Bronchial artery embolization for hemoptysis in cystic fibrosis technique and dictation

Procedure: 

Selective __ bronchial and intercostal arteriography of number branches __ bronchial artery embolization with follow-up post embolization angiogram           

Indication: Hemoptysis. bronch findings and other clinical info.  CF?.

Access site: Right common femoral artery with ultrasound. The arteriotomy was StarClosed.

Operators: Drs.    

Medications:      mg IV Versed,     mcg IV fentanyl

Contrast:      mL non-ionic

Fluoro time:      minutes

Complications:  None immediate.

Technique:

The risk benefits, and alternatives to the procedure and sedation were explained to the patient.  The specific risks of thromboembolic phenomena and non-target embolization were detailed and accepted. Stroke and paraplegia were also discussed as possible complications. Written informed consent was obtained.  A time out/call to order was performed prior to procedure initiation.

The patient was assessed for conscious sedation and found to be an adequate candidate. A dedicated nurse monitored heart rate, blood pressure, and oxygen saturation throughout the procedure.

The right groin was prepped and draped in sterile fashion. Under direct ultrasound guidance, the right common femoral artery was accessed with a 21-gauge needle. Arterial patency and needle entering the artery were documented and images stored to PACS. A 5 French sheath was placed. 

Over a 0.035″ wire, a 5 French multisidehole catheter was advanced to the level of the carina. Nonselective thoracic aortography was performed to identify any enlarged bronchial or intercostal branches.

A multisidehole catheter was exchanged for a     catheter. This was used to selectively catheterize    .  A microcatheter was introduced coaxially and used to gain adequate purchase into the    .  Arteriography was performed.  Intra arterial nitroglycerin (400 mcg) was administered.   Embolization was carried out using 300-500 micron Embospheres.  

Post embolization arteriography was performed through the microcatheter to assess embolic effect. The microcatheter was removed.

Number selected separate right or left intercostal branches were selectively catheterized and arteriography performed. The branches at list levels and side were selectively catheterized.

The images were reviewed.  The catheter was removed over a wire. A StarClose device was deployed, achieving immediate hemostasis.

No immediate complication occurred, and the patient was discharged to the recovery area in satisfactory condition.

Findings:  A CT scan from     was reviewed.

1. An enlarged     is present at the level of the carina.  Selective injection of this branch shows.
2. Microcatheter injection confirms the same, demonstrating abnormal vascularity to greater advantage.
3. After particulate embolization, post-embolization arteriography through the microcatheter demonstrates no significant antegrade flow in    .
4. interpret intercostal arteriography @ each level
5. additional findings
6. Thoracic aortography shows    .

Impression:

Successful embolization of     bronchial artery as described above.

Multiple     intercostal branches were catheterized as described above.