resulted
in adequate
presumably
because
examinations of a better
in all, fit and
a
tighter seal between the cup and shaft of the device and the woman’s cervix. The design of the new device is simibar to the design of the Mabmstrom vacuum-cup device for hystemosalpingography (5), but the new device contains a wider central shaft for the introduction of catheters, is made of plastic, and mequimes no assembly. The vacuum cup on the external cervix does not interfere with uterine catheter manipulations, as does an intrauterine balloon device (6). The vacuum cup on the external cervix allows vigorous traction on the uterus without the painful and cumbersome
use
of a tenaculum
tipped
fectively that
Amy Josef
Tubes:
S. Thurmond, R#{244}sch,MD
terization
opacification faster and
bess
of fluoroscopy.
terms:
Catheters
853.1299
Radiology
1990;
174:572-573
853.1479, 853.29 procedure,
Fal-
#{149}
makes tubal more accurate
cathewith
572
Radiology
#{149}
3.
4.
The authors thank Brian Dexter Elkins of Cook OB/Gyn in designing the equipment.
1 988;
J.
Rosch
for
Radiology
1990;
J, Thurmond
Rosch
tube
AS,
of
Uchida
BT.
Fallo-
technique
1988; Rosch
technique
fallo-
treatment 174:371-374.
catheterization:
date. Radiology Thurmond AS,
8:621-640.
Nonsurgical
recanalization
improved
up-
168:1-6. J. Fallopian for
tubes:
catheterization.
Radiology
1990;
5.
Malmstrom
T.
6.
Obstet Gynecol 1961; 18:773-776. Thurmond AS, Novy M, Uchida BT, Rosch J. Fallopian tube obstruction: selective salpingography 1987;
174:572-573. A vacuum
and
uterine
cannula.
recanalization.
Radiology
163:511-514.
References 1.
Thurmond
Novy
AS,
M.
Rosch J, Patton PE, Burry Fluoroscopic transcervical
Technique
tube
for
of proximal obstruction
(0.038-cm)
by
Catheterization’
fablousing
a
platinum-tipped
guide
wire and a 3-F Teflon catheter is usually successful (1). In some patients, however, the blockage cannot be opened with this system, and a variety of guide wires and catheters have been tried in these difficult cases. Stiffer guide wires were not successful, resulted
in
tubal
perforation,
and
so were
abandoned (personal experience). Successfub catheterization in difficult cases was achieved by using a softer, tapered system
when
the
failed, and this as a supplement canalization.
Materials
standard
system
technique is suggested for fallopian tube me-
and
angle in the fallopian tube, the Cook catheter system was exchanged for a softer, tapered guide wire and catheter (Target Therapeutics, Santa Monica, Calif): 12-cm floppy-tip guide wire tapening from 0.016 inch (0.035 cm) to 0.013 inch (0.029 cm), and 12-cm floppy-tip Tracker catheter tapering from 3 to 2.2 F with a 2.7-F radiopaque tip.
Results Thirty-eight fallopian tubes catheterized in the 22 patients. tubes (24%), forceful injection contrast material through the
were In nine alone of ostium
Methods
The most recent 22 patients who underwent fallopian tube recanalization were studied. Fallopian tube mecanalization was performed as previously described
(1-4).
Initially,
the
Rosch-Thun-
mond fallopian tube catheterization set (Cook, Bloomington, Ind, or Cook OB/ Gyn, Spencer, Ind) was used to mecanalize the fallopian tube. If there was an obstruction more than 2 cm from the tubal ostium, or if theme was an acute
I From the Department of Diagnostic Radiology and the Charles Dotter Memorial Research Laboratory (A.S.T., JR.) and the Department of Obstetrics and Gynecology (A.S.T.), Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd. Portland OR 97201. From the 1988 RSNA annual meeting. Received June 2, 1989; revision requested July 6; revision received September 7; accepted September 1 1 . A.S.T. supported by the RSNA Research and Education Fund and the Medical Research Foundation of Oregon. Address reprint requests to A.S.T. C RSNA, 1990 See also the articles by Thurmond and ROsch (pp 371-374) and Thurmond et al (pp 571-572) in
this issue.
tube
pian
me-
AS,
infertility.
opacifi-
and treatment by tubal ob-
RadioGraphics
Thurmond pian
U
Acknowledgments: Bates of Cook and for their assistance
pian
and catheterization.
struction. 2.
is maintained.
Uterine
ECANALIZATION
unsuccessful.
os efcanal so
cervical
hysterosalpingography.
