Education | Health Care | Research | Site Map

Radiology

Search:  

 

Interventional Radiology

Interventional Radiology Quick Links Arteriography Contrast Allergy Prep Outpatient Arteriography Arteriography Patient Workup Routine Pre-Arteriography Orders Abdominal Aortography Peripheral Arteriography Pulmonary Arteriography Renal Arteriography Thoracic Aortography Visceral Arteriography Lymphangiography Gastrointestinal Dilation Percutaneous Abscess Drainage Percutaneous Aspiration Biopsy Percutaneous Transhepatic Cholangiogram Percutaneous Biliary Drainage Percutaneous Cholecystostomy Percutaneous Gastrostomy And Gastrojejunostomy Tube Placement Hepatic Malignancy Chemoembolization Caval Filter Insertion Peripheral Vessels Stenting Visceral Vessels Stenting Artery & Vein Thrombolysis Transcatheter Embolization - Various Organs Transjugular Intrahepatic Portosystemic Shunt (TIPS) Venous Access Adrenal Venography Inferior Vena Cavography Percutaneous Transhepatic Portography Superior Vena Cavography Upper Extremity Venography Visceral Venography

 

PRE PROCEDURAL PREPARATION FOR CONTRAST ALLERGY

 

Steroid preparation: prednisone 40mg PO given 12 and 2 hours prior to contrast use.

Back to Top

OUTPATIENT ARTERIOGRAPHY

 

Pre procedural evaluation includes a brief medical history, significant PMH, allergies, prior surgical procedures, current medications. Outpatient arteriography is not appropriate for patients with uncontrolled hypertension, azotemia, symptomatic cardiopulmonary failure, anticoagulation or insulin dependent diabetics. Pre procedural labs should include: CBC including platelets, PT/INR/Cr.

Following diagnostic arteriography, patients must undergo a 6-hour observation interval with strict bedrest to avoid complications related to the puncture site. The patients may the be discharged under the supervision of an adult companion with limited activity with respect to the limb puncture site for the remainder of the day with encouraged PO intake. Patient may NOT leave alone.

Back to Top

ARTERIOGRAPHY PATIENT WORKUP

 

Inpatients will be seen the afternoon or evening before any procedure with a complete review of the chart, laboratory data, and previous X-ray examinations, with an emphasis on hemostasis, and allergic reactions. The patient will be briefly interviewed and the study explained with an emphasis on possible complications. The pulses are also checked and marked. The informed consent form is signed and witnessed, as well as a pre procedure note made in the progress sheets of the chart stating that the procedure and complications have been explained to the patient.

Back to Top

ROUTINE PRE-ARTERIOGRAPHY ORDERS

 

1. NPO after midnight.



2. Continue all PO meds (especially antihypertensive regimens).



3. Diabetic patient management: usually insulin doses are halved and oral hypoglycemics discontinued, but in each individual case, this should be determined by the patient's attending physician or the appropriate consultants. These examinations should be scheduled early the following day with monitoring of blood glucose and a resumption of food intake by midday.



4. IV: e.g., 18-gauge heplock in place. Hydration with 1/2 NSS or NSS @ 100cc/hr.



5. Labs: CBC including platelets, BUN/Cr, PT/PTT should be recorded on the chart prior to study.



6. Premedications should be individually tailored to the patient’s needs following discussion with an IR. Prior contrast reactions (e.g., hypotension, bronchospasm, urticaria, angioedema, cardiovascular collapse) mandate preparation with a course of steroids if the examination is to be performed.



7. Consult with the IR and attending/referring physician regarding need for anticoagulation pre procedurally. Heparin will usually be discontinued on call or up to 4 hours prior to arterial puncture; however, some patients require that anticoagulation be continued throughout the proposed diagnostic exam or interventional procedure. Patients on oral anticoagulation (Coumadin) may need to discontinue oral anticoagulant therapy several days prior to arterial puncture, if possible. Persistently elevated PT may require FFP or Vitamin K injections to correct a coagulopathy. Thrombocytopenia: for transbrachial or femoral arterial puncture, platelets should be greater than 50k.



8. Patients at risk for contrast induced ATN (e.g. elevated creatine +/- DM) must receive proper pre procedural and post procedural hydration to minimize the risk of contrast-induced nephropathy.

