The Future of Modern Medicine

Interventional Radiology –History –Benefits Nonsurgical Treatments –Diseases –Prevalence –Solutions

Who are Interventional Radiologists? Board-certified physicians who specialize in minimally invasive, targeted treatments. The most in-depth knowledge of the least invasive treatments available coupled with diagnostic and clinical experience across all specialties. Use X-rays, MRI and other imaging to advance a catheter in the body, usually in an artery, to treat at the source of the disease non- surgically. Inventors of peripheral angioplasty and the catheter-delivered stent. Interventional radiologists pioneered minimally invasive modern medicine.

Benefits of Interventional Radiology Less risk, less pain, less recovery time compared to open surgery Procedures can often be done outpatient Patients often do not require general anesthesia -- just localized numbing IRs manage many surgical complications for surgeons They are consultants to every type of medical specialist For Physician Assistants: Opportunity to do a lot of clinical management with patients

History of Interventional Radiology Angioplasty and stent were first used to treat peripheral vascular disease to avoid amputation of gangrene foot. Charles Dotter, MD - the “father of interventional radiology” was nominated for the Nobel Prize in medicine in 1978.

Educational Materials “Common Terms” fact sheet Patient brochures Web site - –disease information –symptoms –treatments –research –find a local IR

Common Conditions Interventional Radiologists Treat

Deep Vein Thrombosis

Liver Cancer

Osteoporosis

Peripheral Arterial Disease

Stroke

Uterine Fibroid Embolization

Varicose Veins

Vascular Experts IRs use your arteries and veins like roads to deliver treatments throughout your body If blood flows there (except heart) they treat it

Arteries and Veins Arteries - take oxygenated blood from heart to all points of your body Veins - return blood back to heart for more oxygen

Uterine Fibroid Embolization Uterine fibroids are very common noncancerous growths in the uterus % of women 35 and older have uterine fibroids of a significant size. Of the 600,000 hysterectomies performed annually in the U.S., 1/3 are due to fibroids.

Uterine Fibroid Embolization Only 10-20% of women who have fibroids require treatments Symptoms include heavy, prolonged menstrual periods that can lead to anemia Pain - pelvic, back, legs, sex Enlarged abdomen - like a pregnancy Constipation and urinary frequency

Uterine Fibroid Embolization Rather than a hysterectomy... –patients are sedated (dream-like state) –1/4” nick in the skin so catheter can enter femoral artery –using real-time imaging tiny particles (size of sand) are placed in the artery that supplies blood to the fibroid –Without food (blood) fibroid shrinks and dies, and symptoms subside

Uterine Fibroid Embolization The procedure…

Uterine Fibroid Embolization Embolization (blocking blood) has been used to treat tumors since Embolization to treat uterine fibroids has been since The particles are FDA approved for uterine fibroid embolization.

Uterine Fibroid Embolization Recovery –Typically 1 night in the hospital –Back to normal activities in 7-10 days –On average 85-90% of women who have UFE experience significant or total relief of heavy bleeding, pain, and/or bulk-related symptoms

Cancer Cancer is a disease that utilizes the body’s vascular system to move and grow. Interventional radiologists use these same vascular system to deliver isolated cancer killing treatments that have little to effect on other parts of the body (unlike systemic chemotherapy).

Cancer Recently, several devices have become small enough for interventional radiologists to be able to apply them to treating cancer, including: –bone –breast –kidney –liver –lung

Cancer Bone Cancer (metastases) –3rd most common location where cancer spreads –100,000 cases of bone metastasis reported each year in the U.S. –Cancer cells get in the blood stream, reach the bone marrow and multiply, then grow new blood vessels to obtain food and oxygen--causing cancer to spread.

Cancer Bone Cancer (metastases) –Very painful because the tumor eats away at the bone creating holes that make the bone thin and weak. –As bones are replaced with tumors, nerve endings in and around the bone send pain signals to the brain –Left untreated, bone tumors can result in fractures and affect ones quality of life

Cancer Bone Cancer (metastases) –IRs offer nonsurgical treatments –For the most part, the goal of treating bone tumors is not curative but rather palliative reduce pain prevent additional bone destruction improve function

Cancer Breast Cancer –A woman is diagnosed with breast cancer every 3 minutes and one woman will die from disease every 13 minutes –In the U.S. a woman has a 13% lifetime risk of developing breast cancer –Women 50+ account for about 80% of all breast cancers –Between 40 and 50 the incidence doubles, by 70 it doubles again

Cancer Breast Cancer –Surgery offers the best chance for a cure –Until long-term data are available, interventional treatments are reserved for women who cannot or do not want surgery

