Interventional Radiology Overview

Interventional Radiology (IR) is a specialized medical field that utilizes advanced imaging techniques such as angiography, ultrasonography, and computed tomography to perform minimally invasive treatments traditionally managed through surgery. This discipline is unique in that it does not limit its focus to a specific organ system but applies its techniques across various systems to provide non-surgical solutions.

Scope of Treatments in Interventional Radiology

IR encompasses a broad range of procedures, including angiographic treatments of vascular diseases (excluding cardiac veins), needle biopsies, management of bodily fluids and cysts, and specific cancer treatments, notably liver cancer. The treatments also extend to variceal management. The hallmark of these procedures is their minimally invasive nature, typically requiring only a small incision or puncture site, which significantly reduces recovery time and associated risks.

Key Characteristics of Interventional Radiology Treatments

• Minimally Invasive: Most procedures are performed through a tiny pinhole incision, avoiding the scars associated with traditional surgery.
• Reduced Anesthesia Needs: Many procedures do not require general anesthesia.
• Outpatient Basis: Patients commonly return home the same day.
• Lower Risk and Faster Recovery: Procedures are generally safer and recovery is quicker compared to conventional surgery.

In the clinical setting, patients may receive sedatives and pain management medications to ease discomfort and anxiety associated with the procedures. Post-procedure, patients are typically observed for a short period before discharge, although this may vary based on the specific intervention.

1. Vascular Diseases: Treatment of arterial occlusions and other vascular issues, which can significantly impair blood flow and lead to serious health complications. Techniques such as angiography are frequently employed to manage and treat conditions such as leg artery occlusions and carotid artery constrictions.
2. Diabetic Foot Wounds: Often a complication of arterial occlusions in diabetic patients, leading to non-healing wounds that may necessitate amputation if untreated.
3. Buerger's Disease: This smoking-related condition affects primarily young males and involves occlusions in the leg arteries. The cessation of smoking is crucial, and angiographic interventions may offer relief.

Techniques Utilized

• Balloon Angioplasty and Stenting: These involve the insertion of balloons or stent devices to open up blocked arteries and maintain blood flow.
• Atherectomy: This involves the mechanical removal of plaque from arteries, sometimes used in conjunction with stenting or angioplasty.

Our partner centers are recognized as one the international leaders in Interventional Radiology, employs a comprehensive array of therapeutic modalities, including the latest medicated devices and traditional techniques, ensuring a high standard of care and enhanced patient outcomes.

Aortic Aneurysm: Treatment of Thoracic and Abdominal Aorta Aneurysms

An aortic aneurysm involves the dilation or bulging of the aorta, the body's largest artery, which can occur in the thoracic or abdominal regions. Often asymptomatic, aortic aneurysms are usually detected incidentally during routine examinations. If untreated, they can rupture, leading to severe internal bleeding and, frequently fatal outcomes. Our center specializes in the non-surgical treatment of these aneurysms using angiographic techniques to place an aortic stent graft, effectively reinforcing the weakened vessel.

Myoma Treatment through Embolization

Myomas, benign uterine tumors, affect approximately one in three women over the age of 35. These tumors can cause menstrual irregularities, heavy bleeding, anemia, and painful menstruation as they grow in size and number. Treatment varies by age; younger patients may undergo embolization, a minimally invasive procedure that blocks blood flow to the tumors via embolic agents, allowing the myomas to shrink while preserving uterine health. This technique does not require incisions or general anesthesia and can be repeated if myomas recur.

Varicocele Treatment Options

Varicocele, characterized by the enlargement of veins within the scrotum, predominantly affects the left testicle and can lead to pain and infertility due to reduced sperm production. Treatment options include surgical ligation or non-surgical angiographic vein blocking, with the latter being less invasive and primarily addressing the abnormal veins.

