Interventional Radiology

An aortic aneurysm is a weak area in the aorta, the main blood vessel that carries blood from the heart to the rest of the body. As blood flows through the aorta, the weak area bulges like a balloon and can burst if the balloon gets too big. Interventional radiologists are vascular experts who offer minimally invasive treatment for abdominal aortic aneurysm. This minimally invasive technique is performed by an interventional radiologist using imaging to guide the catheter and graft inside the patient’s artery. For the procedure, an incision is made in the skin at the groin through which a catheter is passed into the femoral artery and directed to the aortic aneurysm. Through the catheter, the physician passes a stent graft that is compressed into a small diameter within the catheter. The stent graft is advanced to the aneurysm, then opened, creating new walls in the blood vessel through which blood flows.

Information provided by the Society of Interventional Radiology, www.SIRweb.org © 2004, 2008

This is a technique whereby the interventional radiologist places a catheter via a tiny puncture in the femoral or radial artery directly into the arteries supplying a tumor. Through the catheter various chemotherapeutic and embolic agents are delivered to not only treat the tumor but also cut off vascular supply. This procedure is being used for primary liver cancers (most commonly HCC) as well as cancers that spread to the liver (metastasis).

With this minimally invasive technique, patients do not experience the usual side effects as seen with systemic chemotherapy and allow for a faster recovery time when compared to traditional surgery.

One out of every 20 Americans over the age of 50 has peripheral arterial disease, or PAD. It occurs when fatty deposits, such as cholesterol, cause buildup in the arteries that supply blood to limbs. This buildup, called plaque, narrows these arteries, reducing or blocking the flow of blood. This causes a decreased level of oxygen supply to muscles and other tissues that can be very damaging over time. PAD is most commonly found in the legs, but can also be present in arteries that supply blood to the head, arms, kidneys and stomach. Like clogged arteries in the heart, clogged arteries in the legs increase the risk for a heart attack or stroke.

Angioplasty and Stenting
Interventional radiologists pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease (PAD). Using imaging for guidance, an interventional radiologist threads a catheter through the femoral artery in the groin to the blocked artery in the legs. A balloon is inflated to open the blood vessel where it is narrowed or blocked. In some cases this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip.

Limb Salvage Therapy
Minimally invasive revascularization of patients with rest pain, non-healing ulcers or wounds, or patients with non-healing osteomyelitis in whom amputation is being considered. The goal of this groundbreaking interventional radiology procedure is to achieve greater than 80% limb salvage and wound healing without the need for open surgery (and to avoid amputation).

Information provided by the Society of Interventional Radiology, www.SIRweb.org © 2004, 2008

RFA is a technology that safely heats of “cooks” tumors using radiofrequency induced temperature changes. RFA produces heat-generated coagulation of targeted tissues resulting in tumor necrosis of tumor “death.” The procedure is performed under CT scan and Ultrasound guidance. Through a tiny nick in the skin in the right lower chest, a probe is placed directly into the liver tumor. Once in the proper position, the wires are deployed and the interstitial heating process begins. Heating is applied for about 10 minutes. The probe is withdrawn and the procedure is over. Subsequent CT scans are performed a few times a year to monitor results and for possible new growth. This technique is currently applied to monitor results and for possible new growth. This technique is currently applied to the liver only and is performed on patients who are otherwise poor surgical candidates or who do not wish to undergo major abdominal surgery. Patients with primary liver cancers as well as cancer that spread to the liver (metastasis) are considered candidates. The procedure’s major strength includes its minimally invasive approach without requiring open surgery. Like surgery, however, it is potentially curative.

A new, minimally invasive technique to help alleviate pain and bleeding associated with uterine fibroids. Under x-ray guidance, using sedation and a local anesthetic, a small catheter is advanced into the arteries that supply the fibroid tumors. Once in the position, small particles are injected into the blood vessel to block blood flow. This is referred to as embolization. Without blood flow, the fibroids infarct or die. The tumors then shrink over time and become scar tissue. Most women experience significant pain relief and reduction in bleeding within one month after the outpatient procedure.

Vertebroplasty and kyphoplasty are minimally invasive procedures for vertebral compression fractures, which are fractures in the vertebra, the small bones that make up the spinal column.

When a vertebra fractures, the usual rectangular shape of the bone becomes compressed and distorted, causing pain. These compression fractures, which may involve the collapse of one or more vertebrae in the spine, are a common symptom and result of osteoporosis.

In vertebroplasty, physicians use image guidance to inject a special cement mixture through a hollow needle into the fractured bone. In kyphoplasty, a balloon is first inserted through the needle into the fractured bone to restore the height and shape of the vertebra. Then the balloon is removed and the cement mixture is injected into the cavity created by the balloon.

For more information on vertebroplasty and kyphoplasty visit radiologyinfo.org.

Charleston Radiologists is one of only two Therasphere treatment sites in South Carolina, and the only site in the greater Charleston area. Transarterial Radioembolization with Therasphere is a minimally invasive outpatient cancer treatment for patients with primary liver cancers (hepatocellular carcinoma and cholangiocarcinoma) and liver dominant metastases. Tiny particles which emit high energy radiation (Yttrium-90) are injected through the blood vessels that supply the liver and act locally to kill tumors in the liver while causing minimal to no systemic side effects. Shown to slow disease progression and improve survival and quality of life, Transarterial Radioembolization with Thermasphere can be used to downstage certain patients to curative resection or liver transplantation. The interventional procedure is minimally invasive and can be combined with systemic chemotherapy to provide synergistic anti-tumoral effects.

Dr. Matthew Dunn, Charleston Radiologists interventional radiologist, provides this minimally invasive outpatient treatment of male varicocele. Varicocele occurs in approximately 15% of males. While frequently asymptomatic, varicocele can result in substantial pain and discomfort and can also result in infertility. A combination of venous sclerosis and coil embolization of the dysfunctional veins draining the scrotum leads to substantial improvement in symptoms and has results equivalent to open surgery with 90-95% treatment success rate. This procedure has significantly reduced recovery time compared to open surgical ligation options.