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Role of conventional (catheter-based) angiography in a patient with acute, nonocclusive mesenteric ischemia Conventional arteriography is considered the gold standard test for diagnosis and it also enables therapy with catheter-directed infusion of a vasodilator. However, multidetector CT angiography is fast and noninvasive, and diagnostic sensitivity and specificity continues to improve with technological advances. In a …

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What two types of transcatheter therapy are used for GI bleeding?  Selective embolization and vasopressin (Pitressin) infusion. Vasopressin infusion is rarely used today because of the cardiovascular complications (myocardial ischemia, arrhythmias, visceral ischemia), high rate of rebleeding after discontinuation of the infusion, difficulty in maintaining catheter position, and the long treatment times of 12 to …

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How important is localization of the bleeding site before angiography?  Preangiographic localization of the GI bleeding site is extremely helpful. A visceral arteriogram involves evaluation of the celiac, superior mesenteric, and inferior mesenteric arteries; selective catheterization of these vessels and the multiple angiographic projections needed when looking for a bleeding site can make this a …

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When do diagnostic angiography and percutaneous transcatheter therapy play a role in the management of GI bleeding?  Acute GI bleeding that is refractory to conservative management or invasive endoscopic techniques requires angiographic evaluation. For the interventional radiologist to identify the bleeding site, the following conditions must be met: The patient must be actively bleeding at …

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When is percutaneous cholecystostomy indicated?  Its two primary indications are: Persistent and unexplained sepsis in critically ill patients with acalculous cholecystitis Acute cholecystitis in patients too ill to undergo surgeryIn unstable patients, it can be performed at the bedside, if necessary. Less frequent indications include temporary treatment for gallbladder perforation, drainage for distant malignant biliary …

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Role of metallic stents for the treatment of biliary obstruction The use of permanent metallic stents for the treatment of malignant biliary obstruction is well accepted, especially for inoperable patients whose life expectancies are 6 to 12 months. In these patients, metallic stents have been shown to be cost effective and provide a better quality …

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Indications for PTBD Unsuccessful endoscopic drainage Biliary obstruction at or above the level of the porta hepatis Biliary obstruction following biliary-enteric anastomosis Bile duct injuries after laparoscopic cholecystectomy The most common of these indications is failed endoscopic drainage for any reason.