Back to Top

ABDOMINAL AORTOGRAPHY

 

Description:

A catheter is introduced through a femoral artery by Seldinger technique and positioned at the appropriate level in the aorta. Contrast is injected and imaging is performed.

Indications:

1. Suspected renaovascular hypertension.



2. Peripheral vascular disease (films are also taken of the pelvis and legs).



3. Retroperitoneal or pelvic trauma.

Preparation:

See section "Patient Preparation for IR".

Complications:

1. Cholesterol embolization.



2. Contrast reaction, dissection, embolization.



3. Also see Section "Complications of Arteriography".

Back to Top

PERIPHERAL ARTERIOGRAPHY

 

Description:

A catheter is placed in the artery proximal to the extremity being studied. Contrast is injected while imaging is performed of the extremity distal to the injection.

Indications

1. Peripheral vascular disease.
   
   
2. Trauma with suspected arterial injury.
   
   
3. Evaluation of blood supply of a soft tissue or bone tumor.
   
   
4. Evaluation of vasospastic or collagen vascular disease.
   
   
5. Suspected embolus.

Preparation:

See Section "Patient Preparation for Arteriography"

Complications:

See section "Complications of Arteriography"

Back to Top

PULMONARY ARTERIOGRAPHY

 

Description:

A catheter is introduced through the femoral vein and the inferior vena cava into the heart and through the heart into a main pulmonary artery. Several injections are then made into each pulmonary artery until a clot is demonstrated or the arteries are shown to be normal.

Indications:

1. Suspected pulmonary embolus in the setting of strong clinical suspicion or with abnormal ventilation/perfusion scan, prior to IVC filter placement if DVT or renal vein thrombosis could not be documented.
   
   
2. Evaluation of congenital abnormality (e.g. PAVM).
   
   
3. Evaluation of chronic pulmonary embolism.

Contraindications:

Relative:

1. Pre-existing left bundle branch block may result in complete heart block and requires temporary pacemaker placement (transcutaneous or transvenous) prior to study. A pacemaker electrode is inserted before the study.
   
   
2. Ventricular irritability (e.g., s/p MI). Pulmonary arteriography may be performed only if the risk of systemic anticoagulation or thrombolytic therapy is high.
   
   
3. Severe orthopnea - patients must be able to tolerate supine positioning for the duration of the study.
   
   
4. Other significant co-morbid conditions (e.g., severe CASHD or CHF).
   
   
5. Contrast Allergy.

Preparation:

1. Oxygen as indicated clinically.
   
   
2. No premedication (decreases respiratory drive).
   
   
3. In patients with ventricular arrhythmia or ventricular irritability, prophylactic lidocaine may be indicated (50-100mg IV).
   
   
4. Also see Section "Patient Preparation for Arteriography" .

Complications:

1. See Section "Complications of Arteriography".
   
   
2. Cardiac arrhythmia.
   
   
3. Complete heart block, particularly in patients with prior left bundle branch block.

Back to Top

RENAL ARTERIOGRAPHY

 

Description:

An abdominal aortogram is performed to define location and number of renal arteries. The renal arteries are then selectively catheterized and injected and imaging is performed.

Indications:

1. Renal tumor.
   
   
2. Renal vascular hypertension.
   
   
3. Renal insufficiency with suspected renal arterial stenosis.
   
   
4. Preoperative assessment of renal donors.
   
   
5. Renal transplant evaluation.

Preparation:

See Section "Patient Preparation for Arteriography"

Complications:

1. Contrast reaction, see visceral arteriography.
   
   
2. See Section "Complications of Arteriography".

Back to Top

THORACIC AORTOGRAPHY

 

Description:

The catheter is introduced retrograde from the femoral artery into the aortic root and contrast is injected while rapid sequence filming is performed.

Indications:

1. Suspected thoracic aortic aneurysm.
   
   
2. Suspected aortic dissection.
   
   
3. Suspected occlusion of vessels of the great neck or thorax.
   
   
4. Suspected anomaly (such as coarctation) of the great vessels.
   
   
5. Mediastinal mass, which may be aneurysm or may involve the great vessels.

Preparation:

See Section "Patient Preparation for Arteriography" .

Complications:

See Section "Complications of Arteriography".

Back to Top

VISCERAL ARTERIOGRAPHY

 

Description:

A femoral artery is selectively catheterized by Seldinger technique and the catheter is selectively placed in the appropriate aortic branch and films are taken following injection of contrast material.

