Interventional RadiologistsWhere will they go next?
Dr Simon Travis
MB ChB FRCR
Vascular/Interventional Radiologist
Nottingham University Hospitals
What is an Interventional Radiologist?
Global Statement Defining Interventional Radiology
J Vasc Interv Radiol 2010; 21:1147–1149
1.
Expertise in diagnostic imaging and radiation safety.
2.
Expertise in image-guided minimally invasive procedures
and techniques as applied to multiple diseases and organs.
3.
Expertise in the evaluation and management of patients
suitable for the image-guided interventions included in the scope
of IR practice.
4.
Continual invention and innovation of new techniques,
devices, and procedures.
History
•
1964 Angioplasty
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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
bleeding
•
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
metastases
•
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
diabetes
•
1999 Developed the endovenous laser ablation procedure to treat varicose veins and venous
disease
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?
Vascular
• 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
Oncology
• Vascular Access (ports and lines)
• Image Guided Biopsy
• Tumour Ablation
–
–
–
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RF
Cryo
Microwave
Focused U/S
• Tumour Embolisation with Chemotherapy
• SVC Stenting for SVCO
• Portal Vein Embolisation Prior to Hepatic Resection
Gastrointestinal
• Percutaneous Bile Duct Management
• Colonic Stenting as a Bridge to Surgery (CREST
trial)
• Oesophageal Stenting
• Gastrostomy Insertion
• TIPSS for Ascites Control in Hepatic Cirrhosis
Other Conditions
• Uterine Fibroid Embolisation for Symptom
Relief
• Vertebroplasty for Pain Relief
• Tunnelled Pleural and Ascitic Drains
What’s Our Role in Acute Medical
Care?
• 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
hypertension)
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
Future
• 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
Finally
Train Patients to do Their Own
Procedures?