Transcript VASCULAR INTERVENTIONAL RADIOLOGY VASCULAR INTERVENTIONAL RADIOLOGY • Used as therapy of choice for the ff: – Embolization of arteriovenous fistulas (AVFs) – Ablation of renal.

VASCULAR INTERVENTIONAL
RADIOLOGY
VASCULAR INTERVENTIONAL
RADIOLOGY
• Used as therapy of choice for the ff:
– Embolization of arteriovenous fistulas (AVFs)
– Ablation of renal function
– Treatment of testicular vein and ovarian vein
varices
– Treatment of high-flow priaprism
TRANSCATHETER EMBOLIZATION
•
Embolization is the interventional
radiological procedure (performed by an
interventional radiologist) in which abnormal
vessels are closed off with various
substances (e.g., alcohol, glue, coil).
•
Embolization is a way of occluding (closing)
one or more blood vessels that are doing
more harm than good. Various materials may
be used, depending on whether vessel
occlusion is to be temporary or permanent,
or whether large or small vessels are being
treated.
TRANSCATHETER EMBOLIZATION
• Renal Arteriovenous Fistulas and Malformations
• Bleeding Sites
• Tumors
• Ablation of Renal Function
• Embolization of Primary Varicocele
• Treatment of High Flow Priapism
Renal Arteriovenous Fistulas and
Malformations
• Transcatheter embolization is the treatment of choice
• May be congenital, spontaneous, acquired
• Iatrogenic AVFs
– Type most commonly treated
– Occur as complications of other procedures (percutaneous
renal biopsy, nephrostomy placement, pyelolithotomy)
Renal Arteriovenous Fistulas and
Malformations
• Classical angiographic finding of spontaneous or acquired AVF:
– feeding artery with an early draining vein
• Ancillary findings:
– pseudoaneurysm and extravasation of contrast material
• Congenital AVFs (AV malformation):
– group of multiple coiled communicating vessels that may
be associated with enlarged feeding arteries and draining
veins
Renal Arteriovenous Fistulas and
Malformations
• Clinical Manifestation
– Hematuria
– Retroperitoneal or intraperitoneal hemorrhage
– Congestive heart failure, cardiomegaly or both
– Hypertension
– Bruit
• Duplex Doppler- most useful diagnostic
before angiographic intervention
procedure
Renal Arteriovenous Fistulas and
Malformations
Pre-embolization
Post-embolization
Bleeding Sites
• Transcatheter embolization plays a role in the
management of hemorrhage originating in the
kidney, ureter,, bladder and pelvis
• Uses Gelfoams or coils
Gelfoam Slurry Preparation: First step is to cut the gelfoam into small pieces. Small pieces
are then placed into a syringe and mixed with small amount of contrast solution utilizing a
three-way stopcock. The obtained embolization material should be injected very carefully
under fluoroscopic guidance using appropriate embolization materials (catheters, syringes
etc.)
Metal coils. Occlusion occurs as a result of coil-induced thrombosis rather than
mechanical occlusion of the lumen by the coil. To increase the thrombogenic effect,
Dacron wool tails are attached to coils. The coils are available in many sizes and may
be delivered through commonly used angiographic catheters
Tumors
A. Renal Cell Carcinoma
•
Transcatheter embolization is used as an adjunct
to surgery
– To reduce intraoperative hemorrhage
– Allows immediate ligation of the renal vein
•
Palliation of nonresectable disease thatcauses
pain and hematuria can be achieved by
transcatheter embolization
Tumors
•
Gelfoam pledgets are used for preoperative embolization
•
Postembolization Syndrome (PES)- occurs hours after the
procedure and may persist for days and is due to tissue
necrosis caused by embolization
– Severe pain
- Fever
– Nausea
- Leukocytosis
– Vomiting
•
Severity of PES is related to the quantity of infarcted tissue
Tumors
B. Angiomyolipoma
•
Selective embolization- effective method of
controlling hemorrhage from benign renal
lesions while preserving normal
parenchyma
•
CT scan- identify the fat component of the
tumor; used before embolization and for
follow-up
Tumors
• Ethanol- mixed with ionized oil then injected
into the catheter to produce permanent
occlusion of the vascular bed
• Ionized oil- radiopaque and is useful for
visualizing the flow of the embolic material
during embolization
Ablation of Renal Function
• Total renal infarction using transcatheter
embolization is indicated in the ff:
– Abolition of urine production to assist in healing or
palliation of patients with urinary fistulas
– Prevention of excessive proteinuria
– Management of uncontrollable hypertension
– Obstructive uropathy in patients who are poor surgical
candidates
Ablation of Renal Function
• Total renal ablation must be achieved so that perfusion of
surviving parenchyma via pericapsular branches cannot
occur
• Ethanol- embolic agent of choice
• PES may also occur managed with antibiotics and
analgesics
• Complication: embolization of adrenal artery
– Avoided by using the occlusion balloon technique
Embolization of Primary Varicocele
• Most varicoceles are left-sided
• Color Doppler sonography is done before embolization
• Equally effective comparing it to surgery
• Performed with conscious intravenous sedation and
local anesthesia
• Transjugular venous approach- preferred by physicians
Embolization of Primary Varicocele
• Embolization is achieved by placing coils within the
gonadal vein commencing at the region of the inguinal
ligament and continuing toward the renal vein until the
gonadal vein and collateral vessels are occluded
• 4% recurrence of varicocele after embolization
• Minor complications: contrast extravasation, nontarget
embolization, venospasm, hematoma
Treatment of High-Flow Priapism
• A condition resulting from increased arterial flow into the
lacunar spaces of the cavernous tissue
• Color Doppler sonography demonstrates the abnormality
• Nonselective transfemoral pelvic angiogram is performed to
demonstrate the fistula, which originates from the pudendal
artery
• Followed by superselective catheterization of the injured artery
using microcatheter
• Fistula is closed by deploying microcoils
RENAL ARTERY ANGIOPLASTY AND
STENTING
• Ischemic nephropathy due to atherosclerotic vascular disease
and renal artery stenosis - leading cause of progressive renal
failure
• Renal artery stenosis – most common cause of secondary
hypertension
– Ostial stenosis: within 3mm of the aortic lumen and is
typical of atherosclerotic vascular disease
– Non-ostial stenosis: seen in fibromuscular dysplsia
– Branch vessel stenosis: seen in fibromuscular dysplsia
RENAL ARTERY ANGIOPLASTY AND
STENTING
RENAL ARTERY ANGIOPLASTY AND
STENTING