GGR (GI/GU/Reproductive Service Line)

Background:

As the pioneers of minimally invasive procedures, interventional radiologists have been involved in gastrointestinal and genitourinary interventions for more than 30 years. With the start of biliary manipulation and biliary stents in the early 80’s, interventional radiologists have developed an increasing number of less invasive alternatives to abdominal and pelvic surgeries. By the early 1980’s the transjugular intrahepatic portosystemic shunt technique initially developed by Josef Rosch, MD in 1969 finally became known as an effective means to treat portal venous hypertension and avoid mesocaval shunt surgeries.

The concurrent development of cross sectional and ultrasound imaging in the 1980s and 1990s led to an explosion of the GI and GU interventions. Techniques ranging from percutaneous extraction of gallstones and kidney stones to placement of feeding tubes and ablative treatment of liver and kidney tumors have now become commonplace. Interventional radiologists continue to develop new techniques including Islet cell transplantation to treat diabetes and prostate embolization to treat benign prostatic hypertrophy.

Women’s health is an area of medicine that is underrepresented in traditional radiology training. Our goal, with the help of our clinical colleges in Obstetrics and Gynecology, is to bridge the knowledge gap. The Women’s Reproductive portion of the Service line is unique in its culmination of techniques from many areas of Interventional Radiology including vascular (venous embolization for pelvic congestion syndrome) and musculoskeletal (kyphoplasty in osteoprosis related compression fractures). Additionally, There are several techniques unique to women including fallopian tube recanalization. Yet, it is the uterine artery embolization that is the most well-recognized component of this service line for its utility in chronic and emergent settings.

The goal of the GI/GU/Reproductive service line and this website is be a resource for understanding the clinical relevance, technical considerations, and scientific basis for gastrointestinal, genitourinary and reproductive interventions performed by IR physicians. The role and clinical decision making of hepatobiliary, portal venous, and renal interventions, among others, is often complicated requiring input from multiple specialties. Through electronic media including case files, presentations, webinars, and question and answer sessions this website will be a primary resource for clinical trainees seeking to better understand the clinical roles and considerations of GI, GU procedures and interventionist in Women’s Health.

GGR Team

GI/GU/Reproductive Interventions Service Line (GGR)

Service Line Leadership:
Service Line Liaison: Brian Bones
Vice-Service Line Liaison: Matthew “Czar” Taon
Resident/Fellow Welcome Liaison: David Petrov
Medical Student Welcome Liaison:Lucas Cusumano
Project Management Liaison: Rana Rabei

Active Service Line Members:
Eric Addo
Rakesh (‘Rocky’) Ahuja
David Ballard
Brian Bones
Casey Branach
John Cieslak III
Meghan Clark
Orrie Close
Lucas Cusumano
Kevin Ehlers
Jimmy Epps
Jonathan Fergus
Jason Fischer
Kirema Garcia-Reyes
Luis Goity
David Hu
Karishma Kodia
Ricki Korff
Tamara Koritorav
Nicole Lamparello
Trevor Lewis
Kurt Mauer
Henal Motiwala
Balan Naveen
Amir Noor
Karan Patel
Enio Perez
David Petrov
Rana Rabei
Amer Rasheed
McCann Sara
Kimberley Scherer
Shah Soham
Matthew Czar Taon
Will Warnica
Koethe Yilun
Hu Zhongxia
Adam Zybulewski

Former Service Line Chairs:
Magda Rizer (2015-2016)

Faculty Advisor:
Chuck Martin

GGR Topics

The GGR topic outline is a composite of topics that the service line covers. It is meant to serve as a guide for knowledge and skill development.

Vascular Related GI/GU/Repro

  • Arterial Problems in Obstetrics and Gynecology
  • Uterine Fibroid Embolization
  • Pelvic Congestion Syndrome Venous Ablation
  • Prostate Artery Embolization

Portal and Hepatic Venous Interventions

  • Portal Venous Disease and Transjugular Intrahepatic Portosystemic Shunt
  • Hepatic Venous Disease and Budd-Chiari syndrome
  • Preoperative Portal Vein Embolisation
  • Gonadal Venous Interventions

Gastrointestinal Interventions

  • Enteral Tube Placement (Gastrostomy, Jejunostomy, Caecostomy)
  • Gastrointestinal Stenting
  • Hepato-Pancreatico-Biliary (HPB) Intervention

