Radiology 5th year, 5th lecture (Dr. Salah Mohammad Fatih)

Interventional Radiology

Radiologist ; Dr. Salah M. Fateh

Radiology has provoked from providing purely diagnostic information to therapy, offering effective alternatives in the Rx of abdominal & thoracic & vascular disorders. In some instances I.R. techniques have replaced the conventional surgical approach, removing the need for G.A.

P.B. is possible for most radiologically detected abnormalities.

In the chest usually fluoroscopy or CT used as guide

Fluoroscopy usually provides suitable guidance for biopsy of large parenchymal or perihilar masses in the chest.

CT guidance is an alternative , particularly for small lesions.

In the abdomen, US or CT is used for guidance. Where possible, US should be used.

Small lesions & lesions that cannot be adequately imaged with US, particularly within the retroperitoneum, are more appropriately biopsied under CT control.

Almost any fluid collection in the chest, abdomen or pelvis may be considered for percutanous catheter drainage, which has largely replaced surgery as the initial treatment of choice.

1-Liver Biopsy: It is a commonly performed procedure,

either targeted towards a focal lesion or taken from the Rt. Lobe in diffuse dis.

The major risk is hemorrhage after the procedure so before the biopsy the platelets and must be checked.

A-ERCP

used in patients with obst. Jaundice when there is distal CBD obstruction;

Advantages;1. Both biliary & pancreatic ducts are studied 2. Direct inspection & biopsy of papilla &

duodenum3. sphincterotomy.4. Removal of stone5. Stent placement .

B-Percutaneous Transhepatic Cholengiography(PTC)

Those pt who are not suitable for ERCP , because of previous gastric surgery, difficulties with canulations of the ampula or a tight stricture that cannot be negotiated from below or where there is more proximal biliary obstruction ,in these patients, a percut. transhepatic approach is required. Dilated systems require drainage to reduce the risk of sepsis & relief jaundice.

Through PTC, we can do ;- Balloon dilatation.- Simple external drainage.- External/Internal drainage.- Stent insertion (plastic or expanding metal)

Percut. GB puncture & drainage may be beneficial in acute calculus & acalculus cholecystitis or GB empyema in patients who are at risk for surgery or whose medical condition is unstable.

Injection of liquid agents such as alcohol or acetic acid, heating the tumor by use of laser or radiofrequency probes and freezing the tumor by cryothrapy. Hepatomas are softer & spongier than metastases generally and are more amenable to injection.

Percut. creation of a communication bet. the portal & hepatic venous systems for the relief of portal hypertension. It is an alternative to surgery in patients with recurrent variceal bleeding who are resistant to sclerotherapy or endoscopic banding.

1-Enteric strictures: Esophageal structures:

Dilatation of benign or malig. esoph. strictures can be performed with either endoscopic or fluoroscopic guidance.

In patients with malig. esoph. disease considered

incurable by surgery, esophageal stent placement provides good palliation.

Pyloric strict. & gastric out flow obst.

Benign dis. may be treated by balloon dilatation.

Malig. dis. causing obst. to gastric outlet or duodenum may be palliated with self-expanding metal stents.

Colorectal strictures:

Stents inserted per rectum have two main uses in colorectal malignancy causing obstruction;

- as palliative therapy in inoperable cases or patient with Ca colon but unfit for GA .

-as initial strategy in pat. presenting with malig. Colonic obst. to allow medical optimization of the pat. prior to surgery to minimize surgical morbidity & allow a one-step surgical procedure.

Percut. gastrostomy & gastrojejunostomy Percut. gastrostomy placement provides

a more comfortable alternative to long-term nasogastric feeding .

Percut. nephrostomy: The most common indication is relief of

urinary obst. to preserve renal function or to allow successful treatment of infection.

The procedure is usually best performed under combined US & fluoroscopic control.

Antegrade ureteric stent insertion

A wide range of intervention vascular techniques

has developed from basic angiographicprinciples and has a profound impact on many aspects of medicine & surgery.

1-Percut. transluminal angioplasty: A deflated balloon is inserted through a

guidewire into a stenosis or occlusion & then inflated.

2-Vascular stenting: For osteal renal artery stenosis stents have

been shown to be superior to balloon angioplasty alone.

Rt renal artery stenosis

After stenting

3-Intravascular thrombolysis: Thrombolytic agents can be used to treat

thrombo-embolic dis.4-IVC filters: can be used in pat. with recurrent

pulmonary embolism despite of anticoagulation.

5-Arterial embolization: GIT embolization; management of

refractory upper GI bleeding by this method can be life saving.

Gonadal vein embolization Occlusion of testicular vein by coils appear to be

the agents of choice in the treatment of symptomatic varicocele.

Occlusion of ovarian veins in pelvic congestion syndrome.

Treatment of AVM( arteriovenous malformation) by embolization.

thank you