Indications:

1. Suspected neoplasm including:
   
   
   1. Pancreas
   2. Liver
   3. Uterus or ovary
   4. Kidney or adrenal gland
   
   
   
2. Acute gastrointestinal bleeding.
   
   
3. Acute mesenteric ischemia.
   
   
4. Suspected visceral trauma to:
   
   
   1. Spleen
   2. Liver
   3. Kidney
   
   
   
5. Placement of catheters for infusion of chemotherapy into various viscera.

Preparation:

See Section "Patient Preparation for Arteriography" .

Complications:

1. Contrast reaction.
   
   
2. Arterial thrombosis.
   
   
3. Dissection.
   
   
4. Embolization.
   
   
5. Also see Section "Complications of Arteriography".

Back to Top

LYMPHANGIOGRAPHY

 

Description:

Using micro dissection, lymphatics are cannulated in each foot. Five to ten cc's of an oily contrast material is injected into each foot. Films of the legs and abdomen are made during the study (over several hours).

Indications:

Prior to treatment of thoracic duct injury or leak

Contraindications:

1. Allergy to Ethiodol.
   
   
2. Milroy's disease.
   
   
3. Severe pulmonary disease.

Preparation:

See Section "Patient Preparation for Arteriography" .

Complications:

Infection or non-healing of the foot incisions in patients with diabetes, peripheral vascular disease, or peripheral edema.

Back to Top

NON-VASCULAR INTERVENTIONAL PROCEDURES GASTROINTESTINAL DILATION

 

Description:

After an obstruction in the G.I. tract has been identified, it is bypassed by catheter and guide wire technique. Dilatation balloons are then used to enlarge the strictured area.

Indications:

1. Stricture of the esophagus.
   
   
2. Stricture of a gastroenteric anastomsis.
   
   
3. Other gastrointestinal strictures.

Preparation:

1. Local anesthesia
   
   
2. Also see Section "Patient Preparation for Arteriography"

Complications:

1. Rupture or perforation of a stenotic viscus.
   
   
2. Also see Section "Complications of Arteriography".

Back to Top

PERCUTANEOUS ABSCESS DRAINAGE

 

Description:

After an abscess has been diagnosed and mapped by fluoroscopy, ultrasound, and/or CT scanning, a suitable approach to the abscess is chosen. This may be quite variable.

A needle/catheter combination is passed into the abscess and aspirates are sent for bacteriologic analysis. Catheters are then manipulated through the abscess to obtain adequate drainage. Several or many repeat attempts may be required to completely drain an abscess.

Indications:

The presence of an abscess in an accessible location.

Contraindications:

1. An abscess in an inaccessible location.
   
   
2. Coagulopathy, uncorrected.

Preparation:

1. Antibiotics prior to and following the procedure are mandatory.
   
   
2. Also see Section "Patient Preparation for Arteriography".

Complications:

1. Septic shock.
   
   
2. Spread of the abscess cavity into a previously uninvolved area.
   
   
3. Failure of drainage of the abscess.
   
   
4. Bleeding.
   
   
5. Also see Section "Complications of Arteriography".

Back to Top

PERCUTANEOUS ASPIRATION BIOPSY

 

Description:

Any mass in the abdomen which can be identified by some radiographic means (GI series, ultrasound, CT scanning, IR, or plain fluoroscopy) can be biopsied. A long thin needle is passed through the skin into the area of question and several aspirations are made for cytologic analysis.

Indications:

1. Abdominal mass suspected to be malignant.
   
   
2. For culture of an intra-abdominal abscess.

Contraindications:

Rare: hemorrhage, infection, and symptomatic perforation of a viscus are possible.

Preparation:

1. Normal coagulation parameters.
   
   
2. Imaging study/film for localization of site to be biopsied.
   
   
3. Also see Section "Patient Preparation for Arteriography"

Back to Top

PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAM

 

Description:

A thin needle is passed percutaneously through the right flank into the liver. Contrast is injected into the bile ducts and imaging is performed in multiple projections.

