Treating tumours Understanding ablative techniques The objectives of tumour ablation are to increase patient survival and sometimes to palliate local symptoms and painful tumours. There are several techniques which cause either tissue heating (radiofrequency [RF], microwave, laser, focused ultrasound) or freezing (cryotherapy). Advantages over surgical tumour resection are due to the minimally invasive nature of these therapies, which allows a wider spectrum of patients to be…

Biliary intervention mainly involves biliary drainage and stent insertion. Magnetic resonance cholangiopancreatography (MRCP) and Computed tomography (CT) are the primary tools to investigate stones or other bile duct abnormalities and will usually determine the site and nature of biliary obstruction. Review of CT and MR cholangiography can be invaluable in planning the procedure, particularly for biliary drainage in patients with hilar lesions. Percutaneous transhepatic cholangiography Percutaneous…

Gastrointestinal interventions fall into two main groups: establishing enteral access for feeding and stenting to treat obstruction secondary to malignancy. Nasogastric/nasojejunal tubes Most nasogastric tubes are placed on the ward and most nasojejunal tubes are placed by endoscopists. If a request migrates to interventional radiology for these procedures, it is usually because of problems navigating the nasopharynx. Occasionally, it is an issue with an oesophageal stricture…

Nephrostomy Percutaneous nephrostomy is one of the most frequently performed interventional procedures and is a technique in which every radiologist should feel completely confident. Urgent drainage is required in an infected obstructed system due to the resultant rapid renal loss and septicaemia. Fortunately, nephrostomy is usually an elective procedure, as ureteric obstruction leads to gradual progressive renal loss. Acute renal colic with obstruction and persistent pain…

There are several conditions which have been grouped together relating to the urogenital tract and which loosely impact on fertility. Uterine artery embolization Indications for treatment The vast majority of uterine artery embolization (UAE) is performed to manage symptomatic fibroid disease and to a much lesser extent, other uterine pathologies associated with menorrhagia. UAE is an alternative to surgery (hysterectomy or myomectomy) for patients in whom…

Treating fluid collections and abscesses is part of the bread and butter of interventional radiology. The minimally invasive nature of interventional radiology (IR) drainage makes it an obvious choice for many postoperative collections, particularly in the elderly and frail. Pre-procedure planning Taking a few minutes to plan the procedure is essential and might mean that you actually plan not to do it! Selecting collections to drain…

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…