Does interventional radiology perform pericardiocentesis?

From the Guidelines

Yes, interventional radiology does perform pericardiocentesis, as evidenced by the use of fluoroscopy or echocardiography to guide the procedure, as recommended in the 2015 ESC guidelines 1. Interventional radiologists are specialists who use imaging guidance to perform minimally invasive procedures, and pericardiocentesis is well within their scope of practice. During a pericardiocentesis, an interventional radiologist inserts a needle through the chest wall into the pericardial space to drain excess fluid that has accumulated around the heart (pericardial effusion). This procedure is typically performed under local anesthesia with conscious sedation, and the imaging guidance allows for precise needle placement, reducing the risk of complications such as cardiac puncture or arrhythmias, which can occur in 4 to 10% of cases 1. The key aspects of the procedure include:

• The use of fluoroscopy or echocardiography to guide the needle placement
• The selection of the ideal entry site, avoiding vital structures such as the liver, myocardium, lung, and internal mammary artery
• The careful monitoring of the patient during the procedure, including radiographic, echocardiographic, haemodynamic, and ECG monitoring
• The potential risks and complications, including arrhythmias, coronary artery or cardiac chamber puncture, haemothorax, pneumothorax, pneumopericardium, and hepatic injury, as outlined in the 2015 ESC guidelines 1. While cardiologists and cardiothoracic surgeons also perform this procedure, interventional radiologists offer the advantage of advanced imaging expertise, which is particularly valuable in complex cases or when the effusion is loculated or difficult to access. The procedure typically takes 30-60 minutes, and patients may need to remain under observation for several hours afterward to monitor for any complications, as recommended in the guidelines 1.

From the Research

Interventional Radiology and Pericardiocentesis

• Interventional radiology does perform pericardiocentesis, as evidenced by studies such as 2, which evaluated the safety and efficacy of ultrasound-guided and fluoroscopically guided percutaneous pericardial effusion drainage in patients with symptomatic pericardial effusion.
• The procedure can be performed via different routes, including apical, subxiphoid, and transhepatic approaches, with the choice of approach depending on the distribution of the pericardial effusion 2.
• Other imaging modalities, such as computed tomography (CT) guidance, can also be used to perform pericardiocentesis, as described in studies such as 3 and 4.
• The use of CT guidance can provide certain advantages, including improved visualization of the pericardial space and reduced risk of complications 3, 4.
• Interventional radiologists may perform pericardiocentesis as an alternative to cardiologists, as discussed in 5.
• The procedure can be safe and effective, with high technical success rates and low complication rates, as reported in studies such as 2, 3, and 4.

Imaging Guidance for Pericardiocentesis

• Ultrasound guidance is commonly used for pericardiocentesis, as described in 2 and 6.
• Fluoroscopy can also be used to guide the procedure, particularly in challenging situations, such as postoperative pericardial effusion, as discussed in 6.
• CT guidance can provide improved visualization of the pericardial space and surrounding structures, making it a viable alternative for pericardiocentesis, as described in 3 and 4.

Safety and Efficacy of Pericardiocentesis

• Pericardiocentesis can be a safe and effective procedure for draining pericardial effusions, with high technical success rates and low complication rates, as reported in studies such as 2, 3, and 4.
• The choice of imaging guidance and approach can depend on the individual patient's anatomy and the distribution of the pericardial effusion, as discussed in 2 and 3.
• The use of pericardiocentesis can obviate the need for surgery in most patients, as discussed in 4.