WHAT IS INTERVENTIONAL RADIOLOGY?
"Interventional Radiology" (IR) refers to a range of techniques which rely on the use radiological image guidance (X-ray fluoroscopy, ultrasound, computed tomography [CT] or magnetic resonance imaging [MRI]) to precisely target therapy. Most IR treatments are minimally invasive alternatives to open and laparoscopic (keyhole) surgery. As many IR procedures start with passing a needle through the skin to the target it is sometimes called pinhole surgery!
The essential skills of an interventional radiologist are in diagnostic image interpretation and the manipulation of needles and the use of fine catheter tubes and wires to navigate around the body under imaging control. Interventional radiologists are doctors who are trained in radiology and interventional therapy. No other specialty possesses this unique combination of skills!
There is hardly any area of hospital medicine where IR has not had some impact on patient management. Although the interventional radiologist has many techniques at his/her disposal these fall into 5 broad categories:
The range of conditions which can be treated by IR is enormous and continually expanding. You may have heard of some of the following: It is important to recognise that the interventional treatment is usually one of several treatment options available ranging from nothing, through drug treatment and up to surgery. Each case should be considered on its own merits.
Well recognised advantages of these minimally invasive techniques include reduced risks, shorter hospital stays, lower costs, greater comfort, quicker convalesence and return to work. The effectiveness of treatment is often be better than with traditional treatments. It should be noted that humans are not the only species to benefit from IR. Veterinary surgeons are also turning to interventional techniques so you may find both you and your animals offered similar treatments!
Blood vessel disease
Narrowing of arteries leading to restricted blood flow (peripheral vascular disease): Interventional radiologists treat this by using balloons to stretch the vessel (balloon angioplasty, PTA) and sometimes metal springs called stents to hold them open. Sometimes arteries or bypass grafts block suddenly with a rapid loss of blood supply to the limb. Unless the blood supply is restored this can lead to amputation. Interventional radiologists can help by infusion of clot busting drugs directly into the artery via small catheters thus saving many limbs.
Expanded arteries (aneurysms) at risk of rupture and bleeding: IRs treat these by relining the vessel with a tube called a stent graft
Bleeding (haemorrhage). This is the most common vascular emergency treated by IR. Haemorrhage can come from almost anywhere e.g. from the gut, secondary to major injury or following birth. Bleeding can often permanently be stopped by blocking the vessel (embolization), relining the vessel with a stent graft or by blowing up a balloon in the vessel to stop the bleeding until emergency surgery can be performed. Interventional radiology is also used to prevent bleeding during some sorts of surgery e.g. during caesarean section in patients with a high risk of bleeding from an abnormal placenta (post partum haemorrhage).
Blood clots in the lung (pulmonary embolism, PE): interventional radiologists perform 2 different forms of treatment, placement of devices (inferior vena cava filters) to capture blood clots before they reach the lung preventing further PE. When there is a massive PE causing collapse an interventional radiologist may use small catheter tubes to break up the blood clot and restore blood flow.
Dilated veins (varicose veins): these most commonly occur in the legs but can occur in the pelvis or scrotum. These can be treated by blocking the vein by heat treatment (laser or microwave) or by the use of irritant drugs and embolisation techniques.
Superficial veins that have become enlarged and twisted are called varicose veins. These usually occur just under the skin in the legs. They are sometimes called verico veins.
The disease is slowly progressing and usually result in few symptoms but some may experience fullness or pain in the area. Complications may include bleeding or superficial thrombophlebitis or ulceration.
Varicose veins is most common after age 50. Varicose veins are more prevalent in females. There is a hereditary role. It has been seen in smokers, those who have chronic constipation and in people with occupations which necessitate long periods of standing such as lecturers, nurses, conductors (musical and bus), stage actors, umpires , surgeons, lectern orators, security guards, etc.
Often there is no specific cause.
