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Procedures
These involve obtaining samples from lesions or tumours which are in deep to reach lesions for histopathological diagnosis. Nearly all these procedures are day care procedures not requiring admission performed under Ultrasonography Or CT imaging guidance under local anaesthesia with the patient going home in a few hours. This allows sampling of many lesions thus avoiding open surgical sampling.
The procedures involve either aspiration or drainage of pus or fluid in organs within the body like Liver abscess or the peritoneal or pleural cavity. This is of great importance where a surgery may be un-necessary especially in patients with sepsis or conditions like acute pancreatitis.
Interventional breast procedures are nearly painless. Many women are apprehensive regarding the pain from sampling a suspicious breast lesion. Usg guided breast biopsies are performed with high priority to patient comfort, these are outpatient procedures with the patient ready to leave the hospital within an hour. Other breast intervention procedures like drainage of breast abscess, preoperative hookwire localisation or pretreatment marker clip placements are performed routinely.
Low flow vascular and lymphatic malformations of certain varieties are treated by direct vascular injection of sclerosants under imaging guidance. These procedures over time cause significant shrinkage of these lesions and cosmetic correction is obtained without the need for surgery which could be dangerous due to the risk of haemorrhage.
These are complex endovascular procedures performed in the cathlab for arresting the bleeding from arteries within the body in the setting of trauma, inflammations, post partum, post surgery, tumoral bleeding etc. These are life saving procedures which involve achieving acces to the bleeding vessel through catheters from a small puncture in the groin or wrist artery and embolising or closing these arteries with a wide range of embolic material like coils, gelfoam or particles to arrest the bleeding .
Percutaneous Biliary drainage with a catheter or sometimes accompanied with biliary stenting is performed to relieve obstructive jaundice by ensuring passage of bile in cases of obstruction to flow of bile due to tumours. In addition PTBD is sometimes performed to dilate strictures or narrowing in the bile ducts.
These procedures involve chemical, radiofrequency (RFA) or microwave ablation of tumours in the liver, kidneys and certain tumours in the bone. These are performed for tumours of a certain size and number and recent medical literature upholds this treatment as an alternative to invasive surgery. These procedures are done through pinhole incisions under image guidance and thus avoids the morbidity and long recovery periods associated with invasive surgery.
Interventional radiologists plays a seminal role in the treatment of hepatocellular carcinoma. Other than chemical and radiofrequency or microwave ablation of early localised HCC, Transarterial chemoembolization by endovascular route is performed in certain varieties to achieve a high local dose of chemotherapeutic drug without much systemic side effects, this is followed usually by occlusion of the feeding arteries of the tumour to induce tumour death or necrosis.
Transjugular liver biopsy is performed in patients with deranged blood clotting in whom a percutaneous liver biopsy cannot be performed. It is performed by puncturing a vein in the neck region and reaching liver by specialised hardware by endovascular route. Hepatic vein wedge pressure can also be measured by this technique when required.
A wide variety of vascular narrowings and occlusions are treated by interventional radiologists. These include peripheral arterial narrowings which lead to limb pain/claudication, narrowings in visceral arteries like mesenteric arteries. Vnous occlusions of the periphery or central veins which lead to limb swelling or main venous channels of the body like inferior vena cava etc are dilated and sometimes reinforced by a metallic construct called a stent.
These procedures involve placemet of central venous lines, peripherally inserted central lines(PICC) lines, hickmann line, Permacath insertions in patients on chronic dialysis etc.
Interventional radiologists also perform sampling from veins within the body which are used in the diagnosis of complex endocrinological conditions like inferior petrosal vein sampling, adrenal vein sampling and renal vein renin sampling to name a few.
This procedure has revolutionised the treatment of uterine fibroids which is a common gynaecological condition. The conventional treatment offered by gynaecologists involve hysterectomy or myomectomy, however this embolization technique helps the patient retain her uterus. It is an endovascular procedure requiring a very short(24-48hr) stay in the hospital where the feeding arteries of the fibroid are closed by embolic material. These fibroids later shrink over time. In addition uterine artery embolization is performed in the treatment of life threatening post delivery haemorrhage or other causes of uterine bleeding like arteriovenous malformations, retained vscularised products of conception to name a few.
