Tierärztliche Hochschule Hannover Vergleichende Studie zur

Publikation 3
The three-way stopcock and the catheter were immersed in ethanol before
use. The multiple thrombi in the vessels of the spinal cord may have formed by
remnants of ethanol within the lumen of the stopcock despite flushing with saline
before connection to the catheter. After the catheter was inserted and connected to
the stopcock on flushing with saline these remnants may have entered the aortic
blood stream or, depending on the location of the catheters’ tip, directly into spinal
vessels. Due to the sclerosing properties and local toxic effects related to its protein
denaturant and hydroscopic properties, ethanol is widely used as embolizing agent
for large area tissue destruction 23 . Therapeutic transcatheter arterial embolization is
an established procedure to treat neoplasms and arteriovenous malformations in a
variety of tissues. Major complications described in transcatheter arterial
embolization are spinal cord infarction and distal embolization of particles into the
aorta and its branches 24 . To achieve renal infarction in dogs, 0.2 ml/kg body weight of
pure ethanol was injected into the renal artery, although the authors indicate that a
lower concentration and amount would suffice 25 . It appears unlikely that remnants of
alcohol within the introduced catheter play a role in the pathogenesis of the
thrombembolus since the catheter was flushed with saline before insertion as well as
by aortic blood directly after insertion due to the high arterial blood pressure.
Another cause of embolization may have been small air bubbles, introduced
into the vessel on flushing the catheter. In arterial vessels, cerebral air emboli due to
a patent foramen ovale originating from central venous catheters and resulting in
neurologic manifestations have been described in man 26,27 . However, special
attention was paid on removal of possible air bubbles within the used syringe prior to
65