Transcript Interventional radiology

INTERVENTIONAL RADIOLOGY
DR. M. A. BARADIA
Supervisors: Dr. Wanga, Dr. Sitati
IR/Surgical radiology
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Sub-speciality of radiology
Minimally invasive
Image guided procedures
Body plumbing
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Charles Dotter MD – Father of IR, Nobel
1978
82 yr old gangrenous left foot – Jan 1964
Angioplasty 1964
Embolization for pelvic trauma 1973
Arterial thrombolysis 1974
Embolization/RFA of Bone tumors 1990
Imaging modalities
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Fluoroscopy
Computed tomography
Ultrasound
Magnetic resonance imaging
Orthopedic IR
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Spine
Vascular
Oncology
Trauma
Infection
Spine
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Vertebroplasty
Kyphoplasty
VCF
To do or not to do?
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2 placebo controlled, double blinded trials found no
benefit
Adverse effects
BUT…
Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials: meta-analysis.
Staples MP, Kallmes DF, Comstock BA, Jarvik JG, Osborne RH, Heagerty PJ, Buchbinder R. - BMJ. 2011 Jul 12;343:d3952. doi:
10.1136/bmj.d3952.
Vertebroplasty and kyphoplasty--a systematic review of cement augmentation techniques for osteoporotic vertebral compression
fractures compared to standard medical therapy. - Maturitas. 2012 May;72(1):42-9. doi: 10.1016/j.maturitas.2012.02.010. Epub
2012 Mar 16.
Vascular
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Limb revascularisation
Peripheral artery disease
DVT/Pulmonary embolism
Limb revascularisation
Percutaneous transluminal angioplasty (PTA)
 Cryoplasty
 Cutting and scoring balloons
 Nitinol stents – nickel and titanium
superelasticity & thermal shape
memory
 Nitinol stent grafts/covered stents
 Drug eluting stents
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Limb revascularisation
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Debulking devices – excimer laser and excisional
atherectomy – thermal damage – photochemical
rather than thermal
Rotational atherectomy
Limb Revascularisation
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Percutaneous thrombectomy
 Rheolytic
thrombectomy
 Aspiration thrombectomy
Factors leading to poor results*
length of the diseased segment
the presence of total occlusion – 20 – 40%
diabetes mellitus
poor distal runoff
critical limb ischemia as the clinical presentation
* Overview of New Technologies for Lower Extremity Revascularization
Jason H. Rogers, MD; John R. Laird, MD: Circulation.2007; 116: 2072-2085
Oncology
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Biopsy – guided biopsies
Embolization
 Vascular
embolization
 Chemo-embolization
 Radio-embolization
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Radiofrequency ablation
cryoablation
Vascular Embolization indications*
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definitive treatment of benign lesions
reducing the risk of bleeding prior to biopsy or surgery
palliation of pain, bleeding, fever, and hypercalcemia-like
symptoms in inoperable tumors
preventing further dissemination of a tumor
increasing the response to chemotherapy and radiotherapy,
retention of selectively delivered anti-mitotic agents or
monoclonal antibodies deep into the tumor substance
*Embolization of bone tumors Andreas F. Mavrogenis, MD; giuseppe rossi, MD;
Orthopedics April 2011 - Volume 34 · Issue 4: 303-310
Figures 2A-2B: AP radiograph
of the left elbow of a 70-yearold man with a metastatic renal
cell carcinoma of the olecranon
(A). Pre-embolization
angiography showed 3 feeding
vessels originating from the
median (1) brachial, (2) and
ulnar (3) artery (B).
Embolic agents
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Nontoxic
Sterile
Radiopaque
easy to prepare or to
obtain
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gelatin sponge
polyvinyl alcohol (PVA)
particles
liquid (absolute alcohol),
Coils
tissue adhesives
Ethanol
microfibrillar collagen
autologous blood clot.
Pelvic Trauma
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Embolization of bleeding arterial vessels –
Transcatheter Embolization (TCE)
Bleeding from
 Presacral
venous plexus
 Fractured cancellous bone
 vessels
*Transcatheter Embolization in Pelvic Trauma Scott R. Broadwell, M.D.1 and Charles E. Ray,
Jr., M.D: Semin Intervent Radiol. 2004 March; 21(1): 23–35
Pelvic Trauma*
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Digital subtraction angiography
Vessels affected
 superior
gluteal
 internal pudendal
 Obturator
 lateral sacral arteries
Embolization techniques
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Selective embolotherapy
Shot gun embolotherapy
Embolic agents
Size
of the vessel
Autologous
clot
Permanence
Gelfoam pledgets or slurry
Familiarity
to the
IR working
Coils if coag
system
 Particles/silk suture material
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Pelvic trauma – Cx & Limitations
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nontarget embolization
of lower extremity
vessels
Rhabdomyolysis that may
be worsened by
ischemia,
acute renal failure
colonic and ureteric
infarctions
perineal wound sepsis
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sacral nerve injury
sexual dysfunction
(impotence)
rectal dysfunction
(difficulty defecating)
avascular necrosis of
the femoral head
death.
Infection
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Percutaneous drainage of abscesses and fluid
collection
Advantages
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Minimal incisions/scarring
Shorter hospital stay/outpatient
Reduced recovery time
Anesthetic
Lower risk of complications
Treatment option in poor/risk prone patients
Disadvantages
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Technical expertise – demanding
Equipment
Cost
Adverse effects unique to each procedure
The future
IR
surgeon
gynae
cardio
oncologist
Fractures are safe… for now!
THANK YOU