Indications:

1. Suspected obstruction of the intra or extra hepatic bile ducts by tumor, stricture or stone.
   
   
2. Further investigation of dilated ducts seen by ultrasound, computerized tomography, OR mrcp.

Contraindications:

1. Patient with obvious parenchymal disease of the liver and non-dilated bile ducts seen by ultrasonography.
   
   
2. Uncorrected coagulopathy.

Preparation:

1. Antibiotic coverage.
   
   
2. Also see Section "Patient Preparation for Arteriography"

Complications:

1. Intrahepatic hematoma.
   
   
2. Pneumothorax.
   
   
3. Intraperitoneal hemorrhage.
   
   
4. Cholangitis.

Back to Top

PERCUTANEOUS BILIARY DRAINAGE

 

Description:

If a T-tube is present, it is removed and replaced by a maneuverable catheter, which will permit stone removal or stricture dilatation. Otherwise, a transhepatic biliary drain is inserted after puncturing a biliary radicle, which has been previously opacified via percutaneous transhepatic cholangiography.

Indications:

1. Removal of retained stones in the common bile duct and intrahepatic ducts following surgery.
   
   
2. Drainage of the bile ducts in the patient with obstructive jaundice.
   
   
3. Dilatation of biliary stricture.
   
   
4. Replacement of a T-tube.
   
   
5. Placement of drainage catheter to bypass a duct obstruction.
   
   
6. Placement of a biliary endoprosthesis.

Contraindications:

1. An immature T tube tract (i.e. less than 6 weeks).
   
   
2. Coagulopathy, uncorrected.

Preparation:

1. Intravenous antibiotics.
   
   
2. Moderate sedation.
   
   
3. With difficult manipulation, anesthesia monitoring and sedation or general anesthesia should be arranged.
   
   
4. Pre-existing US, CT, MRI to confirm intrahepatic ductal dilatation.
   
   
5. Local, regional or epidural anesthesia.
   
   
6. Also see Section "Patient Preparation for Arteriography"

Complications:

1. Intrahepatic hematoma.
   
   
2. Biliary tract bleeding.
   
   
3. Post procedural pain.
   
   
4. Cholangitis.
   
   
5. Contrast reaction.

Back to Top

PERCUTANEOUS CHOLECYSTOSTOMY

 

Description:

The gallbladder is punctured under ultrasound and a 5-8 French drain inserted.

Indications:

Acute cholecystitis.

Contraindications:

1. Gangrenous or perforated gallbladder.
   
   
2. Porcelain gallbladder.
   
   
3. Uncorrected coagulopathy

Preparation:

1. Antibiotics.
   
   
2. Moderate sedation.
   
   
3. Standard sterile prep.
   
   
4. Also see Section "Patient Preparation for Arteriography"

Complications:

1. Sepsis.
   
   
2. Intraperitoneal bleed.
   
   
3. Bile peritonitis.

Back to Top

PERCUTANEOUS GASTROSTOMY AND GASTROJEJUNOSTOMY TUBE PLACEMENT

 

Description:

Oral intake is stopped overnight. Preliminary CT or US examinations may be helpful in evaluating the relation between the left hepatic lobe and the stomach to avoid potentially significant hemorrhage or bile extravasation. After a sterile preparation of the left subcostal area and epigastrium, the stomach is insufflated with air per NG tube placed in IR. The stomach is visualized fluoroscopically and the puncture site chosen and then the overlying soft tissues are infiltrated with xylocaine.

A Seldinger needle is used for gastric puncture and following introduction of a guidewire into the gastric lumen, fascial dilators are used to create a tract of adequate diameter for the selected gastric or gastrojejunal catheter.

Indications:

1. Nutritional support in the debilitated patient with inadequate oral intake.
   
   
2. Decompression of chronic small bowel obstruction.
   
   
3. Decreased gastric motility, e.g., diabetic gastroparesis.
   
   

Contraindications:

Absolute:

1. Uncorrectable bleeding diathesis.
   
   
2. Unsatisfactory percutaneous access to the stomach.

Relative:

1. Massive ascites
   
   
2. Abdominal varices from portal hypertension.
   
   
3. Status-post partial gastrectomy with the gastric remnant above the costal margin.
   
   
4. Inflammatory, neoplastic or infectious involvement of the gastric wall which may result in poor wound healing.

Preparation:

1. Stop routine oral intake overnight
   
   
2. Barium suspension taken PO during the 12 hours prior may assist in opacifying the colon.
   
   
3. Pre-procedural laboratory studies to include coagulation profile (CBC, PT/INR, and platelets).
   
   
4. Also see Section "Patient Preparation for Arteriography"

Complications:

