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Interventional radiology Dr. M. A. Baradia

Interventional radiology Dr. M. A. Baradia. Supervisors: Dr. Wanga , Dr. Sitati. IR/Surgical radiology. Sub-speciality of radiology Minimally invasive Image guided procedures. Body plumbing. Charles Dotter MD – Father of IR, Nobel 1978 82 yr old gangrenous left foot – Jan 1964

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Interventional radiology Dr. M. A. Baradia

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  1. Interventional radiologyDr. M. A. Baradia Supervisors: Dr. Wanga, Dr. Sitati

  2. IR/Surgical radiology • Sub-speciality of radiology • Minimally invasive • Image guided procedures

  3. Body plumbing • Charles Dotter MD – Father of IR, Nobel 1978 • 82 yr old gangrenous left foot – Jan 1964 • Angioplasty 1964 • Embolization for pelvic trauma 1973 • Arterial thrombolysis 1974 • Embolization/RFA of Bone tumors 1990

  4. Imaging modalities • Fluoroscopy • Computed tomography • Ultrasound • Magnetic resonance imaging

  5. Orthopedic IR • Spine • Vascular • Oncology • Trauma • Infection

  6. Spine • Vertebroplasty • Kyphoplasty VCF

  7. To do or not to do? • 2 placebo controlled, double blinded trials found no benefit • Adverse effects • BUT… Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials: meta-analysis. Staples MP, Kallmes DF, Comstock BA, Jarvik JG, Osborne RH, Heagerty PJ, Buchbinder R. - BMJ. 2011 Jul 12;343:d3952. doi: 10.1136/bmj.d3952. Vertebroplasty and kyphoplasty--a systematic review of cement augmentation techniques for osteoporotic vertebral compression fractures compared to standard medical therapy. - Maturitas. 2012 May;72(1):42-9. doi: 10.1016/j.maturitas.2012.02.010. Epub 2012 Mar 16.

  8. Vascular • Limb revascularisation • Peripheral artery disease • DVT/Pulmonary embolism

  9. Limb revascularisation • Percutaneous transluminal angioplasty (PTA) • Cryoplasty • Cutting and scoring balloons • Nitinol stents – nickel and titanium superelasticity & thermal shape memory • Nitinol stent grafts/covered stents • Drug eluting stents

  10. Limb revascularisation • Debulking devices – excimer laser and excisional atherectomy – thermal damage – photochemical rather than thermal • Rotational atherectomy

  11. Limb Revascularisation • Percutaneous thrombectomy • Rheolytic thrombectomy • Aspiration thrombectomy

  12. Factors leading to poor results* length of the diseased segment the presence of total occlusion – 20 – 40% diabetes mellitus poor distal runoff critical limb ischemia as the clinical presentation * Overview of New Technologies for Lower Extremity Revascularization Jason H. Rogers, MD; John R. Laird, MD: Circulation.2007; 116: 2072-2085

  13. Oncology • Biopsy – guided biopsies • Embolization • Vascular embolization • Chemo-embolization • Radio-embolization • Radiofrequency ablation • cryoablation

  14. Vascular Embolization indications* • definitive treatment of benign lesions • reducing the risk of bleeding prior to biopsy or surgery • palliation of pain, bleeding, fever, and hypercalcemia-like symptoms in inoperable tumors • preventing further dissemination of a tumor • increasing the response to chemotherapy and radiotherapy, • retention of selectively delivered anti-mitotic agents or monoclonal antibodies deep into the tumor substance *Embolization of bone tumors Andreas F. Mavrogenis, MD; giuseppe rossi, MD; Orthopedics April 2011 - Volume 34 · Issue 4: 303-310

  15. Embolic agents • gelatin sponge • polyvinyl alcohol (PVA) particles • liquid (absolute alcohol), • Coils • tissue adhesives • Ethanol • microfibrillar collagen • autologous blood clot. • Nontoxic • Sterile • Radiopaque • easy to prepare or to obtain

  16. Pelvic Trauma • Embolization of bleeding arterial vessels – Transcatheter Embolization (TCE) • Bleeding from • Presacral venous plexus • Fractured cancellous bone • vessels *Transcatheter Embolization in Pelvic Trauma Scott R. Broadwell, M.D.1 and Charles E. Ray, Jr., M.D: Semin Intervent Radiol. 2004 March; 21(1): 23–35

  17. Pelvic Trauma* • Digital subtraction angiography • Vessels affected • superior gluteal • internal pudendal • Obturator • lateral sacral arteries

  18. Embolization techniques • Selective embolotherapy • Shot gun embolotherapy

  19. Embolic agents • Size of the vessel • Permanence • Familiarity to the IR • Autologous clot • Gelfoampledgets or slurry • Coils if coag system working • Particles/silk suture material

  20. Pelvic trauma – Cx & Limitations • nontarget embolization of lower extremity vessels • Rhabdomyolysisthat may be worsened by ischemia, • acute renal failure • colonic and ureteric infarctions • perinealwound sepsis • sacral nerve injury • sexual dysfunction (impotence) • rectal dysfunction (difficulty defecating) • avascular necrosis of the femoral head • death.

  21. Infection • Percutaneous drainage of abscesses and fluid collection

  22. Advantages • Minimal incisions/scarring • Shorter hospital stay/outpatient • Reduced recovery time • Anesthetic • Lower risk of complications • Treatment option in poor/risk prone patients

  23. Disadvantages • Technical expertise – demanding • Equipment • Cost • Adverse effects unique to each procedure

  24. The future IR surgeon gynae cardio oncologist Fractures are safe… for now!

  25. THANK YOU

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