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Interventional Radiology What is interventional radiology? Who are interventional radiologists? What kind of procedures do interventional radiologists do? What is angiography? What is angioplasty? What are stents? What are stent grafts? What is thrombolysis? What is embolization? What is vertebroplasty? What is radiofrequency ablation? What are the types of problems and treatments interventional radiology deals with? What are other procedures in which interventional techniques are used? What about the radiation hazards involved in interventional radiology? How should I think about interventional radiology versus surgery? For additional information What is interventional radiology? Interventional radiology is a specialty of medicine whose physicians use x-rays and other imaging systems to assist in minimally invasive medical procedures performed without a need for conventional, open-incision surgery. Interventional radiologists use balloon-tipped catheters to open narrowed sections of arteries from within the artery itself, blood-thinning drugs delivered directly at the site of a clot within a blood vessel to dissolve the clot, medical cement injected through straw-sized hollow needles to stabilize fractured vertebrae, and a host of other procedures that previously would have required surgery — or wouldn't have been possible at all. Often, a procedure such as angioplasty can replace a major surgical procedure such as vascular reconstruction, in which a section of vein would be used to by-pass a blockage. When an interventional procedure can be used rather than surgery, the incision required is the size of a pencil point rather than six or more inches, the risk to the patient is much reduced, the hospitalization required is measured in days rather than weeks and the recovery time is similarly reduced. And, the costs involved are substantially lower. The interventional radiologists of Hartford Specialists have significant expertise in the range of interventional radiology skills, and have been leaders in the development and refinement of many techniques. However, not all cases are appropriate for an interventional radiology approach, and Hartford Specialists' staff works closely with members of the vascular surgery service to ensure that the care provided to each patient is best suited for his or her needs. (return to top) Who are interventional radiologists? Interventional radiologists are physicians who have trained and worked in diagnostic radiology, the specialty of using x-ray, ultrasound and magnetic resonance imaging to visualize and diagnose medical issues within the body. In addition to being trained and certified as diagnostic radiologists, interventional radiologists have completed extensive additional training in interventional techniques. They are then eligible for testing and subspecialty certification in vascular and interventional radiology by the American Board of Radiology. Today, there are more than 4,000 physicians providing interventional radiology services throughout the United States — a small number compared to the nearly 32,000 physicians in the field of radiology generally in the United States. (return to top) What kind of procedures do interventional radiologists do? Whether the issue is a blockage presenting a risk of stroke or a blood clot blocking a vein in the lower leg, there is an interventional radiology application available. Many interventional radiology treatments are carried out using flexible catheters the thickness of a strand of spaghetti that can be threaded through blood vessels to deliver a medical dye for imaging purposes (angiography), an inflatable balloon to open up a narrowed or blocked artery (angioplasty), a dose of clot-dissolving drug (thrombolysis), or for other porblems. Procedures done within blood vessels are called endovascular. Others may use a needle to extract tissue samples or fluids. All rely on imaging guidance and extensive clinical skill. (return to top) What is angiography? Angiography is a term for diagnostic imaging procedures to diagnose and define problems within blood arteries and veins throughout the body. Angiography is the use of catheters inserted into the blood vessels, medical dyes that outline obstructions within the vessels, and x-rays that display those images. Angiography is considered the most accurate means of defining the nature and extent of a vascular problem to determine whether it's best treated by angioplasty or surgery, and how. Areas imaged through angiography include the carotid artery in the neck, the renal arteries serving the kidneys, the aorta in the abdomen, the blood vessels in the legs and the coronary arteries supplying the heart (Although developed by interventional radiologists, coronary angiography is usually performed by cardiologists specially trained in interventional techniques). For more information on angiography, click here. (return to top) What is angioplasty? Angioplasty is a procedure to open up narrowed or blocked arteries from within the arteries themselves through the use of a catheter tipped with a tiny