简介
The Techniques in Interventional Radiology series of handbooks describes in detail the various interventional radiology procedures and therapies that are in current practice. The series comprises four titles, which in turn cover procedures in angioplasty and stenting, transcatheter embolization and therapy, biopsy and drainage and ablation. Forthcoming are volumes on pediatric interventional radiology and neurointerventional radiology. Each book is laid out in bullet point format, so that the desired information can be located quickly and easily. Interventional radiologists at all stages, from trainees through to specialists, will find this book a valuable asset for their practice. Interventional Radiology Procedures in Biopsy and Drainage presents the full array of operations using these techniques. The book is split into two sections 鈥?one dedicated to biopsy procedures and the other to drainage procedures. Dr. Debra Gervais is Director of Pediatric Imaging and Associate Director of Abdominal Imaging and Intervention at Massachusetts General Hospital, Boston, Massachusetts, USA. Dr. Tarun Sabharwal is a Consultant Interventional Radiologist at Guy鈥檚 and St Thomas鈥?Hospital, London, UK.
目录
Foreword 5
Preface from the Series Editors 7
Preface from the Editors 8
Contents 9
Contributors 11
General Principles of Biopsy and Drainage 13
Patient and Procedure Selection 13
Diagnostic 13
Therapeutic 13
Consent 14
Sedation 14
Benzodiazepines 14
Anesthetic Input for Conscious Sedation 14
Analgesia 15
Local 15
Systemic 15
Antibiotics 15
Hemostasis 15
Factors Influencing This Include 15
Procedures May Be Graded into Low, Moderate and Significant Bleeding Risk 16
Laboratory Values 16
Medication 16
Embolization 16
Complications and Management 17
Bleeding: Management 17
Infection: Management 17
Unintended Transgression of Organ: Management 17
Imaging Guidance, Access and Planning 18
Abscess/Cavity Drainage Tools and Techniques 19
Biopsy Tools and Techniques 20
Puncture Site Plugging 21
Conclusion 22
Key Questions to Address 22
Suggested Reading 22
Liver Biopsy 23
Clinical Features 23
Diagnostic Evaluation 23
Clinical 23
Laboratory 24
Imaging 24
Indications 24
Contraindications 24
Alternative Therapies 24
Anatomy 25
Normal Anatomy 25
Aberrant Anatomy 25
Equipment 25
Biopsy Needles 25
Medication 26
Procedure 26
Ultrasound-Guidance 26
CT Guidance 27
Planning an Access Route 28
Technique 29
Tissue Preparation 30
Immediate Post-procedure Care 31
Follow-up and Post-procedure Medications 31
Results 31
Complications 31
Suggested Reading 32
Chest Biopsy 33
Clinical Features 33
Diagnostic Evaluation 33
Clinical 33
Laboratory 33
Imaging 34
CXR 34
CT 34
PET 34
US 34
Lung Needle Biopsy Indications 34
Lung Needle Biopsy Contraindications 34
Absolute 34
Relative 35
Relevant Anatomy 35
Aberrant Anatomy 35
Patient Preparation 35
Equipment/Tools 36
Needle Types 36
Results 36
Pre-procedure Medication/Sedation/Analgesia 36
Procedure 37
Planning an Access Route 37
Image Guidance 37
Performing the Procedure 37
Technique 37
End Point 38
Immediate Post-procedure Care 39
Follow-up and Post-procedure Medication 39
Alternative Procedures 39
Complications: How to Avoid and Manage 39
Suggested Reading 42
Mediastinal Biopsy 43
Clinical Features 43
Diagnostic Evaluation 43
Laboratory 43
Imaging 43
Indications 44
Alternative Therapies (Listed in Order of Least to Most Invasive) 44
Contraindications (Relative) 44
Specific Complications 44
Anatomy 46
Normal Anatomy 46
Aberrant Anatomy 46
Equipment 47
