Interventional radiography

Various Procedures
 Angioplasty and Vascular Stenting
 Catheter Angiography
 Catheter Embolization
 CT Angiography
 MR Angiography
 Cryotherapy
 Uterine Fibroid Embolization
 Vertebroplasty
Angioplasty and Vascular Stenting
 Minimally invasive procedure to improve blood flow in
arteries.
 Surgeon threads a balloon tipped catheter to the site.
 The balloon is inflated in order to open the artery –
deflated and then removed.
 Vascular stenting also may be done at the same
time.
 Stent is a permanent device left in the artery
 Assists the healing of the artery in the open position
after angioplasty.
Common uses
 Peripheral Vascular Disease.

 Renal Vascular Hypertension.

 Haemodialysis access maintenance.

 Carotid Artery Disease.

 Coronary Artery Disease.

How is it performed?
 Balloon inserted – inflated – deflated – removed.
 Stents placed over the catheter- scaffolding for the
artery walls.
 Drug-coated stents – used in case of coronary
arteries (FDA approval).
 Stents coated with medication – to prevent
rest en osi s.
 Sometimes stent is not necessary.
Benefits Vs Risks
 Ben ef its
 Compared to bypass – much less invasive, low cost
and low risk.

 No general anesthetic required.

 No surgical cuts or incisions needed.

 Patient can return to normal activities after the

procedure.
Benefits Vs Risks
 Ri sks
 Catheter insertion can lead to injury of the artery.
Balloon can also cause blood clots or rupture the
artery.
 Blockages can recur.
 Heavy bleeding requires special medication or even
blood transfusion.
 Risk of stroke when performed on car otid arter y.
 Abrupt vessel closure – emergency bypass also may
be done.
(Back)
Catheter Angiography
 Type of x-ray which is used to visualize the arteries
of heart, brain, kidney etc.
 Used to determine if arteries are diseased, enlarge,
narrowed or blocked.
 Nowadays has been replaced by less invasive
methods such as MRA and CT Angiography.
 Still used in patients undergoing angioplasty or
stenting.
Common uses
 Show arteriosclerotic disease in carotid artery.
 Demonstrate intra-cranial aneurysm or other
disorders of blood vessels in the brain.
 Indicate disease of renal artery.
 Indicate aneurysm of aorta.
 Show severity of arteriosclerosis in coronary artery.
 Demonstrate a source of bleeding e.g. Stomach
ulcer.
How is it performed?
 X-rays passed through body.
 Catheter inserted which injects contrast material or
dye.
 Gives a detailed picture of the artery from inside the
blood vessel.
 Imaged are stored in computer or captured in film
(can also be viewed like a movie !!)
Benefits Vs Risks
 Ben ef its
 Presents a clear,accurate and detailed picture of the
blood vessels.
 “Super selective Angiography”
 Use of catheter makes it possible to combine
diagnosis and treatment in a single procedure.
 Similar degree of detail is not possible with any other
non-invasive procedure.
Benefits Vs Risks
 Ri sks
 Allergic reaction to the dye – complications.
 Blood may form a clot around tip of catheter.
 Diabetes or kidney disease – kidneys may be injured
when contrast material is eliminated through the
urine.
 Internal bleeding or causing a block “downstream”.
 Pregnant women should not undergo this procedure.

