Professional Documents
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Interventional Radiology
Interventional Radiology
Interventional Radiology
Various Procedures
Angioplasty and Vascular Stenting
Catheter Angiography
Catheter Embolization
CT Angiography
MR Angiography
Cryotherapy
Uterine Fibroid Embolization
Vertebroplasty
Angioplasty and Vascular Stenting
Minimally invasive procedure to improve blood flow in
arteries.
Surgeon threads a balloon tipped catheter to the site.
The balloon is inflated in order to open the artery –
deflated and then removed.
Vascular stenting also may be done at the same
time.
Stent is a permanent device left in the artery
Assists the healing of the artery in the open position
after angioplasty.
Common uses
Peripheral Vascular Disease.
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Catheter Embolization
“Embolization” – way of occluding blood vessels
which are doing more harm than good.
Material is passed through the catheter with its tip
lying in or near the blood vessel to be closed.
Very useful to control excessive bleeding or cut off
blood supply to a tumor.
Therapeutic Embolization serves to eliminate AVM.
Embolus – medication or synthetic material to
occlude the blood vessel.
Common uses
Controlling bleeding from injury, tumor or stomach
ulcer.
To cut off blood supply to a tumor. Can be used in
conjunction with chemotherapy.
To treat benign fibroid tumors of the uterus – an
alternative to hysterectomy. Multiple fibroid tumors
can be treated at one time.
Excellent for treatment of AVM (abnormal connection
of the artery and the vein like a “short circuit”).
For plugging of an aneurysm in the brain.
Treatment of hemangiomas.
How is it performed?
The equipment used is same as in Catheter angiography.
The first step is angiography (injection of x-ray dye into an
artery or vein) to locate the exact site of bleeding or
abnormality
A catheter is introduced and contrast material is injected
(normally through femoral artery).
An appropriate embolic material then is chosen and injected
through the catheter to lodge at the treatment site
Repeat angiograms are done until bleeding is controlled or there
is enough embolic material in a tumor or vascular malformation
Different Embolic materials used
Gelfoam - used to control bleeding until the cause—
such as a bone fracture can be identified and fixed,
or until it has time to heal on its own.
Permanent particulate agents - These agents are
used to occlude small blood vessels permanently.
They are used to stop bleeding or block arteries to a
tumor when the underlying lesion is not likely to
heal. They are the materials used most often to
embolize uterine fibroid tumors. Eg : Polyvinyl
alcohol (PVA).
Different Embolic materials used
Metal coi ls made of stainless steel or
platinum may be used to occlude large
arteries. They come in a range of sizes.
Li qui d scl erosing ag ents such as alcohols
are used to purposely destroy tissue. This
might be desired to treat a large
malformation of veins by filling it with the
liquid to induce clotting and damage the inner
lining of the veins
Benefits vs Risks
Very effective way of controlling bleeding
especially in emergency.
Used to treat tumors and vascular
malformations.
It is much less invasive than conventional
open surgery.
When embolization is used to treat an
intracranial arteriovenous malformation
(AVM), injection of a small amount of material
minimizes the risk of serious brain
dysfunction.
Benefits vs Risks
Embolus can lodge in the wrong place and
deprive normal tissue of its oxygen supply.
Risk of infection after embolization, even if an
antibiotic has been given.
Because angiography is part of the
procedure, there is a risk of an allergic
reaction to contrast material and also there is
a risk of kidney damage in patients with
diabetes or other pre-existing kidney disease.
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Cryotherapy
Cryotherapy, also called cryosurgery,
cryoablation or targeted cryoablation
therapy, refers to the application of
extreme cold to destroy diseased tissue,
including cancer cells.
Common Uses
Used to destroy skin tumors, pre-cancerous
skin moles, nodules, skin tags or unsightly
freckles.
Used to destroy Retinoblastomas.
Physicians have begun to perform
cryotherapy for prostate, liver and cervical
cancer, especially if surgery is not possible.
Current research on cryotherapy for tumors
of the bone, brain, kidney, lung and spine.
How is it performed?
Carried out using cryoprobe (attached via
tubing to a source of N or Ar).
For external masses, liquid N is applied
directly with a cotton swab or spray device.
For internal tumors, liquid N or Ar gas is
circulated through the cryoprobe, which
comes into contact with the diseased tissue.
How is it performed? (contd.)
