Interventional Vascular Radiology Radiology.pdfDNB Radiology, Interventional Radiologist...
Transcript of Interventional Vascular Radiology Radiology.pdfDNB Radiology, Interventional Radiologist...
Interventional Vascular RadiologyImage Guided Surgery
Dr. Rahul S. ChivateDNB Radiology, Interventional Radiologist
Interventional radiology is being practiced since many years but newer advances has
taken this branch to a higher level where it has replaced many complex surgeries and is a
helping hand to surgeons and physicians. Most of the procedures are performed in local
anesthesia with negligible duration of hospital stay.
Dr. Chivate is an Interventional radiologist trained in Tata Memorial Hospital, Mumbai
which is one of the largest referral centre for Oncology in Asia and has also been faculty
of the Interventional Radiology department for more than 2 years. He has also been to
Charite' Hospital, Berlin, Germany for traineeship to learn complex endovascular
procedures and is known to perform challenging Vascular and Non Vascular
Interventions. Having worked in a largest cancer institute he is well versed with
Oncology protocols and Onco Interventions. He also has expertise in Pediatric Vascular
and Non Vascular Interventions.
Dr. Rahul has several national and international publications to his credits and has
conducted workshops and has been invited as faculty in numerous national
conferences.
He is currently heading the Research and Education department of Maharashtra Chapter
of Indian Society of Vascular and Interventional Radiology (ISVIR).
He is afliated with Indian Society of Vascular & Interventional Radiology (ISVIR),
Cardiovascular & Interventional Radiology Society of Europe (CIRSE), Society of
Interventional Oncology (SIO) and Asia Pacic Society of Cardiovascular & Interventional
Radiology (APSCVIR).
Interventional Radiology
New Modality of Treatment in your Area
Dr. Rahul S. ChivateInterventional Radiologist
Ex- Consultant Tata Memorial Hospital
Fellowship Charite' Hospital, Berlin, Germany
+91-9967672397
Image guided Biopsy, FNAC and Drainage catheterization:
Left Para Aortic lymphnode biopsy under CT guidance.(a & b) Transoral approach- (a) Lytic lesion in the body of C2 vertebra, (b) Fluoroscopy guided biopsy from the body of C2 vertebra through transoral approach.
Pig Tail Catheter Drainage for uid collection:
Tumour HistopathologyAbscess/ Fluid collection drainage
USG and CT guided biopsy
Trans Jugular biopsies- Liver, KidneyBone biopsies
34 Y/ M, k/c/o Ca rectum post operative status developed collection/ abscess in the pre-sacral region. Transgluteal approach for drainage.
K/C/O Cholangiocarcinoma post operative status collection in the right paravertebral region. Pigtail catheter inserted for drainage.
Vertebroplasty/ Kyphoplasty:Osteoporotic vertebra- Back pain, Post- traumatic collapse compressionHemangiomaVertebral tumours causing collapse of vertebra
Percutaneous Biliary Duct Drainage and Stenting:
Obstructive jaundice
Cholangiocarcinoma/ Carcinoma Gall Bladder/ Pancreatic Head carcinoma
Cement Instillation into collapsed vertebral body for stability, weight bearing and pain relief.
Radio Frequency Ablation of Bile duct tumours
Stenting of Biliary Tract
Image Guided Surgery
Opacication of dilated biliary radicals with contrast.Stent placement to relieve obstruction.
(a) (b)
Interventional radiology is being practiced since many years but newer advances has
taken this branch to a higher level where it has replaced many complex surgeries and is a
helping hand to surgeons and physicians. Most of the procedures are performed in local
anesthesia with negligible duration of hospital stay.
Dr. Chivate is an Interventional radiologist trained in Tata Memorial Hospital, Mumbai
which is one of the largest referral centre for Oncology in Asia and has also been faculty
of the Interventional Radiology department for more than 2 years. He has also been to
Charite' Hospital, Berlin, Germany for traineeship to learn complex endovascular
procedures and is known to perform challenging Vascular and Non Vascular
Interventions. Having worked in a largest cancer institute he is well versed with
Oncology protocols and Onco Interventions. He also has expertise in Pediatric Vascular
and Non Vascular Interventions.
Dr. Rahul has several national and international publications to his credits and has
conducted workshops and has been invited as faculty in numerous national
conferences.
He is currently heading the Research and Education department of Maharashtra Chapter
of Indian Society of Vascular and Interventional Radiology (ISVIR).
