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Arun Jagannathan MD
Vascular and Interventional Radiology
Central Illinois Radiological Associates
www.radclinic.com
What is an Interventional
Radiologist?
Interventional radiologists are board-certified
physicians who specialize in minim...
Is this a new specialty?
Interventional radiologists pioneered modern medicine
with the invention of angioplasty and the ...
Milestones Pioneered by IR
 1964 Angioplasty
 1966 Embolization therapy to treat tumors and spinal cord vascular malform...
A failure of marketing!
www.radclinic.com
Oncology
Catheter directed chemo/radio/bland hepatic artery
embolization
HCC
Metastatic Liver Lesions
Majority are don...
TACE
www.radclinic.com
Oncology
Percutaneous image guided thermal ablation (RFA,
microwave, or cryoablation)
Liver
Lung
Kidney
Bone
www.radc...
Case Study (GR)
www.radclinic.com
Case Study (GR)
www.radclinic.com
Case Study (GR)
www.radclinic.com
Case Study (GR)
www.radclinic.com
Case Study (HT)
www.radclinic.com
Case Study (HT)
www.radclinic.com
Case Study (HT)
Pre Ablation CT Post Ablation MR
www.radclinic.com
Deep Vein Thrombosis
Catheter directed thrombolysis/thrombectomy
Can be done with a combination of mechanical and
pharma...
DVT
www.radclinic.com
Case Study (DB)
www.radclinic.com
Case Study (DB)
www.radclinic.com
Pulmonary Embolism
IVC Filter Prophylaxis
Retrievable Option (up to 1 yr later with G2)
Can be placed in ICU at bedside...
PE Lysis
www.radclinic.com
Varicoceles
Dx with provocative scrotal US
Tx with catheter directed testicular vein embolization
www.radclinic.com
Pelvic Congestion Syndrome
Dx with MR Venography
Tx with catheter directed ovarian vein embolization
www.radclinic.com
Venous Access
Crucially important to preserve arm veins and
subclavian veins for future fistula/graft creation
Implantab...
Other
Fibroids – UFE
www.radclinic.com
Biliary obstruction – PTC, biliary drain/stent
Urinary obstruction – nephrostomy, ureteral stents
Portal HTN – TIPS
Va...
Vertebral Compression Fx or Sacral Insufficiency Fx –
augmentation cementoplasty
www.radclinic.com
Case Study (PA)
www.radclinic.com
Case Study (PA)
www.radclinic.com
Other
Trauma – Arterial permanent/temporary
embolization
GI Bleeding – Arterial embolization or pharmacologic
Tx with va...
Other
PAD – PTA/stent
Aortic aneurysms –EVAR
Diagnostic Image Guided Needle Bx
Image Guided Abscess Drainage
Thorocos...
Case Study (JH)
www.radclinic.com
Case Study (JH)
www.radclinic.com
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Current applications of interventional radiology 97

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Basic presentation I gave to new nursing grads, 9/10.

