Interventional radiology

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Dr. Nabarun Biswas

1. Interventional Radiology Minimum Access  Maximum Result Dr. Nabarun Biswas Registrar Surgery MMCH

2. What is IR ( Image guided surgery/surgical radiology ) Intervention means “ an action or process of interfering ” so IR in medical practice means interfering of Radiology in diagnostic and/or therapeutic procedures. Definition: It is a medical subspeciality that performs various minimally invasive procedures using medical imaging guidance such as X Ray fluoroscopy, CT scan, MRI, or ultrasonogram

3. History of IR In 1953 Swedish doctor Svenlvar Seldinger introduced Seldinger technique which laid down the foundation of IR. In 1963, Charles Dotter first proposed the idea of IR ( The father of IR) In 1964, Charles Dotter done percutaneous angioplasty through accidental operation. Endovascular stent was proposed in 1969. Percutaneous coronary angioplasty is applied in 1977.  TIPSS started from 1986. Charlse Dotter

4. Common elements for IR Puncture needle Guide wire Sheath Catheters Medical imaging machine X-ray fluoroscopy CT scan MRI USG

5. Prerequisite Informed consent Investigations Platelet > 60,000/cm INR < 1.5 Renal function test Fasting: fasting for 2 hours IV access & hydration Parenteral Antibiotics

6. Types of IR Diagnostic Therapeutic

7. Diagnostic IR Angiography Cholangiography Biopsy

8. Therapeutic IR Vascular Biliary intervention Cather placement Ablative Genitourinary Pain management

9. Vascular Balloon angioplasty/ stent Endovascular aneurysm repair Embolization Thrombolysis IVC filter TIPSS Endovenous LASER treatment for varicose vein

10. Biliary intervention Catheter placement for biliary bypass Biliary stenting cholecystostomy

11. Catheter placement Central venous catheter placement Drainage catheter placement Radiologically inserted gastrostomy/ jejunostomy

12. Ablative Chemoembolization Radioembolization Radiofrequency ablation Cryoablation Microwave ablation

13. Genitourinary Percutaneous nephrostomy Ureteral stent exchange

14. Pain Management Joint and local injections Facet joints Sacroiliac joints Epidural space Selective nerve root injection Chronic pelvic pain Palliative care Nerve block/ablations

15. Bone and spine Leg arteries Blocked arteries Internal Bleeding Targeted cancer treatment Dialysis Blocked bile ducts Aortic aneurysms Blood clots Blood vessel malformations Fibroids Varicose veins Blocked kidneys IR treat many conditions....... Here are just a few

16. Scope of Interventional Radiology Blood Vessel Bleeding control Many other treatments Cancer

17. Blood Vessels Treats blood vessels from 2 mm to 30 mm Narrowed blood vessels are stretched (Angioplasty) to improve blood flow Blocked blood vessels can be internally reopened in many cases Treatment of aneurysms (abnormal bulges in vessels).

18. Unblocking arteries Blocked arm artery (Arrow) causing pain and arm weakness Treated by internally unblocking the artery and placing a stent Major surgery avoided. Total treatment time of one hour

19. Aortic Aneurysm Abnormal bulge (aneurysm) of the main artery in the abdomen Risk of rupture and major bleeding Treated by internally relining the artery (Endovascular aneurysm repair-EVAR) Major surgery avoided. Total treatment time of 90 minutes

20. Bleeding into Bowel Severe bleeding into the large bowel (arrow) Treated with selective Blockage of the bleeding Artery Emergency surgery avoided

21. Cancer Treatment Thermal destruction of small cancers using image guided needles Targeted chemotherapy into blood vessels supplying the tumour Symptom relief Stent insertion into the bowel for relief of obstruction Insertion of lines for delivery of chemotherapy and nutrition

22. Cancer Treatment Small cancer lesion in the liver (arrow) in a patient with previously treated cancer Image guided thermal destruction Surgery and chemotherapy avoided. Treatment time of 60 minutes.

23. complications Bacteremia Septicemia Haemorrhage Pancreatitis Pneumothorax Tumor seedling

24. benefits

25. 8 out of 10 procedures use skin incisions smaller than 5 millimetres

26. 9 out of 10 procedures use only local anaesthetic, sometimes with sedation

27. And it’s often a less invasive option than traditional surgical procedures

28. Up to 8 out of 10 patients go home the same day

29. Some Pictorials of interventional Radiology

30. Sheldingger Technique

31. Uterine artery embolization

32. Bronchial artery embolization by PVA

33. Percutaneous Transhepatic Biliary Bypass

34. Percutaneous Cholecystostomy

35. TIPSS

36. Stereotactic Biopsy

37. Image guided Aspiration

38. Take home massage (Points to write in SAQ) What is IR History Types of IR Common elements Scope of IR Prerequisite Complications Benefits Conclusion

39. Too many procedures... …..too little space Thank You