Method for selective catheterization of left gastric artery

Abstract

FIELD: cardiovascular surgery.SUBSTANCE: used for selective catheterization of the left gastric artery. An introducer is installed, and in the anteroposterior projection of the X-ray apparatus detector, a Cobra 1 4.0 Fr diagnostic catheter is inserted into the abdominal aorta through a 0.035-inch guidewire, positioned at the level of the 12th thoracic vertebra, and the tip of the catheter is placed on the ventral surface of the aorta and positioned at 6 o'clock, if the knee of the catheter is considered the center of the dial. Next, the left lateral projection 90° of X-ray apparatus detector is used. By injecting a contrast agent with a syringe, the catheter is pulled down until the orifice of the celiac trunk is catheterized, after which the detector of the X-ray apparatus is moved to the anteroposterior position, celiacography is performed, and the catheter is inserted along a 0.035-inch hydrophilic guidewire to the orifice of the splenic artery. Next, the left lateral projection 90° of the X-ray detector is used, the catheter is rotated 180° so that the tip of the catheter is turned towards the upper wall of the artery, the hydrophilic guidewire is removed, and the catheter itself is pulled towards the mouth of the celiac trunk until the mouth of the left gastric artery is catheterized.EFFECT: method allows to increase the efficiency of selective catheterization of the left gastric artery using diagnostic catheters.1 cl, 1 ex

Description

[0001] The invention relates to the field of medicine, namely to cardiovascular surgery, and can be used for selective catheterization of the left gastric artery.

[0002] The left gastric artery is one of the four main arteries supplying the stomach. Being a direct branch of the celiac trunk, it is the largest of them, both in diameter and in blood flow volume. The abdominal esophagus, the cardiac region of the stomach, and the area of ​​the so-called "Waldeyer's alimentary canal" represent a zone of selective blood supply from the left gastric artery, simultaneously being the area of ​​the most frequent sources of gastrointestinal bleeding. Accordingly, ligation or embolization of this vessel is the operation of choice for invasive bleeding cessation [1,2]. The development of interventional procedures has facilitated the search for new techniques for excluding this artery from the bloodstream.

[0003] Selective catheterization serves as the main method to perform targeted angiography and delivery of embolic agents [3,5].

[0004] Several methods for catheterization of the left gastric artery using a microcatheter have been described in the literature; however, the use of the latter in addition to diagnostic catheters significantly increases the cost of the operation [5-8]. Moreover, microcatheters of certain sizes require the use of emboli of an appropriate size [4].

[0005] Technical result: development of an effective method for selective catheterization of the left gastric artery using diagnostic catheters.

[0006] Implementation of the invention

[0007] To achieve the technical result, a femoral artery puncture is performed under local anesthesia, an introducer is installed, and in the anteroposterior projection of the X-ray detector, a Cobra 1 4.0 Fr diagnostic catheter is inserted into the abdominal aorta through a 0.035-inch guidewire, positioned at the level of the 12th thoracic vertebra, and the tip of the catheter is installed on the ventral surface of the aorta and positioned at 6 o'clock, if we consider the knee of the catheter to be the center of the dial. Next, the left lateral 90° projection of the X-ray detector is used. Using a syringe to inject a contrast agent, the catheter is pulled downward until the orifice of the celiac trunk is catheterized. After this, the X-ray detector is moved to the anteroposterior position, celiacography is performed, and the catheter is inserted through a 0.035-inch hydrophilic guidewire to the orifice of the splenic artery.Next, the left lateral projection of the 90° X-ray detector is used, the catheter is rotated 180° so that the tip of the catheter is turned towards the upper wall of the artery, the hydrophilic guidewire is removed, and the catheter itself is pulled towards the orifice of the celiac trunk until the orifice of the left gastric artery is catheterized.

[0008] Clinical example

[0009] Patient M., 55, was admitted to the X-ray room with a diagnosis of "Pancreatic head cancer. Condition after pancreaticoduodenectomy. Gastrointestinal bleeding" for embolization of the left gastric artery.

