Digital scan to erase the background of the splenic vein - the portal to explore blood vessels

This is an automatically translated article.

The article is expertly consulted by Master, Resident, Specialist I Trinh Le Hong Minh - Radiologist - Radiology Department - Vinmec Central Park International General Hospital.
There are many ways to explore blood vessels, of which digital scan of the splenic vein - portal vein is a commonly used minimally invasive method.

1. What is a digital scan of the splenic vein - portal?

Digital splenic-portal venography is a minimally invasive vascular exploration technique. This process is accomplished by passing through the liver parenchyma or splenic parenchyma into the splenic-portal venous system. Then, inject iodine contrast and conduct angiography to evaluate the circulation status and pathology of the splenic-portal venous system.
Digital scan of the splenic - portal vein background is often used in the following cases: portal hypertension, stenosis of the splenic - portal vein due to benign or malignant causes, esophageal varices, procedures Surgery is performed before performing other procedures such as treatment of portal vein stenosis after liver transplantation, gastric varices, treatment of esophageal varices.

2. Indications and contraindications for digital scan to erase the background of the splenic - portal vein

2.1 Designation

Gastrointestinal bleeding due to varicose veins of the esophagus and stomach. Increased portal pressure. Obstruction of the portal vein. Portal vein abnormalities.

2.2 Contraindications

Cases of contraindications to digital scan to erase the background of the splenic vein - portal
Allergy to iodine contrast. Severe renal failure (grade IV). Pregnant. Ascites of many degrees. Thrombosis of internal jugular vein, superior vena cava, hepatic vein. Severe and uncontrolled coagulopathy (prothrombin 1.5, platelet count < 50 G/l).

3. Participants performed digital scan to erase the background of the splenic vein - portal

Specialist. Auxiliary physician. Nursing. Optical technician. Doctor, anesthesiologist (if the patient cannot cooperate).

4. Means for digital scan to erase the background of the splenic vein - portal

Digital background removal angiography (DSA). Film, film printer, image storage system. Dedicated electric pump. Ultrasound machine with curved transducer. Sterile nylon bag wraps the ultrasound transducer. Lead vest, apron, X-ray shield.

5. Medicines to prepare before the method

Local anesthetic. Anticoagulants. General anesthetic (if there is an indication for anesthesia). Antiseptic solution for skin and mucous membranes. Water-soluble iodine contrast agent. Anticoagulant neutralizer.

6. Common medical supplies needed

Syringe 1; 3; 5; ten; and 20ml. Syringe pump for electric pump. Gloves, shirt, hat, surgical mask Distilled water or physiological saline. Cotton, gauze, surgical tape. Aseptic intervention kit: knife, scissors, tongs, 4 metal bowls, bean tray, tool tray. Medicine box and first aid kit for contrast drug accidents.

7. Special medical supplies used in digital imaging to erase the background of the splenic - portal vein

Micropuncture needles. The set of inlet tubes size 5-6F. Microcatheter 2-3F. Micro-conductor 0.014-0.018 inch. Standard conductor 0.035 inch. Angiography catheter size 4-5F. Instrumentation kit. Y-connector set. Three-pronged lock.

8. What should the patient prepare before conducting a digital scan to erase the background of the splenic vein - portal?

Patients must clearly understand the procedures of digital scan of the splenic vein - portal so that they can coordinate with the doctor in the process. During the period of 6 hours before the scan, the patient needs to fast and drink. However, the patient can still drink water, but must ensure that the amount of water is less than 50ml.
In the intervention room, the patient lies in the supine position, fitted with a machine to monitor breathing, pulse, blood pressure, electrocardiogram, SpO2. The skin is then disinfected and then covered with a sterile, perforated cloth. In case the patient is too excited and cannot lie still, it is necessary to give sedation or take appropriate measures.

9. Steps to take digital scan to erase the background of the splenic - portal vein

Step 1: Put the tube into the vascular cage
Local anesthetic, skin incision. Use the angiogram to poke through the liver parenchyma into the portal vein branches in the liver. In some cases, it is possible to poke through the splenic parenchyma to enter the splenic vein. Insert a 5-6F lumen into the intrahepatic portal vein branch. Step 2: Angiography
Insert the Cobra catheter and guidewire into the main body of the portal vein, or the mesenteric or splenic vein. A pigtail catheter (Pigtail) or a multi-side perforation catheter with a long lead (260mm) can be selected to replace the Cobra catheter. Withdraw the lead from the Pigtail catheter. Perform digital angiography to erase the background of the splenic - portal vein system through a pigtail catheter (Pigtail). Step 3: Finish the procedure
Withdraw all catheters and wires. Withdraw the tube into the lumen. Before accepting a job at Vinmec Central Park International General Hospital, the position of Doctor of Radiology since February 2018, Doctor Trinh Le Hong Minh used to work as a resident in the Radiology Department at other hospitals. Hospitals: Cho Ray, University of Medicine and Pharmacy, Oncology, People's Gia Dinh, Trung Vuong... from 2012-2015. Officially worked at Cho Ray Hospital from 2015-2016, City International Hospital from 2016-2018.
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