Interventional radiography-Part 2 Flashcards by Josie Curley

Read over the following interventional proceedures

Angioplasty (PTA)
Embolization
IVC filter placement
TIPS
Extraction of foreign bodies
Biopsies
RF Ablations
Central Venous Catheter placement
Angiography
Vertebroplasty/Kyphoplasty

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What scan is shown here?

Lower Extremity Arteriography-CT run off

-Show all the vessels to see if there is any stenosis

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What scan is shown here?

Upper Extremity Arteriography

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What treatment is shown here?

Rotational thoracotomy

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What areas of the body is Arteriography done for?

The Upper Extremity and Lower Extremities

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What are the indications for arteriography?

-Atherosclerotic disease, stenosis, occlusion, trauma
-Embolus or Thrombus (DVT)
-Identify vessels for arterial bypass grafting
-Pre/Post bypass surgery

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What is Claudication?

Decreased blood flow to the veins in the lower E.

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What are the treatments for claudication?

-Angioplasty
-Stenting

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What treatment is done for an embolus or Thrombus (DVT) ?

Thrombectomy (removal) or Thrombolysis

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In the TIPS procedure, what are they going through after the internal jugular vein to get to the hepatic vein?

The brachiocephalic vein, SVC, through the heart (RA) into the IVC and then the hepatic vein

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What are the two types of Thrombectomy procedures?

1.Mechanical removal of clot with special retrieval stents
2.Rotational atherectomy

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What is a rotational atherectomy?

Special device that rotates 160,000 to 200,000 RPM in which pulverized plaque (size of blood cell) is removed by reticuloendothelial system

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When is rotational atherectomy most effective?

Very effective when the plaque is heavily calcified

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When we have plaque in the coronary arteries, when would we do thrombectomy over balloon angioplasty?

If the plaque is very calcified

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What is thrombolysis?

Dissolving the clot using medication
(TPA)

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What is an AV fistula?

AV fistula is the gold standard for access for dialysis

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Who creates an AV fistula?

-Created by vascular surgeon

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What happens if stenosis (especially with grafts) occurs following the creation of an AV fistula?

Interventional Radiologist performs PTA

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T/F

Fistulas take time to mature

True

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Why is an AV fistula the gold standard for dialysis?

Vein gets bigger because of pressure and wall gets stronger (able to withstand multiple needle pokes)

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What does the distal & proximal wires in dialysis take in?

-The more distal one takes the blood to dialysis
-The more proximal takes the clean blood in

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What is shown here?

Upper Extremity Arteriography - Fistula

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What is shown here?

Upper Extremity Arteriography - Fistula

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What artifact is shown here?

IVC Filter

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What are the two main methods for biospies?

Core biopsy Fine Needle Aspiration

What needle is this?

A core biospy needle

What method of biospy is this showing?

Fine needle aspiration

What treatment is this showing?

RF ablation

What treatment is this showing?

RF ablations

What gauge is used for a core biopsy needle; large or small gauge?

Large gauge needle

# T/F A core biopsy needle is hollow

True

How is tissue removed with a core biopsy needle?

A “plug” of tissue removed for analysis by using either a spring-loaded gun or suction to get the sample

What type of analysis is core biopsy used for?

Histologic analysis

What are the risks of core biopsies?

Greater risks (hemorrhage, sepsis, and tumor seeding)

What biopsy method is more accurate?

Core biopsy

What type of analysis is fine Needle Aspiration used for?

-Cytologic analysis only

# T/F With fine needle aspiration, a smaller needle is attached to a syringe to acquire cell samples

True

What modalities are used for guidance during biopsies?

-Fluoroscopy -Ultrasound -CT -Combination of these

What modality is used to reduce the complication rates during a guided biopsy?

CT and U/S used in conjunction with fluoro reduce the complication rates

How is the modality for guided biopsies chosen?

By the physician’s preference, equipment available, patient condition, and organ location

# What is this describing?: High frequency current heats tissue and causes cell death in tumours by using coagulation necrosis

RF ablations

Why is image guidance needed for RF ablations? What modalities are used?

-Image guidance is required to get the needle electrode into position -Ultrasound, CT, and MRI commonly used for image guidance

For an RF ablation that is at 50° - 52° C, how long does it take for the ablation to complete?

4-6 minutes

For an RF ablation that is at >60° C, how long does it take for the ablation to complete?

Instantaneous

# T/F Active tip of an RF ablation needle can be different lengths and configurations

True

What is Necrotic tissue replaced by in RF ablations?

Fibrosis and scar tissue

What can RF ablations be used to treat?

1.Tumours 2.Cardiology issues 3.Pain Management 4.Control Bleeding

What type of tumours does RF ablations treat?

Primary or metastatic tumours in the liver, lung, kidney, pancreas, bone, prostate, breast, lymph nodes

What size of tumour does RF ablations treat?

Small (should be < 3 cm, otherwise inoperable tumours, can be destroyed)

How does RF ablation treat cardiology issues?

It destroys abnormal electrical pathways that lead to arrhythmias

What cardiology pathologies does RF ablations treat?

Atrial flutter, atrial tachycardia, atrial fibrillation

What treatment is shown here?

Rhizotomy-RF ablations

What CVC is this showing?

Dialysis catheter or (PermCath or Raaf)

What CVC is this showing?

Dialysis catheter or (PermCath or Raaf)

What CVC is this showing?

Left: Hickman Right: Broshong

What is the difference between a hickman and a broshong?

Hickman has clamps

What CVC is this showing?

Hickman

What CVC is this showing?

PICC

What vein does a CVC start at?

The basillic vein in the arm

What is Rhizotomy?

Nerves around facet joints of lumbar spine are ablated for pain management

What drug confirms the nerves causing the back pain prior to the ablation?

Lidocaine (local anaesthetic)

How do RF ablations work for pain management?

Damaged nerves prevent pain signals to be sent to the brain

# T/F Rhizotomy is temporary

True…nerves regenerate in time

How long does pain relief from a rhizotomy typically last?

6 – 24 months

When are RF ablations used to Control Bleeding?

-Prior to tumour resections -As the electrode is withdrawn from a vascular area

What doctor inserts CVCs? (Central venous catheters)

Interventional Radiologist

What are the 3 types of central venous catheters?

-Dialysis catheter or (PermCath or Raaf) -Hickman or Groshong -PICC (insertion or adjustment)

What is a dialysis catheter used for?

Shorter term dialysis treatment

What are Hickman or Groshong catheters used for?

-Long term antibiotics, chemo, TPN (total prenatal nutrition)

What are PICCs used for?

Often for antibiotics (infected joint replacement)-Shorter term

Why do they tunnel under the skin when inserting a dialysis catheter into the subclavian vein?

It decreases the rate of infection, you can’t pull it out as easy when you are going through the skin (gives stability)

What tube is shown here?

Pigtail-Abscess Drainage Tube

What tube is shown here?

Pigtail-Abscess Drainage Tube

What tube is shown here?

Percutaneous Nephrostomy Tube

What type of tube is shown here?

Gastojejunal tube

What treatment is shown here?

Vertebroplasty

What tretment is shown here?

Vertebroplasty

What is the purpose of an Abscess Drainage Tube

Draining of Infected collection of fluid

What modalities are used for guidance of the placement of an abscess drainage tube?

CT, US, fluoro used to place tube

Where can abscess drainage tubes be placed in the body?

Chest, pelvis, abdomen

When is a Percutaneous Nephrostomy Tube used?

-When doctors cannot place a ureteral stent in the kidneys -Prostate cancer (where they can’t get a stent in) -bladder cancer

What type of patients usually need a GJ tube?

Stroke patients, esophageal or oral cancer patients

# What is this describing? It is an image-guided, minimally invasive, non-surgical therapy used to strengthen a vertebral body with a compression #

Vertebroplasty or kyphoplasty

What substance is injected into the vertebral body during a Vertebroplasty? Why?

Percutaneous injection of acrylic cement into vertebral body for stabilization and pain relief

What modality is used for guidance with a vertebroplasty?

Often a combination of fluoro and CT is used (c-arm in CT)

# T/F Vertebroplasty can only be used for patients with severe compression fractures.

False; For someone with a minimal compression fracture

What treatment is this showing?

Kyphoplasty

What is Kyphoplasty?

When a balloon is used to actively restore vertebral height, and then the cavity that is formed is filled with cement

# T/F Vertebroplasty is a minimally invasive procedure that can alleviate up to 90% of pain caused by compression #’s

False; this is for kyphoplasty

# T/F Kyphoplasty Can also stabilize the #, restore height & reduce deformity

True

What are the benefits of kyphoplasty and vertebroplasty?

-Short surgical time -Average hospital stay is one day (or less) -Patients can quickly return to normal activities -No bracing required