Robert子宫动脉导管.pptx

DEMONSTRATION OF ROBERTS UTERINE ARTERY ACCESS CATHETER罗伯特子宫动脉导管介绍苏州大学附属第一医院介入科Intended UseUsed for gaining access to the uterine artery,as well as for embolizing vessels in the pelvic region.用于选择性进入子宫动脉，或是用作其它盆腔动脉的栓塞1.这个导管可以非常容易的进入同侧以及对侧髂内动脉。2.导管头端采用专利的Beacon Tip 不透X线材料，由此增强了X线下的可视性。3.有一个不透X线金属标记位于导管转弯部位，非常方便导管在髂动脉分叉处的操作。4.导管头端由5F渐变细为4F,利于插管。5.导管最大流量为12CC/SEC（1200PSI下）Advantages优势ORDER NUMBERTORCON NB ADVANTAGE CATHETERBeacon Tip stainless steel braided nylon French Size5.0Wire GuideDiameter.035 inchLength90TipConfigurationRUCHNBR5.0-35-90-P-NS-RUCRADIOPAQUEMARKERROBERTS UTERINE ARTERY ACCESS CATHETER罗伯特子宫动脉导管RUC两种插管方法RUC插入对侧髂外动脉，推送导管至转折标记点位于主动脉分叉处，继续推送导管进入腹主动脉呈成袢状态，然后下拉导管进入同侧或对侧子宫动脉。在导丝引导下将RUC直接插入对侧子宫动脉，完成介入治疗后，利用导丝在对侧臀上动脉成袢，再行同侧子宫动脉插管。常规应使用第一种方法View of pelvic arteriogram shows a Varrel contralateral flush catheter used for positioning of wire over the bifurcation.A wire guide is placed through the Varrel contralateral flushcatheter and positioned in the contralateral iliac artery.导管在导丝导引下进入对侧髂动脉！The Varrel contralateral flush catheter is removed and the Roberts Uterine Artery Catheter is advanced over bifurcation.罗伯特子宫动脉导管越过髂动脉分叉进入对侧髂动脉Marker positioned at the top of bifurcation(mag shot).导管金属标记到达髂动脉分叉处Catheter is now ready to be reformed.导管准备塑性，以进入对侧髂内动脉Wire guide is now pulled back on other side of radiopaque marker.The Roberts Uterine Artery Catheter is being pushed up to reform loop.导丝退回到同侧导管中，开始向上推并扭转导管，准备成圈Catheter reforming up from right groin.扭控导管，使对侧导管头端指向髂内动脉Catheter mostly reformed导管在扭控中Catheter reformed.Starting to search for the left internal iliac.导管开始进入左侧髂内动脉Catheter now in the origin of the left internal iliacartery.Catheter is being pulled down at the right groin.导管进入左侧髂内动脉起始部，开始从右侧向下拉导管，以使导管深入髂内动脉Catheter tip at the origin of the left uterine artery(continuing to pull down).导管头端进入左侧子宫动脉起始部（继续向下拉导管，以深入子宫动脉）Catheter is now well into the left uterine artery.Ready to start embolizing.导管到达子宫动脉合适位置，准备做栓塞治疗Post-embolization of the left uterine artery左侧栓塞结束Catheter has been pushed up into the aorta,the tip twisted,and the right common iliac artery engaged.导管被推到主动脉中，准备做右侧髂内动脉选择性插管Catheter now being pulled down,bringing tip into the iliac vessel searching for internal iliac artery.导管扭转后被拉入右侧髂动脉Note:The advantage of this catheter is that it allows for contrast to be injected without having to continually manipulate the wire in andout in order to move the catheter(as you would need to do with a Cobra Catheter).使用罗伯特罗伯特子宫动脉导子宫动脉导管管，可以极为容易的做双侧子宫动脉插管，缩短手术时间（即使只有基本导管导丝操作经验的医生，也能很快掌握RUC导管）Catheter has now engaged right internal iliac artery导管进入右侧髂内动脉Catheter positioned in right uterine artery导管进入右侧子宫动脉Post uterine artery embolization of right uterine artery栓塞结束Note:When getting ready to remove catheter,be careful of twists that may have built up in the catheter and may make it prone to knotting.Catheter is positioned back over the left iliac system,and once the marker is pulled down to the bifurcation one can keep pulling thecatheter and pull it through the sheath.I have always used a sheath in the groin with these cases.Anne C.Roberts,M.D.Professor of RadiologyChief of Vascular&Interventional RadiologyUCSD Medical CenterLa Jolla,CA撤出导管的时候应该注意防止导管打结，您只需将导管头端重新送回到对侧髂动脉，即可顺利撤出导管。另外您应该使用动脉血管鞘，以方便导管进出。RUC的缺陷导管必须借助导丝才能顺利跨越主动脉分叉，分叉夹角较小时导管不易进入对侧髂动脉，造成成袢困难。距导管头2cm处是导管不同材质和管径的交接点,操作时因受力不匀容易引起打折，A组发生1例导管打折，原因就在于此 术者技术熟练，操作动作轻柔 宫宫外外孕孕终终止止妊妊娠娠