1. Intraperitoneal leakage of gastric contents.
   
   
2. Aspiration secondary to gastroesophageal reflux with gastric or duodenal tube feedings (approaches 38%).
   
   
3. Potential for hemorrhage, liver laceration or gastrocolic fistula.
   
   

Back to Top

VASCULAR INTERVENTIONAL PROCEDURES CHEMOEMBOLIZATION OF HEPATIC MALIGNANCY

 

Description:

Patients with hepatic malignancies (hepatocellular carcinoma or metastasis) who are not surgical candidates or who have failed other chemotherapeutic regimens are potential candidates for palliative therapy by transcatheter hepatic arterial chemoembolization with delivery of a mixture of chemotherapeutic and embolic agents into the hepatic arterial branches which supply the affected portion of the liver. Routinely, patients are treated in three or more sessions separated by an approximate four-week interval.

Indications:

Hepatic malignancy not surgically resectable or failure of routine systemic chemotherapeutic regimen.

Preparation:

Initial patient evaluation will include a review of the patient’s clinical course, laboratory data and all previous imaging studies. Prior to first chemoembolotherapy procedure, the patient will undergo visceral arteriography and computed tomographic arterioportography to evaluate the vascular supply and distribution of tumor burden within the liver. Subsequently, the patient will undergo transcatheter delivery of chemoembolic agent to the affected portion of the liver. Chemoembolization requires hospital admission for monitoring.

Complications:

1. Patients are subject to the routine risks of arteriography.
   
   
2. Hepatic abscess, necrosis or biloma formation.
   
   
3. Also see Section "Complications of Arteriography".
   
   

Back to Top

INSERTION OF CAVAL FILTER

 

Description:

Following inferior vena cavogram to identify level of renal veins and diameter of the inferior vena cava, the selected filter is inserted percutaneously and deployed below the renal veins. Depending upon the clinical indication, femoral, jugular or cubital venous access may be utilized for the procedure.

Indications:

Recurrent pulmonary emboli refractory to anticoagulants. Thromboembolic disease with contraindications to anticoagulation.

Preparation:

Also see Section "Patient Preparation for Arteriography"

Complications:

1. Migration of filter.
   
   
2. Perforation of IVC.
   
   
3. IVC occlusion.
   
   
4. Also see Section "Complications of Arteriography"
   
   

Back to Top

PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY OR STENTING OF PERIPHERAL VESSELS

 

Description:

A guide wire and catheter are passed through an obstructing lesion in the extremity or central venous circulation. The catheter is then exchanged for an appropriate size balloon catheter. The balloon catheter is centered in the lesion and inflated. A metallic stent may be deployed to improve long-term patency.

Indications:

Symptomatic arterial or venous occlusive disease.

Contraindications:

See "Arteriography".

Preparation:

See Section "Patient Preparation for Arteriography"

Complications:

1. Miscellaneous complications:

   acute thrombotic occlusion	2%
   puncture site hematoma	5%
   arterial injury requiring surgical repair at puncture site	1%
   clinically significant distal embolization	0-2.3%
   vessel perforation	1%
   vasospasm	2%
   pseudoaneurysm	0.3%

   
   
   
2. Also see Section "Complications of Arteriography".
   
   

Back to Top

PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY OR STENTING OF VISCERAL VESSELS

 

Description:

The femoral artery is catheterized by Seldinger technique and a guide wire and catheter are passed through the obstructing lesion in the visceral vessel. This catheter is then exchanged for an appropriate PTA balloon and the balloon is inflated.

Indications:

1. Renovascular hypertension.
   
   
2. Renal insufficiency with known significant renal artery stenosis and deteriorating renal function.
   
   
3. Symptomatic arteriosclerotic narrowing of various visceral vessels.
   
   

Contraindications:

1. Absolute:
   Medically or hemodynamically unstable patient.
   
   
2. Relative:
   Long segment total occlusion.

Preparation:

Also see Section "Patient Preparation for Arteriography"

Complications:

1. Conversion of a stenosis to a complete obstruction
   
   
2. Also see Section "Complications of Arteriography".
   
   

Back to Top

THROMBOLYSIS OF ARTERIES AND VEINS

 

Description:

Following angiographic diagnosis of arterial thrombosis, a small catheter is inserted upstream from the block and its tip buried in the clot. Thrombolysis agent is administered by pump and the catheter gradually advances until all the thrombus is dissolved. Intravenous heparin is usually given concurrently.

