Interventional Radiology in the Older Patient

Dr Stuart KerrConsultant Radiologist

Mid Yorkshire NHS Trust

Dr Charles T Dotter, 1964 Dr Alfred Kratochwil, 1969

Subspecialisation

• coronary → Cardiology• neurological• peripheral vascular• non-vascular

Vascular Intervention

• diagnostic angiogram• angioplasty +/- stent for arterial stenosis• stent graft for aortic aneurysm/dissection• embolisation• IVC filter• SVC stent• Hickman / PICC lines

GI haemorrhage

• Endoscopy first• If negative, diagnostic CT angiogram

- DON’T DELAY!• Low threshold for speaking to Interventional

Radiologist

PICC line

chemotherapy

antibiotics

total parenteral nutrition

Non-vascular Intervention

Ultrasound v CT

• real-time visualisation• portable• quick• no radiation• frees up CT scanner

US-guided biopsy

Cholecystostomy

• indications- severe acute cholecystitis- not improving after 48 hours- gall bladder perforation

• tubogram at 6 weeks• ? percutaneous biliary stent

Percutaneous Transhepatic Cholangiography

Oesophageal stent

Pyloroduodenal stent

Colonic stent

Radiologically Inserted Gastrostomy (RIG)

Nephrostomy

Tumour ablation

• radiofrequency (RFA)• cryotherapy• microwave• chemical• transarterial embolisation /

chemoembolisation (TACE)

J Hepatol 2012;57:794

When things go wrong…..

Consent

Thank you