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Atypical intracranial vascular malformations: their behavior, treatment and follow-up
Voldřich, Richard ; Netuka, David (advisor) ; Haninec, Pavel (referee) ; Přibáň, Vladimír (referee)
Therapy and follow-up of patients with atypical vascular malformations are not standardized. The goals of this dissertation are the comparison of relevant treatment and imaging methods, the determination of an optimal follow-up program based on the type of lesion or the character of therapy, and the documentation of the behavior of atypical malformations after incomplete closure. Long-term observation of 195 embolized dural arteriovenous malformations (DAVM) confirmed the high success rate of Onyx embolic material compared to other agents - complete occlusion was achieved in 88% of cases compared to 35% in the control group. A total of 93% of DAVMs treated with Onyx were closed at the last follow-up. The material also proved to be stable in the long term. Recurrence was diagnosed in 1,8% of patients. The recurrences of DAVM occur due to the accentuation of originally negligible vascular fistulas that are not visible on post-interventional digital subtraction angiography (DSA). Prospective comparison of magnetic resonance angiography (MRA) and DSA concluded that patients after complete embolization of dural fistula can be safely followed using only MRA. In the case of carotid-cavernous fistulas (CCFs), imaging and clinical outcomes of traditional and new endovascular materials, as well as...
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Function of radiographer at embolization procedure
KŘÍŽOVÁ, Pavlína
As a radiographer can be regarded an educated health worker who is prepared to perform demanding work in medical branches. One of them is radiology and its important subspecialty, interventional radiology, where they perform a very responsible work. They communicate with patients, cooperate with medical personnel and operate a complex angiographic apparatus. Therefore it is essential for them to have finished a profes-sional training and to possess the required qualities. A person becomes a radiographer after they have completed a specialised educational programme, which can nowadays be studied at a college and it is completed by achieving a title Bc. (written before the na-me). During the studies they acquire proficiency and competence in the field of radiology which is needed for the experience in the interventional radiology working place. During both theoretical and practical education skills in the field of technical equipment (angiography equipment) and required IT technologies (HIS, PACS) are mastered, as well as the anatomic orientation in examinated area. They learn the latest procedure in the embolization techniques from the medical personnel, orientate themselves in the instrumentarium. Moreover, they are accustomed to the contrasting materials and their undesirable reactions to them. If needed, they are fully able to give the first aid.In addi-tion to that, a non-medical personell who participate in carrying out the embolizations should possess following qualities: communication skills - proficient cooperation with the medical personnel and the patients, empathy - patient awareness, ability to handle stressful situations. Working with an ill person demands a psochologically accurate individual approach and strict following of the medical ethic principles. Embolization is a way of occluding (closing) one or more blood vessels that are doing more harm than good. Various materials may be used, depending on whether vessel occlusion is to be temporary or permanent, or whether large or small vessels are being treated. The material is passed through a catheter with its tip lying in or near the vessel to be closed. This approach can be used to control or prevent abnormal bleeding as well as shut down the vessels that support a growing tumor. Therapeutic embolization may also serve to eliminate an arteriovenous malformation (AVM), an abnormal connection between an artery and a vein. The term "embolization" derives from embolus, which can be any object that circulates in the bloodstream until it lodges in a blood vesel - in this case, a synthetic material or medication specially designed to occlude the blood vessels.
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