Cancer Liver Cancer –14,000 cases of primary liver cancer are diagnosed each year (HCC is most common type) –Due to the increase of hepatitis C, the incidence of HCC is on the rise –Patients with other cancers are at risk in liver since it serves as a way-station for cancer cells that circulate through the bloodstream

Cancer Liver Cancer –Surgical removal of liver tumors offers the best chance for a cure –Unfortunately, liver tumors are often inoperable because it may be too large or has grown into major blood vessels or other vital organs –Surgical removal is not possible for more than 75% with primary and 90% with secondary (metastases)liver cancer

Cancer Lung Cancer –The lung is the most common site for primary cancer worldwide and smoking is the leading risk factor –13% of all new cancers are in the lung –More than 160,00 Americans will die from lung cancer –More American die from lung cancer than from breast, prostrate and colorectal cancers combined

Cancer Treatments –Interventional radiologists can deliver treatments for cancer directly to the cancer without significant side effects or damage to nearby normal tissue –Most IR treatments can be performed along with other treatments and repeated –According to National Cancer Institute, “targeted therapies will give doctors a better way to tailor cancer treatment”

Cancer Treatments –Interventional radiologists can deliver treatments for cancer directly to the cancer without significant side effects or damage to nearby normal tissue

Cancer Radiofrequency Ablation (RFA) –Using imaging, an interventional radiologists guides a small needle into the tumor –From the tip of the needle, radiofrequency energy is transmitted into the targeted tissue, where it produces heat and kills the tumor

Cancer Radiofrequency Ablation (RFA)

Cancer

Cancer –Nonsurgical, localized treatment that kills the targeted tissue with heat, while sparing the health tissue –Nonsystemic side effects –Doesn’t affect patient’s overall health –Return to usual activi

Cancer Chemoembolization –Delivers a high dose of cancer-killing drugs directly to the tumor while depriving the tumor of its blood supply by blocking (embolizing) the arteries feeding the tumor

Cancer Chemoembolization –Using imaging, a catheter is fed through the femoral artery to the blood vessels feeding the tumor

Cancer Chemoembolization –A high dose of chemotherapy is delivered into the tumor and then little particles block the blood vessel to keep drugs in and blood (food) out

Cancer Chemoembolization –The drugs and lack of food cause the tumor to shrink

Cancer Additional cancer treatments –Cryoablation “ice ball” –Yttrium-90 Radioembolization –Vertebroplasty

Vertebroplasty –An interventional radiologists inserts a needle through a knick in the skin, directing it using flouroscopy (continuous, moving X-ray “movies”) –The needle is inserted into the fractured vertebra and medical-grade bone cement is injected –The cement hardens within 15 minutes and stabalizes the fracture, like an internal cast

Vertebroplasty –Used to treat osteoporosis patients in pain and cancer patients

Stroke –Stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is blocked by a clot or bursts, causing the brain to starve. –If deprived of oxygen for even a short period of time, the brain nerve cells will start to die. –Ischemic (is-KEM-ik) –Hemorrhagic (hem-o-RAJ-ik)

Stroke –Time is brain! –Know the symptoms sudden numbness/weakness of face, arm or leg; especially in one side of the body sudden confusion, trouble speaking sudden trouble seeing in one or both eyes sudden trouble walking, dizziness, loss of balance sudden severe headache with no know cause

Stroke –Every 45 seconds someone in the U.S. has a stroke –26% of strokes occur in people under the age of 65 –35% of people who experience a TIA (transient ischemic attack), or mini-stroke, will have a full-blown stroke if left untreated –Stroke is the 3rd leading cause of death in the U.S. behind high blood pressure and cancer

Stroke –Preventing Stroke treating “hardening of the arteries” in the carotid artery in the neck with stenting FDA approved for high-risk patients

Stroke –Treating Stroke IV treatment Catheter delivered “clot- busting drugs” tPA up to 6 hours from symptom onset

And Much More... –Varicose Vein treatment for vein reflux –Old “stripping” had metal rod inserted into leg, vein tied to it and pulled out –New laser treatment is done in 30 minutes

And Much More... –Treating male infertility due to varicoceles with coils—not surgery –Approximately 10% of all men have varicoceles –Infertile couples, the incidence increases to 30%

And Much More... –Abdominal aortic aneurysms (AAA) –A weakened area in the main vessel that supplies blood from the heart to the entire body –80 to 90% of ruptures = death

And Much More... –Pediatrics … many of the same procedures can be performed on children

Patient Tips –Take charge of your personal health –Doctors work for you –Participate in the process -- ask questions –No one care more about your health than you -- be picky and diligent! –Know your options … the more informed you are the better decisions you make

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