Beyond the Bile Duct: Advanced IR Endoscopic Interventions Involving the Gastrointestinal, Genitourinary, and Musculoskeletal Systems

Endoscope-Assisted Traversal of a Ureteral Stricture From Percutaneous Nephrostomy Access

Interventional radiology-operated endoscopy has a small but growing number of applications. In this clinical case report, we describe the use of an endoscope to assist the traversal of a high-grade ureteral stricture from percutaneous nephrostomy (i.e., antegrade) access. Direct visualization of the stricture allowed the identification of a central channel that was not present in fluoroscopic images, making endoscopy essential to the technical success of the procedure. Endoscopy is a powerful adjunct to image-guided techniques, particularly in challenging interventions or cases with complex anatomy.

Intravascular US: Applications in Interventional Radiology

Interventional radiology applications of intravascular US (IVUS) continue to expand, complementing intraprocedural angiography and providing a unique vantage from which to guide endovascular interventions. Vascular pathologic conditions become sonographically visualized rather than inferred from the planar appearance of the opacified vascular lumen. Perivascular targets become sonographically visualized rather than approximated on the basis of fluoroscopic landmarks. The authors introduce broad categories of IVUS catheters, namely radial and side-firing varieties, as well as prevailing options for each and their technical specifications. Common applications within interventional radiology are covered in a systems approach, including deep venous thrombosis, May-Thurner syndrome, nutcracker syndrome, transjugular intrahepatic portosystemic shunts, aortic interventions, peripheral arterial disease, and endovascular or perivascular biopsy. Discussions are accompanied by technical pearls from the authors, and summarized evidence where IVUS has been shown to reduce procedural time, intravascular contrast agent dose, radiation exposure, and morbidity in each space is presented. Finally, emerging applications and future directions are discussed. ^©RSNA, 2022.