Non-Vascular Interventional Procedures

What is a PBD?

percutaneous biliary drainage

Uses/Clinical indications: percutaneous biliary drainage (PBD)

• palliative procedure for unresectable malignant disease

• stone removal

• internal/external drainage

• dilation of obstructed bile duct

• biopsy

Steps: percutaneous biliary drainage (PBD)

1. small incision in skin of abdomen + thin needle passed through and advanced into bile duct using fluoro

2. contrast injected into bile duct

3. guidewire and catheter advanced into bile duct

4. drain inserted so bile can drain into 1 of 2 spaces

   1. externally

   2. internally into duodenum

What is a PAD?

percutaneous abdominal abscess drainage

Uses/clinical indications: percutaneous abdominal abscess drainage (PAD)

• when abd/pelvic abscesses cannot be readily treated with simple incision

• when abscess in safe area for needle entry

Steps: percutaneous abdominal abscess drainage (PAD)

1. abscess is located within chest/abdomen/pelvis

2. needle guided with CT, ultrasound, or fluoro

3. small drainage catheter is left in place to drain the fluid

Why/how is ultrasound significant for a percutaneous abdominal abscess drainage (PAD)?

U/S allows for continuous monitoring & preferred for:

• superficial abscesses

• abscesses in solid material

• abscesses not surrounded by bowel

What is the success rate for a percutaneous abdominal abscess drainage (PAD)?

80%

What interventional procedure is used to obtain cells/tissues from a lesion/organ for analysis/diagnosis?

percutaneous needle biopsy

What is a percutaneous needle biopsy?

procedure where needle is inserted into suspected lesion/organ to obtain cells/tissues for analysis/diagnosis

• for suspected primary/metastatic malignancy

What modalities can be used to guide a percutaneous needle biopsy?

U/S, CT, fluoro

When is U/S used for a percutaneous needle biopsy?

When the lesions/organs of interest are

• significantly different from adjacent structures

AND

• not surrounded by gas/fat/calfcified structures

When is CT used for a percutaneous needle biopsy?

Used for small deep lesions

• especially those surrounded by large vessels or bowel

When is fluoro used for a percutaneous needle biopsy?

Used for lesions with different radiopacity than surrounding tissues

• pulmonary pleura

• osseous lesions

• lymph nodes filled with contrast

What minimally invasive interventional procedure is used to treat neoplastic disease?

radiofrequency ablation (RFA)

What is radiofrequency ablation (RFA)?

Minimally invasive interventional procedure used to treat neoplastic disease

• uses sedation or general anesthesia

What specific kinds of neoplasms is radiofrequency ablation (RFA) used for?

Certain

• liver

• kidney

• bone

• lung

• soft tissue

tumors

Steps: radiofrequency ablation (RFA)

1. needle electrode placed into tumor

2. radiofrequency current passed through electrode

   1. agitates ions in tissues

   2. produces frictional heat

   3. heat destroys tumor tissue

   4. dead tumor cells become scar tissue that shrinks over time

What PTs are candidates for radiofrequency ablation (RFA)?

PTs with disease not suitable for surgery

Risks: radiofrequency ablation (RFA)

depends on the site treated

• hemorrhage (but the heat will cauterize small vessels thus reducing some risk)