current applications of interventional radiology 97
DESCRIPTION
Basic presentation I gave to new nursing grads, 9/10.TRANSCRIPT
Arun Jagannathan MDVascular and Interventional Radiology
Central Illinois Radiological Associateswww.radclinic.com
What is an Interventional Radiologist?Interventional radiologists are board-certified
physicians who specialize in minimally invasive, targeted treatments
TrainingUndergraduate 4 yrsMedical School 4 yrsResidency 5 yrsFellowship 1 yr
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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.
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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
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A failure of marketing!
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OncologyCatheter directed chemo/radio/bland hepatic
artery embolizationHCCMetastatic Liver LesionsMajority are done for palliation but can also be
used (often in conjunction with thermal ablation) to bridge to curative transplant
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TACE
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OncologyPercutaneous image guided thermal ablation
(RFA, microwave, or cryoablation)LiverLungKidneyBone
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Case Study (GR)
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Case Study (GR)
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Case Study (GR)
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Case Study (GR)
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Case Study (HT)
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Case Study (HT)
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Case Study (HT)
Pre Ablation CT Post Ablation MR
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Deep Vein ThrombosisCatheter directed
thrombolysis/thrombectomyCan be done with a combination of mechanical
and pharmacologic methodsPatients 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)
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DVT
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Case Study (DB)
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Case Study (DB)
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Pulmonary EmbolismIVC 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
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PE Lysis
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VaricocelesDx with provocative scrotal USTx with catheter directed testicular vein
embolization
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Pelvic Congestion SyndromeDx with MR VenographyTx with catheter directed ovarian vein
embolization
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Venous AccessCrucially important to preserve arm veins
and subclavian veins for future fistula/graft creation
Implantable Access PortsChest (IJV), lumbar (IVC), and arm
Tunneled Central Lines for long term accessTunneled IJV HD Catheters
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OtherFibroids – UFE
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Biliary obstruction – PTC, biliary drain/stentUrinary obstruction – nephrostomy, ureteral
stentsPortal HTN – TIPSVaricose veins – endovenous ablation
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Vertebral Compression Fx or Sacral Insufficiency Fx – augmentation cementoplasty
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Case Study (PA)
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Case Study (PA)
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OtherTrauma – Arterial permanent/temporary
embolizationGI Bleeding – Arterial embolization or
pharmacologic Tx with vasopressinHemoptysis – Embolization or Thermal
AblationGastrostomy, Gastrojejunostomy, or
Jejunostomy Feeding/Suction Tubes
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OtherPAD – PTA/stentAortic aneurysms –EVARDiagnostic Image Guided Needle BxImage Guided Abscess DrainageThorocostomy tubes
Implantable OptionPleurodesis
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Case Study (JH)
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Case Study (JH)
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