non-vascular interventions

Question 1

basic techniques (to enter the body)

Answer 1

• Seldinger
• Trockar
• Biopsy

Question 2

biopsy

Answer 2

Percutaneous sampling

• cells/cytology: FNAB/21-23G needles, Smear, search for malignancy
• Tissue/core: 24-20G needle, in diffuse or localised pathologies, more complications

Question 3

percutaneous ablative techniques

Answer 3

• chemical: ethanol/PEI
• Thermoablation: cryo, laser, focused US, RFA -> liver, kidney, lung, breast, bone
• percutaneous, laparoscopic, open surgical -> combined

Question 4

major complications in HCC biopsy / intervention

Answer 4

• intraperitoneal hemorrhage
• intrahepatic hematoma
• seeding
• abscess
• hemothorax
• diaphragmatic paresis
• biloma
• PTX
• portal HTN
• stenosis of common hepatic duct
• venous thrombosis
• multisegmental hepatic infarction
• acute cholecystitis
• septicema

Question 5

minor complications in HCC biopsy / intervention

Answer 5

• skin burn
• asymptomatic thickening of gallbladder wall
• self-limiting intraperitoneal bleeding
• artero-portal shunt
• thickening of diaphragm
• subcapsular hematoma
• biloma
• intratumoral hematoma
• pain

Question 6

renal CC ablation

Answer 6

• best indication for RF
• never seen recurrence in treated area
• low complications
• outpatient

Question 7

RF ablation of RCC - indications

Answer 7

1) initial:
- co-morbidities, poor surgical candidate
- life expectancy less that 10 years
- ± solitary kidney
- no evidence of metastatic disease

2) expanded:
- palliation of large central tumors while maintaining renal function
- hematuria control

Question 8

RF ablation of renal tumors - tumor factors

Answer 8

• tumor size:
  3 cm or less is ideal (100% surgical success, > 90% single session).
  3-5.5 cm can be done with more ablations; more sessions. 100% success if exophytic. 70% with single session.

Question 9

aspirate evaluation

Answer 9

• bacteriogram: pus
• leukocytes, no germs: “sterile abscess”
• creatinine: urinoma
• lymphocytes, fat: lymphocele
• bilirubin: bilioma
• amylase: pancreatic pseudocyst

Question 10

sclerotherapy

Answer 10

• cysts, lymphocele, seroma
• percutaneous puncture or drainage
• the amount of agent depends on the volume of fluid in the collection
• alcohol
• betadine/braunol
• 20-30 min to be effective
• aspiration of the sclerotizing fluid
• repeat!

Question 11

biliary obstructions

Answer 11

• can be caused by: stones, stenosis, compression (benign, malignant)
• therapeutic choices: surgical, endoscopic, percutaneous (PTD: percutaneous transhepatic drainage, PTC ~ cholangiography)

Question 12

uroradiology, endourology - applications

Answer 12

• urine deviation
• stone extraction
• dilatation
• ureteroplasty
• stenting
• urology/radiology: retrograde or anterograde

Question 13

special interventions

Answer 13

• TIPS
• shunt pta
• PVE
• islet cell tx
• hepatocyta tx
• GI-stents

Question 14

GI-stents

Answer 14

• in GI occlusion
• when surgery cannot be performed
• palliative stent placement
• OTW or endoscopic route