2. 1.Oncologic therapeutic
procedures :
Tumor Embolization : Method that promotes
tumor destruction by embolization of its
suppliers vessels.
◦ Hepatic radioembolization
Tumor Ablations : Percutaneous local tumor
destruction by using a device to cause cell
death.
6. Liver CancerTreatments
Tumors need a blood supply, which they actively
generate, to feed themselves and grow.
In treating cancer patients, interventional
radiologists attack the cancer tumor from inside
the body without medicating or affecting other
parts of the body by using embolization and
radiofrequency heat.
7. Chemoembolization delivers a high dose
of cancer-killing drug (chemotherapy)
directly to the organ while depriving the
tumor of its blood supply by blocking, or
embolizing, the arteries feeding the tumor.
8. In treating cancer patients, interventional
radiologists use embolization to cut off the
blood supply to the tumor (embolization),
deliver radiation to a tumor
(radioembolization), or combine this technique
with chemotherapy to deliver the cancer drug
directly to the tumor (chemoembolization).
9. Chemoembolization is a minimally
invasive treatment for liver cancer that
can be used when there is too much
tumor to treat with radiofrequency
ablation (RFA), when the tumor is in a
location that cannot be treated with RFA,
or in combination with RFA or other
treatments.
10. Using imaging for guidance, a tiny catheter
up the femoral artery in the groin into
the blood vessels supplying the liver
tumor.
11. Chemoembolization
The embolic agents keep the
chemotherapy drug in the tumor by
blocking the flow to other areas of the
body.This allows for a higher dose of
chemotherapy drug to be used, because
less of the drug is able to circulate to the
healthy cells in the body.
12. Chemoembolization is a palliative, not a
curative, treatment. It can be extremely
effective in treating primary liver cancers,
especially when combined with other
therapies.
13. Catheter is placed via a transfemoral approach with
tip within the selected hepatic artery
14. SIR-Sphere size is small enough to gain entry into
tumor nodules but too large to pass through the end
capillary bed into the venous circulation
Tumor vessels 25μm -75μm
End arterioles 8 μm
SIR-Spheres mean diameter 35 μm
15.
16.
17.
18.
19.
20. Yttrium-90 Radioembolization
Radioembolization is very similar to
chemoembolization but with the use of
radioactive microspheres.This therapy is
used to treat both primary and metastatic
liver tumors.
21. This treatment incorporates the
radioactive isotopeYttrium-90 into the
embolic spheres to deliver radiation
directly to the tumor. Each sphere is
about the size of five red blood cells in
width.
22. These beads are injected through a
catheter from the groin into the liver
artery supplying the tumor.The beads
become lodged within the tumor vessels
where they exert their local radiation that
causes cell death
23. This technique allows for a higher, local
dose of radiation to be used, without
subjecting healthy tissue in the body to
the radiation.
24. Radioembolization is a palliative, not a
curative, treatment-but patients benefit by
extending their lives and improving their
quality of life. It is a relatively new therapy
that has been effective in treating primary
and metastatic liver cancers. It is
performed as an outpatient treatment.
25. TIPS
Portal hypertension condition in which the
normal flow of blood through the liver is
slowed or blocked by scarring (cirrhosis) or
other damage (e.g. hepatitis). Patients with
the condition are at risk of internal bleeding
or other life-threatening complications.
Transjugular intrahepatic portosystemic
shunt (TIPS) formation is a minimally-
invasive treatment to alleviate this impaired
blood flow.
26. Indications
1. Prevention of variceal bleeding
2. Acute bleeding of esophageal varices that is
refractory to medical therapies
3. Esophageal variceal rebleeding
4. Bleeding from gastric varices
5. Prevention of bleeding from portal
hypertensive gastropathy
6. Ascites due to cirrhosis
7. Budd-Chiari syndrome
8. Veno-occlusive diseases
28. Relative contraindications
1. Hepatoma
2. Obstruction of all hepatic veins
3. Portal vein thrombosis
4. Thrombocytopenia of less than
20,000/cm(3)
5. Severe coagulopathy
6. Moderate pulmonary hypertension
29. TIPS
• A catheter is placed in the right
jugular vein
• The catheter is threaded through
the superior and inferior vena cava
to the hepatic vein
• Wall of the hepatic vein is
punctured and the needle is
directed across an approximate 2
inch gap to the portal vein
• Successful passage into the portal
vein is determined by the pattern
of dye injected through the
catheter
30. TIPS
• A guide wire is
threaded through
the needle to
maintain the
passage between
the hepatic and
portal veins
31. TIPS
• A balloon may be used
across the passage to
widen the holes in the
vessel walls and the
passage through the
liver tissue
34. There is a 5-15% incidence of retained stones
after cholecystectomy
Associated with increased risk of recurrent
biliary obstruction, pancreatitis, and cholangitis.
Benign/malignant strictures.
35.
36. ERCP
The diagnostic procedure of choice for
abnormalities of the biliary and pancreatic
ducts offers options of intervention:
Stone extraction
Sphincterotomy
Placement of stents
37. A side viewing endoscope is advanced
into the descending duodenum the papilla
ofVater is identified and cannulated
contrast is injected to visualize the
pancreatic duct and biliary duct systems
38. Causes for ERCP failure include:
Upper GI stricture/stenosis
Complete ductal obstruction limiting
retrograde filling
Postsurgical biliary-enteric fistula
Technical failure
MRCP is an effective alternative when
ERCP is unsuccessful
39.
40.
41. PercutaneousTranshepatic
Cholangiography
Old reliable
Accurate technique for defining the site of
obstruction
Provides option of tissue biopsy and/or
intervention with drain or stent
Has been largely replaced by non-invasive
techniques
42. Indications
Failed ERCP / ERCP not feasible (e.g.
patients with gastrojejunostomy)
Biliary system delineation in presence of
intra and extrahepatic biliary calculi
To identify obstructive cause of jaundice; and
differentiate from medically treatable cause
Anatomic evaluation of complications of
ERCP
Delineating bile leaks
44. Technique
◦ Standard technique:Thin needle puncture in
ninth or tenth intercostal space
◦ Contrast injected during slow withdrawal of
the needle under fluoroscopic guidance
◦ When duct placement confirmed, additional
injection
◦ Films taken in AP, right and left oblique
45.
46. Surgical resection offers potential for cure
but is rarely possible
Palliation alternatives:
1. Surgical bypass
2. Percutaneous drainage
3. Endoscopic or percutaneous stent
placement
47. Three types of drains:External – does not
cross obstruction, drains percutaneously
Internal-external – bile in obstructed
segment enters through the side holes of the
catheter and emerges beyond the
obstruction; the external segment can be
capped
Internal – drains only into enteric system
48.
49. Percutaneous cholecystostomy
Image-guided placement of drainage
catheter into gallbladder lumen.This
minimally invasive procedure can aid
stabilization of a patient to enable a more
measured surgical approach with time for
therapeutic planning.
50. Indications
poor surgical candidate/high risk patients
with acute calculous or acalculous
cholecystitis.
unexplained sepsis in critically ill patients
(Diagnostic for cholecystitis as etiology of
sepsis if clinical improvement after
cholecystostomy).
access to or drainage of biliary tree
following failed ERCP and PTC.
51. Contraindications
Absolute contraindications
usually none
Relative contraindications
bleeding diathesis: all attempts should be
made to correct coagulopathy.
ascites
gallbladder tumor that might be seeded
gallbladder packed with calculi preventing
catheter insertion
