Types of interventional radiology 2

Feb 14, 2022

Therapeutic interventional radiology

Vascular

Balloon angioplasty/stent: Opening of narrow or blocked blood vessels using a balloon, with or without placement of metallic stents to aid in keep vessel patent.
Endovascular aneurysm repair: Placement of endovascular stent-graft across an aneurysm to prevent expansion or progression of the defective vessel.
Embolization: Placement of a metallic coil or embolic substance (gel-foam, poly-vinyl alcohol) to block blood through to a blood vessel, either to stop bleeding or decrease blood flow to a target organ or tissue.
Uterine artery embolization (UAE) or uterine fibroid embolization (UFE)
Prostate artery embolization (PAE)
Pulmonary arteriovenous malformation (PAVM) embolization
Thrombolysis: Catheter-directed technique for dissolving blood clots, such as pulmonary embolism and deep venous thrombosis, with either pharmaceutical (TPA) or mechanical means.
IVC filters: Metallic filters placed in the vena cava to prevent propagation of deep venous thrombus.
Dialysis related interventions: Placement of tunneled hemodialysis catheters, peritoneal dialysis catheters, and revision/thrombolysis of poorly functioning surgically placed AV fistulas and grafts.
TIPS: Placement of a Transjugular Intrahepatic Porto-systemic Shunt (TIPS) for select indications in patients with critical end-stage liver disease and portal hypertension.
Endovenous laser treatment of varicose veins: Placement of thin laser fiber in varicose veins for non-surgical treatment of venous insufficiency.

Biliary intervention

Placement of catheters in the biliary system to bypass biliary obstructions and decompress the biliary system.
Placement of permanent indwelling biliary stents.
Cholecystostomy: Placement of a tube into the gallbladder to remove infected bile in patients with cholecystitis, an inflammation of the gallbladder, who are too frail or too sick to undergo surgery.

Catheter placement

Central venous catheter placement: Vascular access and management of intravenous devices (IVs), including both tunneled and non-tunneled catheters (e.g., PIC, Hickman, port catheters, hemodialysis catheters, translumbar and transhepatic venous lines).
Drainage catheter placement: Placement of tubes to drain pathologic fluid collections (e.g., abscess, pleural effusion). This may be achieved by percutaneous, trans-rectal, or trans-vaginal approach. Exchange or repositioning of indwelling catheters is achieved over a guidewire under image guidance.
Radiologically inserted gastrostomy or jejunostomy : Placement of a feeding tube percutaneously into the stomach and/or jejunum.

Ablative

Chemoembolization: Combined injection of chemotherapy and embolic agents into the arterial blood supply of a tumor, with the goal of both local administration of chemotherapy, slowing "washout" of the chemotherapy drug, and also decreasing tumor arterial supply
Radioembolization: Combined injection of radioactive glass or plastic beads and embolic agents into the arterial blood supply of a tumor, with the goal of both local administration of radiotherapy, slowing "washout" of the radioactive substance, and also decreasing tumor arterial supply
Radiofrequency ablation (RF/RFA): Local treatment in which a special catheter destroys tissue with heat generated by medium frequency alternating currents
Cryoablation: Local treatment with a special catheter that destroys tissue with cold temperature generated by rapid expansion of compressed argon gas—used mostly to treat small renal cancers and for the palliation of painful bone lesions.
Microwave ablation: Local treatment with a special catheter that destroys tissue with heat generated by microwaves

Genitourinary

Percutaneous nephrostomy or nephroureteral stent placement: Placement of a catheter through the skin, directly into the kidney to drain from the collecting system. This is typically done to treat a downstream obstruction of urine.
Ureteral stent exchange: indwelling double-J type ureteral stents, typically placed by urologist using cystoscopy, may be exchanged in retrograde fashion through the female urethra. The IR uses a thin wire snare under fluoroscopy to capture the distal portion of the stent. After partially extracting the distalmost stent, exchange for a new stent can be accomplished over a guidewire.