Vascular invasive diagnostic procedures

Question 1

Advantages of these techniques

Answer 1

Minimally invasive

Only local anesthesia and mild sedation
No major surgical wounds or complications
Can be done in elderly/weak patients that couldn’t stand general surgery

Question 2

Disadvantages

Answer 2

Vascular fluorscopy contrast agents:

Renal function, allergies, same as the risks for normal X-ray contrast agents.

Question 3

Main method of diagnostic vascular imaging.

Answer 3

Digital subtraction angiography.

Fluoroscopy image, where the computer subtracts the contrast enhanced image from the pre-contrast image.
Makes the bones and other structures essentially faded out, and only the contrast is visible.

Question 4

List the arterial interventional radiology procedures

Answer 4

First group: PTA - Percutaneous Transluminal Angioplasty
PCI
PTA for PAD
- used for upper or lower limb symptoms, gangrene,
Carotid stent implantation - for severe carotid artery
disease/stenosis with cerebrovascular symptoms,
stenting to extracranial carotid artery.
Renal angioplasty - can be performed in severe
hypertension or kidney failure, acute renal
insufficiency with no clear kidney cause.
Mesenteric stenting - severe suiperior mesenteric
artery atherosclerotic occlusion.
Dialysis fisula stenosis - Treated by stenting

Second: Thrombolysis and thrombus aspiration, with angiograms for evaluation
-possible complications, Hemorrhage (maybe the clot was preventing a bleed)

Third: Embolisation

• materials: gelfoam for temporary occlusion, metal coils, PVA beads, lipiodol or alcohol
• for aneurysms, vascular malformations, or to control arterial bleeding.
• for malignant or benign tumors
• complication: non-target embolisation.

Fourth: TACE
TACE: Transarterial chemoembolisation- chemotherapy and embolization.
- mainly for liver hepatocellular carcinoma.
- the carcinoma typically derives its supply from the hepatic artery, while normal liver tissue gains its supply from the portal veinous system.
- also used in Renal tumors, and benign bone tumors

Question 5

Why do we perform carotid stent implantation?

Answer 5

Not generally to treat the stenotic symptoms, but rather, to prevent thrombus formation and subsequent emboli that cause stroke.

Question 6

When are stent-grafts or covered stents used?

Answer 6

In severe aortic aneurysms, to prevent rupture.
In popliteal aneurysms, to prevent distal embolisation

In any case of arterial rupture or pseudoaneurysm.

Question 7

Venous invasive radiology techniques

Answer 7

TIPS:
Transjugular intrahepatic portosystemic shunt.
Creates an anastomosis between the portal vein and the hepatic vein, bypassing the fibrotic liver parenchyma.

used for portal hypertension, to releive the tension on anastomosing arteries ie. Esophageal varicies with high risk of bleeding.

SVC stenting to treat stenosis caused by external compression dyue to a pancoast lung tumor (SVC syndrome)

Varicose vein embolization

Chronic veinous line/catheter placement, guided by US or fluroscopy, used for several weeks of chemotherapy or antibiotic therapy is indicated.