Chin Med J (Taipei) 1998;61:S189.

Emergency Interventional Radiology

Harold A. Mitty, M.D.

Professor of Radiology and Urology, Director of Interventional Radiology of The Mount Sinai School of Medicine of the City of University of New York

Abstract

Interventional radiologic techniques have resumed increasing importance in the non-operative management of a wide variety of emergency conditions. This presentation focuses on the most common emergency interventions in a large urban teaching hospital (The Mount Sinai Hospital - New York City).

GASTROINTESTINAL HEMORRHAGE: The indication for angiographic control of hemorrhage have changed significantly over recent years. Medical control of ulcer disease coupled with endoscopic techniques have limited the role of the interventional radiologist. Local infusions of vasopressin to control bleeding sites has been largely replaced by accurate placement of embolic particles or coils by means of micro-catheters.

Esophageal variceal hemorrhage is now one of the areas that radiologic techniques are most important. This is due to the fact that transjugular intrahepatic portosystemic shunts (TIPS) are routinely performed in the interventional radiology suite. Of 200 such patients treated in our hospital 75% had recent history of serious hemorrhage. Fifteen percent of our patients have TIPS for intractable ascites.

Palliative treatment of non-resectable bleeding primary or metastatic malignant GI tumors are also treated by embolotherapy. This avoids major operative intervention in patients with limited life-expectancy.

OTHER HEMORRHAGE: Trauma: Bleeding associated with trauma is often controlled by transcatheter means. Smaller vessel injury is treated by embolotherapy either with particles or coils. The newly emerging technique of peripherally inserted stent-grafts has made it possible to treat major vessel injuries such as carotid and aorta without the need for direct operative intervention.

Iatrogenic Trauma: biopsy related hemorrhage is not common since imaging guidance has evolved Nevertheless, occasional cases of bleeding following biopsy have required transcatheter therapy. (This has been most often a problem following renal biopsies). Microcatheter techniques make it possible to control such bleeding while sparing most of the renal parenchyma.

OBSTETRICAL HEMORRHAGE: It is important to establish protocols with obstetrical services so that postpartum hemorrhage can be controlled without the need for hysterectomy. Our experience with 25 such cases has demonstrated that the uterine arteries can be easily catheterized and hemorrhage controlled even in-patients with disseminated intravascular coagulapathy (D.I.C.)

SEPSIS: One of the most common indications for emergency or prompt percutaneous intervention is the presence of fever and sepsis. The 3 commonest areas requiring drainage are: 1) Post-operative absesses 2) Urinary tract obstruction with sepsis. 3). Biliary sepsis. Spiral CT and real- time CT have made these techniques more reliable.

[Chin Med J (Taipei) 1998;61:S189.]