Intervention of the Genito-urinary Tract and Renal Transplants

  • Pelvicalyceal and Ureteric Obstruction
  • Renal Stone Disease
  • Renal Masses and Perirenal Collections
  • Renal Tumors
  • Gonadal Venous Interventions
  • Fallopian Tube Obstruction
  • Male Infertility
  • Prostate
  • Prostate Cancer
  • Prostatitis (Abscess)
  • Priapism
  • Renal Transplant Interventions
  • Renal Artery Sympathetic Denervation

Article Resources

Gastrointestinal

  • Bruce Wollman, et al. Radiologic, Endoscopic, and Surgical Gastrostomy: An Institutional Evaluation and Meta-Analysis of the Literature. Radiology 1995; 197:699-704
  • Hjalmar C. van Santvoort, et al. A Step-up Approach or Open Necrosectomy for Necrotizing Pancreatitis, N Engl J Med 2010;362:1491-502.
  • Michael M. Maher, et al. Acute Pancreatitis: The Role of Imaging and Interventional Radiology. Cardiovasc Intervent Radiol (2004) 27:208–225
  • Hong-Tao Hu, et al. Fluoroscopically Guided Percutaneous Jejunostomy with Use of a 21-gauge Needle: A Prospective Study in 51 Patients. J Vasc Interv Radiol 2009; 20:1583–1587
  • M.F. Given, et al. Interventional Radiology Techniques for Provision of Enteral Feeding. Cardiovasc Intervent Radiol (2005) 28:692–703
  • Maher, Michael M., et al. Management of Visceral Interventional Radiology Catheters: A Troubleshooting Guide for Interventional Radiologists. RadioGraphics 2002; 22:305–322
  • Akinci, Devrim et al. Percutaneous Drainage of 300 Intraperitoneal Abscesses with Long-Term Follow-Up. Cardiovasc Intervent Radiol (2005) 28:744–750
  • Hans van Overhagen, et al. Percutaneous Jejunostomy. Seminars in Interventional Radiology, volume 21, number 3, 2004.
  • Maher, Michael M., et al. The Inaccessible or Undrainable Abscess: How to Drain It. RadioGraphics 2004; 24:717–735

Biliary Interventions

  • Alampady KPS., et al. Benign Biliary Strictures: A Current Comprehensive Clinical and Imaging Review. AJR 2011; 197:W295–W306.
  • David W Victor, et al. Current endoscopic approach to indeterminate biliary strictures. World J Gastroenterol 2012 November 21; 18(43): 6197-6205
  • Andreas Weber, et al. Diagnostic approaches for cholangiocarcinoma. World J Gastroenterol 2008 July 14; 14(26): 4131-4136
  • Evangelos Kalaitzakis, George J. Webster. Endoscopic diagnosis of biliary tract disease. Curr Opin Gastroenterol 2012, 28:273–279
  • AC Yee and CS Ho. Complications of percutaneous biliary drainage: benign vs malignant diseases. American Journal of Roentgenology 1987 148:6 , 1207-1209

Portal Venous Disease/TIPS

  • Nicholas Fidelman, et al. Hepatic Arterial Injuries after Percutaneous Biliary
    Interventions in the Era of Laparoscopic Surgery and Liver Transplantation:
    Experience with 930 Patients.
    Radiology: Volume 247: Number 3—June 2008

  • Winick, Adam B et al. Complications of percutaneous transhepatic biliary
    interventions.
    Techniques in Vascular & Interventional Radiology, Volume 4, Issue 3, 200 – 206

  • Saad WE. Portosystemic shunt syndrome and endovascular management of hepatic encephalopathy. Semin Intervent Radiol. 2014 Sep;31(3):262-5.
  • Saad WE. Transjugular Intrahepatic Portosystemic Shunt before and after Liver Transplantation. Semin Intervent Radiol. 2014 Sep;31(3):243-7.
  • Saad WE. Combining Transjugular Intrahepatic Portosystemic Shunt with Balloon-Occluded Retrograde Transvenous Obliteration or Augmenting TIPS with Variceal Embolization for the Management of Gastric Varices: An Evolving Middle Ground. Semin Intervent Radiol. 2014 Sep;31(3):266-8.
  • Iwakiri Y. et al. Vascular pathobiology in chronic liver disease and cirrhosis – Current status and future directions. J Hepatol. 2014 Oct;61(4):912-924.
  • Slakey DP1, Klein AS, Venbrux AC, Cameron JL. Budd-Chiari syndrome: current management options. Ann Surg. 2001 Apr;233(4):522-7.
  • Kinjo N. et al. Portal vein thrombosis in liver cirrhosis. World J Hepatol. 2014 Feb 27;6(2):64-71.

