Transarterial chemoembolization (TACE) FOR LIVER TUMOUR

A 54 year old patient presented to us with severe abdominal pain. Ultrasound showed large right lobe liver mass measuring approx 9.2x 6.7x5.5 cm. Contrast triple phase CT done showed that the lesion is a tumour- hepatocellular carcinoma. On further evaluation patient was hepatitis B positive. According to BCLC staging, patient was in BCLC category B (intermediate stage). So TACE was planned for treatment of HCC. Through trans-femoral route, selective cannulation of hepatic artery branches supplying the tumour was done followed by injecting doxorubicin drug mixed with beads. Follow up scan after 1 month showed no residual arterial enhancement with AFP levels back to normal level. Transarterial chemoembolization is standard endovascular treatment for treatment of BCLC intermediate stage hepatocellular carcinoma.

Gastroduodenal artery pseudoaneurysm bleed

A 17 year old post traumatic male patient came to the emergency with hypovolemic shock . CT angiography done shows contrast leak from gastroduodenal artery suggestive of the cause of bleeding. Endovascular coiling of gastro-duodenal artery was done in cathlab. Procedure was uneventful .Bleeding stopped post procedure.Patient is now discharged in a stable state.

Uterine artery embolization

A 33 year old female presented to us with complaints of per-vaginal bleed since last 1 month post-partum. Imaging by CT and ultrasound shows large hypervascular intrauterine lesion likely intrauterine retained products of conception. This was the cause of per-vaginal bleed. Patient was planned for embolization of the feeding vessels .Patient underwent endovascular embolization of feeding vessels in cathlab. Bleeding stopped after the procedure. Patient was kept under observation in the hospital for 5 days. Patient kept for follow up after 1 month post procedure. Repeat imaging shows no residual retained products with no further episodes of per-vaginal bleed.

Percutaneous transbiliary drainage and biliary stenting.

A 52 year old patient , case of inoperable carcinoma gall bladder with involvement of primary biliary confluence with raised liver enzymes (Bilirubin was 21.7).Patient was planned for bilobar PTBD and biliary stenting for biliary drainage to reduce the bilirubin level so that patient can be made eligible for chemotherapy. Bilobar PTBD was done on day 1 followed by biliary stenting on day 3. Bilirubin came down to 2.2 on day 8. Chemotherapy was started on day 10.Patient is presently undergoing chemotherapy with improvemt in disease status.

Tracheal stenting

A patient with inoperable carcinoma esophagus on palliative therapy, developed severe difficulty in respiration. Ct scan showed severe narrowing of trachea due to esophageal tumour growth in tracheal.Patient was planned for urgent tracheal stenting. Endotracheal stenting was done in cathlab. Post stenting patient had relief in respiration with no further respiratory complaints.

Venoplasty of non-working/thrombosed dialysis AV fistula

A 52 year old patient who was on dialysis presented to us with acutely blocked left forearm AV fistula. On Doppler evaluation there was long segment thrombosis of draining vein involving the fistula with narrow calibre of draining vein. Patient was planned for venoplasty and thrombus aspiration of draining vein. Under Ultrasound and fluoro guidance, venoplasty and thrombus aspiration of draining vein and fistula was done. The draining vein and fistula post procedure shows good colour flow on Doppler . Patient underwent dialysis the next day with no problems during dialysis.

Mechanical thromboaspiration of acute limb threatening femoro-popliteal artery thrombosis

A 62 year old patient presented to us with severe acute left lower limb calf pain. Ultrasound Doppler showed acute left distal femoral and popliteal artery thrombosis for a length of approx 8 cm. Patient was emergently taken to cathlab for mechanical thromboaspiration and angioplasty so as to prevent leg from gangrene and amputation.Procedure was uneventful. Patient had complete relief in pain. Post op Doppler showed good flow in the previously thrombosed segemnts.Patient is discharged in a stable state with no further complaints.

IVC stenting

52 year old patient presented to us with acute lower limb deep venous thrombosis which was extending up to infrarenal IVC. IVC filter placement was planned due to high risk of pulmonary thromboembolism and anticoagulation therapy was contraindicated in this patient due to associated high risk. IVC filter was placed with tip just below the renal veins. Procedure was uneventful.

Peripheral arterio-venous malformation (AVM) embolization

A 54 year old patient presented with right arm swelling. Imaging by ultrasound and CT scan was suggestive of high flow arterio venous malformation. Patient was planned for DSA and embolization of AVM. Through right trans-femoral arterial route selective cannulation of right upper limb arterial feeders was done followed by endovascular glue embolization of AVM.Procedure was uneventful and patient was discharged next day in a stable state.

Cystic artery aneurysm coiling

52 year old patient previously underwent laparoscopic cholecystectomy , now presented with massive hematemesis and malena. CT angiography done showed large cystic artery pseudo-aneurysm. Endovascular coiling of pseudo-aneurysm done .Patient had no further episodes of bleeding with stable vitals post procedure and on follow up.