Imaging Modality for Guidance 47
Biopsy Technique 48
Needles 48
Medication 48
Biopsy 49
Patient Position 49
Biopsy Approaches to the Mediastinum 49
Clinical Scenarios 54
Aftercare 54
Follow-up 54
Suggested Reading 55
Bone Biopsy 58
Introduction 58
Aim 58
Indications 58
Contraindications 59
Clinical presentation 59
Pre-procedure laboratory investigations 59
Equipment 59
Anesthesia 60
Image Guidance 60
Procedure 61
Post Biopsy Care 63
Complications 63
Results 63
Adrenal Biopsy 64
Clinical Features 64
Incidence 64
Differential Diagnosis for an Adrenal Mass 64
Diagnostic Evaluation 64
Imaging Features 64
Contraindications 65
Indications 65
Alternatives 65
Pre-procedure 66
Relevant Anatomy 66
Procedure Technique 66
Patient Positioning 66
Equipment and Biopsy 67
Results and Complications 68
Suggested Reading 69
Renal Biopsy 70
Clinical Features 70
Indications 70
Contraindications 71
General Principles 71
Patient Preparation 71
Access 71
Image Guidance 71
Sedation-Analgesia 72
Technique 72
General Complications and Management 73
Tools for Biopsy 73
Needle Types 73
Specimen Handling 73
FNA Versus Core 73
Alternatives 74
Post-Procedure Care and Follow Up 74
Key Points 74
Other Clinical Scenarios: Non-focal Renal Biopsies 74
Indications 74
Contraindications 75
Relevant Anatomy 75
General Principles 75
Patient Preparation 75
Access 75
Image Guidance 75
Sedation-Analgesia 75
Technique 75
General Complications and Management 75
Tools for Biopsy 76
Needle Types 76
Specimen Handling 76
Post-Procedure Care 76
Suggested Reading 76
Pancreatic Biopsy 77
Clinical Features 77
Therapy Options 77
Laboratory Evaluation 77
Imaging 78
Indications 78
Alternatives 78
Contraindications 79
Absolute Contraindications 79
Relative Contraindications 79
Organ Anatomy 79
Anesthesia and Sedation 79
Image Guidance 79
Access 80
Needles and Tissue Sampling 80
Complications 81
Aftercare and Follow-Up 81
Suggested Reading 82
Lymph Node Biopsy 83
Clinical Features 83
Diagnostic Evaluation 83
Discontinuation of Anticoagulants 83
Indications 84
Specific Complications 84
Anatomy-Specific Considerations 84
Equipment 87
Needles 87
Procedure 87
Techniques 87
Modality 88
FNA Versus Core 88
Suggested Reading 89
Splenic Biopsy 90
Clinical Features 90
Diagnostic Evaluation 90
Laboratory 90
Discontinuation of Anticoagulants 90
Indications 92
Specific Complications 92
Anatomy 92
Equipment 92
Needles 92
Medications 93
Procedure 93
Access 93
Modality 93
Aftercare 94
Followup 94
Suggested Reading 95
Thyroid Biopsy 96
Clinical Features 96
Indications 96
Contraindications 97
Relevant Anatomy 97
General Principles 97
Patient Preparation 97
Access 97
Image Guidance 97
Sedo-analgesia 98
Technique 98
General Complications and Management 99
Tools for Biopsy 99
Needle Types 99
Specimen Handling 99
FNA Versus Core 99
Alternatives 99
Suggested Reading 100
Prostate Biopsy 101
Clinical Features 101
Diagnostic Evaluation 101
Clinical 101
Laboratory 101
Imaging 102
Indications 102
Contraindications 102
Patient Preparation 102
Anatomy 102
Equipment 103
Pre-procedure Medications 103
Procedure 103
Immediate Post-Procedure Care 103
Immediate Post-Procure Care CT-guided Transgluteal Prostate Biopsy 105
Complications 105
Alternative Procedures/Future Directions 105
Suggested Reading 106
Drainage of Abdominal Fluid Collections 107
Diagnostic Evaluation 107
Patient Preparation 108
Relevant Anatomy 108
Procedure 110
Planning an Access Route 110
Performing the Procedure 110
Technique 110
Tips 111
Follow-Up and Post-Procedure 111
