Use of the 4F Rösch inferior mesenteric catheter in embolization procedures in the pelvis: a review of 300 cases

Kroencke TJ, Thomas J Kroencke, Kluner C, Claudia Kluner, Hamm B, Bernd Hamm, Annett Gauruder-Burmester, Gauruder-Burmester A
Cardiovascular and interventional radiology · 2007 · doi:10.1007/s00270-006-0192-7 · PMID:17200899
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This review of 300 pelvic embolization cases found the 4F Rösch inferior mesenteric catheter achieved successful catheterization in 91.8% of cases and bilateral internal iliac artery catheterization in 88.5%.

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This single-institution retrospective review evaluated use of a 4F Rösch inferior mesenteric (RIM) catheter for pelvic embolization in 364 patients (357 female; 23–67 years) treated between October 2000 and January 2006 for multiple pathologies, including uterine fibroids and pure adenomyosis. Using a unilateral femoral approach with primarily attempted bilateral catheterization, catheter placement was successful for the vessel territory in 334/364 (91.8%) cases and bilateral internal iliac catheterization was achieved in 322/364 (88.5%), with the remainder requiring contralateral puncture or catheter exchange; the study recorded initial catheterization failures and technical difficulties. The key limitation is that this was a case series focused on technical performance across heterogeneous indications rather than controlled comparison of outcomes. Relevance to endometriosis: adenomyosis is included as a treated uterine pathology (19 cases of pure adenomyosis), though the paper’s main focus is catheter technique for pelvic embolization rather than endometriosis.

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Abstract

The aim of this study is to evaluate the use of a 4F Rösch inferior mesenteric (RIM) catheter for pelvic embolization procedures. Between October 2000 and January 2006, 364 patients (357 female, 7 male; age: 23-67 years) underwent embolization of various pathologies [uterine fibroids (n = 324), pure adenomyosis of the uterus (n = 19), postpartum hemorrhage (n =1), traumatic or postoperative hemorrhage (n = 9), bleeding related to cervical cancer (n =7), AV malformation of the uterus (n = 2) and high-flow priapism (n = 2)] at a single institution. In all cases, bilateral catheterization was primarily attempted with the use of a 4F hook-shaped braided endhole catheter (Rösch-Inferior-Mesenteric, RIM-Catheter, Cordis, Miami, FL). Frequency of initial failure to catheterize the vascular territory of interest and carry out the embolization were recorded and the types of difficulty encountered were noted. Catheterization of the main stem of the vessel territory of interest with the use of a unilateral femoral approach and the 4F RIM catheter was successful in 334/364 (91.8%) the embolization cases. Bilateral catheterization of the internal iliac arteries using a single common femoral artery access and the 4F RIM catheter was achieved in 322/364 (88.5%) patients. In 12/364 (3.3%) patients, a contralateral puncture was performed and the same 4F catheter was used. In 28/364 (7.7%) cases the 4F RIM catheter was exchanged for a catheter with a cobra-shaped or sidewinder configuration. The 4F RIM catheter is a simple and valuable alternative to catheters and techniques commonly employed for pelvic artery embolization.
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Abstract

The aim of this study is to evaluate the use of a 4F Rösch inferior mesenteric (RIM) catheter for pelvic embolization procedures. Between October 2000 and January 2006, 364 patients (357 female, 7 male; age: 23–67 years) underwent embolization of various pathologies [uterine fibroids (n = 324), pure adenomyosis of the uterus (n = 19), postpartum hemorrhage (n =1), traumatic or postoperative hemorrhage (n = 9), bleeding related to cervical cancer (n =7), AV malformation of the uterus (n = 2) and high-flow priapism (n = 2)] at a single institution. In all cases, bilateral catheterization was primarily attempted with the use of a 4F hook-shaped braided endhole catheter (Rösch-Inferior-Mesenteric, RIM-Catheter, Cordis, Miami, FL). Frequency of initial failure to catheterize the vascular territory of interest and carry out the embolization were recorded and the types of difficulty encountered were noted. Catherization of the main stem of the vessel territory of interest with the use of a unilateral femoral approach and the 4F RIM catherer was successful in 334/364 (91.8%) the embolization cases. Bilateral catheterization of the internal iliac arteries using a single common femoral artery access and the 4F RIM catheter was achieved in 322/364 (88.5%) patients. In 12/364 (3.3%) patients, a contralateral puncture was performed and the same 4F catheter was used. In 28/364 (7.7%) cases the 4F RIM catheter was exchanged for a catheter with a cobra-shaped or sidewinder configuration. The 4F RIM catheter is a simple and valuable alternative to catheters and techniques commonly employed for pelvic artery embolization. Similar content being viewed by others

