In Reply to: Re: Case 0298_02 -- CT arterial portography posted by Scott Trerotola on February 06, 1998 at 22:15:38:
We do the CTAP but our approach differ from previous responders in that we place the catheter in the splenic artery rather than SMA, and we hand inject a big bolus of contrast to opacify Celiac on the way to the splenic artery to demonstrate all the arterial mapping that the surgeons may need. Total contrast use in average is 25-30 ml. We are concerned about sterility so we avoid doing angio after CT. The advantages of splenic versus SMA is that with SMA the pancreatic head close to portal vein blushes due to perfusion of inferiorpancraticduodnal artery, also in 10-15% there is a replaced right hepatic artery from SMA which interferes with CTAP. Finally, SMA is a more sacred and less dispensable vessel than splenic artery if any complication like dissection or spasm will occur.