so that the small pieces of Gelfoam, autologous clot, Silastic spheres, or other material a simple
may
be individually
modification
injected.
We
of a two-way
have
stopcock
developed to facilitate
Method The complete
apparatus
is shown
in
modified consists
stopcock of drilling
two-way
stopcock.
the
housing
way
stopcock
two-way
valve
used
figure
1
,
in detail. a tapered The
to avoid
in transcatheter emboliand figure 2 shows the The entire modification side hole in a Luer-Lok
rotor
is removed
damaging
it.
already
has
is preferred
the
before
Although
necessary
for two
side
reasons:
drilling the
three-
hole,
(1) the
C. JACKSON
Gelfoam approximately 1 .5 x 1 .5 x 5 mm which has been soaking in normal saline can easily be inserted through the open side hole into the valve using mosquito forceps. The valve is then notated to the open position (fig. 2A). The side hole is now closed and, in closing, has sheared off any Gelfoam not fully inserted, leaving it clearly visible outside the system. Pressure on the syninge plunger easily pushes the embolus into a clear connecting tube, where its presence may be visually confirmed; from theme it is further advanced into the artery. The procedure is repeated until the desired mesuIts are obtained. Emboli are prepared from commercially available strips or blocks of Gelfoam by the device shown in figure 3. This is simply a stack of five to 10 doubleedged razor blades separated by Lucite or stainless steel spacers 1 .6 mm thick. The spacers coven one cutting edge and both ends of the blades, leaving the working edge exposed to a depth of about 5 mm. The blades are easily replaced by removing the two bolts. Best results are obtained with a combined downward pressure and short slicing motion. This system has shortened the time required to embo-
this process.
zation
DONALD
of Arteries
the
former
has a fitting which, unless removed, interferes with insertion of the embolus; and (2) the three-way stopcock has a T-shaped passage through the rotor which results in a dead space which might trap the embolus. In figure 2B, the modified stopcock is shown in the closed position. In this position the catheter is closed off, preventing back flow of blood. A single piece of
lize
arteries,
reduced
catheter
damage
produced
by me-
peated clamping or kinking, minimized trapping of Gelfoam in dead space between the catheter and syringe, and decreased the chance of introducing air emboli.
Modifi#{176}dstopcock
Catheter
Fig. 1 -Assembled
3”Iong c/ear connecting
apparatus
introducing emboli into catheter. Flushing syringe is attached.
tube
Injecting
syriflge
containing
30%
Renogrofin
Received July 15, 1977; accepted October 5, 1977. All authors: Department of Radiology, Duke University
1
Am J Ro.ntg#{149}nol 130:183-184,
C 1978 American
Roentgen
January Ray Society
1978
Medical
Center,
Durham,
183
North Carolina
27710. Address
0361
reprint
-803X/78/01
requests
to I. 5. Johnsrude.
00-01
83 $02.00
for
Downloaded from www.ajronline.org by 177.104.15.179 on 11/08/15 from IP address 177.104.15.179. Copyright ARRS. For personal use only; all rights reserved
184
TECHNICAL
NOTE
Fig. 3.-Gelfoam cutter consisting alternating with Lucite or stainless steel
B
Fig. 2.-Detail of modified two-way stopcock. A, Side hole closed. In this position emboli are flushed into catheter. B, Side hole open for insertion of emboli. In this position arterial line is not open through side hole as it would be with conventional three-way stopcock.
of double-edged spacers.
razor
blades
