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Interventional radiology

Written by Prince Mahajan

Topic: Natural HealthPublished May 26, 2017
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rnOver the last 20—30 years, interventional radiology has made an essential contribution Breast Surgery to patient management. The speciality has developedrnfrom angiographic techniques, with guidewires and catheters as key ingredients.IVF The parallel developments Bariatric Surgery in cross-sectional imaging havernprovided enhanced guidance for interventional procedures and radiology has evolved Knee Replacement in Inda in the treatment of abdominal and thoracic disorders. In some instances, interventional radiology techniques have replaced thernconventional surgical approach,Hip Replacement removing the need for a general anaesthetic with consequent decreased morbidity and length of hospital stay, Cancer Treatment in Indiawith similar patientrnoutcome. The increasing complexity and sophistication of both surgery and available intetventional techniques requires close liaison Knee Replacement Costin decision making between thernsurgeon and radiologist to choose the optimum method of treatment.rnPercutaneous biopsyrnPercutaneous biopsy is possible for most radiologically detected abnormalities. Small lesions immediately adjacent to major vessels or a biopsy path that traverses therncolon may be regarded as relative contraindications but the decision often depends on local expertise. In general, the shortest route from skin to lesion is chosen if nornvital structure intervenes. Fluoroscopy usually provides suitable guidance for biopsy of large parenchymal or peri hilar masses in the chest.Hip Replacement Cost CT guidance may bernnecessary for small lesions. Ultrasound or CT guidance is most commonly employed in the abdomen. Ultrasound is quick and flexible and allows the needle path to bernfollowed in real time without additional radiation burden to the patient. Small lesions and lesions which cannot be adequately imaged withMedical Tourism in India ultrasound, particularly withinrnthe retroperitoneum, are more appropriately biopsied under CT control (Fig. 2.30).rnA platelet count of less than 80 000 or an international normalised ratio (INR) of greater than 1.3 should be corrected where possible, by the administration of freshrnfrozen plasma and/or vitamin K,Medical Tourism in India where appropriate, prior to biopsy. Gross ascites should be drained prior to liver biopsy unless biopsy via a transjugular approach isrnavailable. The choice of needles is wide. In general, an 18G automatic spring-loaded cutting needle provides an excellent core biopsy. Larger 14G needles may bernuseful where architectural assessment is required in patchy disease, e.g. cirrhosis. Cytological analysis via 22G needle is often adequate for the diagnosis ofrnmalig-nancy. Accuracy rates exceed 80 per cent.Medical Tourism in India Negative biopsies may be due to faulty needle placement. Complications are unusual, occurring in less than 2 perrncent of patients and include haemorrhage, pancreatitis, pneumothorax and occasional seeding of the needle track by tumour.rnDrainage of abscesses and fluid collectionsrnAlmost any fluid collection in the chest, abdomen or pelvis may be considered for percutaneous catheter drainage, which has largely replaced surgery as the treatmentrnof choice. Initially percutaneous drainage was confined to large superficial postopera-tive collections, but use has broadened to include complex multilocularrncollections, multiple abscesses and collections in difficult locations (e.g. presacral space, psoas muscle).rnCT or ultrasound is used to define a safe access route avoiding the penetration of major vessels or bowel. Ultrasound is adequate for superficial collections and mayMedical Tourism in India be preferable where an angled approach is required, e.g. sub-phrenic collections (Fig. 2.31). Superficial collections, where there is little risk of misdirection, may bernsafely drained via a simple one-step trochar catheter system. More complex or deep collections often require the more precise guidance of CT, using the needlernguidewire and catheter exchange system originally devised by Seldinger for arterial puncture (Fig. 2.32). Diagnostic fine needle aspiration should be performed beforerndrainage to determine the nature and viscosity of the collection. Nonviscous fluid — ascites, cysts, seromas, biliomas, urinomas — can be satisfactorily drained via anrn8—10 French catheter. Thick, inspissated, infected material often requires a larger bore catheter (10—14 French) with multiple side holes and, ideally, a double lumenrnfor cavity irrigation. At catheter insertion, the cavity should be evacuated as completely as possible. Saline irrigation may help to decrease the viscosity of the contents Medical Tourism and encourage drainage. Patients should be given broad-spectrum antibiotic cover before and after the procedure. Following catheter placement, regular salinernirrigation (10—20 ml tds) is important to maintain catheter patency. The catheter should be left in situ for several days until drainage ceases. Continued drainage of 50rnml or more suggests possible fistulous communication which may be confirmed by a contrast study via the catheter. Prolonged catheter drainage over several weeksrnmay be necessary in such cases to allow fistulae to close. Successful catheter drainage of simple postoperative collections or localised abscesses can be achieved inrnover 90 per cent of cases. The cure rate for more complex collections such as pancreatic abscesses, abscesses caused by leak from enteric, biliary or urinaryrnanastomosis and thoracic empyaema is lower, between 70 and 85per cent. The multilocular nature of many of these collections makes complete evacuation difficult.rnHowever, in many patients percutaneous drainage achieves palliation and allows the patient to undergo delayed, elective, single-stage surgery in a more stablerncondition with a relatively clean operative bed.rnPercutaneous biliary proceduresrnDrainage of an obstructed biliary system is usually achieved by ERCP.Endoscopic cannulation of the ampulla allows the passage of guidewires and catheters, and thernmajority of strictures can be bypassed and stented by this approach. In gallstone obstruction of the common bile duct, endoscopic stone removal can be achievedrnfollowing sphincterotomy by basket retrieval, mechanical lithotripsy or balloon sweepage of the duct. A proportion of patients with obstructive jaundice is not suitable forrnthis endoscopic approach, because of previous gastric surgery, difficulties with cannulation of the ampulla or a tight stricture which cannot be negotiated from below Inrnthese patients, a percutaneous transhepatic approach is required. Percutaneous transhepatic cholangio-graphy involves puncture of an intrahepatic bile duct with a finernneedle from a right intercostal approach. Successful visualisation of the ducts is achieved in almost all patients with dilated ducts and over 85 per cent of patients withrnnondilated ducts.rnDilated systems require drainage to reduce the risk of sepsis and relieve jaundice. A peripheral duct with a direct line of approach to the common hepatic duct isrnchosen for cannulation. Teflon-coated hydrophilic guidewires are particularly useful in traversing even the tightest strictures. Subsequent management depends on thernnature of the obstruction demonstrated.

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Hello this is Prince Mahajan and i am working as the content writer in the medical company which is Medical Tourism To India.

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