Abscess\u2013Fistula Complex 113
Removal of Drain 113
Causes of Failure 114
How to Avoid 114
Suggested Reading 115
Drainage of Pelvic Fluid Collections 116
Clinical Features 116
Diagnostic Evaluation 116
Clinical 116
Laboratory 116
Imaging 117
Indications 117
Contraindications 117
Alternative Therapies 117
Patient Preparation 117
Relevant Anatomy 118
Normal 118
Aberrant/Altered 118
Equipment 118
Procedure 118
Technique 118
Planning an Access Route 119
Routes of Pelvic Drainage (Fig. 1a) 119
Transgluteal Approach 119
Anterior Approach 120
Transrectal or Transvaginal Access (Figs. 4 and 5) 121
Transperineal Approach 121
Endpoint 123
Results 124
Follow Up 124
Catheter Management 124
Suggested Reading 125
Drainage of Intrathoracic Fluid Collections 126
Clinical Features 126
Diagnostic Features 126
Imaging Appearance 126
Thoracentesis 127
Percutaneous Catheter Drainage 127
Indication for Chest Catheter Drainage 128
Indicators of Successful Drainage 129
Clinical Scenarios 129
Parapneumonic Effusions and Empyema 129
Pneumothorax 129
Lung Abscess 131
Mediastinal Abscess 131
Pleurodesis 131
Normal Anatomy 132
Aberrent/Altered Anatomy 132
Complications 133
Suggested Reading 133
Liver Cyst / Abscess Drainage 134
Clinical Features 134
Diagnostic Evaluation 134
Laboratory 134
Imaging 135
Indications/Contraindications 135
Simple Cyst 135
Hydatid Cyst 135
Liver Abscess 136
Patient Preparation 136
Equipment 136
Pre-proceure Medications 136
Procedure 136
Planning an Access Route 136
Procedure 136
Simple Cyst 137
Hydatid Cyst 138
Liver Abscess 138
Immediate Post-proceure Care 138
Follow-up and Postprocedure Medications 141
Simple cyst 141
Hydatid cyst 141
Liver abscess 141
Results 141
Simple Cyst 141
Hydatid Cyst 142
Liver Abscess 142
Alternative Therapies 142
Complications 142
Simple Cyst 142
Hydatid Cyst 142
Liver Abscess 143
Suggested Reading 143
Drainage of Pancreatic Abscess and Fluid Collections 144
Clinical-Pathologic Features 144
Imaging 144
Indications/Contraindications 145
Pseudocysts 145
Pancreatic Necrosis 145
Pancreatic Abscess 145
Image Guidance-Access Route 145
Technique 147
Pancreatic Abscess-Infected Necrosis 147
Pseudocysts 147
Aftercare 148
Endpoint 148
Alternative Therapies 148
Suggested Reading 149
Percutaneous Biliary Drainage and Stenting 150
Clinical Features 150
Diagnostic Evaluation 150
Clinical 150
Laboratory 150
Imaging 151
Indications 151
Alternative Therapies 151
Contraindications 151
Specific Complications 151
Patient Preparation 152
Anatomy 152
Normal Anatomy 152
Aberrant Anatomy 152
Equipment 152
Pre/Peri-procedure Medications 153
Procedure 153
Planning an Access Route 153
Performing the Procedure 155
Technique 155
Endpoint 156
Immediate Post-procedure Care 156
Follow-up and Post-procedure Medications 157
Results 157
Metallic Stenting 157
Complications 158
How to Avoid Complications 158
Medication 159
Follow-up 159
Suggested Reading 159
Percutaneous Cholecystostomy and Cholecystolithotomy 161
Percutaneous Cholecystostomy 161
Introduction 161
Diagnostic Evaluation 161
Clinical 161
Laboratory 162
Imaging 162
Indications 162
Contraindications 162
Absolute Contraindications 162
Relative Contraindications 163
Relevant Anatomy and Approach 163
Advantages of Transhepatic Approach 163
Equipment 163
Imaging Guidance 163
Medication 163
Hardware Requirements 164
Procedure 164
The Seldinger Technique 164
Trocar Technique 165
Post-procedure Care 166
Complications 166
Outcomes 167
Percutaneous Cholecystolithotomy 167
Important Considerations 167
Hardware Requirements 168
