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Interventional endoscopy and radiology

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Abstract

Interventional endoscopy and radiology offer shorter recovery time, reduced rate of complications and lower mortality compared with many traditional surgical options. This chapter describes equipment and commonly performed techniques for Respiratory, Gastrointestinal and urinary tract conditions, and Vascular interventions.

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Figures

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15.1 A traditional fluoroscopic C-Arm X-ray system and monitor. The operator and assistants should wear personal protective equipment including lead gowns and thyroid shields as a minimum during all procedures using this machine.
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15.2 (a) A 0.035 inch (0.9 mm) hydrophilic angle-tipped Weasel Wire. This is the most commonly used wire in interventional procedures. (b) A 0.035 inch (0.9 mm) straight-tipped Bentson wire.
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15.3 (a) An introducer sheath with a side arm to allow flushing and blood sampling (left). The vascular dilator (right) should be flushed before insertion into the sheath. (b) The introducer sheath with the vascular dilator in place.
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15.4 (a) Commonly used angiographic catheters. The different shapes of the catheter ends allow access to various vessels depending on the procedure being performed. (b) A straight angiographic marker catheter. The metallic marks indicate 1 cm from the back of one mark to the back of the next, allowing accurate measurement during fluoroscopic procedures where magnification of the image occurs.
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15.5 Two deployed nitinol (nickel–titanium) tracheal stents.
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15.6 A balloon dilator catheter.
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15.7 (a) A platinum coil within its delivery system (centre), the coil pusher (left) and a partially deployed coil (right). (b) Multiple deployed coils.
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15.8 Polyvinyl alcohol beads of various sizes for use in embolization procedures.
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15.9 A fluoroscopic image of a deployed tracheal stent.
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15.10 (a) Fluoroscopic image of a nasopharyngeal stenosis (arrowed) being treated by balloon dilation. (b) Fluoroscopic image from later in the same balloon dilation procedure. The area of stenosis visible in (a) is no longer present. (c) Fluoroscopic image of a nasopharyngeal stent deployed over a hydrophilic guidewire. The arrows highlight the radiodense markers at the cranial and caudal aspects of the stent.
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15.11 (a) Fluoroscopic image of an oesophageal stricture during a balloon dilation procedure. The arrow highlights the stricture ‘belt’ that must be fully effaced during the procedure. (b) Complete effacement of the stricture shown in (a).
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15.12 Fluoroscopic image of an intra-arterial approach to the bladder. Access was via the carotid artery. Contrast agent has been injected to highlight both the external and internal iliac arteries.
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15.13 Embolization of the prostatic artery. (a) With the patient in lateral recumbency, a digital subtraction image highlights the prostatic artery (arrowed). (b) Digital subtraction image following prostatic embolization. Note the blunt end of the prostatic artery (arrowed).
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15.14 Fluoroscopic image obtained following percutaneous transvenous embolization of an intrahepatic portosystemic shunt. A stent has been placed within the caudal vena cava (arrowheads) and multiple platinum coils have been deployed within the shunting vessel (arrowed).
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15.15 (a) A surgical diode laser and safety goggles for use when operating the laser. (b) Diode laser fibre and scissors used to trim the fibre.
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15.16 A canine double-pigtail ureteral stent and pusher catheter.
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15.17 Fluoroscopic image of a cystoscopically placed ureteral stent. The cranial aspect of the stent (arrowed) is in the dilated proximal ureter and the distal aspect (arrowhead) is within the bladder.
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15.18 Fluoroscopic image of an implanted subcutaneous ureteral bypass device. The kidney (left) and bladder (right) are filled with contrast agent. The port used for flushing and sampling is highlighted with an arrow.

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