Vascular access is usually gained via the femoral route, although, in certain circumstances, a direct carotid or brachial puncture can be used to facilitate access where vessels are very tortuous. After femoral puncture using the Seldinger technique, a femoral sheath of appropriate size for the guiding catheter is inserted. For most procedures, the patient is then fully heparinized with 5,000iu or 70iu per kg. Ideally, an activated clotting time (ACT) monitor should be in situ in the angiographic suite and the ACT ratio maintained at two to three times normal, depending on the procedure. Full angiography is carried out as appropriate for planning the procedure. The vessel needed to access the lesion (for example, the left internal carotid artery for a left middle cerebral artery aneurysm) is selected and a guiding catheter exchanged into this vessel.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.