In Reply to: Case 997_06 -- Pelvic pseudoaneurysm embolization posted by Editor on September 16, 1997 at 10:56:33:
My approach to pelvic embolization is similar to many of those mentioned up to this point. If the bleed is likely to originate on one side of the pelvis, I'll try to go from the contralateral groin. I tend to use a simple visceral hook catheter or Sos omniselect catheter to negotiate the bifurcation; on the ipsilateral side I will usually reform the hook and pull it down until (sometimes with a bit of manipulation) it enters the internal iliac orifice. If the bleed looks like it is approachable with distal manipulation of a microcatheter, I prefer this selectivity. It takes little time to open it and get it ready for use. Depending on the patient's clinical status, however, I will abandon its use and embolize more proximally if I find I'm "spinning my wheels" trying to get more selective. I also find microcoils (especially the fibered helical coils) give good control and results of embolization and would have favored their use in this case, in conjunction with gelfoam embolization, particularly when the first attempts failed to provide control; I would be very interested as to whether anyone has had any problems long-term with distal embolization in the pelvis using microcoils; to my knowledge (although the "n" is small) I have had none.