CLINICAL HISTORY:

CONTRAST: Visipaque 320 mL

FLUORO TIME:

MEDICATIONS:
Lidocaine 1% mL soft tissue, Fentanyl 100 mcg IV

SEDATION: Monitored for 1.5 hours by the IR registered nurse or surrogate, an independent trained observer.

CONSENT: Following discussion procedure its risks benefits (including bleeding and vessel damage) and alternatives, review of readily available relevant imaging prior to the procedure informed consent was obtained witnessed and documented upon the chart. Standard presurgical timeout confirming patient procedure and when relevant side and site was performed. Any discrepancies were resolved via consultation with appropriate readily available data sources. The patient was prepared and draped in standard sterile fashion.

FINDINGS/PROCEDURE:
The right groin was widely prepped and draped in the usual sterile fashion and local anesthesia was achieved using 1% lidocaine. Conscious sedation was administered using our standard protocol. Using a micropuncture set the right common femoral artery was accessed on the first attempt. Prior to this procedure due to the patient’s severe thrombocytopenia, a total of 2 packed units of platelets were given and a third unit was Hanging during this procedure to prevent bleeding complications. Patient’s platelet levels were measured at 5000 prior to the 3 units given.

A short 6 French vascular sheath was placed over a 035 wire and the splenic artery was subselected using a Cobra and a Kumpe catheter. Using a microcatheter system in a coaxial fashion, the distal splenic artery was super selected and digital subtraction arteriograms were performed in multiple projections. After delineating the vital normal vessels to the pancreas into the stomach, the distal to mid splenic artery was embolized using a total of 10 platinum microcoils ranging from 8 mm to 10 mm in size. Complete stasis was seen within the main splenic artery. There is normal preservation of the pancreatic branch and the gastric branches. Completion angiogram shows no further filling of the splenic arteries throughout the entire spleen. There is normal preservation of the pancreatic branches.

A MYNX hemostatic device was placed into the groin to prevent bleeding complications. Patient had normal baseline femoral and pedal pulses after the procedure.

 

IMPRESSION: