Techniques in vascular and interventional radiology
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Tech Vasc Interv Radiol · Jun 2009
ReviewEmergent nephrostomy tube placement for acute urinary obstruction.
Obstructive uropathy and urosepsis constitute a medical emergency and require emergent decompression of the urinary collecting system. Image-guided percutaneous nephrostomy tube placement using ultrasound and fluoroscopy allows for decompression of the obstructed renal collecting system with minimal complications.
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Tech Vasc Interv Radiol · Mar 2009
ReviewTreatment of facet and sacroiliac joint arthropathy: steroid injections and radiofrequency ablation.
Facet and sacroiliac joint arthropathy are common, specific causes of low back pain. With a combination of a focused physical examination and image guidance, pain originating from these joints can be accurately targeted and these joints respond well to the direct application of long-acting deposition preparation steroids. ⋯ Image guidance is a critical tool in targeting facet joint innervation, performing a central role in the techniques used in both preprocedure testing and the RFA treatment. This article reviews the basic image-guided fluoroscopic and computed tomographic-guided approaches to steroid treatment of the facet and sacroiliac joints and further discusses of the painful facet through RFA.
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Chronic back pain and other refractory pain syndromes are a documented burden on our society. They also are a huge cost in quality of life and dollars spent on health care. ⋯ We describe in this article the basic techniques and methods of both the stimulation trial and the permanent implantation of the leads and generator. With advanced imaging and the minimally invasive approach we further explain how to minimize any risk associated with this percutaneous procedure.
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Tech Vasc Interv Radiol · Mar 2009
ReviewEpidural steroid injections and selective nerve root blocks.
Epidural steroid injections and lumbar nerve root block/steroid injection are commonly performed interventional treatments for spine-related pain. These procedures are the foundation of any image-guided spine pain management practice. While more generic and not target-specific, epidural steroid injections are highly effective in a large proportion of patients, including patients with axial pain (neck or low back pain), radiculopathy, or spinal stenosis with neurogenic claudication. ⋯ Fluoroscopy can be the routine approach to all injections. Computed tomography or computed tomographic fluoroscopy can be used as the primary approach in lumbar epidural or nerve root injections or be used as an alternative technique in unique cases. While the basic technical approach to epidural steroid administration in the cervical, thoracic, and lumbar regions is similar, each region has unique issues that must be addressed.
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The development of image-guided percutaneous techniques for local tumor ablation has been one of the major advances in the treatment of liver malignancies. Over the past two decades, several methods for chemical or thermal tumor destruction have been clinically tested. Among these methods, radiofrequency (RF) ablation is currently established as the primary ablative modality at most institutions. ⋯ In addition, RF ablation is emerging as a viable alternative to surgery for inoperable patients with limited hepatic metastatic disease, especially from colorectal cancer. Several series have shown that RF ablation can result in complete tumor eradication in properly selected candidates, and have provided indirect evidence that the treatment improves survival. In this article, we review technique, indications, and clinical results of percutaneous RF ablation in the treatment of HCC and colorectal hepatic metastases.