#withoutascalpel

Trainees in Interventional Radiology - 1. Does the potential benefit to the patient from the procedure outweigh the risk? 2. Is there a lower risk alternative which can achieve the same benefit? 3. What could go wrong? 4. How will I manage any complication? Remember, nothing is ever routine. #appliedir #appliedinterventionalradiology #interventionalradiology #radiology #withoutascalpel #beprepared #youngdoctors #lifelonglearning #tanzania #tanzaniair https://www.instagram.com/p/B5dB2dqnz7b/?igshid=a3ncclqmuslu

Spine Jack kyphoplasty of osteoporotic debilitation compression fracture of L2. Spine Jack (@strykercorporation) is the first product in years which has the potential to reduce adjacent fracture rates by legitimately restoring vertebral body height and and end plate configuration. #appliedibterventionalradiology #withoutascalpel #kyphoplasty #vertebroplasty #vertebralcompressionfracture #spinefracture #interventionalradiology #compressionfracture #osteoporosis https://www.instagram.com/p/Bvzsg_pHrhA/?utm_source=ig_tumblr_share&igshid=zu07uh4m7lnw

Complications and Calamities - Cases to Stimulate Discussion. This one which was shared with me comes from the realm of percutaneous intrathoracic procedures. An elderly patient with a loculated pleural effusion underwent a diagnostic thoracentesis. CT image of the upper right chest are shown and depict a loculated effusion and extensive bronchiectasis (Image 1). Ultrasound images of the loculated pleural effusion both before and after the thoracentesis are also shown (Images 2 and 3). Shortly after the procedure he became unresponsive and CT of the head and neck was performed. These images are shown from caudal to cranial (Images 4-10). What do you see? How can this be explained? Could it have been predicted or prevented? What is the prognosis? #appliedir #appliedinterventionalradiology #interventionalradiology #withoutascalpel #pulmonology #embolism https://www.instagram.com/p/Bug_gZPHam6/?utm_source=ig_tumblr_share&igshid=11zynh41f9ck0

DIPS in a complex patient with cirrhosis and gastric cancer with liver metastases. Patient had massive medication refractory ascites resulting in severe hypotension and renal malperfusion with subsequent renal failure. Ascites was proven non-malignant. TIPS from the right or middle hepatic veins was precluded by intervening tumors. TIPS was attempted from the left hepatic vein but because of uncorrectable hypovolemia the small size and tortuous origin of the left hepatic vein did not enable a stable platform and capsular perforation occurred (image 3). A DIPS was then performed. IVUS did not provide adequate visualization of the portal vein. The course of puncture was determined by review of cross-sectional Imaging (image 4). A curved needle was used to puncture through the wall of the IVC into the caudate branch of the portal vein. The tract was shorter than the shortest available Viabahn stent so a 4cm balloon expandable Atrium stent was deployed but failed to reverse flow or improve the gradient (image 9). A 5cm Viabahn was then deployed which resulted in an excellent result (final image 10). #appliedir #appliedinterventionalradiology #interventionalradiology #withoutascalpel #cirrhosis #ascites #gastriccancer #TIPSprocedure #DIPSprocedure #portalhypertension #gastroenterology #hepatology https://www.instagram.com/p/Bug_fhAntUE/?utm_source=ig_tumblr_share&igshid=1shqyc4uwfg18

Coil Embolization of a pulmonary artery pseudoaneurysm. This pseudoaneurysm was caused by Swan-Ganz catheter placement during a cardiac catheterization case. The injury corresponds precisely to the location of the Swan-Ganz balloon. Rupture of pulmonary artery aneurysms and pseudoaneurysms is rare, but confers nearly 100% mortality. Embolization in this case requires sacrifice of the lateral basilar segmental artery. The patient tolerated Embolization well. Credit to @curtselser for this excellent case. Thanks Curt! #appliedir #appliedinterventionalradiology #interventionalradiology #withoutascalpel #pulmonaryartery #aneurysm #pseudoaneurysm #embolization #coil #cardiaccath #cardiology #pulmonology https://www.instagram.com/p/Bug_dmHns4Q/?utm_source=ig_tumblr_share&igshid=9x1ukw8qmqmf