The efficacy of the coaxial technique using a 6-Fr introducer sheath in stent placement for treating the obstructions proximal to the descending colon

• Published in: Korean journal of radiology Vol. 12; no. 1; pp. 107 - 112
• Main Authors: Chang, Il Soo, Park, Sang Woo, Hwang, Dae-Yong, Seong, Moo Kyung, Joh, Hee-Kyung, Yoon, So Young, Cho, Yo-Han, Choe, Won Hyeok
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Radiology 01.01.2011
• Subjects: Adult; Aged; Aged, 80 and over; Catheters; Colon, Descending; Colonic Diseases - etiology; Colonic Diseases - therapy; Colonic Neoplasms - complications; Contrast agents; Endoscopy; Female; Fluoroscopy; Humans; Intestinal Obstruction - etiology; Intestinal Obstruction - therapy; Male; Middle Aged; Negotiations; Original; Pancreatic cancer; Patients; Radiography, Interventional; Rectum; Stents; Success; Surgery; Wire; Intervention; Fluoroscopy; Colon; Stent
• ISSN: 1229-6929; 2005-8330
• DOI: 10.3348/kjr.2011.12.1.107

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. 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. 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. 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.