These are complex stenting procedures in the treatment of portal hypertension and its attendant complications like variceal bleeding or refractory ascites. They are advanced procedures involving opening of closed veins within the liver or creation of bypass routes by using minimally invasive techniques.
This is a procedure used to treat large gastric venous dilatations in patients with chronic liver disease which are poorly controlled by endoscopic techniques. It is a complex procedure and often performed on an emergency basis to control bleeding from these gastric venous dilatations.It is an extremely effective procedure for the management of gastric variceal venous dilatations which are otherwise difficult to manage.
Arteriovenous malformations and arteriovenous fistulas may be congenital or acquired conditions with abnormal shunting of blood often leading to large swellings in various regions of the body or affecting organs within the body causing severe symptoms at times like internal bleeding, cardiac failure etc. These are managed by endovascular techniques. Interventional radiologists study the vascular anatomy and hemodynamics of these lesions and use vascular closure embolization techniques to effective manage these complex conditions.
This is used in the treatment of splenic enlargements of various causes or variceal hemorrhages where due to hyperfunctioning of the spleen patient has to face various symptoms like decreased platelet count. Many of these patients are not operated by surgeons for fear of bleeding. Interventional radiology techniques can be used to effectively cut off blood supply from a large area of spleen making it functionally redundant and leads to significant relief in the symptoms of these patients.
Endovascular techniques or direct puncture techniques are used to reduce the blood supply of certain tumours to reduce or eliminate intraoperative blood loss during the resection of highly vascular tumours. These are commonly done for hypervascular tumours of the head and neck like juvenile nasopharyngeal angiofibroma, glomus tumours, vertebral body hemangiomas and renal tumours like angiomyolipoma and renal cell carcinoma.
Endovascular techniques or direct puncture techniques are used to reduce the blood supply of certain tumours to reduce or eliminate intraoperative blood loss during the resection of highly vascular tumours. These are commonly done for hypervascular tumours of the head and neck like juvenile nasopharyngeal angiofibroma, glomus tumours, vertebral body hemangiomas and renal tumours like angiomyolipoma and renal cell carcinoma.
The treatment of acute stroke has seen a revolution with the advent of mechanical thrombectomy. For acute stroke where a portion of brain loses its blood supply due to a clot obstructing blood flow, every minute of delay leads to irreversible brain death. If the patient presents within the window period for treatment some of these clots can be removed by advanced endovascular techniques using stentretrievers and aspiration to restore blood supply to the brain. This mitigates further brain damage and many times complete reversal of the paralysis or neurological deficit is seen.
Brain aneurysms are dilatations in vessels within the head which sometime rupture to lead to life threatening haemorrhage. Historically these aneurysms couls only be handled by clipping performed by neurosurgeons. These surgeries are highly complex with opening of the skull and long hospital stays. With the advent of interventional neuroradiology techniques a large majority of these lesions can be treated by endovascular coiling of the aneurysmal sac done through a small puncture in the leg, thus facilitating a quick recovery.
For patients with significant narrowing in the arteries supplying the brain or kidneys , a stent is placed by endovascular technique to relieve the narrowing of the blood vessel and thus facilitate better blood flow to . This is also done through a pin hole and avoids the morbidity associated with procedures like carotis endarterectomy.
These are complex vascular malformations involving the brain and spinal cord causing life threatening haemorrhage, seizure disorders and paralysis at times. Historically they were very difficult to treat with limited surgical options with grave risks. Using interventional neuroradiology techniques many of these vascular malformations can be accesed and closed by using advanced small microcatheters and liquid embolic agents. These can be a single stage or multistage procedures or may be performed prior to surgery to reduce intraoperative bleeding.
This is a condition where a patient has dilated ugly lookin veins in the leg with additional symptoms like pain and swelling on prolonged standing. These can be managed by laser ablation of these veins thus avoiding surgeries.
This technique involves reinforcing collapsed bony vertebrae in the spinal column by bone cement. They effectively relieve the pain associated with these fractured collapsed vertebrae and give significant relief to these patients who suffer from restricted mobility due to the presence of pain.
In certain patients with advanced malignancies to provide palliative pain relief nerve plexuses can be blocked by image guided injections. Celiac ganglion block, superior hypogastric block, internal pudendal nerve block to name a few.
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