Current applications of interventional radiology 97
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Basic presentation I gave to new nursing grads, 9/10.
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Current applications of interventional radiology 97
- 1. Arun Jagannathan MD Vascular and Interventional Radiology Central Illinois Radiological Associates www.radclinic.com
- 2. What is an Interventional Radiologist? Interventional radiologists are board-certified physicians who specialize in minimally invasive, targeted treatments Training Undergraduate 4 yrs Medical School 4 yrs Residency 5 yrs Fellowship 1 yr www.radclinic.com
- 3. Is this a new specialty? Interventional radiologists pioneered modern medicine with the invention of angioplasty and the catheter- delivered stent, which were first used to treat peripheral arterial disease. By using a catheter to open the blocked artery, the procedure allowed an 82-year-old woman, who refused amputation surgery, to keep her gangrene-ravaged left foot. To her surgeon’s disbelief, her pain ceased, she started walking, and three "irreversibly" gangrenous toes spontaneously sloughed. She left the hospital on her feet —both of them. Charles Dotter, MD, the interventional radiologist that pioneered this technique, is known as the "Father of Interventional Radiology" and was nominated for the Nobel Prize in medicine in 1978. www.radclinic.com
- 4. Milestones Pioneered by IR 1964 Angioplasty 1966 Embolization therapy to treat tumors and spinal cord vascular malformations by blocking the blood flow 1967 The Judkins technique of coronary angiography, the technique still most widely used around the world today 1967 Closure of the patent ductus arteriosis, a heart defect in newborns of a vascular opening between the pulmonary artery and the aorta 1967 Selective vasoconstriction infusions for hemorrhage, now commonly used for bleeding ulcers, GI bleeding and arterial bleeding 1969 The catheter-delivered stenting technique and prototype stent 1960-74 Tools for interventions such as heparinized guidewires, contrast injector, disposable catheter needles and see-through film changer 1970’s Percutaneous removal of common bile duct stones 1970’s Occlusive coils 1972 Selective arterial embolization for GI bleeding, which was adapted to treat massive bleeding in other arteries in the body and to block blood supply to tumors 1973 Embolization for pelvic trauma 1974 Selective arterial thrombolysis for arterial occlusions, now used to treat blood clots, stroke, DVT, etc. 1974 Transhepatic embolization for variceal bleeding 1977-78 Embolization technique for pulmonary arteriovenous malformations and varicoceles 1977-83 Bland- and chemo-embolization for treatment of hepatocellular cancer and disseminated liver metastases 1980 Cryoablation to freeze liver tumors 1980 Development of special tools and devices for biliary manipulation 1980’s Biliary stents to allow bile to flow from the liver saving patients from biliary bypass surgery 1981 Embolization technique for spleen trauma 1982 TIPS (transjugular intrahepatic portosystemic shunt) to improve blood flow in damaged livers from conditions such as cirrhosis and hepatitis C 1982 Dilators for interventional urology, percutaneous removal of kidney stones 1983 The balloon-expandable stent (peripheral) used today 1985 Self-expandable stents 1990 Percutaneous extraction of gallbladder stones 1990 Radiofrequency ablation (RFA) technique for liver tumors 1990’s Treatment of bone and kidney tumors by embolization 1990’s RFA for soft tissue tumors, i.e., bone, breast, kidney, lung and liver cancer 1991 Abdominal aortic stent grafts 1994 The balloon-expandable coronary stent used today 1997 Intra-arterial delivery of tumor-killing viruses and gene therapy vectors to the liver 1999 Percutaneous delivery of pancreatic islet cells to the liver for transplantation to treat diabetes 1999 Developed the endovenous laser ablation procedure to treat varicose veins and venous disease www.radclinic.com
- 5. A failure of marketing! www.radclinic.com
- 6. Oncology Catheter directed chemo/radio/bland hepatic artery embolization HCC Metastatic Liver Lesions Majority are done for palliation but can also be used (often in conjunction with thermal ablation) to bridge to curative transplant www.radclinic.com
- 8. Oncology Percutaneous image guided thermal ablation (RFA, microwave, or cryoablation) Liver Lung Kidney Bone www.radclinic.com
- 15. Case Study (HT) Pre Ablation CT Post Ablation MR www.radclinic.com
- 16. Deep Vein Thrombosis Catheter directed thrombolysis/thrombectomy Can be done with a combination of mechanical and pharmacologic methods Patients with contraindications to pharmacologic lytics can be treated with mechanical lysis alone Often underlying anatomic etiologies are uncovered that can subsequently be treated (such as May-Thurner syndrome) www.radclinic.com
- 20. Pulmonary Embolism IVC Filter Prophylaxis Retrievable Option (up to 1 yr later with G2) Can be placed in ICU at bedside with IVUS for critically ill patients Catheter based thrombolysis/thrombectomy for hemodynamically compromised patients with saddle embolus www.radclinic.com
- 22. Varicoceles Dx with provocative scrotal US Tx with catheter directed testicular vein embolization www.radclinic.com
- 23. Pelvic Congestion Syndrome Dx with MR Venography Tx with catheter directed ovarian vein embolization www.radclinic.com
- 24. Venous Access Crucially important to preserve arm veins and subclavian veins for future fistula/graft creation Implantable Access Ports Chest (IJV), lumbar (IVC), and arm Tunneled Central Lines for long term access Tunneled IJV HD Catheters www.radclinic.com
- 26. Biliary obstruction – PTC, biliary drain/stent Urinary obstruction – nephrostomy, ureteral stents Portal HTN – TIPS Varicose veins – endovenous ablation www.radclinic.com
- 27. Vertebral Compression Fx or Sacral Insufficiency Fx – augmentation cementoplasty www.radclinic.com
- 30. Other Trauma – Arterial permanent/temporary embolization GI Bleeding – Arterial embolization or pharmacologic Tx with vasopressin Hemoptysis – Embolization or Thermal Ablation Gastrostomy, Gastrojejunostomy, or Jejunostomy Feeding/Suction Tubes www.radclinic.com
- 31. Other PAD – PTA/stent Aortic aneurysms –EVAR Diagnostic Image Guided Needle Bx Image Guided Abscess Drainage Thorocostomy tubes Implantable Option Pleurodesis www.radclinic.com