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

Fallopian tubes: improved technique for catheterization.

Successful fallopian tube catheterization for diagnosis or treatment of infertility combines hysterosalpingographic and angiographic techniques. An im...
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