Common Non-Vascular Interventional Procedures

Common Non-Vascular Interventional Procedures

Percutaneous Nephrostomy

  • Definition: A frequently performed interventional radiology (IR) procedure; considered the gold standard for treating obstructive uropathy.

  • Purposer flow is obstructed.: Creates an artificial opening in the kidney to allow urinary excretion when uruary

  • Urgency: Immediate drainage is essential in cases of infected obstruction to prevent renal loss and sepsis.

  • Skills Required: Important to understand renal anatomy and use ultrasound guidance effectively.

Indications for Nephrostomy

  • Renal tract obstruction (hydronephrosis)

  • Stone disease (with or without sepsis)

  • Malignancy (tumors)

  • Benign strictures

  • Cases of unknown cause

  • Note: Avoid performing unless necessary during after hours, especially for non-septic cases.

Contraindications

  • No absolute contraindications, but caution in:

    • Uncorrectable coagulopathy

    • Terminal illness

Hydronephrosis

  • Definition: Dilation of the renal pelvis and calyces resulting from urinary obstruction.

Nephrostomy Procedure

  • Positioning: Patient in prone or oblique prone position.

  • Process:

    1. Perform initial ultrasound for guidance.

    2. Use aseptic techniques and local anesthetic.

    3. Insert a sheathed needle under ultrasound guidance, followed by fluoroscopy.

  • Visualization: Use imaging to confirm needle placement within the kidney.

Complications of Nephrostomy

  • Severe hemorrhage: 1-3%

  • Pneumothorax: < 1%

  • Microscopic hematuria: common

  • Pain: common

  • Urine extravasation: < 2%

  • Death: 0.2%

  • Sepsis: 1%

Hysterosalpingogram (HSG)

  • Definition: A radiologic examination of the uterus and fallopian tubes using fluoroscopy.

Indications for HSG

  • Infertility (failure to conceive after 12 months)

  • Recurrent miscarriage

Contraindications

  • Pregnancy

  • Active pelvic infection

  • Recent surgery involving the uterus or tubes

HSG Technique

  • Perform during the 6th-12th day of the menstrual cycle in the proliferative phase.

  • Steps:

    1. Antiseptic cleaning and insertion of a speculum.

    2. Catheterization of the cervix.

    3. Injection of water-soluble iodinated contrast agent with imaging.

Detectable Pathologies via HSG

  • Uterine:

    • Congenital anomalies

    • Submucosal fibroids

    • Malignancies

    • Adhesions

    • Polyps

  • Tubal:

    • Polyps

    • Malignancies

    • Spasms

    • Hydrosalpinx

    • Benign nodular scarring (SIN)

Complications of HSG

  • Common:

    • Cramping

    • Blood spotting

  • Rare but serious:

    • Pelvic infection

    • Contrast reaction

    • Uterine or tubal perforation

Barium Swallow

  • Definition: A fluoroscopic study involving barium sulfate contrast to visualize the esophagus.

Indications for Barium Swallow

  • Dysphagia (difficulty swallowing)

  • Choking/coughing during swallowing

  • Prolonged intubation and cerebrovascular events

  • Surgery, trauma, or radiation treatments to the head and neck

Contraindications

  • Risk of aspiration of barium

  • Recent surgery

  • Consider using water-soluble contrast, e.g., videofluoroscopy.

Imaging Considerations for Barium Swallow

  • Use short exposure times and high kilovoltage to enhance image resolution and reduce motion blur.

  • Lateral views are useful for evaluating swallowing phases, while oblique views help visualize the pharyngeal opening.

Pathologies Identified via Barium Swallow

  • Diverticular diseases

  • Strictures

  • Tumors

  • Abnormal functions in swallowing processes

Oesophageal Stenting

  • Indications:

    • Obstructing esophageal carcinoma

    • Palliative treatment for dysphagia

    • Can be performed endoscopically or fluoroscopically for strictures anywhere from the cervical esophagus to gastroesophageal junction (GOJ).

Procedure for Oesophageal Stenting

  • Conducted under IV sedation, using a catheter introduced through the mouth into the esophagus.

  • A guidewire navigates the stricture, with a stent released and expanded at the target site.

Complications of Oesophageal Stenting

  • Early complications:

    • Inability to cross stricture/deploy stent: 1%

    • Aspiration: <5%

    • Oesophageal perforation: <1%

    • Significant hemorrhage: <1%

    • Pain: 5-15%

  • Late complications:

    • Stent migration: 4-10%

    • Overgrowth or ingrowth: 2-10%

    • Reflux: 3-30%