1 / 67

Endovascular Interventions - Endovascular Therapy - Endovascular Angioplasty

Endovascular treatments are minimally invasive procedures that are done inside the blood vessels and can be used to treat peripheral arterial disease. Treatments like Anti Platelets, Anti-Diabetics, Statins, Promote Collaterals, etc.

drtejasdharia
Download Presentation

Endovascular Interventions - Endovascular Therapy - Endovascular Angioplasty

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Interventional Radiology ….A Paradigm Shift DR. TEJAS P. DHARIA VASCULAR & INTERVENTIONAL RADIOLOGIST AROGYANIDHI, BSES, CRITICARE(W & E), HOLY FAMILY,HOLY SPIRIT, NANAVATI MAX Endovascular Interventions ……Recent Advances

  2. INTERVENTIONAL RADIOLOGY MEDICAL MANAGEMENT SURGICAL MANAGEMENT 1950 BEGINNING OF MINIMALLY INVASIVE PROCEDURE Subfield of Radiology. Diagnostic and Therapeutic treatment Day care Procedures Local Anaesthesia

  3. Image Guided Interventions - USG/CT Guided FNAC/Biopsy/Pigtailed Catheter insertion - Radiofrequency Ablation Revascularisation Interventions - Peripheral Angiography/Angioplasty - Thrombectomy/Thrombolysis Venous Interventions - Varicose Veins Laser Ablation/Venaseal Injection - Deep Vein Thrombosis Neuro-Interventions - Stroke - Intracranial Aneurysm Coiling - Venous Sinus Thrombosis - AVM Glue Embolisation V & IR Procedures

  4. DIABETIC PATIENTS CALCIFICATION AND HARDENING OF ARTERIES LONG SEGMENT OCCLUSION AND STENOSIS HIGHER INCIDENCE OF SMALL DISTAL VESSEL DISEASE BILATERAL DISEASE- MILD TO MODERATE INJURY COULD END UP WITH LIMB LOSS Peripheral Vascular Disease LEG ATTACK

  5. TREATMENT OPTIONS MEDICAL ANTI PLATELETS ANTI-DIABETICS STATINS PROMOTE COLLATERALS etc • REVASCULARISATION IS THE KEY TO INCREASE THE FLOW • ANGIOPLASTY • STENTING • THROMBOLYSIS

  6. INCREASE BLOOD FLOW TO DOWNSTAGE THE DISEASE

  7. What’s New- CO2 ANGIOGRAPHY

  8. CO2 Angiography CARBON DIOXIDE (CO2) Safe and useful alternative contrast agent Only proven safe contrast agent in Renal Failure and Contrast allergy is highly soluble & has low viscosity displaces the blood and produces a NEGATIVE CONTRAST on DSA should not be used in thoracic aorta, coronary artery and cerebral circulation- Neurotoxicity and Cardiac Arrhythmias Eliminated by the lungs in a single pass

  9. CASE 58Yrs, Male Non HTN DM since 15 yrs ℅ Claudication…. Max Distance of 10mins On Doppler: severe atherosclerotic calcific changes in the Superficial femoral artery with monophasic flow in the Tibial arteries. On Investigations: CBC is normal but, S. Creat : 1.7. Referred for Angiography SOS Angioplasty.

  10. CO2 ANGIOGRAPHY

  11. WHY HAVE WE STARTED PERFORMING THESE PROCEDURES MARKED IMPROVEMENT IN STENT TECHNOLOGY Stent fractures are associated with restenosis and re-occlusions • DEVICES AVAILABLE FOR CROSSING DIFFICULT LESIONS • BETTER DRUGS

  12. NEWER OPTIONS DRUG ELUTING BALLOONS DRUG ELUTING STENTS PLAQUE EXCISION (ATHERECTOMY) BIODEGRADABLE STENTS

  13. 76 yr old lady Non healing ulcer at the left ankle

  14. Peripheral Venous Access a) PICC(Peripherally Inserted Central Catheter) Line b) Hemodialysis(Temporary/Permanent) Catheter Revascularisation Venous Interventions a) A-V Fistulas in CKD patients b) Central Venous Stenosis Deep Vein Thrombosis Varicose Veins VENOUS INTERVENTIONS

  15. PICC(Peripherally Inserted Central Catheter) Limited vascular access Administration of highly osmotic or caustic fluids or medications

  16. Used for intermediate to long term therapy May be single or double lumen Polyurethane/Silastic Inserted percutaneously Basalic vein Cephalic vein Threaded upto the superior vena cava PICC(Peripherally Inserted Central Catheter)

  17. Sterile Dressing Dressing acts as a bacterial shield and helps anchor cath Measure and document external length of PICC with each dressing change Unused ports must be flushed with Heparin solution and clamped PICC(Peripherally Inserted Central Catheter)

  18. DEEP VEIN THROMBOSIS • Risk Factors • Illness or injury that causes prolonged immobility • Age > 40 • Pregnancy, birth control pills and hormone replacement therapy • Cancer and its treatment • Major surgery (ex: abdomen, pelvis, hip facture, knee fracture, hip or knee replacement) • Obesity • Previous DVT or PE

  19. Presentation 50-year old woman who presents with complains of pain in her left calf, which has been present for a week. Venous Doppler Study: an extensive occlusive acute clot in the common femoral, superficial femoral, popliteal and tibial veins vein. What Next CASE

