Fluoroscopic guidance

Using an endocardial monophasic action potential recording, the incidence of early after depolarizations can be determined. The catheter (e.g. Franz combination catheter, EPT No. 1650) can be placed through the jugular vein or carotid artery under fluoroscopic guidance. 

Fig. 7. Schematic diagram of the canine femoral artery copper coil model of thrombolysis. A thrombogenic copper coil is advanced to either femoral artery via the left carotid artery. By virtue of the favorable anatomical angles of attachment, a hollow polyurethane catheter advanced down the left carotid artery nearly always enters the descending aorta, and with further advancement, into either femoral artery without fluoroscopic guidance. A flexible, Teflon-coated guidewire is then inserted through the hollow catheter and the latter is removed. A copper coil is then slipped over the guidewire and advanced to the femoral artery (see inset). Femoral artery flow velocity is measured directly and continuously with a Doppler flow probe placed just proximal to the thrombogenic coil and distal to a prominent sidebranch, which is left patent to dissipate any dead space between the coil and the next proximal sidebranch. Femoral artery blood flow declines progressively to total occlusion over the next 10-12 mm after coil insertion.

Habdank, K., Restrepo, R., Ng, V., Connolly, B.L., Temple, M.J., Amaral, J., Chait, P.G. Combined sonography and fluoroscopic guidance during transjugular hepatic biopsies performed in children A retrospective study of 74 biopsies. Amer. X. Roentgenol. 2003 180 1393-1998... 

Procedure The patient should be on a low-sodium, high-potassium diet and receiving a diuretic for 3 days before the procedure. Under fluoroscopic guidance, percutaneous catheterization is performed, and blood samples are obtained from both renal veins and the inferior vena cava for determination of PRA. 

A balloon catheter is placed per rectum (10 F-18 F). Many operators inflate the balloon on the Foley catheter but this is not universal practice and caution should be used when inflating a balloon catheter in the rectum because of the reported risk of mucosal ischaemia. The buttocks are subsequently taped or gripped firmly to complete a good seal at the anus. Air is then introduced into the distal colon, with a manometer or other monitoring device present on the system to ensure safe and constant pressures of air. The progress of the air (and the reduction of the intussusceptum) is closely observed under fluoroscopic guidance (Fig. 6.8a). It is usual practice to include the whole abdomen within the field of view so as not to miss a perfora-... 

The preferred reduction technique is either that of the air enema under fluoroscopic guidance or of air or hydrostatic enema under ultrasound guidance. The only absolute contra-indication to attempted enema reduction is full thickness bowel necrosis (which will present with features of shock and peritonitis) or if there is imaging evidence of perforation with free air. 

A nasogastric tube is inserted and the stomach inflated. Thereafter it is punctured under fluoroscopic guidance and a T-fastener is inserted (Fig. 7.2). Some radiologists will place up to three T-fasteners in order to secure the gastric wall to the anterior abdominal wall. The advantage of using only one T-fastener is that the procedure can be done with a single puncture of the stomach. 

Under fluoroscopic guidance the stomach is punctured and a guidewire is inserted. Using dilators the needle tract is dilated and a gastrostomy tube is placed within the stomach. The retention balloon is inflated and the gastrostomy tube is fixed to the abdominal wall using the supplied external stabilizer. 

AVM embolization is normally accomplished through transfemoral microcatheter delivery of the material under fluoroscopic guidance. The microcatheter tip is placed where the feeding artery branches off from healthy vasculature and... 

Also, the microcoils are deliverable by the Squirt technique. The Squirt technique is suitable for delivery of all pushable fibered microcoils (0.018 in.) through microcatheters with 0.016- to 0.027-in. end-holes. The microcoil is loaded into the microcatheter and preferably a 3-ml luer lock syringe, filled with saline is attached to the hub of the microcatheter. Under fluoroscopic guidance, the microcoil is delivered with small boluses of saline. Final adjustment of the microcoil is accomplished by moving the microcatheter before final deployment of the coil, if... 

Previous experience with translumbar puncture of the aorta for diagnostic angiography showed that this puncture carries only minor risks, with a retroperitoneal hematoma rate of about 3% [45]. The aorta can be punctured under CT or fluoroscopic guidance. 

Careful correlation with prior CT images will help plan the puncture in relation to the markers on the stent graft. Ideally the left side access is used to avoid IVC. However, if necessary the puncture can be done through the IVC. When performed under fluoroscopic guidance it is useful to frequently rotate the X-ray tube from the AP to the lateral projection, and in between, to help in assessing the needle track, and to avoid puncturing the stentgraft. 

Using CT guidance the initial needle tip placement will be into the leak sac (Fig. 14.3). However, with fluoroscopic guidance and a relatively small leak, the initial puncture may end up in thrombus. In these cases, the leak sac can usually be found fairly easily using a hydrophilic guidewire and catheter. 

Pinto et al. (2001) used 20 and 22 mm uncovered oesophageal Wallstents of 70 mm length in a series of 31 patients. In nine patients two stents were needed and in seven patients a percutaneous, transgastric approach was necessary, either because the delivery device was not long enough or the stent could not be properly positioned. In the other patients a peroral route with catheter technique under fluoroscopic guidance was used. Technical success was achieved... 

Fluoroscopic Guidance. Again the patients are best treated under mild sedation and placed in a left... 

With transverse imaging, the relationship to the adjacent artery is continually imaged. To puncture the vein safely, the needle tip must constantly be imaged (Skolnick 1994). This requires moving the transducer in tandem with needle advancement to keep the tip within the plane of the ultrasound beam (Donaldson et al. 1995). Small adjustments can be made with a rocking motion of the transducer. Once the needle tip is seen to indent the vein wall, a short thrust is made to enter the vein. Then, a small amount of blood is aspirated and the 0.018-in. wire is advanced under fluoroscopic guidance. 

Brant-Zawadzki M, Anthony M, Mercer EC (1993) Implantation of P.A.S. Port venous access device in the forearm under fluoroscopic guidance. AJR Am J Roentgenol 160 1127-1128... 

The track into the collecting system is formed by serial dilatation. This can be done using either serial plastic fascial or telescopic metal dilators under fluoroscopic guidance. We prefer metal dilators, as they maintain continuous tamponade, thus preventing bleeding into the collecting system. 

Fig. 37.2a,b. Patient (prone position) with multiple lung me-tastases. A subpleural nodule in the left lower lobe was chosen for aspiration biopsy under CT-fluoroscopic guidance with a 19-G (10 cm) needle (a). Postinterventional CT (supine posi-... 

Jelinek et al. (2002) reported their results in 110 primary bone tumors that were sampled under CT and fluoroscopic guidance, respectively. Correct final diagnosis could be obtained by biopsy in 88% of the patients, while the only minor complication was a small hematoma (0.9% complication rate). The efficacy of CT-guided percutaneous biopsy in the management of spinal bone lesions has also been evaluated extensively (Renfrew et al. 1991). 

Fig.39. 3a-c. A 55-year-old male patient with a solitary pulmonary metastasis due to colorectal cancer. The patient did not want to undergo open surgery therefore, RF ablation was performed using CT fluoroscopic guidance (b). Control scan (c) 24-h after treatment showed no complication and the lesion completely covered as indicated by the ground-glass opacities surrounding the metastasis... 

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