LOWER EXTREMITY ARTERIOGRAPHY,
NEPHROSTOMY & BILIARY DRAINAGE
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TUMORS
ARTERIOSCLEROSIS OBLITERANS
POOR CIRCULATION
NON-HEALING ULCERS
AV MALFORMATIONS
AV FISTULA
ARTERIAL TRAUMA
RAPID IMAGING (2-4 FRAMES/SEC)
AUTOMATIC INJECTOR
FLUOROSCOPY
MOVABLE, OR STEPPING TABLETOP
(PRE-DIGITAL ERA)
FEMORAL
• TRANSLUMBAR
• AXILLARY OR BRACHIAL
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END-HOLE, MULTIPLE SIDE
HOLE POSITIONED AT L4, OR
SHARP-CURVED CATHETER INTO
COMMON ILIAC ARTERY FROM
CONTRALATERAL FEMORAL
ARTERY
UNILATERAL: 20 - 30 ML
• BILATERAL: 50 -70 ML
• FLOW RATE; 8 -10 ML/SEC
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FRAME RATE: 2 /SEC X 4 SEC
1 /SEC X 8 SEC
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THROMBOSIS
ANEURYSM
EMBOLIZATION
COMPLICATIONS FROM
PERCUTANEOUS VESSEL
ACCESS
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PATIENT SUPINE, FEET INTERNALLY
ROTATED 30 DEGREES
MAKE USE OF HEEL EFFECT
SELECTIVE VERSUS NONSELECTIVE
ATHEROSCLEROSIS
ARTERIOVENOUS MALFORMATIONS
(AVMs)
CONTRALATERAL
NEPHROSTOMY &
BILIARY DRAINAGE
MODIFIED SELDINGER
• TROCAR METHOD
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A 3-PIECE SYSTEM
CONSISTING OF A
CANNULA, CUTTING
STYLET AND CATHETER
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NEPHRO = KIDNEY
STOMY = AN OPENING INTO
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URINARY OBSTRUCTION
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STENT PLACEMENT
DILATION WITH BALOON
CATHETER
REMOVAL OF STONES
THERAPEUTIC INFUSION OF
DRUGS
CONTRAINDICATED IN
PATIENTS WITH
CLOTTING DEFICIENCIES
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CONSIDERED A MINOR SURGICAL
PROCEDURE
PERCUTANEUS NEEDLE INSERTION
UNDER FLUOROSCOPIC,
ULTRASOUND OR CT GUIDANCE
POSTERIOR APPROACH WITH PATIENT
PRONE
NEEDLE INSERTED 2 - 3 CM BELOW THE
12TH RIB (BRÖDEL LINE)
RENAL PELVIS (URETERAL
OBSTRUCTION)
SUPERIOR CALYX (STONE REMOVAL)
MIDDLE OR LOWER POST CALYX
(CATHETER PLACEMENT)
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URINE/FLUID SAMPLES TAKEN
CONTRAST ADMINISTERED
ANTEGRADE
DETERMINATION OF TECHNIQUE
TO FOLLOW
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DOUBLE J-STENT CATHETER USED
TO KEEP URETER OPEN BETWEEN
KIDNEY AND BLADDER
DRAINAGE CATHETER J-STENT
USED TO DRAIN URINE EXTERNALLY
THROUGH PUNCTURE SITE
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MICROSCOPIC HEMATURIA
HEMORRHAGE, PNEUMOTHORAX
INFECTION, PERITONITIS
URINE EXTRAVASATION
CATHETER DISLODGMENT
CATHETER OBSTRUCTION
UNRESECTABLE MALIGNANCY
(PALLIATIVE)
BILIARY OBSTRUCTION
STONE REMOVAL
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WALL STENT TO MAINTAIN INTERNAL
BILIARY DRAINAGE
EXTERNAL BILIARY DRAIN (CATHETER)
STONE BASKET TO REMOVE
CHOLELITHS
Fungus-infected Fluid Collections in Thorax or
Abdomen: Effectiveness of Percutaneous Catheter
Drainage (RSNA Radiology, Vol 236, No. 2)
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ASYMPTOMATIC JAUNDICE
ASCITES
ADVANCED CIRRHOSIS
IMPAIRED COAGULATION
LIFE EXPECTANCY < 1 MONTH
ANTIBIOTICS 1 H BEFORE
PROCEDURE
RIGHT-SIDED PUNCTURE
INTERNAL OR EXTERNAL
DRAINAGE
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SEPSIS
HEMOBILIA
CATHETER OBSTRUCTION
CATHETER DISPLACEMENT
CHOLANGITIS
HEMO/PNEUMOTHORAX
PERCUTANEUS
SEPSIS
ASCITES
PALLIATIVE
STOMA
ARTERIOSCLEROSIS OBLITERANS
ANTEGRADE