GI/GU/Reproductive Service Line

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.

Current Members

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 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

Faculty Advisor:
Chuck Martin

Recommended Resources

Hepatobiliary Interventions:
  • Transjugular Intrahepatic Portosystemic Shunt
    • Saad WE. Portosystemic shunt syndrome and endovascular management of hepatic encephalopathy. Semin Intervent Radiol. 2014 Sep;31(3):262-5.
    • 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.
    • TIPS Animation
    • Portal HTN Video
  • Paracentesis
  • Hepatic Venous Disease and Budd-Chiari syndrome
    • 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.
  • Preoperative Portal Vein Embolization
  • Hepatic Malignancies
  • Biliary Obstruction
    • 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
    • Percutaneous Transhepatic Cholecystostomy Tube Placement Animation
    • 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

 

Gastrointestinal Interventions:
  • Enteral Tube Placement (Gastrostomy, Jejunostomy, Caecostomy)
    • Bruce Wollman, et al. Radiologic, Endoscopic, and Surgical Gastrostomy: An Institutional Evaluation and Meta-Analysis of the Literature. Radiology 1995; 197:699-704
    • 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
    • Hans van Overhagen, et al. Percutaneous Jejunostomy. Seminars in Interventional Radiology, volume 21, number 3, 2004.
    • G-Tube Placement Video 1
    • G-Tube Placement Video 2
  • Abscess Drainage
    • Maher, Michael M., et al. The Inaccessible or Undrainable Abscess: How to Drain It. RadioGraphics 2004; 24:717–735
    • Akinci, Devrim et al. Percutaneous Drainage of 300 Intraperitoneal Abscesses with Long-Term Follow-Up. Cardiovasc Intervent Radiol (2005) 28:744–750
  • Pancreatitis
    • Michael M. Maher, et al. Acute Pancreatitis: The Role of Imaging and Interventional Radiology. Cardiovasc Intervent Radiol (2004) 27:208–225
    • Hjalmar C. van Santvoort, et al. A Step-up Approach or Open Necrosectomy for Necrotizing Pancreatitis, N Engl J Med 2010;362:1491-502.
  • Gastrointestinal Hemorrhage

 

Genitourinary & Reproductive Interventions:
  • Adrenal Biopsy
  • Dialysis Access Placement
  • Pelvicalyceal and Ureteric Obstruction
    • 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.
    • Adamo R1, Saad WE, Brown DB. Percutaneous ureteral interventions. Tech Vasc Interv Radiol. 2009 Sep;12(3):205-15.
    • Leslie A. Dea et al. Advances in Percutaneous Nephrostolithotomy. Urol Clin N Am 34 (2007) 383–395
    • 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 R, Saad WE, Brown DB. Management of nephrostomy drains and ureteral stents. Tech Vasc Interv Radiol. 2009 Sep;12(3):193-204.
    • Nephrostomy Video
    • Ureteroplasty and Ureteral Stent Placement Video
  • Renal Malignancies
  • Renal Artery Stenosis
  • Renal Artery Sympathetic Denervation
  • 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
    • Pelvic Congestion Syndrome Animation
  • 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
    • UFE Video 1
    • UFE Video 2
    • UFE Video 3
    • UFE Video 4
    • UFE Video 5
  • Fallopian Tube Obstruction
    • 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
    • Fallopian Tube Recanalization Video
  • Benign Prostatic Hypertrophy
    • 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.
    • Uchinda et al. High Intensity Focused Ultrasound For Benign Prostatic Hyperplasia. Intl Journal of Urology July 2007 (2) 3; 181:185.
    • 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 Artery Embolization Video
  • Prostate Cancer
    • 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.
    • 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 (Abscess)
    • Ren J et al. Diffusionweighted imaging in normal prostate and differential diagnosis of prostate disease. Abdominal Imaging Nov 2008 33(6):724728.
    • 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.
  • Varicocele / Male Infertility
    • 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
    • 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.
    • 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.
    • Varicocele Embolization Animation

 

Survival Guides

Please select from the available survival guides below. Those without a link are coming soon.

Paracentesis
Percutaneous abscess drainage
Transjugular intrahepatic portosystemic shunt (TIPS)
Percutaneous renal biopsy
Dialysis catheter placement
Gastrostomy and gastro-jejunostomy tube placements

Fallopian tube recalanization
Nephrostomy and nephroureterostomy catheter insertion
Uterine Fibroid embolization
Varicocele embolization
Embolization for pelvic congestion syndrome
Embolization for gastrointestinal hemorrhage
Gastric varices embolization
Prostate artery embolization for Benign Prostatic Hyperplasia
Angiomyolipoma embolization
Gastric artery embolization for bariatric weight loss
Embolization for trauma related hemorrhage
Pre-operative Renal cell carinoma tumor embolization
Preoperative portal vein embolization
Percutaneous transhepatic cholecystostomy catheter placement
Percutaneous liver biopsy
Percutaneous adrenal biopsy
Percutaneous 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

Other Resources

RFS YouTube Channel’s GGR Service Line Playlist

Vumedi.com: great procedure videos/animations

National Meetings

  • Society of Interventional Radiology Annual Meeting
  • Cleveland Clinic Gastrointestinal Interventions

 

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