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Interventional Radiology (Vascular Procedures (Central Venous Access…
Interventional Radiology
Thrombolysis
- fibrinolytic argents: streptokinase, urokinase, prourokinase, rt-PA
- local fibrinolysis often used in combination with methods of thromboectomy
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Vascular Procedures
Central Venous Access
- devices: PICC, external tunneled catheter (Hickman or dialysis catheters), sub cutaneous port.
- complications: venous thrombosis and central venous stenosis, infection including sepsis, pneumothorax
- Indications for Central Venous Access: FAT CAB
Fluids, Antibiotics, TPN, Chemotherapy, Administration of blood, Blood sampling
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Embolization
- injection of occluding material into vessels.
- permanent agents: amplatzer plugs, coils, glue, and onyx
- temporary: gel foam, autologous blood clots
- indications: management of haemorrhage, treatment of arteriovenous malformation, pre-operative treatment of vascular tumours, varicocele embolization for infertility, symptomatic uterine fibroids
- complications: post-embolization syndrome (pain,fever,leukocytosis), unintentional embolization of a non-target organ with resultant ischemia
Thrombolytic Therapy
- infusion of a fibrinolytic agent (urokinase, streptokinase, TNK, tPA – used most commonly) via a catheter inserted directly into a thrombus
- indications: treatment of ischemic limb (most common indication), early treatment of MI or stroke to reduce organ damage, treatment of venous thrombosis (DVT or PE)
- complications: bleeding, stroke, distal embolus, reperfusion injury with myoglobinuria and renal failure if advanced ischemia present
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Angiography
- injection of contrast material through a catheter placed directly into an artery or vein to delineate vascular anatomy
- indications: diagnosis of primary occlusive or stenotic vascular disease, aneurysms, coronary, carotid and cerebral vascular disease, PE, trauma, bleeding, vascular malformations
- complications (<5%ofpatients): puncture site hematoma, infection, pseudoaneurysm, AVfistula, dissection, thrombosis, embolic occlusion of a distal vessel
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