Common IR Procedures


Cardiovascular

Peripheral Arterial Disease
Peripheral arterial disease (PAD) commonly results from atherosclerosis as cholesterol and scar tissue build up along vessel walls. Occlusion of the vessel lumen results in decreased blood flow to the legs, which can lead to intermittent claudication, and eventually gangrene and amputation. Symptoms include painful cramping in the leg or hip that occurs when walking or exercising and typically disappears when the person stops the activity, numbness or tingling in the legs/feet, and pain in legs/feet at night. Interventional radiologists can treat PAD using angioplasty and stenting, which involves inserting and inflating a balloon to open the narrowed artery and keeping the vessel open with a cylindrical mesh. Atherectomy can be performed which involves inserting a small catheter at the site of blockage that is able to "shave" the plaque from inside of the artery to re-establish normal blood circulation.

Varicose Veins
Varicose veins are enlarged, swollen vessels that develop when weak valves allow blood to flow backwards and pool. Symptoms include aching, throbbing, fatigue, and weakness that worsen as the day goes on. Interventional radiologists can treat varicose veins using endovenous ablation. In this procedure, laser or radiofrequency is applied via a catheter to the inside of the abnormal saphenous vein to seal it closed.
Deep Vein Thrombosis
Deep vein thrombosis (DVT) is formation of a blood clot in the deep leg vein, and can lead to permanent damage to the leg (post-thrombotic syndrome) and life-threatening pulmonary embolism. Contractions of the muscles surrounding the deep leg veins and arterial-venous pumps help return blood to the heart against gravity. One-way valves prevent the back-flow of blood between contractions. Slowing of blood circulation due to illness, injury, or inactivity promotes clot formation. Interventional radiologists can treat DVT with catheter-directed thrombolysis, balloon angioplasty, or stenting. Catheter-directed thrombolysis involves inserting a catheter into a vein in the leg to deliver tPA to dissolve the blood clot. Patients who are not ideal candidates for catheter-directed thrombolysis can be treated with the insertion of an IVC filter, a small umbrella-like device inserted in the inferior vena cava to capture blood clots and prevent occlusion of vital vessels.
Pulmonary Embolism
Pulmonary embolism is usually due to thromboembolus from deep vein thrombus involving the femoral, iliac, or popliteal veins. DVT can break up and travel via the blood circulation to the lung where it occludes critical blood supply. Symptoms include shortness of breath, rapid pulse, sweating, sharp chest pain, and bloody sputum. Occlusion of both left and right pulmonary arteries (large saddle embolus) or significant occlusion of a large pulmonary artery can result in sudden death. Interventional radiologists can treat pulmonary embolism by fragmentation of embolus with angiographic catheters. Thrombolytic agents can also be administered similar to treatment of DVT.

Gastrointestinal

Portal Hypertension
Portal hypertension is increased blood pressure in the portal vein, which connects the GI and spleen to the liver, and its branches and tributaries. Causes of portal hypertension include liver diseases such as cirrhosis and hepatitis, which decrease the portal vascular radius resulting in increased vascular resistance and portal blood pressure. Interventional radiologists can treat portal hypertension using a transjugular intrahepatic portosystemic shunt (TIPS) procedure. TIPS relieves high blood pressure in the portal system by creating a channel connecting the portal vein (which brings blood from digestive organs to the liver) to a hepatic vein (which carries blood from the liver back to the heart).
Bile Duct Obstruction
In patients with liver cancer, bile duct cancer, cholecystitis, cholangitis, or other hepatobiliary pathology, the bile duct may become blocked and bile cannot drain from the liver. A stent, a small metal cylinder, or catheter can be placed to help with biliary drainage.

Oncology

Cancers
Interventional radiologists play an integral role in the diagnosis and treatment of different cancers including bone, breast, kidney, liver, and lung. Pathological diagnosis remains the gold standard for diagnosis of most cancers. Interventional radiologists perform needle biopsies for definitive diagnoses. Interventional radiologists are also able to treat using methods such as ablations and chemoembolization. Tumor ablation is a minimally invasive technique to destory cancer cells. There are different types of ablations:

-Radiofrequency ablation employs radiofreqency heat to "cook" and destroy tumor cells. Radiofrequency ablation can be used to treat kidney tumors, liver cancer, lung cancer, and adrenal cancer.
Radiofrequency ablation of liver tumor animation video
Radiofrequency ablation of liver tumor animation video