Procedure 168
Results 168
Complications 169
Suggested Reading 169
Percutaneous Nephrostomy and Antegrade Ureteric Stenting 170
Percutaneous Nephrostomy 170
Clinical Features 170
Diagnostic Evaluation 170
Indications 171
Relative Contraindications 171
Patient Preparation 171
Relevant Anatomy 172
Normal Anatomy 172
Aberrant Anatomy 172
Transplant Anatomy 173
Equipment 173
Procedure 174
Imaging Guidance 174
Positioning the Patient 174
Planning an Access Route 174
Performing the Procedure 174
Technique 174
End-point 175
Immediate Post-Procedure Care 175
Follow-Up and Post-Procedure Medications 175
Results 176
Alternative Therapies 176
Complications 176
How to Avoid 176
Antegrade Ureteric Stenting 177
Indications 177
Contraindications 177
Patient Preparation 177
Equipment 178
Pre-procedure Medication 178
Procedure 178
Imaging Guidance 178
Positioning the Patient 178
Technique 178
Choosing the Stent 179
End-Point 180
Immediate Post-Procedure Care 180
Follow-Up and Post-Procedure Medication 180
Results 180
Alternative Therapies 181
Complications 181
Early Complications 181
Late Complications 181
How to Avoid 181
Suggested Reading 182
Fluoroscopy-Guided Percutaneous Renal Access for Treatment of Stone Disease 183
Clinical Features 183
Diagnostic Evaluation 183
Laboratory 183
Imaging 183
Indications 184
Alternative Therapies 185
Contraindications 185
Specific Complications 185
Anatomy 185
Equipment 186
Access Technique 187
Suggested Reading 188
Percutaneous Gastrostomy and Gastrojejunostomy 189
Clinical Features 189
Diagnostic Evaluation 189
Clinical 189
Laboratory 189
Imaging 190
Indications 190
Contraindictaions 190
Absolute 190
Relative 190
Patient Preparation 190
Relevant Anatomy 191
Aberrant Anatomy 191
Equipment 192
Gastrostomy Tube 192
Gastropexy Kit (T Fasteners) 192
Stiff Guidewire 193
Medication 193
Procedure 194
Planning an Access Route 194
Performing the Procedure: Primary Button Gastrostomy 194
Gastropexy 194
Stomach Puncture 194
Measure Tract 195
Tube Insertion 195
Check Position 195
Performing the Procedure: Balloon- or Locking Pigtail-Retained Tubes 195
Performing the Procedure: \u201cEndoscopic Type\u201d Tubes 196
Immediate Post-Procedure Care 196
Gastrojejunostomy 196
Indications 196
Follow-Up 197
Alternative Therapies 197
Endoscopic Gastrostomy 197
Complications 197
Suggested Reading 198
Index 199
Preface from the Series Editors 7
Preface from the Editors 8
Contents 9
Contributors 11
General Principles of Biopsy and Drainage 13
Patient and Procedure Selection 13
Diagnostic 13
Therapeutic 13
Consent 14
Sedation 14
Benzodiazepines 14
Anesthetic Input for Conscious Sedation 14
Analgesia 15
Local 15
Systemic 15
Antibiotics 15
Hemostasis 15
Factors Influencing This Include 15
Procedures May Be Graded into Low, Moderate and Significant Bleeding Risk 16
Laboratory Values 16
Medication 16
Embolization 16
Complications and Management 17
Bleeding: Management 17
Infection: Management 17
Unintended Transgression of Organ: Management 17
Imaging Guidance, Access and Planning 18
Abscess/Cavity Drainage Tools and Techniques 19
Biopsy Tools and Techniques 20
Puncture Site Plugging 21
Conclusion 22
Key Questions to Address 22
Suggested Reading 22
Liver Biopsy 23
Clinical Features 23
Diagnostic Evaluation 23
Clinical 23
Laboratory 24
Imaging 24
Indications 24
Contraindications 24
Alternative Therapies 24
Anatomy 25
Normal Anatomy 25
Aberrant Anatomy 25
Equipment 25
Biopsy Needles 25
Medication 26
Procedure 26
Ultrasound-Guidance 26
CT Guidance 27
Planning an Access Route 28
