DR. ABEER FAWZY EL SOBKYDR. ABEER FAWZY EL SOBKY

Master Degree In RadiodiagnosisMaster Degree In Radiodiagnosis

INTERVENTIONAL RADIOLOGY AS INTERVENTIONAL RADIOLOGY AS MINIMALLY INVASIVE PROCEDURESMINIMALLY INVASIVE PROCEDURES

What is Interventional Radiology?What is Interventional Radiology?

Interventional radiology procedures are Interventional radiology procedures are minimally invasiveminimally invasive, targeted treatments., targeted treatments.

Interventional radiologists use imaging Interventional radiologists use imaging equipments such as X-rays, ultrasound, equipments such as X-rays, ultrasound, CT and MRI toCT and MRI to guide small instruments guide small instruments such as catheters or wires through the such as catheters or wires through the blood vessels or other pathways to treat blood vessels or other pathways to treat as well as diagnose diseases as well as diagnose diseases percutaneously. percutaneously.

What are the Advantages of Interventional Radiology?

Interventional radiology procedures are generally easier for the patient because: no general anesthesia no large incisions outpatient basis less risk less pain less blood loss less recovery times less expensive

What Procedures doWhat Procedures do Interventional Radiologist Interventional Radiologist

Perform?Perform? Balloon angioplastyBalloon angioplasty Biliary drainage and stentingBiliary drainage and stenting ChemoembolizationChemoembolization EmbolizationEmbolization Radiofrequency ablation (RFA)Radiofrequency ablation (RFA) StentingStenting Stent-graftStent-graft ThrombolysisThrombolysis TIPS TIPS (transjugular intrahepatic portosystemic (transjugular intrahepatic portosystemic

shunt)shunt) CryotCryotherapyherapy BBlood clot filterslood clot filters

CHEMOEMBOLIZATION Delivering cancer treatment directly

to a tumor through its blood supply, then using clot-inducing substances to block the artery, ensuring that the delivered chemotherapy is not "washed out" by continued blood flow.

Used mostly to treat primary liver cancers and metastases of the liver. In about two-third of cases the tumors are stopped or shrunk.

How Does Chemoembolization Work?

Attacks the cancer in two ways:• very high concentration of

chemotherapy in the tumor is achieved by direct delivery through the hepatic artery, sparing most of the healthy liver tissue

• ischaemia of the tumor is caused by embolization of nourishing artery with embolic particles

This treatment preserves liver function and relatively normal quality of life.

Superselective Chemoembolization of a Sole Liver Metastasis

EMBOLIZATION

Highly effective way of controlling bleeding from injury, esp. in abdomen or pelvis, or stomach ulcer, in an emergency situation.

Worldwide succesful treatment of uterine fibroids

Effective treatment of tumors that either cannot be removed surgically or would involve great risk of surgery.

Bleeding from a Stomach UlcerBleeding from a Stomach Ulcer

Selective arteriography Stopped after Selective arteriography Stopped after of left gastric artery Gelfoam embolizationof left gastric artery Gelfoam embolization

Bleeding from JejunumBleeding from Jejunum

Arteriography of superior Stopped after superselective Arteriography of superior Stopped after superselective mesenteric artery metal coils embolization mesenteric artery metal coils embolization

Uterine Fibroid EmbolizationUterine Fibroid Embolization

Angiography of right uterine artery and embolizationAngiography of right uterine artery and embolization

MRI of uterine fibroid visible before andMRI of uterine fibroid visible before and invisible 6 months after embolization invisible 6 months after embolization

Unilateral common femoral artery access sufficient to treat both uterine arteries

AORTIC STENTGRAFTS

Endovascular repair of abdominal aorta aneurysm (AAA) with a fabric-wrapped flexible mesh tube.

Prevention of enlargement or life-threatening rupture of AAA.

How Does Aortic Stentgrafts

Work? An appropriate type of self-expanding

stentgraft is inserted through the femoral artery and placed at the site of the aneurysm of abdominal aorta.

Stentgraft bridges the aneurysm inside and eliminates the blood flow in aneurysmal sac.

Reduction of the aneurysmal sac and decrease of the pressure on the aortic wall as an effective prevention of rupture.

Various Aortic StentgraftsVarious Aortic Stentgrafts

Aortic StentgraftsAortic Stentgrafts

Subrenal Abdominal Aortic Subrenal Abdominal Aortic AneurysmAneurysm

Angiography before and after implantation of stentgraftAngiography before and after implantation of stentgraft

Angioscopy

This is also an invasive method of studying intimal surface of the arterial wall

An angioscope catheter containing optical fibers

By flushing away the blood, which obscures the field of view, the inner surface of both arteries and grafts, atheroma and thrombus can be directly visualized.

Catheter-directed Thrombolysis

Minimally invasive treatment

that dissolves abnormal

blood clots in blood vessels

The blood clot will then be dissolved in one of two ways: By delivering medication

directly to the blood clot. By positioning a mechanical

device at the site to break up the clot.

IVC filters

Metallic filters placed in the

inferior vena cavae to

prevent propagation of deep

venous thrombus, both

temporary and permanent.

Common uses of the procedure:

Patients who have a history of diagnosed deep vein thrombosis (DVT) or pulmonary embolism.

IVC filters are used when patients cannot be successfully treated by other methods, including blood thinning agents

Complications

IVC filter can lodge in the wrong place,

change position or injure a nearby organ.

The IVC filter may break loose and travel

to the heart or lungs causing injury or

death.

Filled with clots Risk of infection.

Phlebotomy of Varicose Veins

Phlebotomy is a minimally invasive

procedure used to remove

varicose veins on the surface of

the leg. This is usually done in a

physician’s office using

local anesthesia

Sclerotherapy of Varicose Veins

Minimally invasive treatment used

to treat varicose and spider veins.

The procedure involves the

injection of a solution directly into

the affected veins, causing them

to shrink and eventually disappear

Cholecystostomy

Placement of a tube into the

gallbladder to remove infected

bile in patients with

cholecystitis, an inflammation of

the gallbladder, who are too sick

to undergo surgery

Drain insertions

Placement of tubes into

different parts of the body

to drain fluids (e.g.,

abscess drains to remove

pus, pleural drains)

Radioembolization

Embolization of liver with

radioactive microspheres of

glass or plastic, to kill

tumors while minimizing

exposure to healthy cells.

NephrostomyPlacing a catheter directly into

the kidney to drain urine in situations where normal flow of urine is obstructed. NUS

catheters are nephroureteral stents which are placed

through the ureter and into the bladder

Radiologically Inserted Gastrostomy

Placement of a feeding

tube percutaneously into

the stomach and/or

jejunum

Vertebroplasty

Percutaneous injection of

biocompatible bone

cement inside fractured

vertebrae

Cryoablation

localized destruction

of tissue by freezing

Biopsy

Taking of a tissue sample

from the area of interest for

pathological examination

from a percutaneous or

transjugular approach

TIPSPlacement of a Transjugular

Intrahepatic Porto-systemic

Shunt (TIPS) for management

of select patients with critical

end-stage liver disease and

portal hypertension

Radiofrequency ablation

(RF/RFA) localized

destruction of tissue (e.g.,

tumors) by heating

Biliary intervention

Placement of catheters in the

biliary system to bypass biliary

obstructions and decompress

the biliary system. Also

placement of permanent

indwelling biliary stents

CONCLUSIONS

Interventional radiology procedures are an advance in medicine that often replace open surgical procedures.

These minimally invasive procedures

involve less blood loss and thus play an important role in bloodless medicine.