-Cryoablation uses extreme cold to freeze and destroy cancer cells. Cryoabation can be used to treat kidney tumors, liver cancer, and prostate cancer.
Cryablation animation video

Chemoembolization can be used to treat tumors too large to be ablated. Chemoembolization involves delivery of a cancer-killing drug through a catheter directly to the organ and embolization of arteries to the tumor to deprive the tumor of its blood supply and prevent the cancer-killing drug from flowing to other areas of the body.
Chemoembolization procedural video


Musculoskeletal and Connective Tissue

Vertebral Compression Fractures
Vertebral compression fractures are often due to osteoporosis and commonly occur in the thoracic or lumbar spine. When pain from vertebral compression fractures fail to respond to conventional treatments such as analgesics, vertebroplasty and kyphoplasty are two available options. In vertebroplasty, medical-grade bone cement is injected into the spine to stabilize the collapsed vertebrate and reduce pain caused by bone rubbing against bone. In kyphoplasty, a balloon is inserted into the vertebrate to create a cavity before cement is injected.

Neurology

Stroke and Carotid Artery Stenosis
Strokes are classified into two type: ischemic (caused by blood clots) and hemorrhagic (caused by blood vessel rupture). CT, MRI, and angiography can be employed to identify type of stroke and localize affected areas of the brain. Within the first three hours from onset of symptoms of an ischemic stroke, tPA (tissue plasminogen activator) can be given to dissolve the clot. Remember that tPA catalyzes the conversion of plasminogen to plasmin, which degrades fibrin clots. If tPA fibrinolysis cannot be performed within the first three hours, interventional radiologists can treat ischemic strokes through intra-arterial thrombolysis treatment. A catheter is inserted through the femoral artery and guided to the blood clot to deliver tPA directly or mechanically breakup the clot. Interventional radiologists can treat hemorrhagic strokes using tiny metal coils to embolize and block the abnormal vessel. The same technique can be used to treat aneurysms and AVMs.


Renal

Renal Artery Stenosis
Renal artery stenosis is often caused by atherosclerosis or fibromuscular dysplasia. It is a common cause of secondary hypertension.
Pathophysiology of renovascular hypertension: Stenosis decreases blood flow to glomerulus. Juxtaglomerular apparatus responds by secreting renin, which converts angiotensinogen to angiotensin I. Angiotensin I is converted to angiotensin II by angiotensin converting enzyme (ACE). Angiotensin II raises blood pressure by contracting arteriolar smooth muscle (increasing peripheral resistance) and promoting adrenal release of aldosterone (which increases resorption of sodium in the distal convoluted tubule and results in expanded plasma volume).
Interventional radiologists can treat renal artery stenosis using balloon angioplasty or stenting. In angioplasty, a deflated balloon is tunneled to the narrowed artery then inflated to open up the vessel and restore blood flow. The addition of a stent strengthens vessels walls to prevent collapse of the artery.

Reproductive

Uterine Fibroids
Uterine fibroids are noncancerous growths that develop in the muscular wall of the uterus. Found in 20-40% of women age 35 and older, fibroids are the most common tumors of the female genital tract. Most women with uterine fibroids are asymptomatic, but 10-20% may experience symptoms such as heavy menstrual periods, pelvic pain, frequent urination (due to pressure on bladder), and abnormally enlarged abdomen. This latter subset of patients can be treated with uterine fibroid embolization (UFE), also known as uterine artery embolization (UAE). The interventional radiologist guides a catheter to the uterine arteries and releases small particles which occlude the fibroid's blood supply and shrink the tumor.
Infertility
A common cause of female infertility is blockage or narrowing of the fallopian tubes through which eggs pass from the ovary to the uterus. In selective salpingography and fallopian tube recanalization, interventional radiologists thread a catheter to the fallopian tube to correct the blockage and allow passage of the egg to the uterus.

Respiratory

Pulmonary Embolism
Pulmonary embolism is usually due to thromboembolus from deep vein thrombus involving the femoral, iliac, or popliteal veins. DVT can break up and travel via the blood circulation to the lung where it occludes critical blood supply. Symptoms include shortness of breath, rapid pulse, sweating, sharp chest pain, and bloody sputum. Occlusion of both left and right pulmonary arteries (large saddle embolus) or significant occlusion of a large pulmonary artery can result in sudden death. Interventional radiologists can treat pulmonary embolism by fragmentation of embolus with angiographic catheters. Thrombolytic agents can also be administered similar to treatment of DVT.