He is afliated with Indian Society of Vascular & Interventional Radiology (ISVIR),
Cardiovascular & Interventional Radiology Society of Europe (CIRSE), Society of
Interventional Oncology (SIO) and Asia Pacic Society of Cardiovascular & Interventional
Radiology (APSCVIR).
Interventional Radiology
New Modality of Treatment in your Area
Dr. Rahul S. ChivateInterventional Radiologist
Ex- Consultant Tata Memorial Hospital
Fellowship Charite' Hospital, Berlin, Germany
+91-9967672397
Image guided Biopsy, FNAC and Drainage catheterization:
Left Para Aortic lymphnode biopsy under CT guidance.(a & b) Transoral approach- (a) Lytic lesion in the body of C2 vertebra, (b) Fluoroscopy guided biopsy from the body of C2 vertebra through transoral approach.
Pig Tail Catheter Drainage for uid collection:
Tumour HistopathologyAbscess/ Fluid collection drainage
USG and CT guided biopsy
Trans Jugular biopsies- Liver, KidneyBone biopsies
34 Y/ M, k/c/o Ca rectum post operative status developed collection/ abscess in the pre-sacral region. Transgluteal approach for drainage.
K/C/O Cholangiocarcinoma post operative status collection in the right paravertebral region. Pigtail catheter inserted for drainage.
Vertebroplasty/ Kyphoplasty:Osteoporotic vertebra- Back pain, Post- traumatic collapse compressionHemangiomaVertebral tumours causing collapse of vertebra
Percutaneous Biliary Duct Drainage and Stenting:
Obstructive jaundice
Cholangiocarcinoma/ Carcinoma Gall Bladder/ Pancreatic Head carcinoma
Cement Instillation into collapsed vertebral body for stability, weight bearing and pain relief.
Radio Frequency Ablation of Bile duct tumours
Stenting of Biliary Tract
Image Guided Surgery
Opacication of dilated biliary radicals with contrast.Stent placement to relieve obstruction.
(a) (b)
Patient having varicose veins treated with laser. Follow up after 3months show complete disappearance of varicosities.
Varicose Veins: EVLT- Endo VenousLaser Therapy:
Done under local anaesthesiaDay care Cosmetic care
Accelerates healing of ulcersPrevents Deep venous thrombosisPrevents bleeding
Esophageal mass invading trachea causing airway narrowing. Plasty and Stenting done. Post stenting CT scan shows patency of tracheal lumen.
Tracheo Bronchial Interventions:
Invasive esophageal cancer
Inoperable tracheal cancer
Maintenance of airway- Palliative Care
Thrombus Management:
IVC Filter placement
Case of Superior Vena Cava Syndrome-Non opacication of right subclavian vein and superior vena cava. Post Thrombectomy, Thrombolysis, Plasty and Stenting patency of SVC and subclavian vein regained.
Catheter directed thrombolysis and thrombectomy of right lower limb vein(femoral vein).Pre and Post thrombolysis images of deep vein thrombosis (DVT).
Stenting
Thromboysis/ Thrombectomy
IVC Filter placement
Radio Frequency Ablation of tumors:
Metastases from operated c/o Ca Rectum showing uptake on FDG PET CT in liver. Post ablation disappearance of uptake- Complete Ablation
Chondroblastoma in epiphysis of tibia showing uptake on PET CT. Post ablation complete disappearance of activity.
Liver tumours- Primary and metastatic
Lung metastases
Bone tumours- Osteoid Osteoma,Osteoblatoma, Chondroblastoma
Soft tissue tumours- Fibromatosis
Can be done simultaneously withchemotherapy
Day care procedure
C/O Osteiod Osteoma Diaphysis of tibia. X ray and contrast MRI done to conrm diagnosis. Pre and post ablation scan shows good
response. Immidiate post- procedure drop in Pain score from 7 to 3.
Renal (kidney) tumour treated using Radio Frequency Ablation.
Right lung tumour underwent radio frequency ablation. Post- ablation cavitation is seen.
PostPre
Patient having varicose veins treated with laser. Follow up after 3months show complete disappearance of varicosities.
Varicose Veins: EVLT- Endo VenousLaser Therapy:
Done under local anaesthesiaDay care Cosmetic care
Accelerates healing of ulcersPrevents Deep venous thrombosisPrevents bleeding
Esophageal mass invading trachea causing airway narrowing. Plasty and Stenting done. Post stenting CT scan shows patency of tracheal lumen.
