Korean J Radiol.  2011 Feb;12(1):107-112. 10.3348/kjr.2011.12.1.107.

The Efficacy of the Coaxial Technique Using a 6-Fr Introducer Sheath in Stent Placement for Treating the Obstructions Proximal to the Descending Colon

• Chang IS
• Park SW
• Hwang DY
• Seong MK
• Joh HK
• Yoon SY
• Cho YH
• Choe WH

• KMID: 991688
• DOI: http://doi.org/10.3348/kjr.2011.12.1.107

Abstract

OBJECTIVE
We wanted to evaluate the efficacy of stent placement using the coaxial technique with a stiff, long introducer sheath in patients with technical failure using an angiographic catheter for the obstructions proximal to the descending colon.
MATERIALS AND METHODS
Self-expandable metallic stent placement was attempted under fluoroscopy-guidance in 77 consecutive patients who had malignant colorectal obstruction. Stent placement was performed using an angiographic catheter and a guide wire. If the angiographic catheter could not be advanced over the guide wire into the obstructive lesions proximal to the descending colon, then a 6-Fr introducer sheath was used. The technical success rate, the clinical success rate and the complications were analyzed.
RESULTS
Successful stent placement was achieved in 75 of 77 patients (97%). The angiographic catheter failed to advance into the obstructive lesions of 11 patients (M:F = 7:4; mean age, 65.5 years) whose lesions were at the level of the splenic flexure or transverse colon. Therefore, the coaxial technique was implemented in all these 11 patients using a 6-Fr stiff introducer sheath and then the stent placement was successful. There were no complications related to the use of a stiff introducer sheath. Clinical success, which was defined as relief of clinical obstructive bowel symptoms, was obtained within 24 hours in all of patients.
CONCLUSION
The coaxial technique using a stiff introducer sheath can increase the technical success of fluoroscopy-guided, self-expandable metallic stent placement in patients with colonic obstruction proximal to the descending colon.

Keyword

Colon; Stent; Intervention; Fluoroscopy

MeSH Terms

Adult
Aged
Aged, 80 and over
*Catheters
*Colon, Descending
Colonic Diseases/etiology/*therapy
Colonic Neoplasms/complications
Female
*Fluoroscopy
Humans
Intestinal Obstruction/etiology/*therapy
Male
Middle Aged
*Radiography, Interventional
*Stents

Figure

• 

  Fig. 1 Schematic diagrams regarding efficacy of coaxial technique using stiff, long introducer sheath. A. Angiographic catheter and guide wire were advanced to descending colon to implant stent for treating malignant colorectal obstruction proximal to descending colon. B. However, angiographic catheter could not be advanced further over guide wire into obstructive lesion proximal to descending colon because angiographic catheter had prolapsed into greater curvature of tortuous sigmoid colon. C. 6-Fr shuttle introducer sheath was inserted over guide wire in place of angiographic catheter. This prevented prolapse of catheter into greater curvature of tortuous sigmoid colon during advancement of catheter over guide wire.

• 

  Fig. 2 75-year-old patient with transverse colonic obstruction due to invasion of pancreatic cancer. A. Placement of guide wire and angiographic catheter under fluoroscopic guidance in descending colon. B. Angiographic catheter prolapsed into greater curvature of tortuous sigmoid colon while it was being advanced to obstructive lesion (arrows). C. Therefore, angiographic catheter could not be advanced into transverse colon and it was placed just at splenic flexure (arrow). D. 6-Fr shuttle introducer sheath was inserted over guide wire in place of angiographic catheter. This prevented prolapse of catheter into greater curvature of tortuous sigmoid colon during advancement of catheter over guide wire. Thereafter, angiographic catheter inserted through sheath was able to successfully reach beyond obstructive lesion (arrow). E. Stent placement (arrows) was successfully performed after guide wire and angiographic catheter had passed over obstructive lesion.

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