Discuss the role of interventional radiology in the management of the critically ill.
Therapeutic or diagnostic
CT or US guided drainage of abscess or fluid collections
Coiling of aneurysm
Embolisation of bleeding vessel Regional thrombolysis or clot removal TIPS procedure
Angioplasty for vasospasm Coronary intervention
IVC filter insertion
Angioseal of cannulated vessel eg inadvertent arterial insertion of vascath Vascular access eg Hickman
Insertion PEG, nasojejunal tubes
Angiography to diagnose vasculitis, cerebral thrombosis, region of haemorrhage (especially intestinal), brain death
May be as effective as surgery (good evidence in aneurysmal SAH) with lower morbidity and mortality
Offers treatment option for patients unsuitable for surgery due to age or co-morbidities Good option in critically ill where surgical risks high eg laparotomy to drain abscess Preferred strategy in management pelvic trauma
May avoid hysterectomy in post-partum haemorrhage
Specific expertise needed but increasingly widespread
Needs to be performed in radiology suite with the risks and difficulties of managing a critically ill patient in a ‘hostile’ environment
Surgical back-up needed if intervention fails Risk of contrast use (allergy, CIN) Complications specific for each procedure
These "discuss the role" questions are difficult to answer in a systematic fashion. The college suggests we "explain the underlying key principles".
The provided answer divides the issue into therapeutic and diagnostic roles, and then discusses the limitations of interventional radiology as a whole. This sort of structure lends itself well to a tabulated format.
|Application||Role||Advantages and Limitations|
|Diagnostic||Diagnosis of cerebral vasculitis|
|Localisation of intestinal haemorrhage||
|Gold standard for confirmation of brain death||
|Therapeutic||Radiologically guided drainage||
|Coiling of aneurysms||
|Embolisation of bleeding vessels||
|IVC filter insertion||
Harris, K. G., et al. "Diagnosing intracranial vasculitis: the roles of MR and angiography." American journal of neuroradiology 15.2 (1994): 317-330.
Hunnam, G. R., and C. D. R. Flower. "Radiologically-guided percutaneous catheter drainage of empyemas." Clinical radiology 39.2 (1988): 121-126.
Nicolaou, Savvas, et al. "Ultrasound-guided interventional radiology in critical care." Critical care medicine 35.5 (2007): S186-S197.