A combination of increased use of diagnostic imaging and advances in therapeutic interventions means that obtaining tissue to aid diagnosis and cellular typing is now more essential than ever. Most diagnostic and interventional radiologists require core skills in biopsy. The vast majority of lesions can be biopsied with minimal risk. Determining a safe access route and accurate targeting requires a clear understanding of the principles of…

Despite being a great opportunity to talk to your patients, obtaining haemostasis after a diagnostic or therapeutic angiogram is tedious. Hence, the art of staunching the flow is often neglected or delegated to the most junior member of staff in the vicinity. This approach risks haematoma or haemorrhage; make sure you give as much importance to haemostasis as you do to arterial access ( Fig. 37.1…

Foreign body retrieval is almost exclusively reserved for iatrogenic problems, most of which will have been of your own making! The techniques and equipment described can also be used for snaring guidewires for pull-through procedures or to reposition misplaced central lines. The majority of foreign body retrieval is within the vascular system, although occasionally these techniques are required in the biliary or urinary system. The toolkit…

Embolotherapy is the deliberate blockage of blood vessels; it is usually performed to stop haemorrhage and may be life-saving in gastrointestinal bleeding and trauma. Embolization is sometimes used as an adjunct to surgery and in the treatment of a variety of benign and malignant tumours. Many types of embolic agents are available to block vessels of different sizes, from arteries to capillaries. The choice of the…

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Expandable stents are used to manage luminal narrowing in many systems from the aorta to the trachea. As with angioplasty, there is a common skill-set required for deployment, regardless of location but the indications and outcomes are very different so try to avoid a ‘have stent, will travel’ mentality. There is a simple basic concept regarding intent, which transcends most applications. A procedure may be undertaken…

Angioplasty and stenting are cornerstone techniques in interventional radiology and have widespread non-vascular and vascular applications. The key skills and equipment choices remain largely the same, regardless of the site. The main indication for angioplasty is the treatment of atherosclerotic plaque. Concentric plaque splits during balloon angioplasty and the intima and media stretch and tear ( Fig. 32.1 ). When there is eccentric plaque, the tears…

Many interventional procedures have the primary aim of managing narrowings or blockages to restore flow of blood, urine, bile, air or even bowel contents. Once access into the appropriate lumen has been achieved, the basic principles of catheters and wires are used to navigate through the diseased segment. This chapter is concerned with the mechanics of getting across to the other side. Success is largely governed…

Knowing the equipment is a great start but it comes into its own if you know how to use it. Remember wires go first, and the initial step of most procedures is to establish safe guidewire access to the target zone. Alarm Exceptions to the catheter follows the wire are: manoeuvring a pigtail up and down the aorta and moving catheters up and down the aorta…

Angiography is a team sport and a successful angiogram depends on cooperation between the patient and the angiography staff (radiographer, nurse and doctor). A little understanding of the basic principles of angiography can vastly improve the standard of the final study. This chapter reviews the key areas in image acquisition and manipulation. Digital subtraction angiography: basic principles Digital subtraction angiography (DSA) uses a computer to subtract…

Vascular access is the starting point for all diagnostic and interventional arterial and venous procedures. Common principles apply regarding choice of access site and equipment but there are significant differences between puncturing arteries and veins. Choice of puncture site is dictated by the planned procedure; think what you need to achieve, consider the site of the lesion, and the size of sheath and catheter required. The…

Many interventional radiology procedures remain dependent on X-ray guidance. It is important to have good technique in order to minimize the radiation dose to the patient, yourself and the staff. Fluoroscopy Fluoroscopy or screening Real-time imaging is essential for catheter and guidewire manipulation. Whenever using fluoroscopy consider how to balance image quality with radiation dose. There are several factors which will come into play and different…

A wide range of interventional procedures can only be safely performed with accurate imaging guidance. The aim of this chapter is to outline the basic principles of imaging-directed intervention. Ultrasound, computed tomography and fluoroscopy have complementary roles; individual circumstances dictate the optimal modality. Ultrasound guidance Ultrasound is ideal for many biopsy and drainage procedures and allows the procedure to be visualized in real-time. Use ultrasound if…

Purpose Ureteric stents are placed across ureteric strictures to relieve ureteric obstruction and restore anatomical drainage from the renal pelvis to the bladder/ileal conduit. Description All ureteric stent systems are hollow plastic tubes with a double-ended pigtail configuration ( Fig. 25.1 ). There are differences in materials and delivery systems. Interventional radiologists are usually involved in antegrade stent placement via a nephrostomy. A pusher is used…

Purpose Drainage catheters allow fluid to be released from collections and structures. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Essential equipment Embolotherapy is the deliberate blockage of blood vessels; embolization may be lifesaving when used to stop haemorrhage. Embolization is increasingly used as an adjunct to surgery and in the treatment of a variety of benign and malignant tumours. Many embolic agents are available to block vessels of different sizes, from large arteries to capillaries. The choice of the agent used depends on the individual…

Purpose Inferior vena cava (IVC) filters are placed to prevent pulmonary embolism. They are most often used when there is a contraindication to anticoagulation. Despite the name, they are occasionally used in the superior vena cava. Description IVC filters use a form of wire lattice, often umbrella-shaped, to catch large blood clots, while allowing flow through the inferior vena cava. They are introduced in a constrained…

Purpose Covered stents provide an impermeable conduit and are used in both the vascular and non-vascular system. In the vascular system, they are called ‘stent grafts’. Vascular The most important indications are treating aneurysms and arterial rupture. Other indications are TIPS and in certain circumstances to manage stenotic and occlusive disease. Non-vascular Outside the vascular world, they tend to be called ‘covered stents’. In the majority…

Purpose Stents are scaffolds used to maintain luminal patency in many systems, e.g. vascular, biliary, gastrointestinal and tracheobronchial. They act by exerting an outward radial force to overcome stenoses/occlusions and elastic recoil after angioplasty. Stents may also reduce the likelihood of distal embolization during angioplasty by trapping plaque/thrombus against the vessel wall. Description Stents comprise a metal strut latticework, they have a high expansion ratio allowing…

Purpose The only way to be certain a balloon is being used at the correct pressure is to use an inflation handle with a pressure gauge ( Fig. 19.1 ). Besides precision, the inflation handle allows you to effortlessly generate and sustain high pressures without hurting your skilled hand. Description These are modified syringes, the plunger is driven into the syringe barrel with a screw thread…