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Basics of respiratory interventional radiology

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Abstract

Interventional radiology (IR) involves the use of contemporary imaging modalities, such as radiography, fluoroscopy and computed tomography (CT) to gain access to specific structures in order to deliver different materials for therapeutic purposes. These techniques are routinely used in human medicine; despite potential applications, however, these procedures have not yet been widely adopted in veterinary medicine. This chapter focuses on the use of IR techniques for tracheal diseases. The following are discussed: General indications; Equipment; Tracheal collapse; Malignant or benign airway obstruction; Tracheal foreign bodies.

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Figures

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6.1 Nitinol mesh self-expanding metallic stent, for intraluminal tracheal stenting, and delivery system during partial deployment.
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6.2 Serial lateral thoracic fluoroscopic images during tracheal sizing and stent placement. Using positive pressure ventilation and an oesophageal marker catheter, measurements are taken to establish the maximal tracheal diameter. The stent delivery system is advanced into the trachea. Note that the cervical and intrathoracic trachea are in line to facilitate unimpeded passage of the stent. Restoration of a patent trachea immediately following placement of an intraluminal tracheal stent.
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6.3 Bronchoscope adapter used to maintain a complete anaesthetic circuit whilst passing the stent delivery system through the bronchoscope opening and down the ET tube.
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6.4 Lateral thoracic radiographs of a cat with tracheal carcinoma. Note the intrathoracic tracheal narrowing (arrowed) due to the tumour. The tracheal lumen has been restored immediately following placement of an intraluminal stent.
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6.5 Radiographic and fluoroscopic images of an 8-week-old Boxer puppy with a ‘plastic bead’ tracheobronchial foreign body. Lateral radiograph demonstrating the large radiopaque foreign body at the level of the carina (arrowhead). Ventrodorsal fluoroscopic image (inverse greyscale) showing the foreign body (arrowhead) in left mainstem bronchus and the guidewire (arrowed). Ventrodorsal fluoroscopic image (inverse greyscale) showing the stone basket (arrowed) in left mainstem bronchus before grabbing the foreign body now located in right mainstem bronchus (arrowhead). Lateral thoracic radiograph immediately following retrieval of the foreign body.

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