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FAQs in Interventional Radiology

What is Interventional Radiology?
Interventional radiology is a sub-specialty of radiology that utilizes various imaging techniques to guide percutaneous minimally invasive procedures for both diagnosis and therapy.

Interventional radiologists (IRs) use their expertise in using X-rays, ultrasound and other medical images to guide small instruments such as catheters (tubes that measure just a few millimeters in diameter) through the blood vessels or other pathways to treat disease percutaneously (through the skin). These procedures are typically much less invasive and much less costly than traditional surgery.

Who are Interventional Radiologists?
Interventional radiologists are radiologist with post doctoral training in Interventional Radiology.

Why Interventional Radiology treatment?
With improvement in science and computer, latest developments have come to this branch of medicine. It is most modern and least invasive form of all treatment modalities. Treatment is short in duration with least complications. Procedures are day care or involve short admission of 1-3 days.We treat various surgical diseases by these methods.

Is it expensive?
No and Yes. It may be expensive on day 1 of the procedure. But overall it is not expensive.

Why I have not heard of so much about Interventional Radiology if it is so good?
It was mostly in large hospitals and approached by various physicians as a part of overall treatment in complex situations. There has been recent expansion to treat various diseases. We treat large number of surgical diseases. Previously we would see only referred cases from other doctors, now we function through our own clinic. You can find out from the organ wise list of diseases we treat. In case of any clarification you can e mail me at drsunil.b@sevenhillshospital.com.

Various procedures in Interventional Radiology we do

As technology advances and high-quality imaging equipment becomes more widely available, interventional radiology is able to offer patients and referral physicians a host of new treatment options.

• Angiography: imaging the blood vessels to look for abnormalities with the use of various contrast media mainly iodinated contrast agents.
• Balloon angioplasty/stent: opening of narrow or blocked blood vessels using a balloon; may include placement of metallic stents as well (both self-expanding and balloon expandable).
• Chemoembolisation: delivering cancer treatment directly to a tumour 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.
• Drain insertions: placement of tubes into different parts of the body to drain fluids (e.g., abscess drains to remove pus,nephrostomy, pleural drains)
• Embolisation: blocking abnormal blood (artery) vessels (e.g., for the purpose of stopping bleeding) or organs (to stop the extra function e.g. embolization of the spleen for hypersplenism) including uterine artery embolization for percutaneous treatment of uterine fibroids. Various embolic agents are used, including alcohol, glue, metallic coils, poly-vinyl alcohol particles, embospheres, encapsulated chemo-microsphere, and gelfoam.
• Thrombolysis: treatment aimed at dissolving blood clots (e.g., leg vein thrombi, thrombosed hemodialysis accesses, pulmonary emboli,) with both pharmaceutical (TPA) and mechanical means.
• Biopsy: taking of a tissue sample from the area of interest for pathological examination from a percutaneous or transjugular approach
• Radiofrequency ablation (RF/RFA): localized destruction of tissue (e.g., tumours) by heating using specilaised equipment under image guidance.
• Venous access: insertion and management of specialized kinds of intravenous devices (IVs) under image guidance.
• IVC filters: metallic filters placed in the inferior vena cava to prevent propagation of deep venous thrombus, both temporary and permanent.
• Vertebroplasty: percutaneous injection of biocompatible bone cement inside diseased or fractured vertebrae
• Nephrostomy/NUS placement: Placing 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.
• Gastrostomy/gastrojejunostomy tube placement: placement of a feeding tube percutaneously into the stomach and/or jejunum.
• Dialysis access/intervention: revision/thrombolysis of poorly functioning surgically placed AV fistulas and grafts.
• TIPS : Placement of a Transjugular Intrahepatic Porto-systemic Shunt (TIPS) for management of select patients with critical end-stage liver disease and portal hypertension
• Biliary interventions: Placement of catheters in the biliary system to bypass biliary obstructions and decompress the biliary system. Also placement of permanent indwelling biliary stents.
• Endovenous ablation of varicose veins (EVLT-Endovenous laser therapy): Placement of thin laser fiber /Radiofrequency catheter in varicose veins for non-surgical treatment of venous insufficiency.
• Intracranial aneurysm coiling: Endovascular occlusion of aneurysms includes the use of detachable coils. This is an angiographic procedure where a small soft catheter is introduced into the blood vessel from the leg artery. From there the catheter is carefully threaded up into the brain and the tip of the catheter is placed in the aneurysm. Then through the catheter small soft coils are introduced into the aneurysm to block it completely.
• Brain arteriovenous malformation embolisation: a small plastic tube called a catheter is introduced into the artery in the groin area. From this artery the catheter is carefully navigated into the brain and specifically into the arteries in the brain that are the shunts of the AVM. Then these shunts are occluded by injection through this catheter of agents that block the blood vessels.
• Carotid Angioplasty and stenting: The angioplasty and stenting is done through the artery in the groin, guiding up the devices inside the blood vessels to the neck. First, a filter device is placed through the narrowed area to capture any debris loosened by the procedure. Then a balloon in placed and inflated to open up the artery pathway if needed and an expandable metallic cage (stent) is placed across the narrowed area. This expands to further open the blood vessel.
• Percutaneous laser disc decompression (PLDD): This treatment is offered to patients who are not responding to medical treatment for two months with contained disc herniation. The disc is treated by laser fibre through a needle. You are allowed to go home same day.
• Intra arterial Stroke thrombolysis: Through angiographic route the thrombolytic (clot dissolving drugs) agents are delivered into the clot in arteries of brain. This may be assisted by mechanical removal of the clot using sophisticated devices.

For any other query please mail Dr Sunil Bhargava at drsunil.b@sevenhillshospital.com

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