20170717 ACA A2 aneurysm s/p embolization / Nutcracker syndrome

•  ACA A2 aneurysm s/p embolization
• Puncture small bowel terminal ileum
• 胖的人puncture針不要太斜，因為很胖會沒入太深可能會太高
• IA cefazolin
• Nutcracker syndrome
• 右邊puncture後C1管子放到左邊腎靜脈，打藥看回流方向，看到有往卵巢靜脈流，把C1拉回來看到管子彈下去卵巢靜脈，用coil把這條塞死
• 架腎靜脈支架，支架會變短??
• 拉回來看右邊血流方向如何，看到往pelvic流，用coil塞調?
• Therapeutic Embolization:
• > Previous MRI revealed stenosis of the Lt renal vein, with varices in the Lt adnexa, and nutcracker syndrome is impressed ; thus PTA was indicated. 
• > Via Rt femoral approach, venography of the Lt renal vein, Lt gonadal vein, Lt internal iliac vein, Rt gonadal vein and Rt internal iliac vein was performed. Reflux with contrast medium stasis of the Lt gonadal vein and Rt internal iliac vein was noted, and embolization of these two vessels was performed using metallic coils. 
• > Angioplasty of the Lt renal vein was performed using Wallstent 12 * 40 mm successfully. 
• > Follow-up venography revealed total obstruction of the embolized venous structures. 
• > The patient tolerated the procedure well.
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