Indications:

Acute or subacute occlusion of a native artery or bypass graft conduit by thrombosis or emboli causing new onset claudication or limb threatening ischemia.

Contraindications:

Absolute:

1. Active gastrointestinal or genitourinary bleeding.
   
   
2. Signs of irreversible limb ischemia.
   
   
3. Recent stroke, cerebrovascular process, intracranial neoplasm, or recent craniotomy (within 2 months).

Relative:

1. Recent major surgery, percutaneous or endoscopic biopsy (within 7-10 days).
   
   
2. History of GI bleeding.
   
   
3. Cavitary TB.
   
   
4. Recent trauma with possible internal injuries.
   
   
5. Recent cardiopulmonary resuscitation.
   
   
6. Subacute bacterial endocarditis.
   
   
7. Pregnancy or postpartum within 10 days.
   
   
8. Severe cerebrovascular disease, severe hypertension, or diabetic hemorrhagic retinopathy.
   
   
9. Recent needle puncture of a non-compressible vessel or lumbar puncture.

Preparation:

1. Minimize handling of patient.
   
   
2. Discontinue IM or subcutaneous injections and substitute appropriate oral or IV.
   
   
3. Also see Section "Patient Preparation for Arteriography"

Complications:

mortality	0 - 3%
major hemorrhage	4 - 25%
renal failure	0 - 6%
cerebrovascular accident	3 - 8%
peripheral embolization	8-16%

Back to Top

TRANSCATHETER EMBOLIZATION OF VARIOUS ORGANS

 

Description:

The femoral vessel is entered using the Seldinger technique and catheter is introduced into the aorta and into the appropriate visceral vessel. Various embolic material and/or pharmacological agents are injected selectively to control bleeding or to embolize tumors.

Indications:

1. Upper or lower gastrointestinal bleeding, hemoptysis, hematuria.
   
   
2. Intractable hemorrhage following extensive trauma.
   
   
3. Known tumor where infarction is indicated as adjunctive or primary therapy.
   
   
4. Arterial malformation.
   
   

Preparation:

1. If an emergency procedure, no preparation is required.
   
   
2. Sedation is necessary for patients undergoing tumor infarction since the procedure is quite painful.
   
   
3. Also see Section "Patient Preparation for Arteriography"

Complications:

1. Embolus to an unintended vessel.
   
   
2. Infarction of organ.
   
   
3. Also see Section "Complications of Arteriography".
   
   

Back to Top

TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS)

 

Description:

After gaining access to the venous circulation, usually by direct jugular puncture, a hepatic vein is catheterized and a needle is directed through the hepatic parenchyma into the portal vein. The hepatic parenchymal tract is then dilated and lined with a metallic stent creating an intrahepatic portosystemic shunt.

Indications:

1. Recurrent variceal bleeding refractory to sclerotherapy.
   
   
2. Portal hypertension with refractory ascites.
   
   
3. Hepatic hydrothorax.
   
   

Contraindications:

Hemodynamically unstable patient with multisystem organ failure.

Preparation:

See Section "Patient Preparation for Arteriography"

Complications:

1. Bleeding.
   
   
2. Hepatic encephalopathy, usually responsive to lactulose.
   
   
3. Transient liver dysfunction including elevation of bilirubin.
   
   
4. Congestive heart failure in the setting of right heart failure.
   
   
5. Contrast induced nephropathy, possibly worsening the hepatorenal syndrome.
   
   
6. Also see Section "Complications of Arteriography".

Back to Top

VENOUS ACCESS

 

Description:

Percutaneous venous access may be established for a variety of indications including: chronic hemodialysis access, plasmaphoresis, chronic administration of medications or blood products, photophoresis, or parenteral nutritional support. Venous imaging may require fluoroscopic imaging with the peripheral injection of contrast or ultrasound guidance.

Preparation:

See Section "Patient Preparation for Arteriography"

Complications:

1. Infection.
   
   
2. Bleeding.
   
   
3. Pneumothorax.
   
   
4. Also see Section "Complications of Arteriography".

Back to Top

VENOGRAPHY ADRENAL VENOUS SAMPLING OR ADRENAL VENOGRAPHY

 

Description:

In adrenal sampling, a catheter is passed through the femoral vein and selectively placed into the adrenal vein on each side. Small samples are withdrawn from the two adrenal veins.

