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What is Interventional Radiology(IR)?
"Interventional Radiology" (IR), new technologies are providing opportunities to offer non-invasive treatment options. Interventional radiology does not require surgical incisions, no stitches and no scars.
Most Interventional Radiology procedures do not require general anesthesia, are less painful and have fewer risks and complications. And most conditions treated with Interventional Radiology can be done in an outpatient setting, or require hospitalization for only a brief time. Treatments such as these usually require less hospital stay and faster healing times.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!
1. 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.
Your physician will firstly confirm all your weak veins, using a Duplex Ultrasound Scan and will determine the best place to insert the catheter. You will be asked to wear protective glasses because laser is used in this procedure. Your physician will then clean, shave and numb this area with a local anesthetic.
Once the area has become numb, a small incision is made and a catheter and a guide-wire are inserted into your skin. Next, a laser fiber is passed through the catheter until it extends approximately 1 to 2 centimeters from the end, at which point it is secured in place. The laser energy seals the faulty vein and blood flow is re-directed to healthy veins. The entire process takes approximately takes an hour.
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 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.
2. 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).
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. 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.