Ultrasound-Guided Percutaneous and Intraoperative Procedures

Contents

Preface: Ultrasound-Guided Percutaneous and Intraoperative Procedures xi

Wael E. Saad

Ultrasound-Guided Vascular Access 283

Peter O. Simon Jr and Wael E. Saad

Ultrasound-guided vascular access is the initial step in an array of medical proce-dures. Ultrasound guidance has been shown to have numerous beneficial effectson accessing arterial and venous structures, including shortened procedure times,more precise access, and reduced morbidity/complication rates. This article dis-cusses the indications, techniques, periprocedure management, imaging modali-ties, and outcomes related to ultrasound-guided vascular access.

Ultrasound-Guided Management of Vascular Access Pseudoaneurysms 299

Nicholas J. Hendricks and Wael E. Saad

Pseudoaneurysm formation is a relatively common vascular complication of cathe-terization. Pseudoaneurysms can be a source of emboli, become infected, or rup-ture. This article sets out to review the indications, techniques, outcomes, andcomplications of the ultrasound guided pseudoaneurysm treatment. The most com-mon treatment techniques for vascular access pseudoaneurysms are direct percu-taneous thrombin injection and ultrasound-guided compression.

Ultrasound-Guided Breast Interventions 309

Jennifer A. Harvey and Alecia W. Sizemore

Widely accepted as a minimally invasive, accurate, cost-effective technique, percuta-neous image-guided biopsy has largely replaced diagnostic surgical biopsy in the eval-uation of breast lesions. The natural curvature of the breast is used to advantage inultrasound-guided breast interventions. Once mastered, free-hand technique is typi-cally the fastest,most accuratemethod for ultrasound-guidedprocedures.Challengingcases require additional planning, however most breast lesions visible on ultrasoundare amenable to ultrasound-guided biopsy. Contraindications and complications arefew. This chapter focuses primarily on ultrasound-guided breast biopsy using freehandguidance. Many of these concepts can be transferred to other ultrasound-guidedinterventions.

Ultrasound-Guided Procedures in Obstetrics 325

Christian A. Chisholm and James E. Ferguson II

Amniocentesis and chorionic villus sampling are the most common techniques forobtaining a prenatal karyotype on a fetus at risk; in appropriately-trained hands,either can be performed with an acceptably low risk of complications. Ultrasoundguidance is used for nearly all invasive diagnostic procedures in obstetrics, andseems to improve the odds for a successful procedure, but may not reduce therisk of procedure-related pregnancy loss. Ultrasound guidance is essential for fetaltherapeutic interventions such as fetal blood transfusion, vesicoamniotic shuntplacement, and thoracentesis.

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Ultrasound-Guided Transvaginal Interventions in the Pelvis 337

Gia A. DeAngelis

An endovaginal approach is often the preferred route in aspirating central pelvic col-lections or biopsy of small lesions. Collections can be managed with aspirationalone. A catheter is considered when the collection is particularly large or complex.The 1-step trocar technique is preferable overall, given it can be performed quicklyand entirely under ultrasound guidance, is usually successful, and can be learnedrapidly. The author has provided several related videos at www.ultrasound.theclinics.com/.

Ultrasound-Guided Abdominal and Pelvic Abscess Drainage 347

Harun Ozer and Wael E. Saad

Imaging-guided percutaneous drainage is a safe and effective treatment of ab-scesses. Interventional radiologists may use ultrasound, fluoroscopy, computed to-mography, or combined modalities for guidance of catheter placement in numerouslocations in the abdomen and pelvis. After catheter placement, the performance ofdaily hospital rounds and the judicious use of follow-up imaging helps to optimizepatient outcomes. Exchange or repositioning of the catheter, or insertion of an ad-ditional catheter, as well as adjuvant thrombolytic therapy, may be needed toachieve complete drainage.

Ultrasound-Guided Visceral Biopsies: Renal and Hepatic 363

Nirvikar Dahiya, William D. Middleton, and Christine O. Menias

Visceral organ biopsies are being routinely performed these days with excellentdiagnostic results. Ultrasound is a safe and reliable imaging modality to provideguidance for the vast majority of biopsies. This article discusses the various factorsassociated with performing ultrasound-guided liver and renal biopsies. The authorshave provided several related videos at www.ultrasound.theclinics.com/.

Percutaneous and Intra-operative Tumor Ablation 377

Jonathan K.West, Minhaj S. Khaja, Maryam Ashraf, and Wael E. Saad

In the past 2 decades there have been significant technological developments andadvancements in image-guided tumor ablation. Radiofrequency ablation (RFA) is themost commonly used and studied form of tumor ablation. This article focuses onRFA and only briefly discusses cryoablation. The article reviews the indications, pre-procedural patient evaluation, techniques, postprocedural management, and com-plications of ultrasound-guided percutaneous and intra-operative tumor ablation,with special attention to hepatic and renal neoplasms.

Percutaneous Transhepatic Biliary Drainage 399

Matthew R. Gossage, Robert F. Short, and Wael E. Saad

Percutaneous transhepatic cholangiography (PTC) is an effective procedure to diag-nose and treat a variety of biliary abnormalities. The operator may elect for a right-sided or left-sided approach for PTC, or both. Generally, right-sided interventionsare strictly performed under fluoroscopy. For a left-sided approach, ultrasound(US) plays an important role in visualization of the left hepatic lobe biliary ducts andvascular structures. US-guided targeting of biliary ducts under direct visualization

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allows more efficient PTC with or without percutaneous biliary drainage placementand helps avoid vascular injury. This article focuses primarily on US-guided left-sidedbile duct access.

Ultrasound-Guided Percutaneous Nephrostomy 413

Matthew R. Bernhard, Allison J. Lippert, Minhaj S. Khaja, and Wael E. Saad

Percutaneous nephrostomy (PCN) is a procedure in which percutaneous access ofthe kidney is obtained to provide external drainage in an obstructed renal collectingsystem or serve as a conduit through which minimally invasive urologic procedurescan be performed. Ultrasound-guided PCN has been validated as an effective andsafe, minimally invasive image-guided procedure. This article reviews the indica-tions, preprocedural patient evaluation, techniques, postprocedural management,and complications of ultrasound-guided PCN.

Index 421