Renal, Pelvicalyceal and Ureters

  • Shuch B et al. Understanding Pathologic Variants of Renal Cell Carcinoma: Distilling Therapeutic Opportunities from Biologic Complexity. Eur Urol. 2014 May 20.
  • Li D, Pua BB, Madoff DC. Role of embolization in the treatment of renal masses. Semin Intervent Radiol. 2014 Mar;31(1):70-81.
  • Venkatesan AM1, Wood BJ, Gervais DA. Percutaneous ablation in the kidney. Radiology. 2011 Nov;261(2):375-91.
  • Leslie A. Dea et al. Advances in Percutaneous Nephrostolithotomy. Urol Clin N Am 34 (2007) 383–395
  • Kwak, Sandy. et al. Percutaneous Balloon Catheter Dilatation of Benign Ureteral Strictures: Effect of Multiple Dilatation Procedures on Long-Term Patency. AJR 1995;165:97-100.
  • Jigish B. Vyas. et al. Balloon dilatation for male urethral strictures “revisited”. Urology Annals | Oct – Dec 2013 | Vol 5 | Issue 4.
  • Raymond B. Dyer, MD. et al. Percutaneous Nephrostomy with Extensions of the Technique: Step by Step. RadioGraphics 2002; 22:503–525
  • Parvati R. et al. Quality Improvement Guidelines for Percutaneous Nephrostomy. J Vasc Interv Radiol 2003; 14:S277–S281.
  • Adamo R1, Saad WE, Brown DB. Percutaneous ureteral interventions. Tech Vasc Interv Radiol. 2009 Sep;12(3):205-15.
  • Adamo R, Saad WE, Brown DB. Management of nephrostomy drains and ureteral stents. Tech Vasc Interv Radiol. 2009 Sep;12(3):193-204.

Uterine Artery Embolization

  • Kahn A. et al. Uterine fibroids: current perspectives. International Journal of Women’s Health 2014:6 95–114
  • Suvranu G. et al. Uterine Artery Embolization in the Treatment of Postpartum Uterine Hemorrhage. J Vasc Interv Radiol 2011; 22:169–176
  • Sundeep S.T. et al. Complication Rates and Effectiveness of Uterine Artery Embolization in the Treatment of Symptomatic Leiomyomas: A Systematic Review and Meta-Analysis. AJR 2012; 199:1153–1163

Fallopian tube interventions

  • Maubon, AJ. et al. Interventional radiology in female infertility: technique and role. Eur. Radiology (2011) 11:771-778
  • Hugh McSwain, et al. Fallopian Tube Occlusion, An Alternative to Tubal Ligation. Tech Vasc Interventional Rad 2006. 9:24-29.
  • Robert Woolcott, et al. Differential impact on pregnancy rate of selective salpingography, tubal catheterization and wire-guide recanalization in the treatment of proximal Fallopian tube obstruction. Human Reproduction vol.10 no.6 pp. 1423-1426, 1995

Pelvic Congestion Syndrome

  • Ignacio EA, Dua R, Sarin S, Harper AS, Yim D, Mathur V, Venbrux AC. Pelvic congestion syndrome: diagnosis and treatment. Semin Intervent Radiol. 2008 Dec;25(4):361-8. doi: 10.1055/s-0028-1102998. PMID: 21326577 [PubMed]
  • Kim HS, Malhotra AD, Rowe PC, Lee JM, Venbrux AC. Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol. 2006 Feb;17(2 Pt 1):289-97. PMID: 16517774
  • Kies DD, Kim HS. Pelvic congestion syndrome: a review of current diagnostic and minimally invasive treatment modalities. Phlebology. 2012 Mar;27 Suppl 1:52-7. doi: 10.1258/phleb. 2012.012S27. Review. PMID: 22312068
  • Hocquelet A, Le Bras Y, Balian E, Bouzgarrou M, Meyer M, Rigou G, Grenier N. Evaluation of the efficacy of endovascular treatment of pelvic congestion syndrome. Diagn Interv Imaging. 2014 Mar;95(3):301-6. doi: 10.1016/j.diii.2013.09.011. Epub 2013 Oct 30. PMID: 24183954

The Prostate

  • Benign Prostatic Hypertrophy
    • Evaluation/Imaging
      • Santos Dias J. Benign prostatic hyperplasia: clinical manifestations and
        evaluation. Tech Vasc Interv Radiol. Dec 2012 15(4):265269.

