Robert子宮動脈導(dǎo)管課件

DEMONSTRATIONOFROBERTSUTERINEARTERYACCESSCATHETER羅伯特子宮動脈導(dǎo)管介紹IntendedUseUsedforgainingaccesstotheuterineartery,aswellasforembolizingvesselsinthepelvicregion.用于選擇性進(jìn)入子宮動脈，或是用作其它盆腔動脈的栓塞

這個導(dǎo)管可以非常容易的進(jìn)入同側(cè)以及對側(cè)髂內(nèi)動脈。導(dǎo)管頭端采用專利的Beacon?Tip不透X線材料，由此增強(qiáng)了X線下的可視性。有一個不透X線金屬標(biāo)記位于導(dǎo)管轉(zhuǎn)彎部位，非常方便導(dǎo)管在髂動脈分叉處的操作。導(dǎo)管頭端由5F漸變細(xì)為4F,利于插管。導(dǎo)管最大流量為12CC/SEC（1200PSI下）Advantages優(yōu)勢RUC兩種插管方法RUC插入對側(cè)髂外動脈，推送導(dǎo)管至轉(zhuǎn)折標(biāo)記點(diǎn)位于主動脈分叉處，繼續(xù)推送導(dǎo)管進(jìn)入腹主動脈呈成袢狀態(tài)，然后下拉導(dǎo)管進(jìn)入同側(cè)或?qū)?cè)子宮動脈。

在導(dǎo)絲引導(dǎo)下將RUC直接插入對側(cè)子宮動脈，完成介入治療后，利用導(dǎo)絲在對側(cè)臀上動脈成袢，再行同側(cè)子宮動脈插管。常規(guī)應(yīng)使用第一種方法

ViewofpelvicarteriogramshowsaVarrelcontralateralflushcatheterusedforpositioningofwireoverthebifurcation.AwireguideisplacedthroughtheVarrelcontralateralflushcatheterandpositionedinthecontralateraliliacartery.導(dǎo)管在導(dǎo)絲導(dǎo)引下進(jìn)入對側(cè)髂動脈！Markerpositionedatthetopofbifurcation(magshot).導(dǎo)管金屬標(biāo)記到達(dá)髂動脈分叉處Catheterisnowreadytobereformed.導(dǎo)管準(zhǔn)備塑性，以進(jìn)入對側(cè)髂內(nèi)動脈Wireguideisnowpulledbackonothersideofradiopaquemarker.TheRobertsUterineArteryCatheterisbeingpusheduptoreformloop.導(dǎo)絲退回到同側(cè)導(dǎo)管中，開始向上推并扭轉(zhuǎn)導(dǎo)管，準(zhǔn)備成圈Cathetermostlyreformed導(dǎo)管在扭控中Catheterreformed.Startingtosearchfortheleftinternaliliac.導(dǎo)管開始進(jìn)入左側(cè)髂內(nèi)動脈Catheternowintheoriginoftheleftinternaliliacartery.Catheterisbeingpulleddownattherightgroin.導(dǎo)管進(jìn)入左側(cè)髂內(nèi)動脈起始部，開始從右側(cè)向下拉導(dǎo)管，以使導(dǎo)管深入髂內(nèi)動脈Catheterisnowwellintotheleftuterineartery.Readytostartembolizing.導(dǎo)管到達(dá)子宮動脈合適位置，準(zhǔn)備做栓塞治療Post-embolizationoftheleftuterineartery左側(cè)栓塞結(jié)束Catheterhasbeenpushedupintotheaorta,thetiptwisted,andtherightcommoniliacarteryengaged.導(dǎo)管被推到主動脈中，準(zhǔn)備做右側(cè)髂內(nèi)動脈選擇性插管Note:Theadvantageofthiscatheteristhatitallowsforcontrasttobeinjectedwithouthavingtocontinuallymanipulatethewireinandoutinordertomovethecatheter(asyouwouldneedtodowithaCobraCatheter).使用羅伯特子宮動脈導(dǎo)管，可以極為容易的做雙側(cè)子宮動脈插管，縮短手術(shù)時間（即使只有基本導(dǎo)管導(dǎo)絲操作經(jīng)驗(yàn)的醫(yī)生，也能很快掌握RUC導(dǎo)管）Catheterhasnowengagedrightinternaliliacartery導(dǎo)管進(jìn)入右側(cè)髂內(nèi)動脈Catheterpositionedinrightuterineartery導(dǎo)管進(jìn)入右側(cè)子宮動脈Note:Whengettingreadytoremovecatheter,becarefuloftwiststhatmayhavebuiltupinthecatheterandmaymakeitpronetoknotting.Catheterispositionedbackovertheleftiliacsystem,andoncethemarkerispulleddowntothebifurcationonecankeeppullingthecatheterandpullitthroughthesheath.Ihavealwaysusedasheathinthegroinwiththesecases.AnneC.Roberts,M.D.ProfessorofRadiologyChiefofVascular&InterventionalRadiologyUCSDMedicalCenterLaJolla,CA撤出導(dǎo)管的時候應(yīng)該注意防止導(dǎo)管打結(jié)，您只需將導(dǎo)管頭端重新送回到對側(cè)髂動脈，即可順利撤出導(dǎo)管。另外您應(yīng)該使用動脈血管鞘，以方便導(dǎo)管進(jìn)出