09
AUG
2016

Welcome to the IR Revolution

by Christopher Zinsmeister, MS2, Wake Forest University School of Medicine

Interventional Radiology, deemed its own primary specialty in 2012 by the American Board of Medical Specialties, is a burgeoning field that offers treatment for an increasing number of diseases. The arsenal of procedures in the IR armamentarium enables IR physicians to operate on virtually every organ system in the body. IR procedures offer several advantages: they are minimally invasive, technology-driven, innovative, and adaptable. These traits bode well for the future of IR. No longer itself a “sub-specialty,” IR may now solidify its role in other domains of medicine, perhaps establishing its own sub-specialties.

For example, interventional oncology is a developing field within interventional radiology. The multidisciplinary cancer team has welcomed IR, which offers novel, targeted, and minimally invasive techniques to treat a variety of cancers of the bone, liver, breast, kidney, and lungs. Poor surgical candidates and patients who have reached their radiation limits benefit from the array of procedures employed by IR physicians. These procedures include and are not limited to radio- and chemo-embolization, cryoablation, and radiofrequency ablation. Magnetic chemotherapy and gene therapy are two additional IR techniques which are on the vanguard of cancer therapy.

Women’s health and infertility are additional areas where IR offers therapeutic intervention. Presently, conditions such as pelvic congestion syndrome, uterine fibroids, and varicose veins can all be treated by non-surgical techniques performed by IR physicians. IR also offers non-surgical procedures to treat infertility in both men and women. For example, mechanical blockade of the fallopian tube, the most common cause of infertility in women, can be successfully treated by IR physicians without making a single incision.  For males, varicoceles of the testes can be corrected with embolization in lieu of surgical ligation.

IR can also address chronic pain conditions, particularly persistent spinal pain. For example, pain related to vertebral compression fractures that is refractory to pharmacological intervention can be treated by a procedure known as vertebroplasty. In this procedure, imaging guides an injection of bone cement to stabilize the diseased vertebrae. IR has also broadened the scope of treatment for compression fractures. Advancing the traditional treatment of vertebroplasty, IR physicians perform radiofrequency ablation of pathologic fractures prior to cement augmentation to immediately relieve pain, while complementing future radiation therapy treatments.

The expanding profile of IR procedures offers many opportunities to improve the status quo of treatment for a multitude of diseases. In the realm of neuro-interventional radiology, coil embolization has established itself as an effective, low-risk treatment for intracranial aneurysms1. Promising clinical trial data suggest that IR techniques such as yttrium-90 radioembolization can augment traditional chemotherapy regimens2. In other cases, IR techniques are considered superior. For example, transjugular intrahepatic portosystemic shunting (TIPS) is more effective in preventing re-bleeding in the management of esophageal variceal hemorrhages than endoscopy and pharmacological treatment3.

The field of IR – although historically rooted in treating vascular disease – is already beginning to apply its minimally invasive, targeted approach to combat and treat a host of other diseases and ailments. With continued improvements in medical imaging and technology, the role of IR in other fields of medicine – such as the aforementioned – will continue to grow. IR is ripe to further sub-specialize into more concentrated areas of focus such as vascular IR, neuro-IR, interventional oncology, Women’s health and fertility, and so on.

References:

  1. Miri, M. et al. Coil Embolization of Intracranial Aneurysms: A Six-Month Follow-Up Study. Iran J Radiol 12, e10986 (2015).
  1. Van Hazel, G. A. et al. SIRFLOX: Randomized Phase III Trial Comparing First-Line mFOLFOX6 (Plus or Minus Bevacizumab) Versus mFOLFOX6 (Plus or Minus Bevacizumab) Plus Selective Internal Radiation Therapy in Patients With Metastatic Colorectal Cancer. Clin. Oncol. 34, 1723–1731 (2016).
  1. Halabi, S. A. et al. Early TIPS Versus Endoscopic Therapy for Secondary Prophylaxis After Management of Acute Esophageal Variceal Bleeding in Cirrhotic Patients: A Meta-Analysis of Randomized Controlled Trials. Gastroenterol. Hepatol. (2016). doi:10.1111/jgh.13303
  1. Glossary of Nonsurgical Interventional Techniques – SIR. Available at: http://www.sirweb.org/patients/minimally-invasive-treatments/. (Accessed: 3rd August 2016)

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