Interventional Radiology

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Interventional Radiology
Done By Faten Zaidan Zahra AlHaj Issa Areej
Hussain
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• Content
• Brief History
• Definition and Advantage
• Types
• Indications
• Contraindications
• Patients Preparation
• Side Effects and Complications

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Since when it started?
Charles Dotter, 1960s
 "Father of Interventional Radiology"
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Definition
The use of radiology, image guidance, to perform
minimally invasive procedures for diagnostics and
treatments.
Advantage
Offer patients the least invasive option first,
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Types
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• Heart and Vascular care
• Coronary Angiography
• Abscess Angiography
• Angioplasty and Vascular Stenting
• Cerebral Angiography
• Deep Venous Thrombosis
• Stent Graft Repair of Aneurysms
• Stent for Stenosis/Obstruction
• Thrombolysis
• Central Venous Access
• Embolization
• Varicose Vein Treatment
• VNUS and EVLT Phlebectomy and Sclerotherapy,
  Laser Vein Ablation
• 12) Vena Cava Filter Placement and Removal

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• Gastointestinal care
• Biliary Drainage and Stentin
• TIPS Transjugular Intrahepatic Portosystemic
  Shunt
• Gastrostomy/Jejunostomy tube

• Genitourinary care
• Nephrostomy
• Varicocele Embolization
• Ureteral Stent or Embolization
• Fallopian Tube Recanalization
• Suprapubic Cystostomy
• Uterine Fibroid Embolization (UFE)

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• Pain Management Care
• Epidural Steroid Injections
• Nerve Blocks
• Facet Blocks
• SI Joint Injections

• Breast Care
• Needle Biopsy
• Pre-op Needle Localization
• Stereotactic Core Biopsy
• Ultrasound Guided Core Biopsy
• Fine Needle Aspiration Biopsy

Cancer Care Chemoembolization Radiofrequency
Ablation
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We will focus on the following types -Angiograph
y of Coronary Arteries. -Angioplasty of Coronary
Arteries. -Varicose Veins Endovenous Laser
Treatment. -Chemoembolization of Hepatocellular
Carcinoma (HCC).
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Indications Contraindications
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• Angiography of Coronary Arteries
• Indications
• Detection of CAD in sussceptable patients.
• Preoperative coronary assessment prior to
• noncoronary cardiac surgery
• Evaluation of new or worsening symptoms of CAD
• Risk assessment post-revascularization
• Evaluation of cardiac structure and function

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• Angiography of Coronary Arteries
• Contraindications
• Pregnancy is considered an absolute
  contraindication.
• Since an iodine-containing contrast agent is
  used, contrast agent allergy, hyperthyroidism or
  renal function impairment are relative
  contraindications.

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• Angioplasty of
• Coronary Arteries
• Indications
• Acute ST-elevation MI (STEMI)
• NonST-elevation acute coronary
  syndrome (NSTE-ACS)
• Asymptomatic or mildly symptomatic patient
  with objective evidence of a moderate-sized to
  large area of viable myocardium or moderate to
  severe ischemia on noninvasive testing
• Angiographic indications include hemodynamically
  significant lesions in vessels serving viable
  myocardium (vessel diameter gt1.5 mm).

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• Angioplasty of
• Coronary Arteries
• Contraindications
• Intolerance of chronic antiplatelet therapy
• The presence of any significant comorbid
  conditions that severely limit patient lifespan
  (this is a relative contraindication).
• Relative angiographic contraindications include
  the following
• Arteries lt 1.5 mm in diameter
• Diffusely diseased saphenous vein grafts
• Other coronary anatomy not amenable to PCI

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Varicose Veins Endovenous Laser Treatment

• Indications
• Symptoms affecting quality of life like Aching,
  Throbbing, Heaviness, Fatigue, Restlessness,
  Night cramps, Pruritus and Spontaneous hemorrhage
• Skin changes associated with chronic venous
  hypertension like eczema, Healed or active
  ulceration and pigmentation.
• Cosmetic (restorative) concerns.
• Anatomical indications are as follows
• Significant reflux documented on DUS
  examination (reflux gt0.5 seconds)
• Straight vein segment

