5 fr cobra catheter

We accessed the right common femoral artery in every patient and a 5-Fr introducing angiographic sheath (Terumo Corporation, Tokyo, Japan) was placed. A 5-Fr Cobra catheter (Cook, Bloomington, IN, USA) was used to perform nonselective angiograms of the internal iliac arteries in order to achieve a general understanding of the vascular anatomy associated with the uterine AVM; the right internal iliac artery was selected after creating a Waltman loop with the Cobra catheter. In lateralized UVMs, i.e. UVMs located predominantly off the midline and toward one side, the dominant uterine artery ipsilateral to the lesion was initially super-selected using a microcatheter ranging from 2.0 to 2.4 Fr (Terumo Corporation, Tokyo, Japan). Particulate embolic materials such as gelatin sponge pledgets (Gelfoam; Pharmacia & Upjohn Co., Kalamazoo, MI, USA) or polyvinyl alcohol particles (Contour; Boston Scientific, Cork, Ireland) were commonly used, yet micro-coils were occasionally chosen. Aor-tograms were obtained after bilateral UAE in all patients in order to identify any extra-uterine blood supply.

Non-selective embolization of bilateral IIAs was performed by first placing a 5 Fr sheath in the femoral artery on the less damaged side, and then selecting the contralateral IIA with a 5 Fr cobra catheter (Cook, Bloomington, Indiana, USA) or a shepherd hook type catheter (Hanaco Medical, Saitama, Japan). A gelatin sponge cut to a uniform size of 2 mm was injected from the beginning of the IIA and embolization was performed. Similarly, the IIA on the same side was also embolized. MSA arteriography was performed if a pelvic X-ray or CT findings showed injury to the posterior pelvic components, such as a sacral fracture or sacroiliac dissection, or if hemodynamics were unstable after bilateral IIA embolization. The MSA was selected by pulling down the shepherd hook, which faced backward, to sit on the aortic bifurcation. At this stage, a 2.2 Fr microcatheter (Goldcrest; Kosin Medical, Tokyo, Japan) was advanced to the MSA and selectively contrasted. Embolization was performed at the location of CE, but if selective contrast did not show any enhancement, the procedure was completed with a contrast scan alone. Embolizing agents, such as a gelatin sponge and n-butyl-2-cyanoacrylate, were selected for MSA embolization with the discretion of the interventional radiologist, depending on the coagulation capacity of the patients (Figure 1).