What is Interventional Radiology?

Interventional Radiology uses image guidance (x-ray, ultrasound, and magnetic resonance) to perform minimally invasive surgical techniques. Image guidance allows for increased precision in performing procedures. Most procedures are performed on an outpatient basis. They include opening blocked arteries, occluding blood flow to tumors and bleeding sites, draining abscesses and using fine needles to biopsy masses. Conscious sedation, analgesia and local anesthesia are used for patient comfort.

Interventional and Vascular procedures that Charleston Radiologists offers:

  • Diagnostic arteriography and venography
  • Vascular angioplasty and stenting
  • Dialysis graft interventions
  • Thrombolysis including treatment of DVT
  • Venous Access
  • Inferior Vena Cava stenting and IVC filter placements
  • Biliary drainage and intervention
  • GU tract intervention
  • Gastrostomy and gastrojejunostomy tube placement and revisions
  • TIPS (transjugular intra-hepatic portosystemic shunt)
  • Biopsy and abscess drainages
  • Chemoembolization of liver tumors
  • Radiofrequency ablation of liver tumors
  • Uterine artery embolizations for uterine fibroids
  • Vertebroplasty for thoracic and lumbar spine fractures and compressions

Patient Preparation

Prior to most interventional procedures patients will not be allowed to eat or drink anything after midnight on the day before your procedure. Most people should continue to take their prescribed medications as long as it can be tolerated on an empty stomach. If you are a diabetic and take insulin, DO NOT TAKE YOUR INSULIN. If you take blood thinners such as Coumadin, tell your doctor so it can be stopped prior to your procedure. If you have any allergy to contrast (x-ray dye) or iodine, let your doctor know immediately. Do not smoke for at least 24 hours before your procedure. A nurse from the department will call you the day before your test to go over any special preparations and to answer your questions.

Applications and Treatments

Abdominal Aortic Aneurysm (AAA)

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

Hepatic Artery Chemoembolization

This is a technique whereby the interventional radiologist places a small catheter through a tiny nick in the groin directly into the artery supplying the cancer. Through the catheter, concentrated chemicals suspended in oil are delivered regionally to “flood” the cancer. Once this is performed, small particles of dried alcohol are injected to “starve” the cancer of arterial flow and help prevent the chemo-products from washing out. This procedure is being used for primary liver cancers as well as cancers which spread to the liver (metastasis).

The procedure’s major strengths include its minimally invasive approach, which results in no significant scarring after the placement of a band-aid over the skin nick. With this technique, patients do not experience the usual side effects seen with systemic chemotherapy. It is typically a painless procedure with some associated nausea.

Peripheral Arterial Disease (PAD)

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.

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

Radiofrequency Ablation (RFA)

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.

Uterine Fibroid Embolization

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

Vertebroplasty and kyphoplasty are minimally invasive procedures for vertebral compression fractures, which are fractures in 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.

Transarterial Radioembolization with Therasphere

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.

EKOS Catheter Directed Trombolysis

EKOS Catheter Directed Thrombolysis is the first FDA approved device for pulmonary artery thrombolysis for treatment of Pulmonary Embolism. Interventional radiologists use this procedure for treatment of peripheral arterial or venous thrombolysis and treatment of Deep Venous Thrombosis (DVT). A wire within the catheter generates ultrasound waves which accelerates clot breakdown and lysis.

Catheter-directed Thrombolysis of a Massive Pulmonary Embolism Case Study
Pulmonary Embolism Interventional Radiology Treatment

Varicocele Embolization

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.

Limb Salvage Terapy for Treatment of Critical Limb Ischemia

Limb Salvage Therapy is a 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 ground breaking interventional radiology procedure is to achieve greater than 80% limb salvage and wound healing, without the need for open surgery (and to avoid amputation).

Other Interventional Treatments

Other interventional, minimally invasive treatments available include:
– Interventional Oncology including Transarterial Chemoembolization, Transarterial Radioembolization, and Thermal ablation of liver, renal and pulmonary malignancies
– Interventions for Cirrhosis and Portal Hypertension including TIPS, BRTO, and spleenorenal shunt embolization
– Interventions for Womens Health including Uterine Fibroid Embolization and Treatment of Pelvic Congestion Syndrome
– Peripheral Arterial Disease including endovascular repair of Abdominal aortic aneurysms, treatment of lower extremity claudication, and treatment of mesenteric ischemia

AngioVac

Angiovac is an exciting new technology used for the removal of blood clots within the venous system, right heart, and pulmonary arteries, and is most commonly used to treat thrombosis of the IVC and iliac veins as well as massive pulmonary embolism. It can also be used to remove thrombus or vegetations from around the tip of central venous catheters as well as to remove right atrial tumors. The procedure is performed percutaneously with no open incisions.

View the animated AngioVac procedure at http://www.angiodynamics.com/products/angiovac.

Varicose Vein Treatments

Highly effective endovenous laser treatment for swollen veins under the skin. Treat unsightly veins safely and effectively with the latest state of the art technology.

Resources:

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