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Varicose Veins Endovenous Laser Treatment

• Contraindications
• Patients who are pregnant or breastfeeding
  (concerns related to anesthetic use and heated
  blood effluent that may pass through the placenta
  to the fetus)
• Obstructed deep venous system inadequate to
  support venous return after ELA
• Liver dysfunction or allergy making it impossible
  to use a local anesthetic.
• Severe uncorrectable coagulopathy
• Severe hypercoagulability syndromes
• Thrombus or synechiae in the vein or tortuous
  vein making passage of an endovenous device
  impossible

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Chemoembolization of HCC

• Indications
• Palliative treatment for unresectable HCC
• Patients on transplant list
• Prior to Radio frequency ablation
• Residual tumors
• Patients with metastatic neuroendocrine tumors in
  liver

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Chemoembolization of HCC
Contraindications ABSOLUTE?Extensive
liver disease?Encephalopathy?Large
burden metastatic disease outside the
liver RELATIVE?Borderline Liver
function?Portal vein thrombosis ?Uncorrectable
coagulopathy ?Poor general health?Significant
AV shunting through tumor?Anaphylactic reaction
to chemotherapeutic drugs or contrast
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Patient Preparation
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• The following is a list of important information
  all patients must know prior to having any
  procedure with Interventional Radiology
• Most patients must have a ride home.
• All patients having angiograms need someone to
  stay with them overnight.
• Most procedures require no food or drinks after
  midnight except for sips of water to take with
  medication.
• All blood pressure medications need to be taken
  the morning of the procedure.
• If patient is on insulin, the patient should only
  take half of their morning dosage.
• If there are any questions about medications,
  patients should bring their meds with them, or a
  complete list of the medication which include the
  dosage.
• All blood thinners and aspirin need to be held 5
  days prior to the procedure. Ibuprofen is
  24hours.

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Side effects Complications
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• Angiography
• The contrast medium that is used usually produces
  a sensation of warmth lasting only a few seconds,
  but may be felt in a greater degree in the area
  of injection.
• If the patient is allergic to the contrast
  medium, much more serious side effects are
  inevitable however, with new contrast agents the
  risk of a severe reaction are less than one in
  80,000 examinations.
• Additionally, damage to blood vessels can occur
  at the site of puncture/injection, and anywhere
  along the vessel during passage of the catheter.
• If digital subtraction angiography is used
  instead, the risks are considerably reduced
  because the catheter does not need to be passed
  as far into the blood vessels thus lessening the
  chances of damage or blockage

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• Balloon angioplasty
• Embolization, or the launching of debris into the
  bloodstream
• Arterial rupture from over-inflation of a balloon
  catheter or the use of an inappropriately large
  or stiff balloon, or the presence of a calcified
  target vessel.
• Hematoma or pseudoaneurysm formation at the
  access site
• Angioplasty may also provide a less durable
  treatment for athrosclerosis, and be more prone
  to re-stenosis, relative to vascular bypass or
  coronary artery bypass grafting

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• Vericose veins Endovenous laser treatment
• Side effects can be categorized as minor, or
  serious.
• Minor complications include
• Bruising
• Hematoma
• Temporary numbness
• Phlebitis
• Induration
• Sensation of tightness
• More serious complications include
• Skin burns
• Deep venous thrombosis
• Pulmonary embolism
• Nerve injury
• Retinal damage is a serious but very rare
  complication (lt1)
• that can occur during the use of lasers.
•  
•  

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• Chemoembolization
• As with any interventional procedure, there is a
  small risk of hemorrhage and/or damage to blood
  vessels.
• Pseudoaneurysm can develop at the site of
  puncture in the femoral artery.
• During this procedure contrast media is utilized,
  to which patients may develop an allergic
  reaction.
• Symptomatic hypothyroidism may result from the
  high retained iodine load of the contrast.
  Specialized techniques and devices may decrease
  the risk.
• The resulting necrosis releases cytokines and
  other inflammatory mediators into the
  bloodstream. A self-limiting postembolization
  syndrome of pain, fever, and malaise may occur
  due to hepatocyte and tumor necrosis.

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