Indications:

Increased mineralocortocoid (aldosterone) production--to distinguish unilateral (adenoma) from bilateral (hyperplasia) disease.

Preparation:

1. Consultation with IR and Renal-electrolyte physicians regarding antihypertensive regimen and desired volume status should be done prior to study.
   
   
2. Also see Section "Patient Preparation for Arteriography"

Complications:

1. Contrast extravasation may result in Addisonian crisis which may occur over several days/weeks post-procedure.
   
   
2. Also see Section "Complications of Arteriography".

Back to Top

INFERIOR VENA CAVOGRAPHY

 

Description:

Either femoral or jugular vein is punctured by Seldinger technique and a catheter placed in one of the iliac veins. Contrast material is injected rapidly while imaging of the inferior vena cava is performed.

Indications:

1. Suspected vena caval obstruction.
   
   
2. Preoperative work up of patients with renal cell carcinoma to exclude tumor thrombus.
   
   
3. Bilateral lower extremity edema.
   
   
4. Prior to IVC filter placement.
   
   

Preparation:

See Section "Patient Preparation for Arteriography"

Contraindications:

Also see Section "Complications of Arteriography".

Back to Top

PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY

 

Description:

The portal venous system is entered by percutaneous puncture of the liver. A catheter is then used to explore the portal, splenic and mesenteric veins.

Indications:

1. Pancreatic venous sampling of suspected small active endocrine tumors (insulinoma, glucagonoma). Preoperative demonstration of anatomy in planned portal venous surgery. This anatomy can more readily be demonstrated by visceral arteriography. Embolization of varicies.
   
   
2. Islet cell transplant.
   
   

Preparation:

1. Normal coagulation parameters prior to study.
   
   
2. Also see Section "Patient Preparation for Arteriography"

Complications:

1. Intra- or -extra hepatic hemorrhage.
   
   
2. Portal venous thrombosis.
   
   
3. Recurrence of varices (frequent) in embolization cases.
   
   
4. Contrast reaction.
   
   
5. Intraperitoneal hemorrhage.

Back to Top

SUPERIOR VENA CAVOGRAPHY

 

Description:

Needles are placed in the antecubital veins of each arm and 30 to 50ml of contrast are injected rapidly while imaging is performed of the mediastinal area.

Indications:

1. Suspected vena caval obstruction.
   
   
2. Assessment of superior vena caval involvement by mediastinal masses.
   
   
3. Evaluation of central vein patency for venous access.
   
   

Preparation:

1. 18-gauge heplock/angiocath should be placed in peripheral vein of each arm prior to IR.
   
   
2. Also see Section "Patient Preparation for Arteriography"

Contraindications:

Absence of appropriate arm veins (peripheral access) for injection.

Complications:

1. Extravasation at injection site.
   
   
2. Also see Section "Complications of Arteriography".

Back to Top

UPPER EXTREMITY VENOGRAPHY (see also Preop Venogram Protocol)

 

Description:

A peripheral vein of the arm is cannulated and 30-50 cc. of contrast material are injected. Imaging of the arm, axillary, and subclavian veins is performed.

Indications:

Suspected thrombosis of the axillary or subclavian vein, particularly in patients with long-term central venous lines in place. Vein mapping pre-dialysis procedure access placement.

Preparation:

1. 18-20 gauge heplock/angiocath in peripheral vein of arm being studied prior to IR.
   
   
2. Also see Section "Patient Preparation for Arteriography"

Complications:

1. Contrast extravasation.
   
   
2. Contrast-induced phlebitis.
   
   
3. Also see Section "Complications of Arteriography".

Back to Top

VISCERAL VENOGRAPHY

 

Description:

A femoral vein is punctured by Seldinger technique and a catheter is advanced through the inferior vena cava. The vein of interest is then selectively catheterized and injected.

Indications:

1. Suspected venous thrombosis of:
   1. a. Kidney
   2. Liver (Budd-Chiari syndrome).
   
   
   
2. Investigation of a known or suspected tumor of:
   1. Adrenal gland
   2. Kidney
   
   
   
3. To localize the pampiniform plexus of the testicle in the patient with cryptorchidism and/or assess hemodynamics of suspected varicocele.
   
   

Preparation:

See Section "Patient Preparation for Arteriography"

Complications:

1. Venous thrombosis and sequellae related to organ under study.
   
   
2. Also see Section "Complications of Arteriography".

Back to Top