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  • Stem cells are “non-specialized” cells that have the potential to form into other types of specific cells, such as blood, muscles or nerves. They are unlike 'differentiated' cells which have already become whatever organ or structure they are in the body. Stem cells are present throughout our body, but more abundant in a fetus.
    Medical researchers and scientists believe that stem cell therapy will, in the near future, advance medicine dramatically and change the course of disease treatment. This is because stem cells have the ability to grow into any kind of cell and, if transplanted into the body, will relocate to the damaged tissue, replacing it. For example, neural cells in the spinal cord, brain, optic nerves, or other parts of the central nervous system that have been injured can be replaced by injected stem cells. Various stem cell therapies are already practiced, a popular one being bone marrow transplants that are used to treat leukemia. In theory and in fact, lifeless cells anywhere in the body, no matter what the cause of the disease or injury, can be replaced with vigorous new cells because of the remarkable plasticity of stem cells. Biomed companies predict that with all of the research activity in stem cell therapy currently being directed toward the technology, a wider range of disease types including cancer, diabetes, spinal cord injury, and even multiple sclerosis will be effectively treated in the future. Recently announced trials are now underway to study both safety and efficacy of autologous stem cell transplantation in MS patients because of promising early results from previous trials.
    History
    Research into stem cells grew out of the findings of two Canadian researchers, Dr’s James Till and Ernest McCulloch at the University of Toronto in 1961. They were the first to publish their experimental results into the existence of stem cells in a scientific journal. Till and McCulloch documented the way in which embryonic stem cells differentiate themselves to become mature cell tissue. Their discovery opened the door for others to develop the first medical use of stem cells in bone marrow transplantation for leukemia. Over the next 50 years their early work has led to our current state of medical practice where modern science believes that new treatments for chronic diseases including MS, diabetes, spinal cord injuries and many more disease conditions are just around the corner.
    There are a number of sources of stem cells, namely, adult cells generally extracted from bone marrow, cord cells, extracted during pregnancy and cryogenically stored, and embryonic cells, extracted from an embryo before the cells start to differentiate. As to source and method of acquiring stem cells, harvesting autologous adult cells entails the least risk and controversy.
    Autologous stem cells are obtained from the patient’s own body; and since they are the patient’s own, autologous cells are better than both cord and embryonic sources as they perfectly match the patient’s own DNA, meaning that they will never be rejected by the patient’s immune system. Autologous transplantation is now happening therapeutically at several major sites world-wide and more studies on both safety and efficacy are finally being announced. With so many unrealized expectations of stem cell therapy, results to date have been both significant and hopeful, if taking longer than anticipated.
    What’s been the Holdup?
    Up until recently, there have been intense ethical debates about stem cells and even the studies that researchers have been allowed to do. This is because research methodology was primarily concerned with embryonic stem cells, which until recently required an aborted fetus as a source of stem cells. The topic became very much a moral dilemma and research was held up for many years in the US and Canada while political debates turned into restrictive legislation. Other countries were not as inflexible and many important research studies have been taking place elsewhere. Thankfully embryonic stem cells no longer have to be used as much more advanced and preferred methods have superseded the older technologies. While the length of time that promising research has been on hold has led many to wonder if stem cell therapy will ever be a reality for many disease types, the disputes have led to a number of important improvements in the medical technology that in the end, have satisfied both sides of the ethical issue.
    CCSVI Clinic
    CCSVI Clinic has been on the leading edge of MS treatment for the past several years. We are the only group facilitating the treatment of MS patients requiring a 10-day patient aftercare protocol following neck venous angioplasty that includes daily ultrasonography and other significant therapeutic features for the period including follow-up surgeries if indicated. There is a strict safety protocol, the results of which are the subject of an approved IRB study. The goal is to derive best practice standards from the data. With the addition of ASC transplantation, our research group has now preparing application for member status in International Cellular Medicine Society (ICMS), the globally-active non-profit organization dedicated to the improvement of cell-based medical therapies through education of physicians and researchers, patient safety, and creating universal standards. For more information please visit http://www.neurosurgeonindia.org/
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  • After 6 months of offering stem cell therapy in combination with the venous angioplasty liberation procedure, patients of CCSVI Clinic have reported excellent health outcomes. Ms. Kasma Gianopoulos of Athens Greece, who was diagnosed with the Relapsing/Remitting form of MS in 1997 called the combination of treatments a “cure”. “I feel I am completely cured” says Ms. Gianopoulos, “my symptoms have disappeared and I have a recovery of many functions, notably my balance and my muscle strength is all coming (back). Even after six months, I feel like there are good changes happening almost every day. Before, my biggest fear was that the changes wouldn’t (hold). I don’t even worry about having a relapse anymore. I’m looking forward to a normal life with my family. I think I would call that a miracle.”
    Other recent MS patients who have had Autologous Stem Cell Transplantation (ASCT), or stem cell therapy have posted videos and comments on YouTube. www.youtube.com/watch?v=jFQr2eqm3Cg.
    Dr. Avneesh Gupte, the Neurosurgeon at Noble Hospital performing the procedure has been encouraged by results in Cerebral Palsy patients as well. “We are fortunate to be able to offer the treatment because not every hospital is able to perform these types of transplants. You must have the specialized medical equipment and specially trained doctors and nurses”. With regard to MS patients, “We are cautious, but nevertheless excited by what patients are telling us. Suffice to say that the few patients who have had the therapy through us are noticing recovery of neuro deficits beyond what the venous angioplasty only should account for”.
    Dr. Unmesh of Noble continues: “These are early days and certainly all evidence that the combination of liberation and stem cell therapies working together at this point is anecdotal. However I am not aware of other medical facilities in the world that offer the synthesis of both to MS patients on an approved basis and it is indeed a rare opportunity for MS patients to take advantage of a treatment that is quite possibly unique in the world”.
    Autologous stem cell transplantation is a procedure by which blood-forming stem cells are removed, and later injected back into the patient. All stem cells are taken from the patient themselves and cultured for later injection. In the case of a bone marrow transplant, the HSC are typically removed from the Pelvis through a large needle that can reach into the bone. The technique is referred to as a bone marrow harvest and is performed under a general anesthesia. The incidence of patients experiencing rejection is rare due to the donor and recipient being the same individual.This remains the only approved method of the SCT therapy.
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Transcript of "Current applications of interventional radiology 97"

  1. 1. Arun Jagannathan MD Vascular and Interventional Radiology Central Illinois Radiological Associates www.radclinic.com
  2. 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. 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. 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. 5. A failure of marketing! www.radclinic.com
  6. 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
  7. 7. TACE www.radclinic.com
  8. 8. Oncology Percutaneous image guided thermal ablation (RFA, microwave, or cryoablation) Liver Lung Kidney Bone www.radclinic.com
  9. 9. Case Study (GR) www.radclinic.com
  10. 10. Case Study (GR) www.radclinic.com
  11. 11. Case Study (GR) www.radclinic.com
  12. 12. Case Study (GR) www.radclinic.com
  13. 13. Case Study (HT) www.radclinic.com
  14. 14. Case Study (HT) www.radclinic.com
  15. 15. Case Study (HT) Pre Ablation CT Post Ablation MR www.radclinic.com
  16. 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
  17. 17. DVT www.radclinic.com
  18. 18. Case Study (DB) www.radclinic.com
  19. 19. Case Study (DB) www.radclinic.com
  20. 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
  21. 21. PE Lysis www.radclinic.com
  22. 22. Varicoceles Dx with provocative scrotal US Tx with catheter directed testicular vein embolization www.radclinic.com
  23. 23. Pelvic Congestion Syndrome Dx with MR Venography Tx with catheter directed ovarian vein embolization www.radclinic.com
  24. 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
  25. 25. Other Fibroids – UFE www.radclinic.com
  26. 26. Biliary obstruction – PTC, biliary drain/stent Urinary obstruction – nephrostomy, ureteral stents Portal HTN – TIPS Varicose veins – endovenous ablation www.radclinic.com
  27. 27. Vertebral Compression Fx or Sacral Insufficiency Fx – augmentation cementoplasty www.radclinic.com
  28. 28. Case Study (PA) www.radclinic.com
  29. 29. Case Study (PA) www.radclinic.com
  30. 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. 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
  32. 32. Case Study (JH) www.radclinic.com
  33. 33. Case Study (JH) www.radclinic.com
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