Interventional Radiology, a subspecialty developed from Diagnostic Radiology, made relentless progress in last few decades. Today its impact can be felt in every field when patients need to be treated minimally or less invasively. Even Interventional Radiology having subspecialties or superspecialities under its belt like neuro, GI, vascular etc. Today IR can help in almost every aspect from diagnosis to treatment, from palliation to cure.
In following paragraphs, I am Trying to give a brief overview what all possible today and the major indications which can come handy during daily practice, some alternative approaches and in some life saving situations where an Interventional Radiologist can be engaged for a better outcome although awareness about these procedures are very low.
AMRI hospitals giving special emphasis on this subject, trying to make these facilities available across all of its group hospital with introduction of new team of dedicated Interventional Radiologists, nearly coving entire gamut of procedures available for the benefit of patients coming to them, round the clock and probably only hospital in Eastern India where everything will be available be it Neuro., GI, Onco., other vascular or non-vascular interventions.
AMRI Mukundapur stands out for its advanced Stroke Management facilities 24 X 7 backed by experienced and most updated stroke neurologist, Neuro surgeons and rehabilitation team. Most advanced treat, ent procedures like IV thrombolysis and thrombectomy are about start with the opening up of cath lab here. A major focus will be on stroke prevention as well where after evaluation appropriate steps will be advised to high risk groups.
A wide range of advanced diagnostic angiography services are now can be performed by properly trained IR’s like cerebral, spinal , mesenteric, pulmonary, visceral or peripheral angiography without major complications. Venous system evaluation and treatment almost completely under purview of IR only.
Cases of bleeding from different organs are frequently referred complications and at times require life saving treatment, specially if it is of arterial origin like hemoptysis, GI bleeds, retroperitoneal bleeds, massive epistaxis, traumatic massive uncontrollable haemorrhages, uterine bleeding like post- partalhaemorrhage, hematuria, iatrogenic to name a few. A well equipped cathlab and well trained IR needs to be called upon in any such emergencies to stop the bleeding by embolisation procedures. Similarly embolisation for vascular malformations likeArterio- venous malformations of any organ system like cerebral, pulmonary, visceral, spinal or gastrointestinal tract can be treated efficiently with great outcome.
Similarly partial splenic artery embolisation for hypersplenism, embolisation to treat priapism in extreme cases, embolisation for varicocoeles, percutaneous embolisation for superficial vascular malformations including sclerotherapy can also be done.
Interventional Radiology is highly effective in large number of cases where regular ERCP cannot be carried out like cases of obstructive jaundice where ERCP procedure failed, in patients having Cholangitis or where ERCP is not possible like post operative patients.
IR usually under USG guidance, puncture one of the suitable biliary radicle transhepatically and then either place a catheter to drain the bile outside (PTBD) or if possible place a stent across the stricture for internal drainage (Preferred). This procedure not available in all centers and we get referral from many major hospitals across the city. Even treatment of benign strictures and biliary clearing procedures can be done by extension of PTBD.
Similarly PCN and antegrade ureteric stenting are also possible when other measures fail.
Carcinoma in Liver which are not operable require interventional procedures either for complete treatment or palliation. TransarterialChemoembolisation(TACE) is a well established therapy for HCC, colonic metastasis and neuroendocrine tumours. At times chemoinfusion required can be done. Portal vein embolization in suitable patients is also offered after volumetric evaluation. TARE (radioembolisation) is a promising technique came up recently.TACE we are offering in both conventional as well as with drug eluting beads.
This procedure is requiredfor fibroid disease of uterus and post partum haemorrhage which is done under local anesthesia where a catheter selectively inserted into uterine artery and blocked using PVA particles. This helps avoiding not only hysterectomy but also its immediate and delayed complications like ureteric ligation, VVF, urinary incontinence, adhesion, intestinal obstruction, hernia etc. In this procedure recovery period is shorter and in some patients future pregnancies also reported. UAE progressed phenomenally since its inception due to its inherent advantages.
We are also going to start a counterpart in males of prostatic artery embolisation for benign prostatic hyperplasia or BPH.
It is also a very useful procedure in patients with osteoporotic fractures and in some patients with metastasis. It can be combined with biopsy and RF ablation if required. Similarly, Cementoplasty can be done for other long and flat bones as well mainly for pain management.
RFA of solid tumors of different organs is now a most advanced and established method of treatment with durable long term results of tumor size 3-5cm specially of liver, kidney, pancreas, lung etc.. OsteoidOsteoma of bone no longer requires any surgery and CT guided RFA is the treatment for it.
This procedure is an outstanding edge over LASER treatment with proven lesser recurrences along with sutureless surgery for stripping and sclerotherapy as complete treatment in a single sitting for symptomatic patients.
One of the most neglected group of disorders in our part of country which if treated effectively and timely can save large no. of limbs specially in diabetics and patients of chronic kidney disease. We now have very good non-invasive way of evaluating them and then can decide treatment depending upon them. With latest hardwares available we can go for peripheral arterial stenting and opening of chronic occlusions. Thrombolysis for both arterial and venous system now possible with if require retrievable IVC filter placement.
For longtermdialysis access placement of PERM catheters is offered with fistuloplastyfor A-V fistula. Similarly Chronic Total Occlusion of central venous system & SVC obstruction can be opened up by angioplasty and stenting.IVC and hepatic vein stenting for Budd- Chiarri syndrome can also be done.
A range of highly effective procedures has been recently introduced for PAIN MANAGEMENT of CT guided blocks like EPIDURAL injections, FACET blocks and foraminal blocks.
FNAC’s, biopsies and catheter drainages are certainly in the purview of IR. Collections anywhere in body if accessible will be drained, if required with large bore catheters. This certainly had changed the management of pancreatic collections and now in many cases we can avoid high risk surgeries in acute settings.
TIPS and AAA repair are mostly done by well trained IR only and we are going to offer them to our patients as well.
In Short, An entire range of Interventional procedures are now available and are getting done in AMRI. We would encourage personal as well as group discussion and would like to get involved in patients management whenever required. It may be better if anybody gives us a call to discuss in any situation where we might give another option to manage the patient over the established conventional methods.