Interventional radiography-Part 2 Flashcards
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
What scan is shown here?
Lower Extremity Arteriography-CT run off
-Show all the vessels to see if there is any stenosis
What scan is shown here?
Upper Extremity Arteriography
What treatment is shown here?
Rotational thoracotomy
What areas of the body is Arteriography done for?
The Upper Extremity and Lower Extremities
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
What is Claudication?
Decreased blood flow to the veins in the lower E.
What are the treatments for claudication?
-Angioplasty
-Stenting
What treatment is done for an embolus or Thrombus (DVT) ?
Thrombectomy (removal) or Thrombolysis
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
What are the two types of Thrombectomy procedures?
1.Mechanical removal of clot with special retrieval stents
2.Rotational atherectomy
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
When is rotational atherectomy most effective?
Very effective when the plaque is heavily calcified
When we have plaque in the coronary arteries, when would we do thrombectomy over balloon angioplasty?
If the plaque is very calcified
What is thrombolysis?
Dissolving the clot using medication
(TPA)
What is an AV fistula?
AV fistula is the gold standard for access for dialysis
Who creates an AV fistula?
-Created by vascular surgeon
What happens if stenosis (especially with grafts) occurs following the creation of an AV fistula?
Interventional Radiologist performs PTA
T/F
Fistulas take time to mature
True
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)
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
What is shown here?
Upper Extremity Arteriography - Fistula
What is shown here?
Upper Extremity Arteriography - Fistula
What artifact is shown here?
IVC Filter
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
