Interventional Radiology

Question 1

What are the commonly used imaging modalities for interventional radiology? Are any others used?

Answer 1

Most common is USS and fluoroscopy

Can use MRI and CT

Question 2

What are the benefits of image guided procedures?

Answer 2

Minimally invasive, no need for general anaesthetic, quicker, less complications, out-patient cases

Question 3

What are The indications for a IVC filter?

Answer 3

1. When anticoagulation is a contraindication (pregnancy, intracranial bleed, GI bleed, clotting disorders)
2. DVT/PE Despite adequate anticoagulation
3. DVT in pregnancy

Question 4

What imaging is used in aneurysm coil embolisation and PCI?

Answer 4

Angiography (fluoroscopy) of the circle of Willis or the coronary arteries

Question 5

What is the imaging used for IVC filter insertion?

Answer 5

Inferior venacavagram

Question 6

What are the complications of vascular procedures?

Answer 6

Dissection
Pseudoaneurysm
Arteriovenous fistula
Groin haemorrhage 
Retroperitoneal haemorrhage

Question 7

What are the pre-procedure considerations before vascular intervention is performed?

Answer 7

PMHx of bleeds/renal (iodine contrast in coronary angioplasty), Ix clotting/INR, eGFR (contrast), DHx (anticoagulation), alternative options, risks/benefits

Question 8

What are the post-procedure considerations before vascular intervention is performed?

Answer 8

Adequate compression of puncture site
Safety net
IV fluids (contrast)
Plan for when to come back on anticoagulation if stopped

Question 9

Examples of non vascular procedures

Answer 9

Drain ascites
Tissue biopsies e.g. Breast
Nerve blocks
Oesophageal/colonic/hepatobiloary stents (Tumour)
PEG/JEG insertion

Question 10

What technique is used for tissue biopsy?

Answer 10

Seldinger technique

Needle to target –> guidewire into needle –> needle removed –> catheter slid over guidewire

Question 11

What is HIFU? What is it useful in? What is a disadvantage?

Answer 11

High intensity focused ultrasound

A non-invasive ablation technique of SMALL tumours using focused US beam

Uses MRI guidance

PANCREATIC Ca

Disadvantage: long Rx time

Question 12

What vascular procedures can you carry out using itnerventional radiology?

Answer 12

1. gastric artery embolisation (experimental - grehlin)
2. IVC filters
3. PCI –> balloon angiography or coronary stenting
4. aneurysm coil embolisation
5. EVAR (endovascular aortic repair)
6. thrombectomy
7. Tunnel line insertion (e.g. TPN)