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Toronto Notes 2019 Interventional Radiology
Inferior Vena Cava Filter
• insertionoftemporaryorpermanentmetallic“umbrellas”tomechanicallytrapemboliandpreventPE • insertedviafemoralvein,jugularvein,orantecubitalvein
• usuallyplacedinfrarenallytoavoidrenalveinthrombosis
• indications:contraindicationtoanticoagulation,failureofadequateanticoagulation(e.g.recurrentPE
despite therapeutic anticoagulant levels), complication of anticoagulation
Central Venous Access
• varietyofdevicesavailable
• PICC,externaltunneledcatheter(Hickmanordialysiscatheters),subcutaneousport(Portacath®)
• indications:chemotherapy,TPN,long-termantibiotics,administrationoffluidsandbloodproducts,
blood sampling
• complications:venousthrombosis,centralvenousstenosis,infectionincludingsepsisand
pneumothorax
Nonvascular Interventions
Percutaneous Biopsy
• alternativetoopensurgicalprocedure
• many sites are amenable to biopsy using U/S, fluoroscopy, CT or MR guidance
• complications:falsenegative(samplingerrorortissuenecrosis),pneumothoraxin30%oflungbiopsies
(chest tube required in ~5%), acute pancreatitis (pancreatic biopsies), bleeding from liver biopsies in patients with uncorrectable coagulopathies or ascites (can be minimized with transjugular approach)
Abscess Drainage
• placementofadrainagecatheterintoaninfectedfluidcollection
• administerbroadspectrumIVantibioticspriortoprocedure
• routes:percutaneous(mostcommon),transgluteal,transvaginal,transrectal
• complications:hemorrhage,injurytointerveningandnearbystructures(e.g.bowel),bacteremia,sepsis,
failure to access
Percutaneous Biliary Drainage/Cholecystostomy
• placementofdrainagecatheter±metallicstentintoobstructedbiliarysystem(PBD)orgallbladder (cholecystostomy) for relief of jaundice or infection
• percutaneousgallbladderaccesscanbeusedtocrushorremovestones
• indications
■ cholecystostomy: acute cholecystitis
■ PBD: biliary obstruction secondary to stone or tumour, cholangitis, acute biliary pancreatitis
• complications
■ acute: sepsis, hemorrhage
■ long-term: tumour ingrowth and stent occlusion
Percutaneous Nephrostomy
• placementofcatheterintorenalcollectingsystem
• indications:hydronephrosis,pyonephrosis,uretericinjurywithorwithouturinaryperitonitis
(traumatic or iatrogenic)
• complications:bacteriaandsepticshock,hematuriaduetopseudoaneurysmorAVfistulas,injuryto
adjacent organs
Gastrostomy/Gastrojejunostomy
• percutaneousplacementofcatheterdirectlyintoeitherstomach(gastrostomy)orthroughstomachinto small bowel (transgastric jejunostomy)
• indications:inabilitytoeat(mostcommonlyCNSdysfunction,e.g.stroke),esophagealobstruction,or decompression in gastric outlet obstruction
• complications:gastroesophagealrefluxwithaspiration,peritonitis,hemorrhage,bowelorsolidorgan injury
Radiofrequency Ablation
• U/S-orCT-guidedprobeisinsertedintotumour,radiofrequencyenergydeliveredthroughprobe causes heat deposition and tissue destruction
• indications:hepatictumours(HCCandmetastases),renaltumours
• complications:destructionofneighbouringtissuesandstructures,bleeding,periproceduralembolism
Medical Imaging MI29
Figure 42. Retrievable IVC filter
Indications for Central Venous Access
FAT CAB
Fluids
Antibiotics
TPN
Chemotherapy Administration of blood Blood sampling
Figure 43. Femoral arteriogram: distal occlusionofsuperficialfemoralartery