[0010] The right femoral artery was punctured in the upper third of the thigh, and a 6 Fr introducer was installed. A 4.0 Fr Cobra 1 diagnostic catheter was inserted into the abdominal aorta along a 0.035-inch guidewire and positioned at the level of the 12th thoracic vertebra. The catheter tip was positioned on the ventral surface of the aorta at 6 o'clock, considering the catheter knee to be the center of the dial. Next, the left lateral projection of the 90° detector of the X-ray apparatus was used. Using a syringe to inject contrast medium, the catheter was pulled down until the orifice of the celiac trunk was catheterized. Then, the detector of the X-ray apparatus was moved to the anteroposterior position, celiacography was performed, and the catheter was inserted along the 0.035-inch hydrophilic guidewire to the orifice of the splenic artery. Next, a 90° left lateral projection of the X-ray detector was used, and the catheter was rotated 180°.The hydrophilic guidewire was removed, and the orifice of the left gastric artery was catheterized by pulling the catheter toward the orifice of the celiac trunk; embolization of the left gastric artery was performed.

[0011] Bibliography

[0012] 1. Litvinenko L.M. Vascular and nervous complexes of the human body. - M.: ZAO Business Olympus; 2011.

[0013] 2. Lubotsky D.N. Fundamentals of topographic anatomy / D.N. Lubotsky - M: Medgiz, 1953.

[0014] 3. Dolgushin B.I. Interventional radiology in oncology. VIDAR; 2022.

[0015] 4. Schneider P.A. Techniques of endovascular manipulations. Guidewires and catheters in endovascular surgery Moscow - GEOTAR - Media, 2024 - 680 p.

[0016] 5. Lebedev D.P., Stankevich V.R., Smirnov A.V., Ivanov Yu.V., Panchenkov D.N., Abdulkerimov Z.A., Zlobin A.I. Method of gastric embolization for the treatment of obesity. Patent. Russian Federation No. RU2792281C1; published 21.03.2023.

[0017] 6. Pavlov A.V., Murashkin A.P., Borovsky S.P., Pantileikin R.A. Arterial embolization in the treatment of bleeding in inoperable gastric cancer: have all issues been resolved? Pacific Medical Journal. 2021;(2):89-92. https: / / doi.org / 10.34215 / 1609-1175-2021-2-89-92.

[0018] 7. Efremov B.I., Pervova O.V. "Embolization of the left gastric artery in the comprehensive treatment of patients with complex hernias." Diagnostic and interventional radiology. 2024;18(Supplement No. 1):12.

[0019] 8. Pervova O.V., Protopopov A.V., Cherdantsev D.V., Litvinyuk N.V., Efremov B.I., Shipitsyn N.E., Gavrilova A.O. Embolization of the left gastric artery in the complex preparation of patients with complex hernias / / Bulletin of new medical technologies. Electronic publication. 2024. No. 5. Publication 1-7. URL: http: / / www.medtsu.tula.ru / VNMT / Bulletin / E2024-5 / 1-7.pdf (accessed: 08.10.2024). DOI: 10.24412 / 2075-4094-2024-5-1-7. EDN ZFEMBN*

Claims

A method for selective catheterization of the left gastric artery, characterized in that under local anesthesia, a puncture of the femoral artery is performed in the upper third of the thigh, an introducer is installed, and in the position of the anteroposterior projection of the X-ray apparatus detector, a Cobra 1 4.0 Fr diagnostic catheter is inserted into the abdominal aorta along a 0.035-inch conductor, positioned at the level of the twelfth thoracic vertebra, and the tip of the catheter is installed to the anterior semicircle of the aorta and positioned at 6 o'clock, if we consider the knee of the catheter to be the center of the dial, then the left lateral projection of 90° of the X-ray apparatus detector is used, supplying a contrast agent with a syringe, the catheter is pulled down until the orifice of the celiac trunk is catheterized, after which the X-ray apparatus detector is moved to the anteroposterior position and celiacography is performed, then the catheter is inserted along the 0.035-inch hydrophilic conductor until orifice of the splenic artery,Next, the left lateral projection of the 90° detector of the X-ray apparatus is used, the catheter is turned 180° so that the tip of the catheter is directed upward, the hydrophilic guide is removed, and the catheter itself is pulled towards the mouth of the celiac trunk until the mouth of the left gastric artery is catheterized.