      • Thorpe A, Neal D. Benign Prostatic Hyperplasia. The Lancet April 2003
        361(9366):13591367.
    • Treatment High Frequency Ultrasound (HIFU)
      • Kennedy J. HighIntensity focused ultrasound in the treatment of solid tumours. Nature Reviews Cancer April 2005(5):321327.
      • Uchinda et al. High Intensity Focused Ultrasound For Benign Prostatic Hyperplasia. Intl Journal of Urology July 2007 (2) 3; 181:185.
    • Treatment Prostate Artery Embolization
      • Justin P.et al Society of Interventional Radiology Position Statement:
        Prostate Artery Embolization for Treatment of Benign Disease of the
        Prostate. Journal of vascular and interventional radiology; July 2014.

      • Sandeep B. et al. Early Results from a United States Trial of Prostatic Artery
        Embolization in the Treatment of Benign Prostatic Hyperplasia. Journal of
        vascular and interventional radiology; January 2014.

      • Sandeep B. et al. Utility of ConeBeam CT Imaging in Prostatic Artery
        Embolization. Journal of vascular and interventional radiology November
        2013 (24)11:16031607.

      • Golzarian J. et al. ProstaticArtery Embolization to Treat Lower Urinary Tract
        Symptoms Related to Benign Prostatic Hyperplasia and Bleeding in Patients with Prostate Cancer: Proceedings from a Multidisciplinary Research Consensus Panel JVIR May 2014 (25)5:665674.

      • Pisco JM et al. Prostatic Artery Embolization to treat Benign Prostatic Hyperplasia. JVIR Jan 2011 (22)1:1119.
  • Prostate Cancer
    • Evaluation/Imaging
      • Hricak H, Dooms GC, Jeffrey RB, Avallone A, Jacobs D, Benton WK, Narayan P and Tanagho EA. Prostatic Carcinoma: staging by clinical assessment, CT and MR imaging. Radiology 1987 162(2).
      • Boonsirikamchai P et al. MR imaging of Prostate Cancer in Radiation Oncology: What Radiologists Need to Know. Radiographics 2013 (33): 741761.
      • Bonekamp D, Jacobs MA, ElKhouli R, Macura KJ. Advancements in MR Imaging of the Prostate: From Diagnosis to Interventions. Radiographics 2011 (31):677703.
      • Yablon CM et al. Complications of Prostate Cancer Treatment: Spectrum of Imaging Findings. Radiographics 2004 (24):S181S194.
      • Puech P, Villers A, Ouzzane A, Lemaitre L. Prostate cancer: Diagnosis, parametric imaging and standardized report. Diagn Interv Imaging. 2014 JulAug;95(78):743752.
      • Yacoub JH, Oto A, Miller FH. MR imaging of the prostate. Radiol Clin North Am. 2014 Jul;52(4):811837.
    • Intervention
      • Hong CW, Amalou H, Xu S, Turkbey B, Yan P, Kruecker J, Pinto PA, Choyke PL, Wood BJ. Prostate Biopsy for the Interventional Radiologist JVIR†May 2014 25(5):675684.
      • Hong CW et al. Comparison of MRUS fusion guided prostate biopsies obtained from axial and sagittal approaches. BJU Int. 2014.
      • Cheung WH et al. Prostate Biopsy for the Interventional Radiologist. JVIR 25(5):675684.
  • Prostatitis
    • Evaluation/Imaging
      • Ren J et al. Diffusionweighted imaging in normal prostate and differential
        diagnosis of prostate disease. Abdominal Imaging Nov 2008 33(6):724728.
    • Intervention
      • Maher MM et al. The Inaccessible or Undrainable Abscess: How to Drain it. Radiographics 2004 (24):717735.
      • Harisinghani MG et al. CTguided Transgluteal Drainage of Deep Pelvic Abscesses: Indications, Technique, Procedurerelated complications and Clinical Outcome. Radiographics 2002 (22):13531367.

Male Infertility

  • Pathogenesis
    • Yigal Gat, Zvi Zukerman, Joana Chakraborty, Michael Gornish, 2005,
      Varicocele, hypoxia and male infertility. Fluid Mechanics analysis of the impaired testicular venous drainage system, Human Reproduction;20 (9), pp. 2614-2619.