(Back)
Catheter Embolization
 “Embolization” – way of occluding blood vessels
which are doing more harm than good.
 Material is passed through the catheter with its tip
lying in or near the blood vessel to be closed.
 Very useful to control excessive bleeding or cut off
blood supply to a tumor.
 Therapeutic Embolization serves to eliminate AVM.
 Embolus – medication or synthetic material to
occlude the blood vessel.
Common uses
 Controlling bleeding from injury, tumor or stomach
ulcer.
 To cut off blood supply to a tumor. Can be used in
conjunction with chemotherapy.
 To treat benign fibroid tumors of the uterus – an
alternative to hysterectomy. Multiple fibroid tumors
can be treated at one time.
 Excellent for treatment of AVM (abnormal connection
of the artery and the vein like a “short circuit”).
 For plugging of an aneurysm in the brain.
 Treatment of hemangiomas.
How is it performed?
 The equipment used is same as in Catheter angiography.
 The first step is angiography (injection of x-ray dye into an
artery or vein) to locate the exact site of bleeding or
abnormality
 A catheter is introduced and contrast material is injected
(normally through femoral artery).
 An appropriate embolic material then is chosen and injected
through the catheter to lodge at the treatment site
 Repeat angiograms are done until bleeding is controlled or there
is enough embolic material in a tumor or vascular malformation
Different Embolic materials used
 Gelfoam - used to control bleeding until the cause—
such as a bone fracture can be identified and fixed,
or until it has time to heal on its own.
 Permanent particulate agents - These agents are
used to occlude small blood vessels permanently.
They are used to stop bleeding or block arteries to a
tumor when the underlying lesion is not likely to
heal. They are the materials used most often to
embolize uterine fibroid tumors. Eg : Polyvinyl
alcohol (PVA).
Different Embolic materials used
 Metal coi ls made of stainless steel or
platinum may be used to occlude large
arteries. They come in a range of sizes.
 Li qui d scl erosing ag ents such as alcohols
are used to purposely destroy tissue. This
might be desired to treat a large
malformation of veins by filling it with the
liquid to induce clotting and damage the inner
lining of the veins
Benefits vs Risks
 Very effective way of controlling bleeding
especially in emergency.
 Used to treat tumors and vascular
malformations.
 It is much less invasive than conventional
open surgery.
 When embolization is used to treat an
intracranial arteriovenous malformation
(AVM), injection of a small amount of material
minimizes the risk of serious brain
dysfunction.
Benefits vs Risks
 Embolus can lodge in the wrong place and
deprive normal tissue of its oxygen supply.
 Risk of infection after embolization, even if an
antibiotic has been given.
 Because angiography is part of the
procedure, there is a risk of an allergic
reaction to contrast material and also there is
a risk of kidney damage in patients with
diabetes or other pre-existing kidney disease.
(Back)
Cryotherapy
 Cryotherapy, also called cryosurgery,
cryoablation or targeted cryoablation
therapy, refers to the application of
extreme cold to destroy diseased tissue,
including cancer cells.
Common Uses
 Used to destroy skin tumors, pre-cancerous
skin moles, nodules, skin tags or unsightly
freckles.
 Used to destroy Retinoblastomas.
 Physicians have begun to perform
cryotherapy for prostate, liver and cervical
cancer, especially if surgery is not possible.
 Current research on cryotherapy for tumors
of the bone, brain, kidney, lung and spine.
How is it performed?
 Carried out using cryoprobe (attached via
tubing to a source of N or Ar).
 For external masses, liquid N is applied
directly with a cotton swab or spray device.
 For internal tumors, liquid N or Ar gas is
circulated through the cryoprobe, which
comes into contact with the diseased tissue.
How is it performed? (contd.)
 More advanced forms of cryotherapy, such as
for treatment of liver cancer, involve the
insertion of the probe through an incision or
threaded through the skin. Then using
imaging device the physician targets and
freezes the tumors.
 Likewise, for prostate cancer, six to eight
needle probes can be inserted through the
perineum (the tissue between the rectum and
the scrotum/penis) and ultrasonically guided
to freeze the cancer.
Benefits vs Risks
 For intraoperative cryotherapy recovery time
is much less than for major surgical removal
of the tumor.
 Percutaneous cryotherapy has great potential
to evolve into an outpatient procedure.
 Less traumatic than open surgery since only a
small incision is needed.
 It causes minimal scar tissue and apparently
no calcifications.
Benefits vs Risks (contd.)
 Treatment of the liver can damage bile ducts or
cause heavy bleeding
 Treatment of the kidney can damage the urine-
collecting systems or cause heavy bleeding.
 Treatment of lung tumors can cause the lung to
collapse and fluid to accumulate around the lung.
 Care must be taken anywhere nerves are near the
tumor. Completely frozen nerves can cause motor
weakness or numbness in the area supplied by the
nerves.
(Back)
CT Angiography
 CTA uses X-rays to visualize arterial and
venous vessels throughout the body.
 CT combines use of x-rays with
computerised analyzis of the image.
 CTA is much less invasive and more
patient friendly than catheter
angiography.
Common uses
 To examine pulmonary arteries to rule out pulmonary
embolism.
 Visualize blood flow in the renal arteries in patients
with high blood pressure and those suspected of
having kidney disorders. Also done in kidney donors.
 Identify aneurysms in the aorta or in other major
blood vessels.
 Detect atherosclerosis disease that has narrowed the
arteries to the legs.
 Detect thrombosis (clots) in veins, for example large
veins in the pelvis and legs.
How is it performed?
 Before the actual exam a contrast agent is injected
into a vein.
 During the examination, the rotating device spins
around the patient, creating a fan-shaped beam of x-
rays, and the detector takes snapshots of the beam
after it passes through the patient.
 As many as one thousand of these pictures may be
recorded in one turn of the detector.
 Then reconstruction techniques are used to view
images as desired.
Benefits vs Risks
 CTA can be used to examine blood
vessels in most parts of the body.
 More precise than MR Angiography and
Ultrasound
 Useful way of screening arterial blood
vessels because it is safer and less time
consuming than Catheter Angiography.
Risks
 Risk of allergic reactions because of
contrast agents like iodine.
 Dangerous for patients with kidney
disorders and diabetes.
 Skin damage may occur because of
excess contrast agent.
(Back)
MR Angiography
 MRI produces images of the body without the
use of X-rays.
 The electromagnetic energy that is released
when exposing a patient to radiofrequency
waves in a strong magnetic field is measured
and analyzed by a computer
 MRA is MRI study of the blood vessels.
 Provides detailed images of the images
without using contrast agents.
Common uses
 Used in checking patients for diseased
intracranial (in the head) arteries.
 Used to detect disease in the aorta and
in blood vessels supplying the kidneys,
lungs and legs.
 Used for confirmation of carotid artery
stenosis.
How is it performed?
 Traditional MRI units are used.
 Patient is placed in the MRI unit.
 Exposing the patient to radio waves in a
strong magnetic field generates data that are
used by a computer to create images of
tissue slices that may be viewed in any plane
or from any direction.
 Contrast material used is Gadolinium. It is
given by IV injection during one of the
imaging sequences.
Benefits Vs Risks
 Ben ef its
 Procedure time and time to recover is relatively
small.
 Cost-effective procedure.
 No exposure to x-rays.
 Very useful for patients having allergic reactions to
contrast material.
 Possible to defer surgery.
Benefits Vs Risks
 Ri sks
 In case of implants being present, it is difficult to get
a good quality image.
 Pregnant women cannot be allowed for this
procedure.
(Back)
Uterine Fibroid Embolization
 New way of treating fibroid tumors.
 Also called as myo mas , fibroid tumors are masses of
fibrous and muscle tissue in the uterine wall which
are benign but can cause heavy bleeding, pain in the
pelvic region or pressure on the bladder and the
bowel.
 Much less invasive than open surgery.
 UFE was first used to limit blood loss during surgical
removal of fibroid tumors.
 Now it is a stand-alone treatment for women who
have symptoms of uterine fibroid tumors.
Common uses
 Obviously for fibroid tumors.