Technique 29
Tissue Preparation 30
Immediate Post-procedure Care 31
Follow-up and Post-procedure Medications 31
Results 31
Complications 31
Suggested Reading 32
Chest Biopsy 33
Clinical Features 33
Diagnostic Evaluation 33
Clinical 33
Laboratory 33
Imaging 34
CXR 34
CT 34
PET 34
US 34
Lung Needle Biopsy Indications 34
Lung Needle Biopsy Contraindications 34
Absolute 34
Relative 35
Relevant Anatomy 35
Aberrant Anatomy 35
Patient Preparation 35
Equipment/Tools 36
Needle Types 36
Results 36
Pre-procedure Medication/Sedation/Analgesia 36
Procedure 37
Planning an Access Route 37
Image Guidance 37
Performing the Procedure 37
Technique 37
End Point 38
Immediate Post-procedure Care 39
Follow-up and Post-procedure Medication 39
Alternative Procedures 39
Complications: How to Avoid and Manage 39
Suggested Reading 42
Mediastinal Biopsy 43
Clinical Features 43
Diagnostic Evaluation 43
Laboratory 43
Imaging 43
Indications 44
Alternative Therapies (Listed in Order of Least to Most Invasive) 44
Contraindications (Relative) 44
Specific Complications 44
Anatomy 46
Normal Anatomy 46
Aberrant Anatomy 46
Equipment 47
Imaging Modality for Guidance 47
Biopsy Technique 48
Needles 48
Medication 48
Biopsy 49
Patient Position 49
Biopsy Approaches to the Mediastinum 49
Clinical Scenarios 54
Aftercare 54
Follow-up 54
Suggested Reading 55
Bone Biopsy 58
Introduction 58
Aim 58
Indications 58
Contraindications 59
Clinical presentation 59
Pre-procedure laboratory investigations 59
Equipment 59
Anesthesia 60
Image Guidance 60
Procedure 61
Post Biopsy Care 63
Complications 63
Results 63
Adrenal Biopsy 64
Clinical Features 64
Incidence 64
Differential Diagnosis for an Adrenal Mass 64
Diagnostic Evaluation 64
Imaging Features 64
Contraindications 65
Indications 65
Alternatives 65
Pre-procedure 66
Relevant Anatomy 66
Procedure Technique 66
Patient Positioning 66
Equipment and Biopsy 67
Results and Complications 68
Suggested Reading 69
Renal Biopsy 70
Clinical Features 70
Indications 70
Contraindications 71
General Principles 71
Patient Preparation 71
Access 71
Image Guidance 71
Sedation-Analgesia 72
Technique 72
General Complications and Management 73
Tools for Biopsy 73
Needle Types 73
Specimen Handling 73
FNA Versus Core 73
Alternatives 74
Post-Procedure Care and Follow Up 74
Key Points 74
Other Clinical Scenarios: Non-focal Renal Biopsies 74
Indications 74
Contraindications 75
Relevant Anatomy 75
General Principles 75
Patient Preparation 75
Access 75
Image Guidance 75
Sedation-Analgesia 75
Technique 75
General Complications and Management 75
Tools for Biopsy 76
Needle Types 76
Specimen Handling 76
Post-Procedure Care 76
Suggested Reading 76
Pancreatic Biopsy 77
Clinical Features 77
Therapy Options 77
Laboratory Evaluation 77
Imaging 78
Indications 78
Alternatives 78
Contraindications 79
Absolute Contraindications 79
Relative Contraindications 79
Organ Anatomy 79
Anesthesia and Sedation 79
Image Guidance 79
Access 80
Needles and Tissue Sampling 80
Complications 81
Aftercare and Follow-Up 81
Suggested Reading 82
Lymph Node Biopsy 83
Clinical Features 83
Diagnostic Evaluation 83
Discontinuation of Anticoagulants 83
Indications 84
Specific Complications 84
Anatomy-Specific Considerations 84
Equipment 87
Needles 87
Procedure 87
Techniques 87
Modality 88
FNA Versus Core 88
Suggested Reading 89
Splenic Biopsy 90
Clinical Features 90
Diagnostic Evaluation 90
Laboratory 90
Discontinuation of Anticoagulants 90
Indications 92
Specific Complications 92
Anatomy 92
Equipment 92
Needles 92
Medications 93
