Robert子宫动脉导管

DEMONSTRATIONOFROBERTSUTERINEARTERYACCESSCATHETER罗伯特子宫动脉导管介绍苏州大学附属第一医院介入科IntendedUseUsedforgainingaccesstotheuterineartery,aswellasforembolizingvesselsinthepelvicregion.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ORDERNUMBERTORCONNB®ADVANTAGECATHETERBeacon®TipstainlesssteelbraidednylonFrenchSize5.0WireGuideDiameter.035inchLength90TipConfigurationRUCHNBR5.0-35-90-P-NS-RUCRADIOPAQUEMARKERROBERTSUTERINEARTERYACCESSCATHETER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ViewofpelvicarteriogramshowsaVarrelcontralateralflushcatheterusedforpositioningofwireoverthebifurcation.AwireguideisplacedthroughtheVarrelcontralateralflushcatheterandpositionedinthecontralateraliliacartery.导管在导丝导引下进入对侧髂动脉！TheVarrelcontralateralflushcatheterisremovedandtheRobertsUterineArteryCatheterisadvancedoverbifurcation.罗伯特子宫动脉导管越过髂动脉分叉进入对侧髂动脉Markerpositionedatthetopofbifurcation(magshot).导管金属标记到达髂动脉分叉处Catheterisnowreadytobereformed.导管准备塑性，以进入对侧髂内动脉Wireguideisnowpulledbackonothersideofradiopaquemarker.TheRobertsUterineArteryCatheterisbeingpusheduptoreformloop.导丝退回到同侧导管中，开始向上推并扭转导管，准备成圈Catheterreformingupfromrightgroin.扭控导管，使对侧导管头端指向髂内动脉Cathetermostlyreformed导管在扭控中Catheterreformed.Startingtosearchfortheleftinternaliliac.导管开始进入左侧髂内动脉Catheternowintheoriginoftheleftinternaliliacartery.Catheterisbeingpulleddownattherightgroin.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Cathetertipattheoriginoftheleftuterineartery(continuingtopulldown).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）Catheterisnowwellintotheleftuterineartery.Readytostartembolizing.导管到达子宫动脉合适位置，准备做栓塞治疗Post-embolizationoftheleftuterineartery左侧栓塞结束Catheterhasbeenpushedupintotheaorta,thetiptwisted,andtherightcommoniliacarteryengaged.导管被推到主动脉中，准备做右侧髂内动脉选择性插管Catheternowbeingpulleddown,bringingtipintotheiliacvesselsearchingforinternaliliacartery.导管扭转后被拉入右侧髂动脉Note:Theadvantageofthiscatheteristhatitallowsforcontrasttobeinjectedwithouthavingtocontinuallymanipulatethewireinandoutinordertomovethecatheter(asyouwouldneedtodowithaCobraCatheter).使用罗伯特子宫动脉导管，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）Catheterhasnowengagedrightinternaliliacartery导管进入右侧髂内动脉Catheterpositionedinrightuterineartery导管进入右侧子宫动脉Postuterinearteryembolizationofrightuterineartery栓塞结束Note:Whengettingreadytoremovecatheter,becarefuloftwiststhatmayhavebuiltupinthecatheterandmaymakeitpronetoknotting.Catheterispositionedbackovertheleftiliacsystem,andoncethemarkerispulleddowntothebifurcationonecankeeppullingthecatheterandpullitthroughthesheath.Ihavealwaysusedasheathinthegroinwiththesecases.AnneC.Roberts,M.D.ProfessorofRadiologyChiefofVascular&InterventionalRadiologyUCSDMedicalCenterLaJolla,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，操作动作轻柔宫外孕终止妊娠