References

Gomez-Jorge J, Keyoung A, Levy EB, et al. (2003) Uterine artery anatomy relevant to uterine leiomyomata embolization. Cardiovasc Intervent Radiol 26: 522–527 Worthington-Kirsch RL, Andrews RT, Siskin GP, et al. (2002) II. Uterine fibroid embolization: technical aspects. Tech Vasc Intervent Radiol 5: 17–34 Waltman AC, Courey WR, Athanasoulis C, et al. (1973) Technique for left gastric artery catheterization. Radiology 109: 732–734 Pelage JP, Soyer P, Le Dref O, et al. (1999) Uterine arteries: Bilateral catheterization with a single femoral approach and a single 5-F catheter. Radiology 1210: 573–575 Shlansky-Goldberg R, Cope C (2001) A new twist on the Waltman loop for uterine fibroid embolization. J Vasc Intervent Radiol 12: 997–1000 Brunereau L, Herbreteau D, Gallas S, et al. (2000) Uterine artery embolization in the primary treatment of uterine leiomyomas: Technical features and prospective follow-up with clinical and sonographic examinations in 58 patients. Am J Roentgenol 175: 1267–1272 Hovsepian DM, Siskin GP, Bonn J, et al. (2004) Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. Cardiovasc Intervent Radiol 27: 307–313 Smeets AJ, Lohle PN, Vervest HA, et al. (2006) Mid-term clinical results and patient satisfaction after uterine artery embolization in women with symptomatic uterine fibroids. Cardiovasc Intervent Radiol 29: 188–191 Hehenkamp WJ, Volkers NA, Birnie E, et al. (2006) Pain and return to daily activities after uterine artery embolization and hysterectomy in the treatment of symptomatic uterine fibroids: results from the randomized EMMY trial. Cardiovasc Intervent Radiol 29: 179–187 Razavi MK, Wolanske KA, Hwang GL, et al. (2002) Angiographic classification of ovarian artery-to-uterine artery anastomoses: Initial observations in uterine fibroid embolization. Radiology 224: 707–712 Ho SS, Cowan NC (2005) Uterine artery embolisation for uterine fibroids using a 4F Rosch inferior mesenteric catheter. Eur Radiol 15: 1168–1172 Spies JB (2003) Uterine artery embolization for fibroids: Understanding the technical causes of failure. J Vasc Intervent Radiol 14: 11–14 Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Kroencke, T.J., Kluner, C., Hamm, B. et al. Use of the 4F Rösch Inferior Mesenteric Catheter in Embolization Procedures in the Pelvis: A Review of 300 Cases. Cardiovasc Intervent Radiol 30, 268–272 (2007). https://doi.org/10.1007/s00270-006-0192-7 Published: Issue date: DOI: https://doi.org/10.1007/s00270-006-0192-7

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Catheterization Chemoembolization, Therapeutic Pelvis Pelvis Adult Aged Arteries Arteries Arteriovenous Fistula Arteriovenous Fistula Chemoembolization, Therapeutic Endometriosis Endometriosis Equipment Design Female Hemorrhage Hemorrhage Humans Leiomyoma Leiomyoma

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