Risk factors include obesity, not enough exercise, leg trauma, and a family history of the condition. They also occur more commonly in pregnancy. Occasionally they result from chronic venous insufficiency. The underlying mechanism involves weak or damaged valves in the veins. Diagnosis is typically by examination and may be supported by colour Doppler study or duplex study. In contrast spider veins involve the capillaries and are smaller. Read more about spider veins and about spider vein treatment in thane/ sclerotherapy.
Varicose veins become more common with age. Women are affected about twice as often as men. Varicose veins are very common, affected about 30% of people at some point in time. Varicose veins has been described throughout history and have been treated with surgery since at least A.D. 400.
When varices occur in the scrotum it is known as a varicocele while those around the anus are known as haemorrhoids.
What stage is my disease is a common concern of all patients.
The CEAP (Clinical, Etiological, Anatomical, and Pathophysiological) Classification. developed in 1994 by an international ad hoc committee of the American Venous Forum, outlines these stages
C0 –no visible or palpable signs of venous disease
C1 – telangectasia or reticular veins
C2 –varicose veins.
C4a –pigmentation or eczema
C4b –lipodermatosclerosis, atrophie blanche
C5 –healed venous ulcer
C6 –active venous ulcer
•Each clinical class is further characterised by a subscript depending upon whether the patient is symptomatic (S) or asymptomatic (A) e.g. C2S.
Clinical tests that may be used for diagnosis include:
Trendelenburg test–to determine the site of venous reflux and the nature of the saphenofemoral junction. Now however many tributary saphenous junctions with reflux may be seen as cause of varicose veins. Hence Ultrasound colour Doppler is better in evaluating cause.
Further information: Ultrasonography / colour Doppler of chronic insufficiency of the legs and varicose veins
Traditionally, varicose veins were investigated using imaging techniques only if there was a suspicion of deep venous insufficiency, if they were recurrent, or if they involved the saphenopopliteal junction. This practice is now less widely accepted. People with varicose veins should now be investigated using lower limbs venous ultrasonography. The results from a randomised controlled trial on patients with and without routine ultrasound have shown a significant difference in recurrence rate and reoperation rate.
Dr Ashish Sarode is a vein specialist, treating varicose veins in Thane. venous mapping and Colour doppler is also performed by Dr Ashish Sarode.
Blocked veins: this can occur in the context of blood clot in the veins (venous thrombosis, DVT) which is sometimes treated by the injection of blood clot dissolving medicines (thrombolysis) through a small catheter passed into the vein. Some patients develop blood clots, DVT as a result of a narrowing in a vein, when the clot has been broken down using balloons and stents. Sometimes tumours in the chest will compress a vein leading to facial swelling, headache and other symptoms which can usually be relieved with a stent.
Non vascular intervention
This is sometimes referred to as interventional oncology but the treatments are also effective in benign conditions. IR therapies are used for the following:
to treat the tumour / cancer (tumour ablation, embolization)
to relieve the effects of the cancer on other systems e.g. blockage of the gullet (oesophagus), bowel, kidney (nephrostomy) or liver (biliary drainage)
To drain collections of fluid or pus in the chest or abdomen
To place feeding tubes (gastrostomy, jejunostomy)
To treat collapsed spinal bones (vertebroplasty)
Tumour therapies: these treatments are intended to shrink or destroy tumours at their primary site or which have spread to other areas (metastases). This is an area of increasing interest and leading to improved survival with reduced morbidity.
Liver, kidney and other tumours (e.g. bone, lung): these can be treated by destructive therapies (ablation) usually involving heat (radiofrequency, laser, microwave, ultrasound) or cold damage (cryotherapy). The treatment is performed and monitored using imaging (ultrasound, computed tomography or magnetic resonance imaging).
. Embolization is sometimes combined with drug therapy (chemoembolization) or radiotherapy (radioembolization) which targets the effect to the tumour and limits some of the side effects of cancer therapy.
Uterine fibroids : heavy menstrual bleeding and pain can be caused by benign tumours called fibroids. These can be treated by blocking blood vessels (uterine fibroid embolization, UFE) which leads to shrinkage