Interventional radiology1
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Interventional radiology1

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Interventional radiology1 Interventional radiology1 Presentation Transcript

  • ULTRASOUND & CT
  • Puncture sitesAccess:•Meticulous guiding ultrasound exam. - Shortest skin-target distance - Avoid blood vessels, biliary tree, bowel - Use Doppler may be helpful - Once access decided: Test respiratory training (deep or shallow) with short apnea to simulatebiopsy momentAdvantages of US: - Real-time visualisation of the target. -Good visualisation of the access window. - Real-time progression of the needle with possible modification of the trajectory.
  • InterventionalUltrasound Always Avoid  AVOID IF POSSIBLE  Large vessels,  Bowel proximal organ vessels Liver  !Ureter  Distal vessels  Gallbladder  Parenchymatous organs:kidney, spleen, pancreas
  • CONDITIONS OF REALISATIONOne day Hospitalization(Outpqtient (if cooperative, family at home, classical techniqueFastingClinical and imaging dataplatelets >150 000 -PT >70 %s -TCA < 2x Normal -.Stop anticoagulant TTT 8 days beforeSedation - anxiolytic 2 hours before!!No sleeping patient
  • ULTRASOUND (.Cleaning of probe, keyboard and cable (protocol Select probe and application depending on procedure  (Try to choose sectorial view if linear probe is used)  
  • INTERVENTIONAL PROCEDURE Skin antispetic measures by technician according to protocol Patient covered with sterile field Sterile material on sterile table Cover the US probe with sterile protection
  • INTERVENTIONAL PROCEDURE (Local Anesthesia (10 à 20 cc Lidocaïne 1%  IM or LP needle according to depth of the target Evaluation of the trajectory- !Take care of air in the syringe- If liver biopsy go to capsule - (Needle guide (US/TDM  anesthesia (Skin deep incision with scalpel axis //ribs (intercostal artery 
  • GUIDANCE METHODBiopsy Kit : Adaptable systeme on the probe: visualization of target andneedle trajectory“ Free-hand” Technique : Probe is positioned at the entry point with needle along axis ofUS beam allowing visualisation of the whole length of the trajectory(abdominal). Always visualize your entry path with real-time needle progression
  • GUIDANCE METHOD Always prefer Free-hand technique  possibility of orientation adjustment at last minute and angle of skin penetration. Once capsule is traversed no more adjustment possible: withdraw and redress your angle Needle aligned in the axis of US  beam to visualize its swhole length If you loose trajectory move probe 1  or 2 degrees/ needle then scree with probe in Doppler mode to search needle
  • GUIDANCE METHOD Always prefer Free-hand  technique Needle aligned in the axis of US  beam to visualize its swhole length If you loose trajectory move probe 1  or 2 degrees/ needle then scree with probe in Doppler mode to search needle
  • Interventional Ultrasound Lateral decubitus Intercostal approach! Scalpel Orientation when doing skin incision
  • NeedlesMany varietiesDifferent sizes, calibers, form, shape and nature of the procedure• Cytology : Chiba needle, Franseen• Histology : Bard needle
  • NeedlesMany varieties
  • Interventional Ultrasound ’If solid mass : biopsy 18/16 G ‘True cut  If cystic mass : initial Fine Needle Aspiration  (FNA)-Don’t empty-wall biopsy If possible do microbiopsy (histology) of the  wall
  • Co-axial’ Technique‘types : co-axial - tandem 2 Coaxial : 1 large bore needle (19G) in contact with the lesion ; multiple samples taken with smaller and longer needle inserted(within it (20GAdvantage : One puncture with multiple samples (<hemorragic( risk but only one directionTandem : 1 needle in the lesion ; biopsy needle parallel Advantage : trajectory already done and multiple directions ofbiopsy
  • Interventional UltrasoundAutomatic needle: one action movement Progression with needle tip visualisation during apneaAdjust needle length If gun is used consider length of specimen((wall/necrosis Specimens 3 Change needle (FNA / microbiopsy) depending on tissue obtained •Biopsy of normal liver also
  • Liver Increased hemorragic risk if hemangioma puncture  Fill the needle track with Gelfoam 
  • Interventional UltrasoundPossible puncture of distal portal or hepatic branches .Biopsy subcapsular lesion by penetration through normal liver Use respiration to move the diaphragm and keep away the pleuram recess from the needle to get below it Coaxial Technique 
  • GUERIDON PRELEVEMENTSterile table  gauze 1 (ampoule of normal saline (moisten biopsy 1 bottle of Formol or wet gauze 1 If drainage : tubes of bacteriology for culture & sensitivity 
  • DEALING WITH SPECIMENS :BIOPSIES LIVER KIDNEY LYMPH NODES PANCREAS OR ABDOMINAL MASS(1st time : place on gauze then wet with normal saline (during puncture . 2nd time : Place in formol : FNA OR COLLECTION DRAINAGE .Aspiration with syringe then put aspirate in sterile tube for bacteriological studies 
  • COMPLICATIONSComplications are rare (0,008% à 0,03 %)-Vasovagal attackSevere complications- hemorrhage, arterio-veinous fistula, hematoma andpneumoperitoneum (liver)- Acute pancreatitis if normal pancreatic tissue- Metastatic seeding of the needle track.