  20. In the Past Start treatment with LMWH as soon as possible and continue it for at least 5 days and then switch over to oral anticoagulants Standard of Treatment In addition to the LMWH, you should now consider IVC Filter Placement & Catheter-directed thrombolytic therapyfor her because she is otherwise well, has a normal life expectancy, has a low risk of bleeding and the DVT is of less than 14 days’ duration. so we plan for IVC Filter Placement Catheter Directed Thrombolysis(CDT)

  21. Temporary IVC Filter Placed to reduce the risk of Intraprocedure Pulmonary Embolism

  22. Pt turned prone and Left Popliteal Vein punctured under sono-guidance Multiple passes are made and the thrombus load aspirated

  23. Post Thrombo Aspiration A bolus of r-TPA or Urokinase is given An infusion of r-TPA is started at 1mg /hr from the popliteal sheath and of Heparin at 500 IU from the right femoral sheath. Pt shifted to the ICU for 24hrs and Check Venogram after 24 hrs

  24. Contra-Indications for CDT • Active Internal Bleeding • Any major surgery within 3 months • Head trauma within 3 months • Any known Intracranial abnormality • What’s New-

  25. ANGIOJET CATHETER

  26. AngioJet ™ has 2 components ULTRA console Combined Pump Set and Catheter (integrated, sterile, and packaged as one) 2015 BOSTON SCIENTIFIC CORPORATION OR ITS AFFILIATES. ALL RIGHTS RESERVED; PI 330901 AA JULY 2015

  27. AngioJet™ Catheter Mechanism of Action Jet tube shown inside AngioJet catheter tip Saline jets travel backwards at approximately half the speed of sound to create a low pressure zone.

  28. Pharmaco-mechanical Thrombectomy (PMT) PMT may be used to maximize and combine the advantages and minimize the risks and disadvantages of both Chemical Thrombolysisand Mechanical Thrombectomy1. Drug AngioJet™ + Thrombolytics = PMT + Devices to debulk the thrombus Potentially Lower doses of lytic

  29. AngioJet ™ is isovolumetric, which means unchanging volumes. Thus, the volume of saline that is delivered equals the fluid volume that is removed from the patient Saline escapes from the outflow window of the catheter and acts to loosen thrombus and push it toward the inflow windows The thrombus is captured through the inflow windows, fragmented within the AngioJet ™ catheter and evacuated through the catheter.

  30. Sequential venograms performed following thrombectomy passes

  31. Pharmaco-mechanical Thrombectomy (PMT) • Advantages • Safe and effective treatment • Reduction of the need for concomitant CDT • No ICU care required • Reduction of thrombolytic agent dose and infusion time • Reduction of the bleeding risk associated with CDT.

  32. HEPATOCELLULAR CARCINOMA- • Transarterial Chemoembolisation

  33. Varicocele Embolisation Uterine Fibroid Embolisation Prostatic Artery Embolisation Interventional Radiology ….A Paradigm Shift NEWER PROCEDURES

  34. VARICOCELE Dilatation and tortuosity of the pampiniform plexus and also of the testicular vein. Seen commonly in men aged 15-30yrs and rarely after 40 yrs. Occurs in 15-20% of all the males and 40% of all infertile males. Normal vessels of the plexus -0.5mm; --- More than 2mm-Varicocele

  35. VARICOCELE Seen commonly on the Left side Longer Enters at rigt angle to the renal vein Left Testicular artery arching over it Compressed between the aorta and SMA. A loaded Sigmoid colon.

  36. VARICOCELE- aetiology Primary/Idiopathic: due to Incompetent valves 98% occur on the left side Secondary: Pelvic or abdominal mass- RCC, RP Fibrosis/Adhesions Nutcracker’s Syndrome- SMA compressing the Left vein.

  37. VARICOCELE- Symptoms SYMPTOMS Swelling Dragging or aching pain in the groin ‘Bag Of Worms’ feelings Bow Sign- hold varicocele b/w thumb and fingers, pt is asked to bow- reduces in size Cough Impulse present Fertility problem

  38. VARICOCELE- Investigation Venous Doppler of the Scrotum and Groin - - -Standing/Valsalva Manouevre USG Abdomen- to look for any Kidney tumours Semen Analysis

  39. VARICOCELE- Indication for Surgery Palpable Varicocele Couple with documented Infertility Female has normal fertility or potentially correctable infertility Male Partner- one or more abnormal semen parameters or sperm function test In Adolescents-

  40. VARICOCELE- Treatment Varicocelectomy Microdissection Laproscopy What’s New

  41. Tiny metallic coils or other embolic agents introduced into the testicular vein under fluoroguidance(in Cathlab) Minimally Invasive Procedure No stitches needed Patient can go in 6hrs. Lower rates of complications Endovascular Coil Embolisation

  42. Varicocele Embolisation

  43. Varicocele Embolisation

  44. UTERINE ARTERY EMBOLISATION

  45. UTERINE FIBROID Most common tumour of the pelvis Benign tumour of uterine smooth muscle Fibroids are not considered to be precancerous Fibroids are linked to oestrogen > 50% women eventually develop fibroids 10-30% are symptomatic

  46. UTERINE FIBROID -Symptoms Heavy prolonged Menstrual Bleeding Pain Dyspareunia - painful intercourse Infertility or Miscarriage Pressure Symptoms - Frequent Urination or constipation - Constant urge to urinate

  47. UTERINE FIBROID -Diagnosis Clinical Examination USG Pelvis MRI Pelvis

More Related