Interventional Radiologists

Interventional RadiologistsWhere will they go next?
Dr Simon Travis
Vascular/Interventional Radiologist
Nottingham University Hospitals
What is an Interventional Radiologist?
Global Statement Defining Interventional Radiology
J Vasc Interv Radiol 2010; 21:1147–1149
Expertise in diagnostic imaging and radiation safety.
Expertise in image-guided minimally invasive procedures
and techniques as applied to multiple diseases and organs.
Expertise in the evaluation and management of patients
suitable for the image-guided interventions included in the scope
of IR practice.
Continual invention and innovation of new techniques,
devices, and procedures.
1964 Angioplasty
1966 Embolization therapy to treat tumors and spinal cord vascular malformations by blocking the blood flow
1967 The Judkins technique of coronary angiography, the technique still most widely used around the
world today
1967 Closure of the patent ductus arteriosis, a heart defect in newborns of a vascular opening between the pulmonary
artery and the aorta
1967 Selective vasoconstriction infusions for hemorrhage, now commonly used for bleeding ulcers, GI bleeding and arterial
1969 The catheter-delivered stenting technique and prototype stent
1960-74 Tools for interventions such as heparinized guidewires, contrast injector, disposable catheter needles and seethrough film changer
1970’s Percutaneous removal of common bile duct stones
1970’s Occlusive coils
1972 Selective arterial embolization for GI bleeding, which was adapted to treat massive bleeding in other
arteries in the body and to block blood supply to tumors
1973 Embolization for pelvic trauma
1974 Selective arterial thrombolysis for arterial occlusions, now used to treat blood clots, stroke, DVT, etc.
1974 Transhepatic embolization for variceal bleeding
1977-78 Embolization technique for pulmonary arteriovenous malformations and varicoceles
1977-83 Bland- and chemo-embolization for treatment of hepatocellular cancer and disseminated liver
1980 Cryoablation to freeze liver tumors
1980 Development of special tools and devices for biliary manipulation
1980’s Biliary stents to allow bile to flow from the liver saving patients from biliary bypass surgery
1981 Embolization technique for spleen trauma
1982 TIPS (transjugular intrahepatic portosystemic shunt) to improve blood flow in damaged livers from
conditions such as cirrhosis and hepatitis C
1982 Dilators for interventional urology, percutaneous removal of kidney stones
1983 The balloon-expandable stent (peripheral) used today
1985 Self-expanding stents
1990 Percutaneous extraction of gallbladder stones
1990 Radiofrequency ablation (RFA) technique for liver tumors
1990’s Treatment of bone and kidney tumors by embolization
1990’s RFA for soft tissue tumors, i.e., bone, breast, kidney, lung and liver cancer
1991 Abdominal aortic stent grafts
1994 The balloon-expandable coronary stent used today
1997 Intra-arterial delivery of tumor-killing viruses and gene therapy vectors to the liver
1999 Percutaneous delivery of pancreatic islet cells to the liver for transplantation to treat
1999 Developed the endovenous laser ablation procedure to treat varicose veins and venous
Why Interventional Radiology
Shorter Hospital Stays
Money Saving
Reduction in Transfusion Requirements
Better QoL for patients
Faster Recovery
High Intensity Localised treatments
What’s Our Role in Chronic Care?
• Treatment of Ischaemic limbs
• Diabetic foot ulcers
• Management of Aneurysms of the Aorta and
Visceral vessels
• Vascular Access Management for Renal
Replacement Therapy
• Varicose Vein Ablation
• Renal Artery Disease
• AVM management
• Vascular Access (ports and lines)
• Image Guided Biopsy
• Tumour Ablation
Focused U/S
• Tumour Embolisation with Chemotherapy
• SVC Stenting for SVCO
• Portal Vein Embolisation Prior to Hepatic Resection
• Percutaneous Bile Duct Management
• Colonic Stenting as a Bridge to Surgery (CREST
• Oesophageal Stenting
• Gastrostomy Insertion
• TIPSS for Ascites Control in Hepatic Cirrhosis
Other Conditions
• Uterine Fibroid Embolisation for Symptom
• Vertebroplasty for Pain Relief
• Tunnelled Pleural and Ascitic Drains
What’s Our Role in Acute Medical
• Control of Haemorrhage
– Uterine Postpartum (Health Commission report on
Northwick Park)
– Acute Aneurysm Rupture
– Acute Aortic Dissection
– Post Traumatic Vascular and Visceral Injury
– GI Haemorrhage
• Acutely Ischaemic Limbs
• DVT and PE management
• Emergency Venous Access in Dialysis Patients
What’s New?
• Renal Artery Denervation for Difficult to
Control Hypertension
• Prostate Embolisation
• Desolving Stents
Renal Artery Denervation
• Transarterial Catheter directed RF Ablation of
Renal Sympathetic Nerves
• Good results from proof of principal cohort
study (45 patients with drug resistant
Prostate Embolisation for BPH
• Injection of micro particles (100-200 micron)
into the prostatic arteries to shrink the organ
• Promising results in animal and human studies
• Day case procedure with the potential for a
return towards normal micturition with out
medication (better QoL and cost saving)
How Will We Affect Health Care in The
• Save Money
– Reduced Bed stays
– Reduced Transfusion Requirements
– More Rapid Patient Recovery
– More Rapid Return to Normal Life/Work
• Improve QoL for Patients
• More Procedures by the month
• Better Cancer Outcomes
Interventional Radiology
• Has been recognised as a distinct subspeciality
by the Royal Colleges
• We now have our own training program
• We have our own syllabus
• 3 years of Radiology Training followed by 3
years of Interventional Training
Train Patients to do Their Own
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