Transcript Indications - helpfuldoctors

Interventional Radiology
Done By:
Faten Zaidan
Zahra AlHaj Issa
Areej Hussain
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Brief History
Definition and Advantage
Types
Indications
Contraindications
Patients’ Preparation
Side Effects and Complications
Since when it started?
Charles Dotter, 1960’s
"Father of Interventional Radiology"
Definition
The use of radiology, image guidance, to
perform minimally invasive procedures for
diagnostics and treatments.
Advantage
Offer patients the least
invasive option first,
Types
Heart and Vascular care
1) Coronary Angiography
2) Abscess Angiography
3) Angioplasty and Vascular Stenting
4) Cerebral Angiography
5) Deep Venous Thrombosis
6) Stent Graft Repair of Aneurysms
7) Stent for Stenosis/Obstruction
8) Thrombolysis
9) Central Venous Access
10)Embolization
11)Varicose Vein Treatment:
VNUS and EVLT Phlebectomy and Sclerotherapy, Laser Vein Ablation
12) Vena Cava Filter: Placement and Removal
Gastointestinal care
1) Biliary Drainage and Stentin
2) TIPS – Transjugular Intrahepatic Portosystemic Shunt
3) Gastrostomy/Jejunostomy tube
Genitourinary care
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6)
Nephrostomy
Varicocele Embolization
Ureteral Stent or Embolization
Fallopian Tube Recanalization
Suprapubic Cystostomy
Uterine Fibroid Embolization (UFE)
Pain Management Care
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Epidural Steroid Injections
Nerve Blocks
Facet Blocks
SI Joint Injections
Breast Care
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2)
3)
4)
Needle Biopsy
Pre-op Needle Localization
Stereotactic Core Biopsy
Ultrasound Guided Core Biopsy
& Fine Needle Aspiration Biopsy
Cancer Care
Chemoembolization & Radiofrequency Ablation
We will focus on the following types:
-Angiography of Coronary Arteries.
-Angioplasty of Coronary Arteries.
-Varicose Veins Endovenous Laser Treatment.
-Chemoembolization of Hepatocellular Carcinoma (HCC).
Indications &
Contraindications
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
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.
Angioplasty of
Coronary Arteries
Indications
•Acute ST-elevation MI (STEMI)
•Non–ST-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 >1.5 mm).
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 < 1.5 mm in diameter
• Diffusely diseased saphenous vein grafts
• Other coronary anatomy not amenable to PCI
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 >0.5
seconds)
Straight vein segment
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
Chemoembolization of HCC
Indications
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Palliative treatment for unresectable HCC
Patients on transplant list
Prior to Radio frequency ablation
Residual tumors
Patients with metastatic neuroendocrine
tumors in liver
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
Patient Preparation
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.
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
Balloon angioplasty
• Embolization, or the launching of debris into the
bloodstream
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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.
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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
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 (<1%)
that can occur during the use of lasers.
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.