Teaching Case

Admitted for acute urinary retention in benign prostatic hypertrophy. During the hospitalization acute haematuria with significant anemia occurred (Hb. 6.9 g/dl) for which multiple transfusions were done. For this reason an endovascular embolization of internal iliac arteries (IIA) was scheduled.

The procedure was done in two sessions. In the first session the right IIA was catheterized and embolization of bladder and prostatic arteries with particles was done. The procedure was stopped because patient was suffering and treatment using a contralateral approach appeared complex(Fig.1). The second procedure was done 1 week later. In order to avoid a long procedure we decided to try an original approach and we tested it before trying the manoeuvre on the patient and it looked feasible(Fig.2-movie). We used an ipsilateral approach from the left side and we directly inserted a 4F Sim1-catheter(Glidecath-Terumo) already fold through the valve of the 8F-introducer-sheath(Advantx-Cordis)(Fig.3a-d) and the catheter easily selected the IIA(Fig.4-movie). A second trick we adopted was to cut the last 2 cm of the Sim1-catheter to facilitate IIA catheterization. Embolization was done with particles (Contour Emboli-Boston) and coils(IMWCE-Cook) with a good result(Fig.5,6). The patient was discharged after 24h with good clinical improvement.

Catheterization of hypogastric arteries is frequently performed in interventional radiology and with the increasing popularity of some interventional procedures as uterine fybromas embolization, or pelvic trauma embolization or benign prostatic hyperplasia embolization the number of these procedures will probably increase more and more. In young patients the procedure can be easily performed also from not experienced interventionalists but in older patients catheterization of hypogastric arteries may be difficult and time consuming. The technique described here seems to be quite easy, unexpensive and time-saving. An alternative can be to perform catheterization from a brachial access however we believe that in a case like this one it could be difficult. Looking at the literature we were unable to find other papers reporting this type of approach and we found only a few papers describing other techniques, such as a simultaneous double approach with two introducer-sheaths from the femoral artery [1], the more similar procedure that we found, the descend from a brachial approach [2], or the direct percutaneous access for the gluteal artery [3]. We believe that our solution is an interesting and easy trick to adopt in selected cases where the conventional manoeuvres appear complicated.