In Reply to: Re: Case 0298_02 -- CT arterial portography posted by Pasteur Rasuli on February 08, 1998 at 11:38:35:
Problems with the splenic:
1) more difficult to select; I have seen a lot more iatrogenic lesions from selective splenic catheterization than SMA
2) because of laminar flow in the PV you may get relatively preferential flow into the left lobe; however most mets are in the right lobe for the opposite reason (ie laminar flow from SMV to RPV)
3) if you reflux to the caliac at all you may get hepatic arterial flow and "cancellation"
As for replaced RHA and IPDA, as long as the catehter is beyond these (Sim 2 or cobra) there is no problem (as long as you don't reflux)
I think infection is a non-issue. We did go to the trouble to put sterility sleeves as used for Swan-Ganz caths at one time, but as noted in my previous posting we now angio beforehand.
Probably the best approach in the ideal world would be combined SMV and Splenic catheters as outlined by the Emory group a couple years ago, but that seems like too much work/risk.
I reiterate that a good spiral CT with two passes appears to obviate CTAP.