For the fourth week, one of the interesting procedures was shadowing
a doctor removing the clot filter previously placed in the inferior vena cava(IVC).
The purpose of the filter was to stop clots from reaching the heart. The clots
are usually caused by diseases such as cancer or by lying down for a long time
which may be due to an illness.
During the procedure a guiding wire was inserted in the
jugular vein. The access hole was made by a needle that was inserted into the
jugular vein by the visual aid of Ultrasound. The wire was then guided to the
filter location by fluoroscopy visual aid. Next, a catheter was inserted and
guided to the filter location by the wire, the wire was then removed and long
forceps were used to remove the filter by grasping its tip and pulling it
through the catheter. The filter is cone shaped with the tip pointing towards
the blood flow direction, the cone is made of wire strips which filter out the
clot and allow un-clotted blood through.
These filters are usually removed after it is determined
that the clot is no longer there or it is no longer a threat to the patient. If
left for a long time, the filters may build into the vessel walls and also if
they become clogged they may cause adverse health issues.
Usually filters are used in place of blood thinners in
situations such as for surgery patients, to prevent over-bleeding.
Another interesting procedure involved measurement of
pressure gradient across a shunt placed in the liver between right port vein
and right hepatic vein. The purpose of the shunt was to prevent GI bleeding due
to the stenosis in the liver. During pressure measurement, Higher pressure
gradient would indicate narrowing of the shunt which would necessitate
ballooning to extend it, lower pressure gradient means too wide a shunt which
means most blood from the gut is going straight into the heart without being
cleansed of the toxins by the liver.
I also shadowed doctor performing a tumor ablation in the kidney.
Microwave technology was used to ablate the tumor. After inserting the microwave
probe into the tumor by aid of CT, the probe temperature was raised to 65
degrees Centigrade. This would kill all the cancer cells since temperatures
above 55 degrees centigrade kill cells.
These are just some of the interesting IR procedures I have
shadowed this week
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