Interventional Vascular Radiology Radiology.pdfDNB Radiology, Interventional Radiologist...

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Interventional Vascular Radiology Image Guided Surgery Dr. Rahul S. Chivate DNB 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

[email protected]

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

[email protected]

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

[email protected]

Nirman Diagnostic CentreStPushpachandra 1 Floor, Next to NC High School, S.V. Road

Malad- West Mumbai- 400 O64 Tel:O22- 28081815, 022- 28643903

Nirman Diagnostic Centre (HITECH)Poddar Road, Malad- East Mumbai- 400 097 Tel: 022- 28445600 / 5610 / 5611