Gastrointestinal (GI) Bleed Angiogram Technique and Dictation

Procedure:

1. Selective SMA angiogram in the AP and RAO projections.
2. Selective celiac axis angiogram.
3. Selective IMA angiogram in the AP and LAO projections.
4. Limited right common femoral angiogram.
5. Closure of arteriotomy with VasCade device.

Indication: A __-year-old female with GI bleed and positive tagged nuclear medicine scan in the region of the distal small bowel. Capsule endoscopy performed recently shows bleeding in the mid to distal ileum.

Date: 

Access site: Right common femoral artery with US

Operators: John Doe, MD (Attending)/Jane Doe, MD (Fellow)    

Medications:  2 mg IV Versed, 200 mcg IV fentanyl  1 g Ancef IV.

Contrast:  125 mL non-ionic

Fluoro time:  20.7 minutes

Complications:  None immediate.

Technique:

The risk benefits, and alternatives to the procedure and sedation were explained to the patient.  The specific risks of vascular damage, contrast induced renal injury, thromboembolic phenomena and non-target embolization were detailed and accepted. 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. The common femoral artery was accessed via Seldinger technique and a vascular sheath placed. Over a 0.035″ wire, a 5 French Simmons I glide catheter was reformed in the descending thoracic aorta using Tevdek suture.

The SMA was selected and DSA images performed. DSA images were acquired in AP and RAO projections.  Magnification views of the pelvis in the AP and RAO projections were repeated.

microcatheter?

The images were reviewed.  The catheter was removed over a wire.  

The 5 French sheath was flushed and limited angiographic evaluation of the right common femoral artery was obtained. Hemostasis achieved with a VasCade device.  No immediate complication occurred, and the patient was discharged to the recovery area in satisfactory condition.

Findings:

1. Multiple DSA image acquisitions of the SMA demonstrates no active extravasation or concerning findings for active bleeding. Conventional SMA anatomy is maintained.
2. Celiac DSA image acquisitions demonstrate no evidence of active bleeding. Conventional celiac anatomy is noted.
3. Multiple DSA image acquisitions of the IMA demonstrate no active extravasation.
4. Limited right common femoral angiogram demonstrates puncture site below the inferior epigastric artery and above the CFA bifurcation adequate for closure device. Atherosclerotic narrowing is noted throughout the external iliac and common femoral arteries.
5. Successful arteriotomy closure with VasCade device with immediate hemostasis achieved.

Impression:

No evidence of active bleeding in the GI tract from the SMA, celiac, or IMA distributions. No intervention was performed.

Plan: 

Continue medical management of patient’s GI bleed. Please call Interventional Radiology with questions/ concerns.