In Reply to: Case 497_07 -- Attempted GDA embolization for UGI bleeding posted by Editor on April 18, 1997 at 11:17:10:
It's never a good idea to embolize a vessel when flow is towards the catheter. The easiest way to reverse flow in the GDA in this patient is to place a balloon occlusion catheter into the proximal SMA and inflate the balloon enough to reverse GDA flow. This may not require full occlusion of the SMA. After flow is reversed, any of the techniques suggested by the other discussants may be used to access the GDA. Personally, I like a Glidewire and a Cobra 2, either in its native shape or in a Waltman loop. However, nothing works every time, and the only way to get into some arteries is to try everything until something works.