Interventional Radiology

Interventional radiology (IR) is a special sub-operation under general radiology. It is used to find, diagnose and treat a disease in almost every body system. The process of interventional radiology is very noninvasive to help with the recovery and outcome of the procedure. It utilizes x-rays, CT, ultrasound, MRI, and other modes of imaging in order to direct tools in the body as well as a variety of catheters, narrow tubes, so that incisions can be minimalized.

How it is Performed

Interventional Radiology is performed a number of ways depending on the organs or areas being checked. Through Angiography, radiologists look for abnormalities in blood vessels. If a narrow or blocked blood vessel is located through the angiograph test, a balloon angioplasty or stent placement can be performed to reopen the vessel using a balloon or metallic stent. Cholecystostomy is the placement of a tube into the gallbladder to remove infected bile in patients with cholecystitis. Interventional Radiologists also place tubes in the body to drain fluids; this process is called drain insertion. Embolization is used by blocking abnormal arteries or organs to subcutaneous. Chemoembolization is a form of embolization that blocks the artery after delivering cancer treatment directly to a tumor so that the blood flow does not “wash out” the chemotherapy. Radioembolization is another form of embolization that treats tumors with controlled radioactive microspheres of plastic or glass. Thrombolysis works to dissolve blood clots through mechanical and pharmaceutical technologies. Biopsies take tissue samples from interesting areas to test for pathological examinations. Radiofrequency ablation (RF/RFA) destroys tissues through extreme heat while cryoablation destroys tissues through the application of extreme cold. Line insertion is the management and vascular access of intravenous devices (IVs). IVC filters are the metallic filters placed in the inferior vena cavae to prevent the spread of deep venous thrombus. Vertebroplasty is the subcutaneous injection of bone cement in fractured vertebrae. Nephrostomy placement is the placement of a catheter to a kidney to drain urine; nephroureteral stents sre places through the ureter and into the bladder. Radiologically inserted gastronomy (RIG) is when a feeding tube is place either directly to the stomach or the small intestine through the skin. Dialysis access and related interventions are placements of catheters and revision/ thrombolysis of poorly functioning surgically placed AV fistulas and grafts. Placement of a Transjuglar Intrahepatic Porto-systemic Shunt (TIPS) is used to manage the status of patients with critical end-stage liver disease and portal hypertension. Biliary intervention is the use of catheters in the biliary system or the placement of permanent indwelling biliary stents to go decompress the biliary system and bypass biliary blocks. Endovenous laser treatment of varicose veins uses thin laser fibers to treat a venous insufficiency. These are all different kinds of noninvasive procedures classified as Interventional Radiology.

Who May Need Interventional Radiology

There are a number of reasons why one may need access to interventional radiology; from simple procedures to extreme diseases or injuries. There are many vascular diseases that are treated trough IR. This includes Peripheral artery disease (PAD), the lack of a normal blood flow to the upper and lower parts of the body, which can be treated through stenting, angioplasty and mechanical atherectomy. Acut limb ischemia, the change in blood flow from an artery because of a blood clot or other, is another vascular diseases treated through catheter-directed thrombolysis (a form of IR). Oncologic diseases, such as Liver cancer, Kidney cancer, etc., can be treated through embolization and its sub-treatments. Certain Neurologic problems such as stroke, multiple sclerosis, and cartoid artery stenosis are treated because these patients are too weak or are poor candidates for an open surgery.

Organ Systems that Benefit from IR
•    Vascular
•    Oncologic
•    Neurologic
•    Spine
•    Hepatobiliary
•    Kidney
•    Etc.

Tools Used in Interventional Radiology
•    Diagnostic angiographic catheters
•    Micro catheters
•    Drainage catheters
•    Balloon catheters
•    Central venous catheters

Image Caption: Treatment of CCSVI – endovascular angioplasty, balloon dilatation of stenosis of the left internal jugular vein. Credit: Sergei Gutnikov/Wikipedia