Vascular Interventional Imaging Procedures

What are the benefits of interventional imaging procedures?

• less invasive and cheaper than traditional medical/surgical procedures

• shorter hospital stays/recovery time

• alternative for non-surgical candidates

What minimally invasive procedure opens blocked/stenosed arteries allowing unobstructed blood flow to the heart/organ?

Percutaneous transluminal angioplasty (PTA) & stent placement

Risks: percutaneous transluminal angioplasty (PTA) & stent placement

• vessel rupture/perforation

• embolus

• stent thrombosis

• vessel occlusion/dissection

Steps: percutaneous transluminal angioplasty (PTA) & stent placement

1. catheter advanced into vessel

2. hemodynamic pressures recorded proximally/distally to area of stenosis

3. angiogram to assess extent of blockage

4. angiogram after blockage is cleared

5. hemodynamic pressure measured to ensure vessel is patent

What interventional procedure is used to dissolve a blood clot?

Thrombolysis

Steps: thrombolysis

1. guidewire and catheter advanced through clot or as far into the clot as possible

2. clot busting drug / dissolving agent injected into the clot

How long does it take for a thrombus to dissolve after thrombolysis?

It may take several hours or days for the thrombus to fully dissolve depending its size and location

Complications: thrombolysis

• bleeding

• partially dissolved clot dislodges and blocks other vessel(s)

What device may be implanted in a PT to trap a pulmonary embolism?

IVC filter

Clinical indications: IVC filter

• Hx of recurrent PEs

• PTs with pelvic & lower extremity FXs post trauma

  • Risk of developing PE

Where would an IVC filter be placed and why?

Just inferior to the renal veins to avoid obstructing them

What are some risks involved with an IVC filter?

• infection

• bleeding

• filter dislodging and migrating into heart or lungs

• clogging/occluding of the filter over time

What interventional procedure uses an angiographic approach to create an embolus?

Transcatheter embolization

What is transcatheter embolization?

Interventional procedure using angiography to create an embolus

Purpose: transcatheter embolization

• control/prevent hemorrhage/bleeding before/after surgical procedures

• reduce blood flow to a tumor

• treat an aneurysm

What are the 3 types of transcatheter embolization MRTs may see?

• uterine fibroid embolization

• chemoembolization

• intracranial endovascular coil embolization

What is uterine fibroid embolization for and how is it performed?

• shrink fibroid tumors

• potentially prevent need for hysterectomy

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the uterine artery is embolized

What is chemoembolization for and how is it performed?

• treat hepatic malignancies

• alternative to riskier surgical interventions

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chemotherapy agents are injected into the tumor vasculature

What is intracranial endovascular coil embolization and how is it performed?

• used to occlude aneurysms in the head/neck

• alternative therapy to high risk procedures

---

microcatheters and detachable coils are used to occlude the aneurysm

What 3 embolic agents are used in transcatheter embolization?

• chemical agent

• heat

• coil device

What procedure serves as a form of Tx for an abdominal aortic aneurysm (AAA) and other traumatic vascular injuries?

Endovascular stent graft

(AKA endovascular aneurysm repair)

What is an endovascular stent graft?

Form of TX for abdominal aortic aneurysm (AAA) reinforcing the wall to prevent rupture

Clinical indications: endovascular stent graft

• abdominal aortic aneurysm (AAA)

• traumatic vascular injuries

• therapeutic option for non-surgical candidates

• lower risk options for surgical candidate PTs

What teams are involved in an endovascular stent graft procedure?

• vascular surgical teams

• interventional radiology teams

Steps: endovascular stent graft

1. angiographic cut-down (small cut in skin to expose and isolate a blood vessel)

2. fluoro used to advance catheter to site of aneurysm

3. stent is delivered

4. stent graft expands, attaches, and anchors to vessel wall

Complications: endovascular stent graft

• leakage of stent graft

• migration of device

• potential rupture of vessel