    • Cathy K. Naughton, Ajay K. Nangia, Ashok Agarwal, (2001), Varicocele and male infertility: Part II: Pathophysiology of varicoceles in male infertility, Human Reproduction Update; 7 (5) , pp. 473-481.
    • Yigal Gat, Michael Gornish, Uri Navon, Joana Chakraborty, Gil N Bachar, Izhar Ben-Shlomo, 2006, Right varicocele and hypoxia, crucial factors in male infertility: fluid mechanics analysis of the impaired testicular drainage system, Reproductive BioMedicine Online;13 (4), pp. 510–515.
    • Csilla Krausz , 2011, Male infertility: Pathogenesis and clinical diagnosis, Best Practice & Research Clinical Endocrinology & Metabolism;25 (2) , pp 271-285.
  • Evaluation/Imaging
    • Sandro C. Esteves,I Ricardo Miyaoka,I Ashok Agarwal, (2011), An update on the clinical assessment of the infertile male,Clinics; 66(4); pp. 691-700.
    • R B Parsons , A M Fisher, N Bar-Chama,H A Mitty, (1997), MR Imaging in Male Infertility, Radiographics; 17(3);pp. 627-637.
  • Treatment
    • Richard D. Et al. Percutaneous Varicocele Embolization versus Surgical Ligation for the Treatment of Infertility: Changes in Seminal Parameters and Pregnancy Outcomes, 1997 Journal of Vascular and Interventional Radiology; 8( 5),pp 759-767.
    • Selahittin Çayan, Shavkat Shavakhabov,Ateş Kadioğlu, (2009),Treatment of Palpable Varicocele in Infertile Men: A Meta-analysis to Define the Best Technique, Journal of Andrology; 30 (1),pp 33-40.

Procedural Education

RFS YouTube Channel’s GGR Service Line Playlist

General Video Resource: https://www.vumedi.com/accounts/login/

Interventional Oncology: https://www.vumedi.com/term/interventional-oncology/

1. Uterine Fibroid Embolization

2. Varicocele Embolization

3. Pelvic Congestion Syndrome

4. Gastrointestinal Embolization for Hemorrhage

5. Embolization for Trauma Related Hemorrhage

6. Pre-operative RCC Tumor Embolization

7. AML Embolization

8. Preoperative Portal Vein Embolization

9. Gastrostomy and Gastro-jejunostomy Tube Placements

10. Percutaneous Transhepatic Cholecystostomy Tube Placement

11. CT and US-guided Biopsies

12. Portal Venous Disease and Transjugular Intrahepatic Portosystemic Shunt (TIPS) Placement

13. Chemoembolization (TACE)

14. Radioembolization (Y-90)

15. Percutaneous Ablation

16. Cryoablation

17. Nephrostomy and Nephroureterostomy Catheter Placements

18. Ureteroplasty and Ureteral Stent Placement

19. Renal Artery Stenosis

20. Dialysis Access Placement

21. Paracentesis

22. Prostate Artery Embolization for BPH

23. Fallopian Tube Recanalization

24. Renal Artery Sympathetic Denervation

National Meetings

Society of Interventional Radiology Annual Meeting

Cleveland Clinic Gastrointestinal Interventions

More to come!

Survival Guides

GGR Survival Guides:

Click here for GGR Survival Guides

Topics Include:
Fallopian tube recalanization
Nephrostomy and nephroureterostomy catheter insertion
Uterine Fibroid embolization
Varicocele embolization
Embolization for pelvic congestion syndrome
Embolization for gastrointestinal hemorrhage
Dialysis catheter placement
Gastric varices embolization
Percutaneous abscess drainage
Paracentesis
Prostate artery embolization for Benign Prostatic Hyperplasia
Angiomyolipoma embolization
Transjugular intrahepatic portosystemic shunt (TIPS)
Gastric artery embolization for bariatric weight loss
Embolization for trauma related hemorrhage
Pre-operative Renal cell carinoma tumor embolization
Preoperative portal vein embolization
Gastrostomy and gastro-jejunostomy tube placements
Percutaneous transhepatic cholecystostomy catheter placement
CT and US guided
Renal biopsy
CT and US guided Liver biopsy
CT and US guided Adrenal biopsy
CT and US guided Pancreatic biopsy
Hepatic Venous Disease and Budd-Chiari syndrome
Ureteroplasty and ureteral stent insertion
Renal artery stenosis
Renal artery sympathetic denervation
Tunneled peritoneal drainage catheter insertion

Journal Primer

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