Fluoroscopy control of biliary tree puncture & defining common bile duct CBD occlusion level.
Step-by-step images of first part of stenting common bile duct (CBD) procedure: from biliary tree puncture to proper catheter placement.
- Ultrasound-guided puncture of right-lobe intrahepatic biliary tree. Contrast agent filling the biliary tree confirms proper needle placement. Care must be taken as minimal needle movement will result with losing its proper intra-biliary position.
- Further biliary contrast filling through soft introduction needle. Needed for most distal ducts visualization.
- Guidewire placed in the furthest part of biliary tree - will be used for changing introduction needle for angled catheter.
- Angled catheter mounted in the beginning of stricture. Using this catheter hydrophilic guidewire will be used to traverse the patent part of common bile duct.