Interventional Radiology Procedures in Critically Ill Cancer Patients

  • Steven M. YevichEmail author
Reference work entry


Interventional radiology provides a wide scope of procedures to address the palliative needs of the critically ill cancer patient. The specialty spawned decades ago to apply image guidance to relieve and treat pathology in a minimally invasive manner. All procedures are performed through the advancement of low-profile needles and small-caliber drains under direct observation with ultrasound, fluoroscopy, computed tomography, or magnetic resonance imaging. Interventions to prevent or treat acute disease in the critically ill cancer can be grouped into the broad categories of central venous access, enteric access, drainage of obstructed or infected fluid, correction of vascular obstruction, occlusion of active bleeding, and pulmonary embolus prevention and treatment. This chapter provides a concise review of the interventional radiology procedures within each category. General indications and pragmatic considerations are discussed to illustrate the procedural applications as they pertain to the critically ill cancer patient.


Interventional radiology Image guidance Catheter directed Central venous access Enteric tube Drain Thrombolysis Inferior vena cava filter Embolization Pulmonary embolus 


  1. 1.
    Arous EJ, Messina LM. Temporary inferior vena cava filters: how do we move forward? Chest. 2016;149(5):1143–5.CrossRefGoogle Scholar
  2. 2.
    Beland MD, Gervais DA, Levis DA, et al. Complex abdominal and pelvic abscesses: efficacy of adjunctive tissue-type plasminogen activator for drainage. Radiology. 2008;247(2):567–73.CrossRefGoogle Scholar
  3. 3.
    Brass P, Hellmich M, Kolodziej L, et al. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev. 2015;1:CD006962.PubMedGoogle Scholar
  4. 4.
    Brass P, Hellmich M, Kolodziej L, et al. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev. 2015;1:CD011447.PubMedGoogle Scholar
  5. 5.
    Bua-Ngam C, Norasetsingh J, Treesit T, et al. Efficacy of emergency transarterial embolization in acute lower gastrointestinal bleeding: a single-center experience. Diagn Interv Imaging. 2017;98(6):499–505.CrossRefGoogle Scholar
  6. 6.
    Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest J. 2012;141(2_suppl):e326S–50S.CrossRefGoogle Scholar
  7. 7.
    Erdoes LS, Ezell JB, Myers SI, et al. Pharmacomechanical thrombolysis for phlegmasia cerulea dolens. Am Surg. 2011;77(12):1602–12.Google Scholar
  8. 8.
    Fadeget D, Thony F, Timsit JF, et al. Endovascular treatment of malignant superior vena cava syndrome: results and predictive factors of clinical efficacy. Cardiovasc Intervent Radiol. 2013;36(1):140–9.CrossRefGoogle Scholar
  9. 9.
    Kabrhel C, Jaff MR, Channick RN, et al. A multidisciplinary pulmonary embolism response team. Chest J. 2013;144(5):1738–9.CrossRefGoogle Scholar
  10. 10.
    Konstantinides S, Torbicki A, Agnelli G, et al. ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;2014:ehu283.Google Scholar
  11. 11.
    Kreiser K, Grober I, Zimmer C, et al. Stent grafts in patients with carotid blowout syndrome: outcome and antiplatelet therapy in prevention versus emergency cases. Head Neck. 2018;40:2521–7.. Epub ahead of printCrossRefGoogle Scholar
  12. 12.
    Lalu MM, Fayad A, Ahmed O, et al. Ultrasound-guided subclavian vein catheterization: a systematic review and meta-analysis. Crit Care Med. 2015;43(7):1498–507.CrossRefGoogle Scholar
  13. 13.
    Liang SJ, Tu CY, Chen HJ, et al. Application of ultrasound-guided pigtail catheter for drainage of pleural effusions in the ICU. Intensive Care Med. 2009;35(2):350–4.CrossRefGoogle Scholar
  14. 14.
    Morrison JJ, Kharoti Y, Farsad K. Exsanguinating aortoesophageal fistula: a Herculean effort. J Vasc Interv Radiol. 2016;27(8):1226–7.CrossRefGoogle Scholar
  15. 15.
    Piran S, Le Gal G, Wells PS, et al. Outpatient treatment of symptomatic pulmonary embolism: a systematic review and meta-analysis. Thromb Res. 2013;132(5):515–9.CrossRefGoogle Scholar
  16. 16.
    PREPIC Study Group. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study. Circulation. 2005;112(2):416–22.CrossRefGoogle Scholar
  17. 17.
    Takashima M, Schults J, Mihala G, et al. Complication and failures of central vascular access device in adult critical care settings. Cri Care Med. 2018;46:1998–2009. Epub ahead of print.Google Scholar
  18. 18.
    Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122:1712–23.CrossRefGoogle Scholar
  19. 19.
    Winbladh A, Gullstrand P, Svanvik J, Sandstrom P. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford). 2009;11(3):183–93.CrossRefGoogle Scholar
  20. 20.
    Yuan Y, Zhao Y, Xie T, Hu Y. Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances. Cochrane Database Syst Rev Interv. 2016;2:CD009198.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.The University of Texas MD Anderson Cancer CenterHoustonUSA

Section editors and affiliations

  • Garry Brydges
    • 1
  • Ninotchka Brydges
    • 2
  1. 1.Department of Anesthesiology Division of Anesthesia, Critical Care and Pain MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Critical Care and Respiratory CareThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations