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Interventional Radiology in the Older Patient

Interventional Radiology in the Older Patient. Dr Stuart Kerr Consultant Radiologist Mid Yorkshire NHS Trust. Dr Charles T Dotter, 1964. Dr Alfred Kratochwil, 1969. Subspecialisation. coronary → Cardiology neurological peripheral vascular non-vascular. Vascular Intervention.

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Interventional Radiology in the Older Patient

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  1. Interventional Radiology in the Older Patient Dr Stuart Kerr Consultant Radiologist Mid Yorkshire NHS Trust

  2. Dr Charles T Dotter, 1964 Dr Alfred Kratochwil, 1969

  3. Subspecialisation • coronary → Cardiology • neurological • peripheral vascular • non-vascular

  4. Vascular Intervention • diagnostic angiogram • angioplasty +/- stent for arterial stenosis • stent graft for aortic aneurysm/dissection • embolisation • IVC filter • SVC stent • Hickman / PICC lines

  5. GI haemorrhage • Endoscopy first • If negative, diagnostic CT angiogram - DON’T DELAY! • Low threshold for speaking to Interventional Radiologist

  6. PICC line chemotherapy antibiotics total parenteral nutrition

  7. Non-vascular Intervention

  8. Ultrasound v CT • real-time visualisation • portable • quick • no radiation • frees up CT scanner

  9. US-guided biopsy

  10. Cholecystostomy • indications - severe acute cholecystitis - not improving after 48 hours - gall bladder perforation • tubogram at 6 weeks • ? percutaneous biliary stent

  11. PercutaneousTranshepaticCholangiography

  12. Oesophageal stent

  13. Pyloroduodenal stent

  14. Colonic stent

  15. Radiologically Inserted Gastrostomy (RIG)

  16. Nephrostomy

  17. Tumour ablation • radiofrequency (RFA) • cryotherapy • microwave • chemical • transarterial embolisation / chemoembolisation (TACE)

  18. J Hepatol 2012;57:794

  19. When things go wrong…..

  20. Consent

  21. Thank you

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