More advanced forms of cryotherapy, such as
for treatment of liver cancer, involve the
insertion of the probe through an incision or
threaded through the skin. Then using
imaging device the physician targets and
freezes the tumors.
Likewise, for prostate cancer, six to eight
needle probes can be inserted through the
perineum (the tissue between the rectum and
the scrotum/penis) and ultrasonically guided
to freeze the cancer.
Benefits vs Risks
For intraoperative cryotherapy recovery time
is much less than for major surgical removal
of the tumor.
Percutaneous cryotherapy has great potential
to evolve into an outpatient procedure.
Less traumatic than open surgery since only a
small incision is needed.
It causes minimal scar tissue and apparently
no calcifications.
Benefits vs Risks (contd.)
Treatment of the liver can damage bile ducts or
cause heavy bleeding
Treatment of the kidney can damage the urine-
collecting systems or cause heavy bleeding.
Treatment of lung tumors can cause the lung to
collapse and fluid to accumulate around the lung.
Care must be taken anywhere nerves are near the
tumor. Completely frozen nerves can cause motor
weakness or numbness in the area supplied by the
nerves.
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CT Angiography
CTA uses X-rays to visualize arterial and
venous vessels throughout the body.
CT combines use of x-rays with
computerised analyzis of the image.
CTA is much less invasive and more
patient friendly than catheter
angiography.
Common uses
To examine pulmonary arteries to rule out pulmonary
embolism.
Visualize blood flow in the renal arteries in patients
with high blood pressure and those suspected of
having kidney disorders. Also done in kidney donors.
Identify aneurysms in the aorta or in other major
blood vessels.
Detect atherosclerosis disease that has narrowed the
arteries to the legs.
Detect thrombosis (clots) in veins, for example large
veins in the pelvis and legs.
How is it performed?
Before the actual exam a contrast agent is injected
into a vein.
During the examination, the rotating device spins
around the patient, creating a fan-shaped beam of x-
rays, and the detector takes snapshots of the beam
after it passes through the patient.
As many as one thousand of these pictures may be
recorded in one turn of the detector.
Then reconstruction techniques are used to view
images as desired.
Benefits vs Risks
CTA can be used to examine blood
vessels in most parts of the body.
More precise than MR Angiography and
Ultrasound
Useful way of screening arterial blood
vessels because it is safer and less time
consuming than Catheter Angiography.
Risks
Risk of allergic reactions because of
contrast agents like iodine.
Dangerous for patients with kidney
disorders and diabetes.
Skin damage may occur because of
excess contrast agent.
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MR Angiography
MRI produces images of the body without the
use of X-rays.
The electromagnetic energy that is released
when exposing a patient to radiofrequency
waves in a strong magnetic field is measured
and analyzed by a computer
MRA is MRI study of the blood vessels.
Provides detailed images of the images
without using contrast agents.
Common uses
Used in checking patients for diseased
intracranial (in the head) arteries.
Used to detect disease in the aorta and
in blood vessels supplying the kidneys,
lungs and legs.
Used for confirmation of carotid artery
stenosis.
How is it performed?
Traditional MRI units are used.
Patient is placed in the MRI unit.
Exposing the patient to radio waves in a
strong magnetic field generates data that are
used by a computer to create images of
tissue slices that may be viewed in any plane
or from any direction.
Contrast material used is Gadolinium. It is
given by IV injection during one of the
imaging sequences.
Benefits Vs Risks
Ben ef its
Procedure time and time to recover is relatively
small.
Cost-effective procedure.
No exposure to x-rays.
Very useful for patients having allergic reactions to
contrast material.
Possible to defer surgery.
Benefits Vs Risks
Ri sks
In case of implants being present, it is difficult to get
a good quality image.
Pregnant women cannot be allowed for this
procedure.
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Uterine Fibroid Embolization
New way of treating fibroid tumors.
Also called as myo mas , fibroid tumors are masses of
fibrous and muscle tissue in the uterine wall which
are benign but can cause heavy bleeding, pain in the
pelvic region or pressure on the bladder and the
bowel.
Much less invasive than open surgery.
UFE was first used to limit blood loss during surgical
removal of fibroid tumors.
Now it is a stand-alone treatment for women who
have symptoms of uterine fibroid tumors.
Common uses
Obviously for fibroid tumors.
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