In Reply to: Case 997_06 -- Pelvic pseudoaneurysm embolization posted by Editor on September 16, 1997 at 10:56:33:
Question 1: An average case involves placement of a 5 fr sheath in the R CFA. The left internal iliac can usually be rapidly accessed with a 5fr cobra. Do angio. Get distal (+/- tracker as needed). embolize. Exchange for 5fr Simmons 1 or 2. Form on aortic bifurcation. R internal iliac easily accessed with this. Do angio, get distal, embolize.
Question 2. Depends on how distal the problem is and how fast the pt is bleeding. For distal bleeds in confined places PVA is great. For larger less distal bleeds, gelfoam is faster and better. Back up Coils are usually a good idea.
Question 3. Rarely necessary; I only do this if the patient is unstable, and I am unable to get distal position easily enough. Otherwise you should be able to infuse embolic materials under enough control to avoid backflow into the posterior division.