MEDICAL ADVANCES ARE COMING IN LEAPS AND BOUNDS, MAKING MANY HIGHLY INVASIVE PROCEDURES A THING OF THE PAST. TODAY, LASER AND DIGITAL IMAGING PROVIDE DOCTORS WITH ADVANCED MEDICAL PROCEDURES THAT ARE BOTH EFFECTIVE AND MINIMALLY INVASIVE. IN THIS ARTICLE WE EXPLORE, WITH MEDICAL JARGON INCLUDED, SOME OF THE MOST COMMON VASCULAR AND INTERVENTIONAL RADIOLOGY PROCEDURES.
By Moises Roizental MD.
Vascular and interventional radiology is a medical specialty that uses image-guided, minimally invasive diagnostic and treatment techniques that are often an alternative to surgery. Interventional radiologists are highly trained in imaging, performing medical procedures and patient management. The interventional radiologist treats a variety of disease processes, including treatments for peripheral vascular disease with angioplasty and stenting, aortic stent grafts for aneurysm repair, uterine fibroid embolization, chemoembolization, radiofrequency ablation, percutaneous biopsy, temporary and permanent vascular access for dialysis and chemotherapy, percutaneous drainage procedures, vertebroplasty, kyphoplasty, and much more using small catheters or other devices and tools guided by x-ray imaging. Procedures performed by interventional radiologists are generally less costly and are less traumatic to the patient, involve smaller incisions, less pain, minimal to moderate sedation, less risk, and shorter hospital stays. In fact, many procedures may be performed in an outpatient or office setting. The following are explanations of just a few of the most common procedures performed.
Peripheral Vascular Disease
Peripheral vascular diseases (PVD) are referred to as diseases affecting the blood vessels (arteries and veins) other than the heart and the brain. Left untreated, these diseases will progress and may lead to limb or organ loss, or death. Interventional endovascular treatment, when indicated, has become the first line of management in the treatment of PVD because it is less risky than open surgery. As examples, interventions may be aimed at either revascularization to open a blocked vessel, or deliberate occlusion of diseased vessels for treatment of cancer or abnormal bleeding.
Blood travels through veins in the leg leading to the heart. Valves in the veins prevent blood from flowing backwards by gravity, which prevent dilation of the veins (varices/varicose veins/spider veins). When the valves do not work properly the blood does not circulate well and veins dilate progressively. Over time, they become visible and palpable, leading to cosmetic consequences such as changes in skin color, as well as medical issues including swelling, pain, inflammation, infection and ulcers. Endovascular laser, a minimally invasive procedure performed through a small puncture in the vein, may be performed in the office with outstanding results. Almost 50% of woman will suffer symptoms from varicose veins, easily treated with endovenous laser. Symptoms improve quickly and many patients state they see and feel relief in a matter of days. Spider veins are treated with laser and sclerotherapy.
Uterine Fibroid Embolization
Uterine fibroids are very common non-cancerous growths that develop in the muscular wall of the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding. Uterine fibroid embolization (UFE) is a procedure performed through a small puncture in the artery in the groin to block blood flow to fibroids in the uterus. For women who are not planning a pregnancy in the future, UFE is a possible option in place of surgery for fibroids.
Vertebroplasty / Kyphoplasty
Vertebroplasty and kyphoplasty are minimally invasive procedures for the treatment of painful vertebral compression fractures in the spine, often caused by osteoporosis. Osteoporosis is a disease that results in loss of normal bone density, mass and strength, leading to a condition in which bones are increasingly porous, and vulnerable to breaking. Vertebrae may also become weakened by cancer.
During vertebroplasty, the interventional radiologist uses x-ray guidance to inject a cement mixture into the fractured bone through a needle. In kyphoplasty, a balloon is first inserted into the fractured bone through the needle to create a cavity. The balloon is then removed and cement is injected into the cavity. Patients often feel immediate relief after the procedure and no longer need narcotics, pain medicine or corsets.