Tracheo Bronchial Interventions:
Invasive esophageal cancer
Inoperable tracheal cancer
Maintenance of airway- Palliative Care
Thrombus Management:
IVC Filter placement
Case of Superior Vena Cava Syndrome-Non opacication of right subclavian vein and superior vena cava. Post Thrombectomy, Thrombolysis, Plasty and Stenting patency of SVC and subclavian vein regained.
Catheter directed thrombolysis and thrombectomy of right lower limb vein(femoral vein).Pre and Post thrombolysis images of deep vein thrombosis (DVT).
Stenting
Thromboysis/ Thrombectomy
IVC Filter placement
Radio Frequency Ablation of tumors:
Metastases from operated c/o Ca Rectum showing uptake on FDG PET CT in liver. Post ablation disappearance of uptake- Complete Ablation
Chondroblastoma in epiphysis of tibia showing uptake on PET CT. Post ablation complete disappearance of activity.
Liver tumours- Primary and metastatic
Lung metastases
Bone tumours- Osteoid Osteoma,Osteoblatoma, Chondroblastoma
Soft tissue tumours- Fibromatosis
Can be done simultaneously withchemotherapy
Day care procedure
C/O Osteiod Osteoma Diaphysis of tibia. X ray and contrast MRI done to conrm diagnosis. Pre and post ablation scan shows good
response. Immidiate post- procedure drop in Pain score from 7 to 3.
Renal (kidney) tumour treated using Radio Frequency Ablation.
Right lung tumour underwent radio frequency ablation. Post- ablation cavitation is seen.
PostPre
Vascular Access :
Jugular catheter placement.
Bleeder Management :
Common hepatic artery pseudo-aneurysm treated with stent graft and glue embolization maintaining hepatic arterial supply.
Pre operative embolizationof tumours :
Tumour in region of right maxillary sinus with signicant tumour blushon angiography. Post embolization of tumour shows complete absence of tumour blush.
Intra Arterial (Chemo Embolization) Treatment of liver tumours
Chemo/Radio embolization :
Liver cancers- Hepatocellular carcinoma, Cholangiocarcinoma
Liver Metastases- Colorectal (Bowel),Neuro endocrine.
Vascular tumours
Decreases intra operative blood loss
Less morbidity and mortality
Non operable tumours embolized for pain
relief
Urinary bleeders- Hematuria from kidney or urinary bladder
Head and Neck- Oral bleeding/ Epistaxis
Bronchial Artery Embolization- Hemoptysis
GI bleeders- Hematemesis/ Malena/ Hematochezia
Port insertion
Dialysis access
PICC line
Central Venous line access
Graphical representation of TIPS procedure along with radiological image showing stent placement to reduceportal hypertension.
Portal Hypertension Management:
Vascular MalformationManagement :
Case of Supra clavicular hemangioma. Post 2 sessions of sclerotherapy shows near complete resolution of the mass.
Arterio- venous malformation, hemangioma, Lympho- venous malformation.
Sclerotherapy Embolization
TIPS- Transjugular Intra hepatic Porto- Systemic Shunt- Ascites, Esophageal varices (Bleeding).
BRTO- Balloon Retrograde Transvenous Obliteration-Gastric Varices, Left sided portal hypertension.
Peripheral Vascular Disease :
Supercial femoral artery ow regained by angioplasty and stenting.
Atherosclerotic Arterial disease Gangrene and Wounds
Portal Vein Embolization
2 yeard old child with right lobe hepatoblastoma and inadequate volume of left hepatic lobe treated with Trans Arterial Chemo Embolization and Portal Vein Embolization. Signicant increase in volume of left hepatic lobe post therapy.
Portal vein embolization- for contralateral liver hypertrophy- To increase future liver remnant.
Vascular Procedures Onco Interventions
Chemo Embolization- Hepatocellular Carcinoma, Colo
rectal hepatic metastases
Bland Embolization- Neuro endocrine hepatic metastases
Radio Embolization- Hepatocellular carcinoma, Colorectal
hepatic metastases, Cholangiocarcinoma
Pre operative embolization- of vascular tumours helps in
reducing intra operative blood loss further achieving good
surgical margin.
Tumour Ablation- Radio Frequency/ Microwave :
Hepatic- Hepato cellular carcinoma, Neuro endocrine
tumours, Metastases
Lung- Primary and metastases
Bone- Osteoid Osteoma, Chondroblastoma, Osteoblastoma,
Metastases
Renal tumours
Adrenal Lesions
Soft tissue tumours- Fibromatosis
Vascular Access :
Jugular catheter placement.