balloon. An angioplasty resembles an angiography test to the point at which the interventional radiologist inflates a tiny, high-tech balloon on the catheter's tip to widen the channel by pushing its walls outward. Often, in conjunction with angioplasty, the doctor will place a stent, a tiny tube-shaped metal scaffolding, at the site within the artery to prevent restenosis, or re-closure. (return to top) What are stents? Stents are cylinder-shaped, mesh-like metal scaffolding devices that an interventional radiologist can place within a channel to keep it open. Often, after performing an angioplasty procedure within an artery, the doctor will place a tiny stent at the newly widened site to keep the arterial wall from collapsing and to prevent restenosis. For more information on stents used with angioplasty, click here. (return to top) What are stent grafts? stent grafts are often larger stents, usually coated with plastic or "fabric" material, used to maintain an artery's integrity and structure. stent grafts are most often used to repair aortas (the body's main artery, located just below the heart) that are subject to aneurysms (weakened tissue in the wall of an artery that swells outward as blood pools in it and poses a risk of bursting and causing uncontrolled bleeding). As a "patch" over an aneurysm, placement of a stent-graft essentially cuts off the aneurysm and eliminates the risk of blood pooling and bursting. (return to top) What is thrombolysis? Thrombolysis is a technique in which a dose of TPA, urokinase or other "clot-busting" drug is delivered through a catheter to the site of a clot within a blood vessel to dissolve the obstructing clot and restore the flow of blood. Obstruction of blood flow to the brain can cause a stroke, to the heart can cause a heart attack or in the legs can cause damage to tissue there, possibly leading to the loss of the leg. (return to top) What is embolization? Embolization is a procedure using a catheter to place clotting agents — such as tiny plastic beads, foam particles, coils or glues — directly at a site of existing or possible blood flow. This can be to stop abnormal bleeding as might occur from a fibroid tumor in the uterus, to cut off the flow of blood to abnormal tissue such as a tumor, or to eliminate the danger of an aneurysm that may burst and cause bleeding. (return to top) What is vertebroplasty? Vertebroplasty is a procedure in which an interventional radiologist can stabilize and strengthen a fractured vertebra — one of the bones that comprise the spine — by injecting medical cement into the fragmented pieces. Heating up of the cement as it is injected also serves the purpose of cauterizing inflamed nerve endings and reducing or eliminating pain. For more information about vertebroplasty, click here. (return to top) What is radiofrequency ablation? Radiofrequency ablation is a treatment technique in which a thin needle is inserted into a tumor so that radiofrequency can be used to heat up the cancerous tissue and destroy it. (return to top) What are the types of problems and treatments interventional radiology deals with? Interventional radiologists are concerned with medical problems almost literally from head to toe. Whether the issue is an arterial blockage presenting risk of stroke or a blood clot blocking a vein in the lower leg, there is an interventional radiology application available. Abscess Drainage. Through the use of a guide wire inserted through the skin and underlying tissue into an abscess, an interventional radiologist can use a hollow needle or catheter to drain fluid from an abscess within the body, avoiding the need for surgical intervention. Aortic Aneurysms. Aneurysms in the aorta are weakened tissue in the wall of the body's main artery that swell outward as blood pools in them and pose a risk of bursting and causing uncontrolled bleeding. stent grafts coated with plastic or "fabric" material are used to maintain the aorta's integrity and structure — in effect "patching" over an aneurysm to cut it off and eliminate the risk of blood pooling and bursting. Carotid Artery Disease. When the carotid artery, the blood vessel that runs up the side of the neck to provide blood to the brain, is narrowed or blocked by plaque, a surgical procedure called endarterectomy is often performed to resolve the problem. However, angioplasty and stenting are increasingly being used as nonsurgical alternatives, especially for patients who are not suitable for surgery. Biliary Drainage and Stenting. When ducts leading from the liver are blocked, interventional radiologists can use small stents to open them and enable the drainage of bile to resume. Cancer Treatment. Interventional radiologists can use thin needles inserted into suspicious tissue in the breast and many other locations to obtain tissue samples for analysis — needle biopsy. Embolization, the strategic placement of clotting agents such as gels or tiny plastic beads, can be used to cut off the supply of blood to cancerous tissue, thus killing or shrinking it. Chemoembolization involves the delivery of anti-cancer drugs directly to the site of