Improved
Successful fallopian tube catheterization for diagnosis or treatment of infertility combines hysterosalpingographic and angiographic techniques. An improvement in the catheterization strategy was developed so that angled, tortuous, or more distally obstructed fallopian tubes could be catheterized. In 22 patients, 38 fallopian tubes were catheterized by using this strategy. In nine tubes (24%), forceful ostial injection alone of contrast material was able to open and/or depict the fallopian tube. In 13 tubes (34%), a discrete obstruction was recanalized by using the standard fallopian tube catheterization set. In 12 tubes (32%), successful recanalization required the use of a softer, tapered guide wire and catheter. In four tubes (10%), recanalization was
catheterization for diagnosis of female infertility caused
acorn-
cervical
cation also allows one to document suits with pre- and postrecanalization
MD
Fallopian tubes, diseases, lopian tubes, interventional
the
The
the
opacification
Uterine use
2).
in
occludes
0.015-inch
Index
shaft
uterine
KA,
Fallopian
(Fig
sliding
Figure
1.
angled
fallopian
acute
Successful
angle
alization was ing the softer, ter (radiopaque catheter).
tube.
recanalization This
in the proximal
patient
left tube.
in an had
an
Recan-
successfully performed by ustapered guide wire and cathebead marks the tip of the
February
1990
a.
b.
Figure
2.
Failed
fails to open bal injection ration.
via
the
the tube. of contrast
5.5-F
catheter depiction
of
guide
from
the
(32%), and
only
and
the
the
set.
In 12 tubes
tapered
guide
wire
needed
to
system
was
recanabize
the
tubes
recanalization
successful
with tubes
both
was guide
one
technical
suc-
commercially
performed
with
of
pian
tube;
this
tion
of the
catheter
will
open
the
tube.
the
tube,
we
the
open and
contrast
variations
technique
anatomy
tions this
in
and
depending
the
encountered. procedure
pathologic
We on
the
have basis
on condi-
developed of our
expe-
Teflon
the
#{149} Number
2
ostial into
of the
and If this advise first,
the
shorter,
Also,
more
expensive, making it a good If an obstruction is beyond 2-3 cm of the tube or if the (Fig
the
2),
catheter
and
for
less
angled
tube,
we
as shown at the site
by intratuof the perfo-
U
it is much
AS, Uchida BT, Sovak transcervical fallopian tube
Selective
technique
gy 1988; Thurmond
168:1-5. AS. Rosch
pian tube infertility.
recanalization Radiology
Thurmond
KA,
AS,
Novy
M.
Rosch for
of female struction 4.
infertility .
Thurmond terosalpingography
catheterization.
update.
J.
Nonsurgical
J,
Patton
caused
Rosch
fallo-
PE,
J.
Radiology
Burry
and
treatment
by tubal 1 988;
and
of
transcervical
diagnosis
RadioGraphics AS,
Radiolo-
for treatment 1990; 174:371-374.
Fluoroscopic
catheterization
soft-
1-2 cm set has a
length
in
first
fallopian
the
standard
appropriate
3.
recanalize
use tool.
the
the
2.
wire
first
the
via the 5.5-F catheter
R#{246}schJ, Thurmond catheterization:
not
to
1.
fallo-
does
since
cases.
M.
using
soft
difficult
injec-
cases
guide too
ostium
in perforation, in the tube
tapered catheter system. A positive feature of the softer tapered system is the radiopaque bead at the tip of the catheter, which improves depiction in more
posi-
in some
within
tube.
the the
left tubal
References is best
confirm
catheter
obstructions
exchanging
174
recent
equipment.
material will
is often
acutely
Volume
most
platinum-tipped
em system
is simior interit requires
the
a selective
tion
of
in
pa-
By report-
catheterization
un-
2).
tube mecanalization other angiographic procedure in that
a hundred
3 years.
available
tube
(Fig
Discussion Fallopian bar to any ventional
than
past results
Failopian
standard
the
more
the
22
of
with
(Fig
over
into
and resulted acute angulation
patients, we endeavored to describe a strategy of catheterization that works in 90% of patients and invoives the use
was
perforated wime
with
tients
material
was attempted shows the
ing
obstruction
systems;
mience
of contrast
guide injection
13
catheter
softer,
injection
was
0.0 15-
3-F
1). In four these
In
standard
catheter
standard
standard
obstruction
by using
cessfuiiy
the
tube.
set. (a) Selective
with the 0.015-inch platinum 3-F catheter. (c) Repeat ostial
and/or
fallopian
wire
the
the
opening
the
the standard
Recanalization material via
a discrete
mecanalized
with
from
enabled
(34%),
inch
(b)
catheter
set
tubes
recanalization
ob-
8:621-640.
Device fallopian
1990;
for hystube
174:571
-
572.
initial the tube is
recommend
for
the
softer,
Radiology
.
573