Bleeder Management :
Common hepatic artery pseudo-aneurysm treated with stent graft and glue embolization maintaining hepatic arterial supply.
Pre operative embolizationof tumours :
Tumour in region of right maxillary sinus with signicant tumour blushon angiography. Post embolization of tumour shows complete absence of tumour blush.
Intra Arterial (Chemo Embolization) Treatment of liver tumours
Chemo/Radio embolization :
Liver cancers- Hepatocellular carcinoma, Cholangiocarcinoma
Liver Metastases- Colorectal (Bowel),Neuro endocrine.
Vascular tumours
Decreases intra operative blood loss
Less morbidity and mortality
Non operable tumours embolized for pain
relief
Urinary bleeders- Hematuria from kidney or urinary bladder
Head and Neck- Oral bleeding/ Epistaxis
Bronchial Artery Embolization- Hemoptysis
GI bleeders- Hematemesis/ Malena/ Hematochezia
Port insertion
Dialysis access
PICC line
Central Venous line access
Graphical representation of TIPS procedure along with radiological image showing stent placement to reduceportal hypertension.
Portal Hypertension Management:
Vascular MalformationManagement :
Case of Supra clavicular hemangioma. Post 2 sessions of sclerotherapy shows near complete resolution of the mass.
Arterio- venous malformation, hemangioma, Lympho- venous malformation.
Sclerotherapy Embolization
TIPS- Transjugular Intra hepatic Porto- Systemic Shunt- Ascites, Esophageal varices (Bleeding).
BRTO- Balloon Retrograde Transvenous Obliteration-Gastric Varices, Left sided portal hypertension.
Peripheral Vascular Disease :
Supercial femoral artery ow regained by angioplasty and stenting.
Atherosclerotic Arterial disease Gangrene and Wounds
Portal Vein Embolization
2 yeard old child with right lobe hepatoblastoma and inadequate volume of left hepatic lobe treated with Trans Arterial Chemo Embolization and Portal Vein Embolization. Signicant increase in volume of left hepatic lobe post therapy.
Portal vein embolization- for contralateral liver hypertrophy- To increase future liver remnant.
Vascular Procedures Onco Interventions
Chemo Embolization- Hepatocellular Carcinoma, Colo
rectal hepatic metastases
Bland Embolization- Neuro endocrine hepatic metastases
Radio Embolization- Hepatocellular carcinoma, Colorectal
hepatic metastases, Cholangiocarcinoma
Pre operative embolization- of vascular tumours helps in
reducing intra operative blood loss further achieving good
surgical margin.
Tumour Ablation- Radio Frequency/ Microwave :
Hepatic- Hepato cellular carcinoma, Neuro endocrine
tumours, Metastases
Lung- Primary and metastases
Bone- Osteoid Osteoma, Chondroblastoma, Osteoblastoma,
Metastases
Renal tumours
Adrenal Lesions
Soft tissue tumours- Fibromatosis
Paediatric Intervention
Oncology Supportive Procedures :
Paracentesis/ Thoracocentesis
PICC line placement
Chemo port placement
Tunnelled catheter placement
Percutaneous Biliary Drainage and Stenting
Percutaneous Nephrostomy and DJ stenting
Combination of Interventions (Vascular + Non Vascular)
Intra Arterial Chemo Embolization + Ablation Therapy- Curative
Radio Frequency Ablation + Cementoplasty- Weight Bearing bony lesions- Palliation
Non Vascular
Tumour Ablation- Hepatic, Lung lesions. Fibromatosis
Biopsy
Fluid Aspiration and Drainage- Minimally
invasive technique using CT and ultrasound
Nephrostomy
Percutaneous Transhepatic Cholangiography
Vascular- Venous
Venography
Inferior Vena Cava- Plasty and Stenting
TIPS- Trans Jugular Porto Systemic Shunt
Central Venous Line Insertion
PICC line insertion
Vascular- Arterial
Hepatic tumour embolization- Hepatoblastoma
Bleeder Management- Ruptured tumours
Chemoinfusion- eg- Ophthalmic Artery
Chemoinfusion for Retinoblastoma
Pre operative embolization- Vascular tumours
like Juvenile Nasopharyngeal Angiobroma
Sclerotherapy- Vascular malformation
Angio embolization
Jeevan Jyot Hospital M. G. Road, Opp Shahu market, Near Naupada Police Station, Naupada, Thane west 400602. Cell +91- 9967672397Tel. 022-25380778, 022-25406465
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