rAdIoLoGy NoTeS 14: How to Coil an Aneurysm 2/19/2009 05:00:00 PM

At times you end up doing what you don't like to do...

I have made it no secret since junior clerkship that I have absolutely no liking for doing anything remotely surgical... from suturing to performing a minor operation to looking into someone's insides... well, you name it... Mind you, I'm not the squeamish type, but while doing a surgical rotation way back in the internship (a.k.a. senior clerkship), one resident once remarked to my groupmate: "Dili lagi na siya ganahan ug O.R., noh? (She doesn't like the O.R., does she?)"

A few years later, I find myself doing my first month of interventional radiology rotation in my second year of residency. Like I said, it is no secret to the entire department that I don't like being first assist on the biopsies, the stenting, the cyst aspiratuions, the angiograms, and finally, today, assisting for the first time in coil embolization of an aneurysm. I have already made it clear to the hospital's lone intervetionist that I have no plans whatsoever of following in his footsteps.

I never intend this blog to go into the scientific nitty-gritty details of the procedure. So, i will just expound on the experience in laymens' terms.

Initially it would begin with an angiogram, but we had already done that for the same patient a few days earlier. The neurosurgeon had to abandon clipping the aneurysm on opening up thus patient was referred back for the procedure.

Patient was placed under general anesthesia. A small incision is made into the femoral artery where the catheters and guide wires are passed throught the larger arteries of the body into the blood supply of the brain. Everything is checked using real-time fluoroscopy and digital subtraction angiography with the introduction of radio-opaque contrast material. The guide wire with the platinum coil is then introduced and gently eased into the aneurysm.

Some of the guide wires had to be softened with a specialized steamer. Before introduction into the patient, the coil is first checked in a small basin of water. After precision placement, the coil is released from its guide using an electric charge and the guides are withdrawn.

Without complications or other confounding circumstances, everything is done in about two hours, as in the case I assisted today. Only two coils were put in place.

It's a pretty amazing and relatively safe procedure done to save a life.

Then again, I have no intention of ever doing it myself in the near future. I have never felt at ease in the OR.

(Note: Above image was taken from the internet and not of the patient refered to above.