Procedure 93
Access 93
Modality 93
Aftercare 94
Followup 94
Suggested Reading 95
Thyroid Biopsy 96
Clinical Features 96
Indications 96
Contraindications 97
Relevant Anatomy 97
General Principles 97
Patient Preparation 97
Access 97
Image Guidance 97
Sedo-analgesia 98
Technique 98
General Complications and Management 99
Tools for Biopsy 99
Needle Types 99
Specimen Handling 99
FNA Versus Core 99
Alternatives 99
Suggested Reading 100
Prostate Biopsy 101
Clinical Features 101
Diagnostic Evaluation 101
Clinical 101
Laboratory 101
Imaging 102
Indications 102
Contraindications 102
Patient Preparation 102
Anatomy 102
Equipment 103
Pre-procedure Medications 103
Procedure 103
Immediate Post-Procedure Care 103
Immediate Post-Procure Care CT-guided Transgluteal Prostate Biopsy 105
Complications 105
Alternative Procedures/Future Directions 105
Suggested Reading 106
Drainage of Abdominal Fluid Collections 107
Diagnostic Evaluation 107
Patient Preparation 108
Relevant Anatomy 108
Procedure 110
Planning an Access Route 110
Performing the Procedure 110
Technique 110
Tips 111
Follow-Up and Post-Procedure 111
Abscess\u2013Fistula Complex 113
Removal of Drain 113
Causes of Failure 114
How to Avoid 114
Suggested Reading 115
Drainage of Pelvic Fluid Collections 116
Clinical Features 116
Diagnostic Evaluation 116
Clinical 116
Laboratory 116
Imaging 117
Indications 117
Contraindications 117
Alternative Therapies 117
Patient Preparation 117
Relevant Anatomy 118
Normal 118
Aberrant/Altered 118
Equipment 118
Procedure 118
Technique 118
Planning an Access Route 119
Routes of Pelvic Drainage (Fig. 1a) 119
Transgluteal Approach 119
Anterior Approach 120
Transrectal or Transvaginal Access (Figs. 4 and 5) 121
Transperineal Approach 121
Endpoint 123
Results 124
Follow Up 124
Catheter Management 124
Suggested Reading 125
Drainage of Intrathoracic Fluid Collections 126
Clinical Features 126
Diagnostic Features 126
Imaging Appearance 126
Thoracentesis 127
Percutaneous Catheter Drainage 127
Indication for Chest Catheter Drainage 128
Indicators of Successful Drainage 129
Clinical Scenarios 129
Parapneumonic Effusions and Empyema 129
Pneumothorax 129
Lung Abscess 131
Mediastinal Abscess 131
Pleurodesis 131
Normal Anatomy 132
Aberrent/Altered Anatomy 132
Complications 133
Suggested Reading 133
Liver Cyst / Abscess Drainage 134
Clinical Features 134
Diagnostic Evaluation 134
Laboratory 134
Imaging 135
Indications/Contraindications 135
Simple Cyst 135
Hydatid Cyst 135
Liver Abscess 136
Patient Preparation 136
Equipment 136
Pre-proceure Medications 136
Procedure 136
Planning an Access Route 136
Procedure 136
Simple Cyst 137
Hydatid Cyst 138
Liver Abscess 138
Immediate Post-proceure Care 138
Follow-up and Postprocedure Medications 141
Simple cyst 141
Hydatid cyst 141
Liver abscess 141
Results 141
Simple Cyst 141
Hydatid Cyst 142
Liver Abscess 142
Alternative Therapies 142
Complications 142
Simple Cyst 142
Hydatid Cyst 142
Liver Abscess 143
Suggested Reading 143
Drainage of Pancreatic Abscess and Fluid Collections 144
Clinical-Pathologic Features 144
Imaging 144
Indications/Contraindications 145
Pseudocysts 145
Pancreatic Necrosis 145
Pancreatic Abscess 145
Image Guidance-Access Route 145
Technique 147
Pancreatic Abscess-Infected Necrosis 147
Pseudocysts 147
Aftercare 148
Endpoint 148
Alternative Therapies 148
Suggested Reading 149
Percutaneous Biliary Drainage and Stenting 150
Clinical Features 150
Diagnostic Evaluation 150
Clinical 150
Laboratory 150
Imaging 151
Indications 151
Alternative Therapies 151
