temp lec 11 introduction to interventional radiology

Radio 250 [8]: ICC in Radiology and Nuclear Medicine Lec ##: Introduction to Interventional Radiology Jason Catibog, MD, FPCR, FPCVIR, FCTMRISP # October 20, 2014 Page 1 / 3 TANGCO & TURALDE TOPIC OUTLINE I. Interventional Radiology Procedures A. Vascular Procedures B. Non-vascular Procedures II. Catheterization A. Catheters and Guidewires B. Seldinger Technique III. Vascular Procedures A. Angiography and DSA B. Embolization C. Angioplasty and Stenting D. Transjugular Intrasystemic E. Shunt (TIPS) F. Transarterial Chemoembolization (TACE) IV. Non-vascular Procedures A. Biopsy B. Radiofrequency Ablation C. Percutaneous Drainage D. Percutaneous Cholecystostomy E. Percutaneous Transhepatic Biliary Drainage (PTBD) Legend: Discussed by sir, not in the powerpoint From 2016 I. INTERVENTIONAL RADIOLOGY PROCEDURES Diagnostic or therapeutic Vascular or non-vascular Advantages of Interventional Radiology over Surgery o Minimally-invasive; no incision, sir’s widest incision is 5mm o Sometimes, general anesthesia is not needed – just IV sedation or local anesthesia o Most procedures are done inside the catheterization lab A. VASCULAR PROCEDURES 1. Increase Blood Flow Mechanical methods o Dilatation of stenotic artery stent shows an excellent radiographic result. (Images from Brant and Helms, 2007) Figure 11. Percutaneous Liver Abscess drainage, CT Radiographs D. PERCUTANEOUS CHOLECYSTOSTOMY Drainage of the biliary system For cholesystitis, when the patient is in sepsis and there’s coagulopathy the patient is surgically unstable and can’t be operated on they can’t just take the gall bladder out. Insert a catheter and drain the pus inside and when the patient is stable, operate. Figure 12. Percutaneous Cholcystostomy diagram (UL), radiograph (UR), Sonogram guidance (bottom) showing a stent through the gall bladder FROM 2016: E. PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE (PTBD) When the patient has obstructive biliary pathologies and the bile becomes stagnant, he becomes prone to developing infection, which can lead to sepsis, then shock, or even death. To avoid ascending cholangitis we can put a tube to drain the biliary tree so the bile is free flowing and decreases the chance of sepsis. Needle is placed into liver and bile duct Guide wire is inserted through the needle and down into the bile duct Needle is removed and the catheter is passed over the guide wire and into the bile ducts. Figure 13. Percutaneous transhepatic biliary drainage, TOP: Needle placed into liver and bile duct (A), a guidewire is passed through the needle and down into the bile ducts(B), the needle will be removed from the bile ducts and liver through the guide wire (C), the soft plastic biliary tube catheter will be passed over the guidewire and into the bile ducts (D), BOTTOM (L to R): The percutaneous catheter is pushed through the stenosed common bile duct, so that bile is advanced inside the catheter towards the bowel loops; Metallic Stent is placed into the common bile duct, keeping the stenosed area patent. Now the percutaneous catheter can be taken out.

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TOPIC OUTLINE

I. Interventional Radiology Procedures

A. Vascular ProceduresB. Non-vascular Procedures

II. Catheterization

A. Catheters and GuidewiresB. Seldinger Technique

III. Vascular Procedures

A. Angiography and DSAB. EmbolizationC. Angioplasty and StentingD. Transjugular Intrasystemic E. Shunt (TIPS) F. Transarterial Chemoembolization (TACE)

IV. Non-vascular Procedures

A. BiopsyB. Radiofrequency AblationC. Percutaneous DrainageD. Percutaneous CholecystostomyE. Percutaneous Transhepatic Biliary Drainage (PTBD)

Legend:Discussed by sir, not in the powerpointFrom 2016

I. INTERVENTIONAL RADIOLOGY PROCEDURES Diagnostic or therapeutic Vascular or non-vascular

Advantages of Interventional Radiology over Surgeryo Minimally-invasive; no incision, sir’s widest incision is 5mmo Sometimes, general anesthesia is not needed – just IV sedation or

local anesthesiao Most procedures are done inside the catheterization lab

A. VASCULAR PROCEDURES1. Increase Blood Flow Mechanical methodso Dilatation of stenotic artery

stent shows an excellent radiographic result. (Images from Brant and Helms, 2007)

Figure 11. Percutaneous Liver Abscess drainage, CT Radiographs

D. PERCUTANEOUS CHOLECYSTOSTOMY Drainage of the biliary system For cholesystitis, when the patient is in sepsis and there’s

coagulopathy the patient is surgically unstable and can’t be operated on they can’t just take the gall bladder out.

Insert a catheter and drain the pus inside and when the patient is stable, operate.

Figure 12. Percutaneous Cholcystostomy diagram (UL), radiograph (UR), Sonogram guidance (bottom) showing a stent through the gall

bladder

FROM 2016: E. PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE (PTBD)

When the patient has obstructive biliary pathologies and the bile becomes stagnant, he becomes prone to developing infection, which can lead to sepsis, then shock, or even death.

To avoid ascending cholangitis we can put a tube to drain the biliary tree so the bile is free flowing and decreases the chance of sepsis.

Needle is placed into liver and bile duct Guide wire is inserted through the needle and down into the bile duct Needle is removed and the catheter is passed over the guide wire

and into the bile ducts.

Figure 13. Percutaneous transhepatic biliary drainage, TOP: Needle placed into liver and bile duct (A), a guidewire is passed through the needle and down into the bile ducts(B), the needle will be removed from the bile ducts and liver through the guide wire (C), the soft plastic biliary tube catheter will be passed over the guidewire and into the bile ducts (D), BOTTOM (L to R): The percutaneous catheter is pushed through the stenosed common bile duct, so that bile is advanced inside the catheter towards the bowel loops; Metallic Stent is placed into the common bile duct, keeping the stenosed area patent. Now the percutaneous catheter can be taken out.

_________________________________________________________END OF TRANSCRIPTION

TANGCO: RADIOLOGY! RAD-YOLO-GY! LIKE FORT LIU! HAZZA!

October 20, 2014

#Radio 250 [8]: ICC in Radiology and Nuclear MedicineLec ##: Introduction to Interventional RadiologyJason Catibog, MD, FPCR, FPCVIR, FCTMRISP

TANGCO & TURALDE Page 1 / 2