METHOD OF CATHETERIZATION AND METHOD OF ENDOVASCULAR OCCLUSION OF BRONCHIAL AND INTERCOSTAL ARTERIES Russian patent published in 2018 - IPC A61M25/01 A61B17/12 

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine, namely to X-ray and endovascular methods of diagnosis and treatment. Catheterization is performed in several stages. Stage 1 – conduct a survey aortography from the arterial access. Stage 2 – obtained aortograms reveal pathologically altered bronchial and intercostal arteries, namely arteries expanded to 3 mm in diameter, crimped stem – the initial parts of the intercostal and bronchial arteries, and also reveal the mouth of the altered arteries and measure the transverse diameter – the lumen of the thoracic aorta at the level of the bodies of 4–6 thoracic vertebrae. Stage 3 – perform selective catheterization of the mouths of the altered intercostal and bronchial arteries by replacing the catheter introduced at the first stage with a selective catheter with an atraumatic conical tip and an individually selected size. Size is determined taking into account the transverse diameter – the lumen of the thoracic aorta at the level of the bodies of 4–6 thoracic vertebrae, namely, the length of the distal segment of the working part of the angiographic bronchial catheter is selected before the beginning of the first bend of the catheter – segment-S1, as follows: with a transverse lumen of the thoracic aorta 17–21 mm, a bronchial catheter having a segment length of S1 17 mm is used, with a transverse lumen of the thoracic aorta of 22–25 mm, a bronchial catheter having a segment length of S1 20 mm is used, with a transverse lumen of the thoracic aorta 26–30 mm, a bronchial catheter having a segment length of S1 23 mm is used, with a transverse lumen of the thoracic aorta of 31–35 mm, a bronchial catheter having a segment length of S1 25 mm is used. Selective catheter is conducted along the angiographic conductor coaxially to level of the thoracic aortic isthmus, then the angiographic conductor is removed. Perform a diagnostic search for the interstices of the intercostal and bronchial arteries by performing a reciprocating catheter with an amplitude of 1–2 cm for each traction until the appearance of pulsating movements of the catheter. Introduce the radiopaque substance to confirm the selective catheterization of the mouth of the intercostal or bronchial artery. Another method developed is the method of occluding the bronchial and intercostal arteries. If the arteriograms of intercostal and bronchial arteriograms obtained by the method of catheterization, obtained by the method described above, from branching of bronchial arteries into segmental or lobar branches of the pulmonary artery, or respiratory tract, through a selective catheter fixed at the mouth of a pathologically altered bronchial artery, a suspension of spherical microembols with a diameter of 500–600 mcm mixed with an isotonic NaCl solution and a radiopaque substance in a volume ratio of 1:1:1 is introduced. Volume of suspension necessary for endovascular occlusion of the lumen of the bronchial artery is selected taking into account the nature of the trunk's hyperplasia and branching of the bronchial artery. Embolisation suspension is administered in portions of 1–2 ml, slowly under the control of fluoroscopy, until the symptom of “standing contrast”. Then, a control selective arteriography is performed with the administration of the radiopaque substance and the registration of the selective arteriogram. Occlusion of the artery is considered sufficient if the solution of the radiopaque substance does not enter the main part of the peripheral branches and trunk of the bronchial artery – the lumen of the artery is blocked.

EFFECT: group of inventions allows to reduce the risk of complications caused by catheterization of the bronchial and intercostal branches of the thoracic aorta of small diameter.

2 cl, 2 ex, 9 dwg