In Reply to: Re: Case 0298_02 -- CT arterial portography posted by Scott Trerotola on February 11, 1998 at 11:08:56:
Scott thank you for the comments.
As for your first comment. Difficulty is a relative term, the more you do splenic catheterization the easier it gets. We rarely have to do a SMA injection due to technical difficulty and we rarely ever had a splenic complication. The point that I was making was that should a dissection occur in the splenic artery it is inconsequential, while in the SMA the same is a major disaster.
Your point number 2, if it is true, then by the same token when doing SMA injection you are not getting proper visualization of left lobe due to laminar flow from splenic vein, and because as you say most cancers are on the right lobe then surgeons are interested to find out from CTAP if the left lobe is free of mets so they can carry out a right lobectomy.
Your point number 3 regarding the reflux, I bet it is easier to reflux into the inferior pancreaticoduodenal and replaced hepatic artery than refluxing to proper hepatic artery from a splenic injection when your cobra 3 catheter is 3-4 cm in the splenic artery. We never use a sidewinder because it has a tendency to move back out of the vessel during transfer.
As for performing angio before the CT we are in agreement because as I had indicated we do the same, because we hate putting those sleeves.