cancerous tissue. Radiofrequency ablation can be used to destroy tumor masses with heat. Claudication. Claudication is pain that occurs in the legs due to blood clots or stenosis — the build-up of plaque that narrows or blocks a blood vessel. Stenosis affecting the arteries serving the legs often can be treated with angioplasty, especially if it occurs in the iliac artery near the pelvis. If a blood clot has occurred in a vein in the legs — called deep vein thrombosis — thrombolysis, dissolving the clot with clot-busting drugs, can be used. Fallopian Tube Catheterization. When a woman's fallopian tubes have become blocked, thus preventing the passage of eggs, interventional radiologists can use catheters to open fallopian tubes without a need for surgery. Hemodialysis Grafts. Angioplasty can be used to maintain blood vessel grafts connecting arteries and veins in the arms of renal dialysis patients, who need such connections so that blood can be removed, filtered and replaced during dialysis. Otherwise, they are at risk of closing up periodically. Liver Failure. In patients with severe liver disease, an interventional radiology procedure called transjugular intrahepatic portosystemic shunt (TIPS) can be performed to make a connection between two veins, improving blood flow and preventing hemorrhage. Renal Artery Disease. When the arteries leading to one or both kidneys become narrowed or blocked by the build-up of plaque, the results can be renal hypertension and the shutting down of the kidney. Angioplasty can be used to reopen the artery, often restoring kidney function and resolving the hypertension. Uterine Fibroid Embolization. Uterine fibroid embolization involves the placement of sand-sized plastic beads in the arteries supplying blood to benign tumors in the uterus called fibroids, eliminating bleeding and causing the fibroids to shrink. For many women, the procedure can replace hysterectomy and other surgery as a treatment for fibroids. (return to top) What are other procedures in which interventional techniques are used? Interventional radiology techniques are also used by specially trained cardiologists to define and treat disease of the coronary arteries and by subspecialists called interventional neuroradiologists to treat aneurysms, clots and malformations of arteries and veins within the brain. Coronary Angioplasty Although coronary angioplasty was developed by interventional radiologists, it is performed by cardiologists specially trained in x-ray-guided interventional techniques. It is intended to be an alternative to coronary bypass surgery to resolve lack of blood supply to the heart. Interventional Neuroradiology Subspecialists of interventional radiology, interventional neuroradiologists in the United States number less than 200, as compared to interventional radiology's 4,000 practitioners. Interventional neuroradiology involves threading a catheter into the arteries within the brain to treat brain aneurysms and malformations with placement of coils or other clotting material at the site of the aneurysm to eliminate bleeding (or the risk of bleeding). Clots blocking arteries in the brain are treated with thrombolysis — the application of clot-dissolving agents delivered directly to the site of the obstruction. (return to top) What about the radiation hazards involved in interventional radiology? Minimizing an individual's exposure to radiation is always a goal in any medical endeavor, and fortunately the equipment used today is designed to work with the lowest amount of radiation possible. In addition, when necessary, shielding through strategically placed lead aprons is used. (return to top) How should I think about interventional radiology versus surgery? Interventional radiology is a dynamic new field of medicine that offers many capabilities as an alternative to surgical intervention. The advantages of interventional radiology include much smaller incisions, less risk to the patient, much shorter hospitalization and recovery time and lower costs than with surgery. Not all cases are appropriate for an interventional radiology approach, and Hartford Specialists' staff works closely with members of the vascular surgery service to ensure that the care provided to each patient is best suited for his or her needs. Techniques of treatment are always being improved in both interventional radiology and vascular surgery. The interventional radiologists of Hartford Specialists have significant expertise in the range of interventional radiology skills, and have been leaders in the development and refinement of many techniques. (return to top) For additional information You can find additional information about interventional radiology at web sites sponsored by government agencies, societies and healthcare institutions. It should perhaps be noted that the World Wide Web is open to many sources posting questionable information and promises, and you are encouraged to seek information from established, reputable organizations. A likely source includes: The Society of Interventional Radiology www.sirweb.com

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