Anteriogram of the Pudendal Artery
Posted: Thu Oct 07, 2010 3:46 am
My Pudendal Anteriogram done at Boston Medical College
Pelvic, Bilateral Internal Pudendal Arteriogram 10/5/2010
Technique:
The risks, benefits and alternatives to the procedure including conscious sedation were discussed with the patient, and written informed consent obtained. IV conscious
sedation was administered to the patient under Dr. Kim's supervision (intraservice time was
over one hour) during the procedure, using a total of 225 mcg fentanyl and 2 mg versed IV
• with continuous monitoring by nursing staff.
Using sterile technique, a Foley catheter was placed into the urinary bladder by the
nurse. The patient received a total of 45 mg (30 mg first and 15 mg later) of Papavarine
via intracavernosal injection to achieve a firm erection. The patient's right groin was
prepped and draped in the usual sterile fashion. 2% Lidocaine was used for local
anesthesia. The right common femoral artery was punctured using an 18 gauge single
wall technique under ultrasound guidance, which showed the right fermoral artery to be patent
and was permanently stored on PACS. A 3J wire was advanced into the abdominal aorta
under fluoroscopic guidance and the needle was exchanged for a 5 French sheath.
The 5 French Omni flush catheter was advanced to the distal abdominal aorta.
Digital subtraction pelvic angiograms were then obtained in the RAO and LAO
projections. Following evaluation of these images, the Omni Flush catheter was replaced
with Roberts catheter, which was placed in the left internal iliac artery (second order branch)
for internal iIIiac angiography. The catheter was then placed in the left internal pudendal
artery (third order branch) for selective left internal pudendal angiographies in LAO and AP
t projections. The catheter was withdrawn into the abdominal aorta and then was placed in the right internal iliac artery (first order branch) for internal iliac angiorgaphy. The catheter was then placed in the right internal pudendal artery. Digital subtraction angiographies of the right internal pudendal artery (third order branch) were performed in the AP and RAO projections following intra-arterial administration of 7.5 mg of Phentolamine in total (5 mg for the first run and additional 2.5 mg for the second run). After reviewing the images, the catheter was removed and hemostasis was achieved with manual compression. The patient tolerated the procedure well with no immediate complications.
Findings: Pelvic angiogram -Distal abdominal aorta and aortic bifurcation are normal. Both common iliac arteries, internal iliac arteries and external iliac arteries are normal in caliber. The right inferior epigastric artery has a solitary origin without major branches proximally. The left inferior epigatric artery has a common origin with the external obturator artery. Both internal pudendal arteries are normal in caliber.
Left internal pudendal arteriogram shows normal common penile and left dorsal penile arteries. There is a cavernosal branch arising from the proximal portion of the left dorsal penile artery which supplies the proximal and mid portions of the cavernosal territory.
Right internal pudendal arteriogram shows normal common penile and right dorsal penile
arteries. However, the right dorsal penile artery is relatively smaller than the left. There is a
short cavernosal branch on the right arising from the proximal portion of the right dorsal
penile artery which supplies the proximal cavernosal territory. There is a longer carvernosal
branch arising from the rnid portion of the right dorsal penile artery, which supplies the mid and
distal cavernosal territories.
Impression:
Normal iliac arteries bilaterally.
Normal bilateral inferior epigastric arteries.
Bilateral common penile, dorsal penile and cavernosal arteries are patent and normal, as
described above.
Dr. Kim was present for the entire procedure and agrees with the dictatating report.
Pelvic, Bilateral Internal Pudendal Arteriogram 10/5/2010
Technique:
The risks, benefits and alternatives to the procedure including conscious sedation were discussed with the patient, and written informed consent obtained. IV conscious
sedation was administered to the patient under Dr. Kim's supervision (intraservice time was
over one hour) during the procedure, using a total of 225 mcg fentanyl and 2 mg versed IV
• with continuous monitoring by nursing staff.
Using sterile technique, a Foley catheter was placed into the urinary bladder by the
nurse. The patient received a total of 45 mg (30 mg first and 15 mg later) of Papavarine
via intracavernosal injection to achieve a firm erection. The patient's right groin was
prepped and draped in the usual sterile fashion. 2% Lidocaine was used for local
anesthesia. The right common femoral artery was punctured using an 18 gauge single
wall technique under ultrasound guidance, which showed the right fermoral artery to be patent
and was permanently stored on PACS. A 3J wire was advanced into the abdominal aorta
under fluoroscopic guidance and the needle was exchanged for a 5 French sheath.
The 5 French Omni flush catheter was advanced to the distal abdominal aorta.
Digital subtraction pelvic angiograms were then obtained in the RAO and LAO
projections. Following evaluation of these images, the Omni Flush catheter was replaced
with Roberts catheter, which was placed in the left internal iliac artery (second order branch)
for internal iIIiac angiography. The catheter was then placed in the left internal pudendal
artery (third order branch) for selective left internal pudendal angiographies in LAO and AP
t projections. The catheter was withdrawn into the abdominal aorta and then was placed in the right internal iliac artery (first order branch) for internal iliac angiorgaphy. The catheter was then placed in the right internal pudendal artery. Digital subtraction angiographies of the right internal pudendal artery (third order branch) were performed in the AP and RAO projections following intra-arterial administration of 7.5 mg of Phentolamine in total (5 mg for the first run and additional 2.5 mg for the second run). After reviewing the images, the catheter was removed and hemostasis was achieved with manual compression. The patient tolerated the procedure well with no immediate complications.
Findings: Pelvic angiogram -Distal abdominal aorta and aortic bifurcation are normal. Both common iliac arteries, internal iliac arteries and external iliac arteries are normal in caliber. The right inferior epigastric artery has a solitary origin without major branches proximally. The left inferior epigatric artery has a common origin with the external obturator artery. Both internal pudendal arteries are normal in caliber.
Left internal pudendal arteriogram shows normal common penile and left dorsal penile arteries. There is a cavernosal branch arising from the proximal portion of the left dorsal penile artery which supplies the proximal and mid portions of the cavernosal territory.
Right internal pudendal arteriogram shows normal common penile and right dorsal penile
arteries. However, the right dorsal penile artery is relatively smaller than the left. There is a
short cavernosal branch on the right arising from the proximal portion of the right dorsal
penile artery which supplies the proximal cavernosal territory. There is a longer carvernosal
branch arising from the rnid portion of the right dorsal penile artery, which supplies the mid and
distal cavernosal territories.
Impression:
Normal iliac arteries bilaterally.
Normal bilateral inferior epigastric arteries.
Bilateral common penile, dorsal penile and cavernosal arteries are patent and normal, as
described above.
Dr. Kim was present for the entire procedure and agrees with the dictatating report.
The reason that I had done it at Boston Medical College is because they do it with an artificial induced Penile erection which shows better blood flow in men and presssure in the Pudendal artery.The one which is done at St. Josephs Hospital by Dr. Olga is done without an artificial Penile erection.