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Fig. 1 | CVIR Endovascular

Fig. 1

From: Ultraselective transcatheter arterial embolization with small-sized microcoils for acute lower gastrointestinal bleeding

Fig. 1

A 72-year-old man with ascending colonic hemorrhage due to colonic diverticulosis. Ultraselective TAE was performed with a triaxial system after hemostatic clipping via colonoscopy was unsuccessful. a Superior mesenteric angiography showed the vasa recta with near clipping (black arrow); however, contrast extravasation could not be identified. b Selective angiography through the colic branch (white arrow) of the ileocolic artery with a 2.6-F microcatheter (Masters HF; Asahi Intecc) showed a small and considerably bent vasa recta (long branch, black arrowhead; short branch, open white arrowhead) and a long branch of the vasa recta with contrast extravasation (black arrow). c Ultraselective angiography through the long branch of the vasa recta with a 1.6-F microcatheter (Carnelian Marvel S; Tokai Medical Products) (black arrowhead) showed contrast extravasation (black arrow). After identifying the bleeding site, a 1.6-F microcatheter was inserted into the bleeding branch as close as possible to the bleeding site (not shown). d Digital radiography showing a microcoil (Galaxy G3 MINI Microcoil; Codman & Shurtleff. Inc.) of 1 mm in diameter with a 2 cm coil (white arrowhead) placed at the site of contrast extravasation. However, contrast extravasation did not completely disappear (black arrow). e Digital radiography showing an additional microcoil (Galaxy G3 MINI Microcoil) of 1 mm in diameter with a 2 cm coil (white arrowhead) placed at the bleeding branch. f After ultraselective TAE, selective angiography through the colic branch showed no further contrast extravasation, occlusion of the long branch and maintenance of the short branch (open white arrowhead)

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