 Otherwise, also to limit the bleeding after child birth

or caused by malignant gynecological tumors.
How is the procedure performed?
 Carried out in an angiography suite with x-ray equipment and
vital signs being monitored.
 Nick in the groin area.
 Catheter is introduced via the femoral artery.
 Catheter threaded to the uterine arteries.
 X-ray guidance and periodic injection of radiographic contrast
material is done to map the blood vessels.
 Embolization particles are injected till the uterine arteries are
not completely blocked.
 Both arteries can be blocked in a single procedure.
 Site of skin is then cleaned and bandaged.
Benefits Vs Risks
 Benefi ts
 Minimally invasive, patient can resume normal activities weeks
earlier than compared with hysterectomy, minimal blood loss,
general anesthesia is not required.
 85% of women experienced significant reduction in pain or
complete resolution of their symptoms.Overall, fibroid size
becomes half in about 6 months after UFE.
 More permanent solution as even small fibroid tumors are
eliminated. No regrowth occurs.
 Better procedure compared to hormone therapy.
 Regrowth is also a problem with laser treatment of these
fibroids.
Benefits Vs Risks
 Ri sks
 Catheter related risks
 Allergic reactions to the contrast material.
 2-3% of women may have to undergo D& C to
ensure there is no bleeding and infection.
 Menopause occurs immediately in about 1-5% of
women undergoing this procedure.
 Future fertility..??
(B ack)
Vertebroplasty
 Image-guided, minimally invasive, non-
surgical therapy.
 Mainly to strengthen a broken vertebra that
has been weakened by osteoporosis or cancer.
 Successful at alleviating the pain caused by
compression fracture.
 Is accomplished by injecting an orthopedic
cement mixture by means of a needle into the
fractured bone.
Common uses
 To treat pain caused by osteoporotic
compression fractures.
 Often performed on patients too elderly or frail
to tolerate open spinal surgery, or with bones
too weak for surgical spinal repair.
 Usually recommended after simpler
treatments.
How is it performed?
 Usually performed in the morning – the patient is
sedated and local anesthetic is used along with
intravenous antibiotics.
 With the help of a fluoroscope, a hollow needle is
passed through the spinal muscles till its tip is
positioned within the fractured vertebra.
 After the position is confirmed (introsseous
venography), the orthopedic cement is injected into
the fracture.
 Cement hardens in about 10 to 20 minutes.
 Entire procedure takes less than 2 hours (provided
only one site is being treated)
Benefits Vs Risks
 Ben ef its
 Patients feel significant relief almost
immediately.
 About 75 percent of patients regain lost
mobility and become more active, which helps
combat osteoporosis.
 Increased activity builds more muscle
strength, further encouraging mobility.
Benefits Vs Risks
 Ri sks
 Small amount of orthopedic cement can leak
out of the vertebral body. This does not
usually cause a serious problem, unless the
leakage moves into a potentially dangerous
location such as the spinal canal.
 Possible complications include infection,
bleeding, increased back pain and neurological
symptoms such as numbness or tingling.
Paralysis is extremely rare.
References
 www.radiologyinfo.com

 www.pubmed.com

 www.wikipedia.org