INTERVENTIONAL RADIOLOGY AS MINIMALLY INVASIVE PROCEDURES

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• INTERVENTIONAL RADIOLOGY AS MINIMALLY INVASIVE
  PROCEDURES
• Radka Slipac
• Department of Radiology Brno, Czech Republic

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What is Interventional Radiology?

• Interventional radiology procedures are minimally
  invasive, targeted treatments.
• Interventional radiologists use imaging
  equipments such as X-rays, ultrasound, CT and MRI
  to guide small instruments such as catheters or
  wires through the blood vessels or other pathways
  to treat as well as diagnose diseases
  percutaneously.

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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

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What Procedures do Interventional Radiologist
Perform?

• Balloon angioplasty
• Biliary drainage and stenting
• Chemoembolization
• Embolization
• Radiofrequency ablation (RFA)
• Stenting
• Stent-graft
• Thrombolysis
• TIPS (transjugular intrahepatic
  portosystemic shunt)
• Cryotherapy
• Blood clot filters

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CHEMOEMBOLIZATION

• Used mostly to treat primary liver cancers and
  metastases of the liver. In about two-third of
  cases the tumors are stopped or shrunk.
• Using this unique principle
• The liver receives about 85 of its blood supply
  through the portal vein and only 15 through the
  hepatic artery.
• But the tumor receives almost all of its supply
  from the hepatic artery.

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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.

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Superselective Chemoembolization of a Sole Liver
Metastasis
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Chemoembolization of LiverMetastases of Gastric
Cancer
1. before TCE 2. regression
after 6 months 3. stabilized after 9 months
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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
  with reduced menstrual bleeding, pelvic pain and
  other complaints as an alternative to the
  surgical removal of the uterus.
• Effective treatment of tumors that either cannot
  be removed surgically or would involve great risk
  of surgery.

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How Does Embolization Work?

• Delivery of clotting agents directly to a
  bleeding or problematic area.
• Temporary embolic agents such as Gelfoam (a
  gelatin sponge material) block vessels for enough
  time (days to weeks) for the body to heal the
  problem causing the bleeding, f.e. injury or
  gastric ulcer.
• Permanent embolic agents such as Polyvinyl
  alcohol (PVA) occlude vessels parmanently, f.e.
  are used to embolize uterine fibroid tumors.

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Bleeding from a Stomach Ulcer
Selective
arteriography Stopped after
of left gastric artery
Gelfoam embolization
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Bleeding from Jejunum
Arteriography of superior Stopped after
superselective mesenteric artery
metal coils embolization
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Uterine Fibroid Embolization
Angiography of right uterine artery and
embolization
MRI of uterine fibroid visible before and
invisible 6 months after embolization
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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.
• Less invasive, less blood loss, effective and
  safe alternative especially for patients with
  great risk of surgery.

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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.

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Various Aortic Stentgrafts
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Aortic Stentgrafts
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Subrenal Abdominal Aortic Aneurysm
Angiography before and after implantation of
stentgraft
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Implantation of Bifurcated Aortic Stentgraft
Aortography before CT after 6 months
CT after one year
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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.