Modern Treatments for Varicose Veins

Varicose veins are prevalent, particularly among women, and can range from cosmetic concerns to painful conditions impacting quality of life. Our center utilizes advanced, non-surgical methods such as laser, radiofrequency (RF), steam, and foam treatments tailored to specific varicose vein types, addressing both the symptoms and the underlying causes, like venous valve insufficiency.

Deep Vein Thrombosis (DVT) Management

DVT, a significant venous occlusion primarily in the leg veins, can lead to severe complications such as pulmonary embolism if untreated. Individuals at higher risk include those with genetic predispositions, history of DVT, cancer, pregnancy, or post-operative states. Early and accurate diagnosis is crucial. Our center offers both early and late-stage treatments using intravascular angiography and thrombolytic therapies to dissolve clots, or mechanical thrombectomy to remove clots. Chronic DVT cases, often leading to venous insufficiency, can also be managed through angiographic interventions to alleviate occlusions with balloons or stents.

Treatment of Vascular Malformations:

Vascular malformations, which may manifest in any part or organ of the body, are venous disorders sometimes referred to as glomuvenous malformations. These lesions, distinct from varicose veins, are typically present from a young age and grow progressively with age. They pose both aesthetic concerns and potential pain for patients. Our department offers two primary treatment options: surgical removal and needle therapy, also known as ablation treatment, with some cases requiring a combination of both methods. Currently, we focus on needle therapy for the non-surgical treatment of vascular malformations.

The Dialysis fistulas can experience contractions, clogging, and occlusions, which may lead to arm swelling, numbness, or the formation of wounds in the fingers. Crucially, these issues compromise the fistula’s functionality, preventing effective dialysis. In such cases, an intravascular catheter may be placed to facilitate dialysis, though it can lead to long-term vascular occlusions. Our interventional radiology services provide the following treatments for dialysis patients:

1. Angiography is utilized to treat all constriction and occlusions within the fistula, employing non-surgical thrombolysis or thrombectomy techniques. If a graft has been used for dialysis access, angiographic methods are also applied to clear any occlusions.
2. Arm swelling following fistula placement, particularly in patients with prior central venous catheter placement, is addressed by resolving occlusions in the humeral vein.
3. Emergency situations requiring dialysis via catheter placement are supported with ultrasonic imaging to ensure patient safety and comfort.

Our interventional radiology department offers specialized services to oncologic patients, categorized into procedures supplementary to oncologic treatment and those directly treating cancer:

1. Supplementary Procedures: These include biopsy sample collection from tumors, placement of ports for easy medication administration, relief of occlusions in bile ducts or urinary tracts, fluid drainage from lungs, and stent placement in the esophagus, alimentary canal, or intestines when surgical interventions are not feasible. Additionally, conditions like deep vein thrombosis common in oncologic patients are treated using advanced endovascular methods.
2. Direct Cancer Treatments: Recent advancements in interventional oncology include:
   • Ablation Therapy: Utilizing imaging-guided needle insertion, this non-surgical procedure destroys cancerous masses through methods like radiofrequency (RF ablation), microwaves, cryoablation, or irreversible electroporation. Ablation is highly effective for liver tumors under 3 cm, and applicable to kidney and lung tumors as well.
   • Angiographic Treatments: Techniques such as Transarterial Chemoembolization (TACE) and Transarterial Radioembolization (TARE) involve injecting drug-laden or radioactive beads into arteries feeding tumors, offering more effective outcomes than traditional chemotherapy.

• Needle Biopsies: Performed under imaging guidance, needle biopsies involve tissue sampling from virtually any organ without the need for major surgical interventions. These procedures are primarily used to establish definitive diagnoses and investigate potential organ diseases.
• Drainage Procedures: Fluid accumulations due to occlusions or other pathological conditions are managed through targeted drainage techniques. This includes biliary drainage for obstructive jaundice, nephrostomy for urinary tract obstructions, and the drainage of abscesses and other fluid accumulations.

Cyst Treatment: Non-surgical methods are employed to treat parasitic hydatid cysts and large liver or kidney cysts through needle drainage and medication injection.