Contraindications 151
Specific Complications 151
Patient Preparation 152
Anatomy 152
Normal Anatomy 152
Aberrant Anatomy 152
Equipment 152
Pre/Peri-procedure Medications 153
Procedure 153
Planning an Access Route 153
Performing the Procedure 155
Technique 155
Endpoint 156
Immediate Post-procedure Care 156
Follow-up and Post-procedure Medications 157
Results 157
Metallic Stenting 157
Complications 158
How to Avoid Complications 158
Medication 159
Follow-up 159
Suggested Reading 159
Percutaneous Cholecystostomy and Cholecystolithotomy 161
Percutaneous Cholecystostomy 161
Introduction 161
Diagnostic Evaluation 161
Clinical 161
Laboratory 162
Imaging 162
Indications 162
Contraindications 162
Absolute Contraindications 162
Relative Contraindications 163
Relevant Anatomy and Approach 163
Advantages of Transhepatic Approach 163
Equipment 163
Imaging Guidance 163
Medication 163
Hardware Requirements 164
Procedure 164
The Seldinger Technique 164
Trocar Technique 165
Post-procedure Care 166
Complications 166
Outcomes 167
Percutaneous Cholecystolithotomy 167
Important Considerations 167
Hardware Requirements 168
Procedure 168
Results 168
Complications 169
Suggested Reading 169
Percutaneous Nephrostomy and Antegrade Ureteric Stenting 170
Percutaneous Nephrostomy 170
Clinical Features 170
Diagnostic Evaluation 170
Indications 171
Relative Contraindications 171
Patient Preparation 171
Relevant Anatomy 172
Normal Anatomy 172
Aberrant Anatomy 172
Transplant Anatomy 173
Equipment 173
Procedure 174
Imaging Guidance 174
Positioning the Patient 174
Planning an Access Route 174
Performing the Procedure 174
Technique 174
End-point 175
Immediate Post-Procedure Care 175
Follow-Up and Post-Procedure Medications 175
Results 176
Alternative Therapies 176
Complications 176
How to Avoid 176
Antegrade Ureteric Stenting 177
Indications 177
Contraindications 177
Patient Preparation 177
Equipment 178
Pre-procedure Medication 178
Procedure 178
Imaging Guidance 178
Positioning the Patient 178
Technique 178
Choosing the Stent 179
End-Point 180
Immediate Post-Procedure Care 180
Follow-Up and Post-Procedure Medication 180
Results 180
Alternative Therapies 181
Complications 181
Early Complications 181
Late Complications 181
How to Avoid 181
Suggested Reading 182
Fluoroscopy-Guided Percutaneous Renal Access for Treatment of Stone Disease 183
Clinical Features 183
Diagnostic Evaluation 183
Laboratory 183
Imaging 183
Indications 184
Alternative Therapies 185
Contraindications 185
Specific Complications 185
Anatomy 185
Equipment 186
Access Technique 187
Suggested Reading 188
Percutaneous Gastrostomy and Gastrojejunostomy 189
Clinical Features 189
Diagnostic Evaluation 189
Clinical 189
Laboratory 189
Imaging 190
Indications 190
Contraindictaions 190
Absolute 190
Relative 190
Patient Preparation 190
Relevant Anatomy 191
Aberrant Anatomy 191
Equipment 192
Gastrostomy Tube 192
Gastropexy Kit (T Fasteners) 192
Stiff Guidewire 193
Medication 193
Procedure 194
Planning an Access Route 194
Performing the Procedure: Primary Button Gastrostomy 194
Gastropexy 194
Stomach Puncture 194
Measure Tract 195
Tube Insertion 195
Check Position 195
Performing the Procedure: Balloon- or Locking Pigtail-Retained Tubes 195
Performing the Procedure: \u201cEndoscopic Type\u201d Tubes 196
Immediate Post-Procedure Care 196
Gastrojejunostomy 196
Indications 196
Follow-Up 197
Alternative Therapies 197
Endoscopic Gastrostomy 197
Complications 197
Suggested Reading 198
Index 199
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