radiologi iaaaaantervensional
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DEFINISI
Radiologi intervensional
(Interventional Radiology/IVR):Pemeriksaan/tindakan terapetik yang dilakukan dengan memakai sarana imejing yang dikerjakan oleh ahli radiologi yang terlatih.
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SEJARAH
Dr. Charles Dotter, Portland Medical University of Oregon, USA
The Father of IVR. Majalah “Circulation” 1964, PTA
kelahiran IVR.
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BIDANG RADIOLOGI INTERVENSIONAL
Vascular interventional. Non vascular interventional.
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VASCULAR INTERVENSIONAL(ANGIOGRAFI)
Diagnostik Terapetik
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ANGIOGRAFI DIAGNOSTIK
Adalah pemeriksaan pembuluh darah dengan menggunakan zat kontras.
Dibagi menjadi 2 kelompok: Arteriografi. Flebografi-venografi.
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ARTERIOGRAFI
Pemeriksaan pembuluh darah arteri menggunakan zat kontras.
2 teknik dasar: Pungsi jarum perkutan. Kateterisasi arteri perkutan.
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Arteriografi mesenterika superior. Arteriografi mesenterika inferior. Arteriografi mesenterika inferior. Arteriografi pankreas (pankreatikografi). Arteriografi lien. Arteriografi serebral. Arteriografi vertebral. Angiokardiografi. Arteriografi koroner. Arteriografi paru.
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Arteriografi superselektif, antara lain: Superselektif arteri hepatika kanan dan kiri. Superselektif arteri karotis eksterna & arteri
karotis interna. Superselektif arteri iliaka interna.
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Arteriografi koroner
Stenosis Left Anterior Descending (LAD) Artery
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INDIKASI ARTERIOGRAFI
Kelainan kongenital.Agenesis/hipogenesis ginjal, ginjal ektopik.
Perdarahan yang tidak jelas sumbernya. Melena, hematuria, batuk darah.
Trauma.Untuk melihat apakah terjadi ruptur vaskuler.
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Kelainan pembuluh darah.Stenosis, aneurisma, oklusiDisplasi (fibromuscular dysplasia)Fistula arterio-venosusMalformasi arterio-venosusHemangioma, dll.
Tumor. Pendorongan p. darah, hipervaskularisasi,
neovaskularisasi, amputasi p. darah, dll. Pemeriksaan donor dan resipien pada
transplantasi organ.
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KONTRAINDIKASI ARTERIOGRAFI
Kontraindikasi mutlak (absolut):Alergi kontras Iodium.Gagal ginjal berat.
Kontraindikasi relatif:Pasien dengan kelainan jantung.Pasien yang tidak dapat berbaring.Pasien dengan kelainan pembekuan
darah.Pasien dengan KU buruk.
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KOMPLIKASI ARTERIOGRAFI
Komplikasi umum.Alergi kontras (ringan, sedang, berat).Emboli.Septikemia.Refleks vagal.
Komplikasi lokal.Lokasi pungsi.
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Perdarahan. Aneurisma dissekans. Fistula arteri-venosus. Injeksi kontras ke subtimal atau perivaskuler. Trombosis lokal. Infeksi lokal. Kerusakan saraf di dekatnya.
Kerusakan target organ akibat ekstravasasi kontras atau emboli oleh catheter clot.
Fraktur dan lepasnya ujung guide-wire.Pembentukkan knot di kateter.
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FLEBOGRAFI/VENOGRAFI
Pemeriksaan pembuluh darah vena dengan menyuntikkan zat kontras ke dalam vena tersebut.
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JENIS-JENIS FLEBOGRAFI
Flebografi ekstremitas atas/lengan. Kavografi superior-mediastinografi. Kavografi inferior. Flebografi pelvis. Flebografi vena hepatika. Flebografi renal.
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Flebografi ekstremitas bawah/tungkai. Flebografi suprarenal. Splenoportografi. Flebografi vena paravertebralis. Flebografi intra-osseus. Flebografi orbita.
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INDIKASI FLEBOGRAFI
Edema karena kelainan vena. Pelebaran vena. Gangguan katup vena, misalnya insufisiensi
katup vena-vena perforantes. Mengukur tekanan vena di tempat tertentu. Penekanan vena oleh massa tumor,
misalnya tumor-tumor medistinum.
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KONTRA INDIKASI FLEBOGRAFI
KI mutlak: alergi iodium. KI relatif: gangguan jantung berat.
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ANGIOGRAFI TERAPETIK Percutaneus Transluminal Angioplasty (PTA). Vascular embolization. Vascular stenting. Vascular thrombolysis. Intra-arterial drug therapy. Transarterial Infusion. Transarterial embolization. Pemasangan vena cava filter. Pemasangan porta catheter. TIPS.
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PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY (PTA).
Suatu tindakan untuk tujuan dilatasi stenosis dan rekanalisasi oklusi, menggunakan kateter transluminal yang dimasukkan secara perkutan.
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EMBOLISASI Suatu tindakan mengoklusi pembuluh darah
arteri secara transkateter. Menggunakan agen embolan, bisa berupa:
jaringan biologis (otot, jaringan fibrosa, lemak, autologous clot), gelatin, fiber, metalik, plastik (PVA), steel coil dengan rangkaian-rangkaian fiber, bukrilat (agen adhesif organik), agen sklerosing (alkohol, media kontras), atau detachable balloons.
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Indikasi embolisasi:Perdarahan yang tidak terkontrol dengan terapi
konvensional.Kelainan vaskuler:
Malformasi arteri-venosus. Fistula arteri-venosus. Aneurisma.
Tumor (ganas, jinak).Ablasi organ (mis: ginjal, lien), sebagai alternatif
pembedahan.Terapi varikokele.
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INTRA-ARTERIAL DRUG THERAPY Kemoterapi
Dapat memasukkan obat kemoterapi dengan dosis maksimal secara langsung ke tumor melalui kateterisasi arterial superselektif.
Indikasi: Tumor inoperabel. Terapi pra bedah terhadap tumor besar.
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Vasokonstriktor.Tindakan memasukkan obat vasokonstriktor
sebagai terapi perdarahan masif Trombolisis.
Pemberian obat trombolitik secara infus intraarterial.
Indikasi: Emmboli akut Oklusi trombus akut di pembuluh darah perifer.
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TACI/TACE
TACI: Transarterial Chemo Infusion. TACE: Transarterial Chemo
Embolization. Sebagai terapi terhadap tumor ganas
hepar. Kateter diletakkan secara superselektif
di arteri yg memperdarahi tumor (feeding artery).
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TACE
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NON VASCULAR INTERVENTIONAL Percutaneus Biliary Drainage/Stenting. Percutaneus Gastrostomy. Percutaneus Renal Drainage/Ureter Stenting. Tubal Recanalization & Embolization. Percutaneus Abscess Drainage. CT/MRI/US Guided Biopsy/Therapy.
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INDIKASI NON-VASCULAR INTERVENTIONAL
Obstruksi stenosis:Traktur biliaris.Traktus urogenital.Traktus gastrointestinal.
Drainage abses. Percutaneus biopsi atau terapi.
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KESIMPULAN
Radiologi intervensional (IVR) dapat sebagai diagnostik dan terapi.
Sebagai terapi dapat sebagai terapi alternatif dan terapi definitif
KelebihanIVR: mengurangi waktu rawat
di rumah sakit, mengurangi rasa sakit. Kelemahan IVR: memerlukan ahli radiologi
yang terlatih, hanya ada di kota besar.
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SekianSekianSelamat BelajarSelamat Belajar