Hydrophilic guidewire

Perforation and dissection of the uterine artery are less common causes of failure [6]. These complications can occur with the use of hydrophilic guidewires associated to the arterial tortuosity (Fig. 10.5.1). Vasospasm occurring primarily in patients undergoing hormone therapy is an important cause of vessel damage. Careful catheterization, use of a microcatheter and experience of operator performing the procedure are all important factors in reducing this type of failure. In cases where... 

The most common cause for spasm is related to the catheterization. Careful catheterization is essential, although spasm can occur even in experienced hands. Use of a smaller catheter size (4 F) with hydrophilic coating and smaller hydrophilic guidewires (0.021 instead of0.035 ) may reduce the occurrence of spasm. Systematic usage of the microcatheter is now recommended. The guiding catheter is placed at the origin of the uterine artery or even in the internal iliac artery. However, even with the systematic use of a microcatheter, spasm was present in 31% of cases in a recent study by Spies et al [Ij. 

Using CT guidance the initial needle tip placement will be into the leak sac (Fig. 14.3). However, with fluoroscopic guidance and a relatively small leak, the initial puncture may end up in thrombus. In these cases, the leak sac can usually be found fairly easily using a hydrophilic guidewire and catheter. 

French Cobra 2 hydrophilic catheter and angled hydrophilic guidewire... 

A flexible bronchoscope is introduced into the trachea to assess the proximal and distal margin of the tracheal and/or bronchial obstruction. Flexible bronchoscopy should further delineate the location of the stricture in relation to adjacent bronchial ostia and the carina. If a stricture can not be passed with a flexible bronchoscope, recanalization can be obtained using a regular (usually hydrophilic coated) guidewire and an angiographic catheter. Once the lesion has been traversed, the postobstructive bronchial system should be visualized by injection of a small amount of non-ionic iodinated contrast material (ideally a non-ionic dimer with a low osmolality should be used). 

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