PROCEDURES IN INTERVENTIONAL RADIOLOGY LAD(DSA LAB)

.Procedures in Interventional Radiology ( DSA) Lab

Invasive procedures are done in the Digital Subtraction Angiography (DSA) Lab situated at first floor of Block II.  The invasive procedures done in this lab are either vascular procedures or nonvascular procedures.

Vascular procedures

Angiography: 4 vessel angiogram and peripheral angiogram.

Balloon angioplasty: Percutaneous transluminal angioplasty (PTA).

Blood vessel stenting: Often performed with angioplasty. A small wire mesh tube called a stent is placed in the newly opened artery to help it remain open.

Catheter delivered chemotherapy for cancer: Deliver a high dose of cancer killing drugs directly to the tumor depriving the tumor of its blood supply by emboli zing the arteries feeding the tumor, especially in case of liver tumors.

Endovascular embolization: Occlusion of one or more vessels or vascular malformation.

Thrombolysis: is the break up of blood clot that restricts normal blood flow.

Non vascular procedures

Vertebroplasty strengthens vertebral body by injecting bone cement (for vertebral haemangioma, osteoporosis, and malignant tumors). Abscess drainage, bile drainage for obstructed liver bile ducts, Radio Frequency Ablation (RFA) in which a small needle is guided in to the tumor . Radio frequency energy is transmitted into the targeted tissue from the tip of the needle, where it produces heat and kills tumor. 

Carotid angiography (4-vessel angiography)

Both the carotid and vertebral arteries are studied by injecting radio opaque contrast material through specially designed catheters. The usual approach is through right femoral artery (FA). The catheter is navigated from FA through iliac artery, abdominal aorta, arch of aota and then selectively into the cerebral vessels. The contrast material is injected and DSA technology is used whereby the bony and muscular structures are masked and only the arterial tree is visualized.

Indications

1.   To diagnose vascular abnormalities like arteriovenous malformation (AVM), aneurysm and arteriovenous (AV) fistula.

2.   To detect any obstruction in the blood flow.

3.   To assess tumor vascularity.

4.   To detect patency and cross circulation of cerebral blood vessels when the opposite side is occluded or ligated.

Post procedural care

Once the procedure is over the catheter is taken out and manual compression over the artery is applied for 10-15 minutes. When the bleeding stops, distal pulse is confirmed and pressure bandage is applied. After verifying the hemodynamic status, proper documentation is done and patient is shifted to the ICU/ward along with relatives.

Nursing evaluation

Check vital signs, level of consciousness and ensure proper hydration. Observe the site for any bleeding or hematoma, color of the extremity and distal pulses. Observe for allergic reaction, head ache etc. Immobilise the extremity for 4-6 hours.

Spinal angiography

Spinal angiogram is an X-ray study of the blood vessels supplying to the spine.  It is usually performed to detect abnormality of the vessels or to treat a vascular tumour or a vascular malformation.  The angiogram is a minimally invasive procedure.

Contra indications

·         Allergy to radiopaque dye

·         Pregnancy

·         Patients on anticoagulants

·         Recent embolic or thrombotic occurrences

·         Severe liver, thyroid, or kidney disease

Procedure

A catheter is placed and is verified by fluoroscopy. Femoral artery is most commonly used. Contrast medium is injected and series of X-rays are taken for visualization of arterial and venous circulation. After the test, catheter is removed and pressure is applied to the site and pressure dressing is applied when the bleeding stops.

Complications

·        Anaphylactic reaction

·        Seizures

·        Cerebrovascular accidents

·        Visual disturbances

·        Pulmonary embolism

·         Hemorrhage from puncture site

Angioplasty: It is done for stenotic lesions in the concerned vasculature. Once the lesion is made clear by the diagnostic study, the stenotic lesion is crossed with a guide wire over which the balloon catheter is introduced and dilated under fluoroscopic guidance.  Check angiogram is done to evaluate the effectiveness.

Embolization: It is the introduction of an artificial embolizing material through specially designed catheters to block the feeding vessel of arterio venous malformation, arterio venous fistula or aneurysms which are at high risk of rupture when approached surgically. Uterine artery embolization is also done to control the bleeding risk in
post partum hemorrhage or bleeding due to fibroid in the uterus. For various causes of gastrointestinal and pulmonary bleeding also, embolization is useful.

Once the catheter is in situ, embolizing material is injected and check angiogram is done repeatedly till the desired effect is achieved. All major cases are done usually under G.A. Strict aseptic precautions is observed to prevent infection.

CONCLUSION

Interventional Radiology is a speciality in which image guided procedures are used to diagnose and treat multitude of diseases. Today many conditions that once required surgery can be treated nonsurgically by these techniques. Nursing care is pivotal in case of such patients.

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