Interventional Radiology (IR) - what is that? Wojciech Ćwikiel MD

Radiology is a medical specialty there imaging methods are used to diagnose and treat diseases seen within the body

Imaging methods used in radiology: - X-ray images computer tomography (CT) magnetic resonance imaging (MRI) ultrasonography (USG) other (e.g. nuclear medical imaging)

Computed tomography X-ray images Bullet Bleeding Unborn Fracture

X-ray – angiography = examination of vessels (veins and arteries) Lungs

Magnetic Resonance Imaging

Ultrasonography (ultrasound) unborn gallbladder

Medical intervention surgical endoscopic (through the tube) - open - e.g. take out part of the bowel - laparoscopy (keyhole surgery) – e.g. take out gallbladder endoscopic (through the tube) e. g. removal of a polyp from lumen of the bowel radiologic e. g. insertion of drain to the kidney e. g. closure of the artery to stop bleeding

Interventional radiology (IR) interventional procedures performed inside the body using percutaneous (puncture through the skin) techniques under imaging guidance

Why IR procedure? minimal invasive treatment of disease or symptoms short recovery time results superior/compatible to other methods fewer complications new treatment methods possibility of repeated treatment

IR knowledge – anatomy (e.g.): Arteries Veins Bile ducts

IR knowledge – pathology (disease) Arteries Veins Bile ducts

IR knowledge Materials Methods How to do it Catheter Stent

IR procedure Puncture with a needle through the skin of (e.g.): vessel (vein or artery) bile duct kidney fluid collection Procedures are done through the puncture channel

Drainage tube placement To drain out e.g. infected fluid collections To take out fluid for examination To create communication between two cavities in the body

Treatment or …? Drainage Pus collection in the liver Puncture with a needle Draining tube in place

Interventions in the artery To reopen arteries closed by the disease To close (embolize) arteries to the tumor, bleeding etc. Treatment of abnormal arteries (e.g. malformations)

Arterial intervention artery closed by cloth (before treatment) artery reopen (after treatment)

Stent tube of metal mesh, which may be placed through a small catheter in the artery, vein, bile duct etc. to keep it open

Treatment or …? Stent-treatment of arterial narrowing Stent Narrowing

Treatment of bleeding (coil through catheter) Bleeding from ruptured spleen Bleeding stopped

Interventions in veins Occlusive disease (stop in vein) - thrombosis (cloth) – fragmentation, removal, filter placement to prevent cloth migration - narrowing/stop (dilation, stent) Venous insufficiency (varices) - laser treatment - injection of sclerosing agent (to cause cloth formation)

Venous thrombosis (cloth in the vein) Cloth catched in filter placed to prevent migration to the lungs Cloth (thrombus) in the leg

Interventions in the bile ducts Occlusive disease (stop in bile duct) - stone removal - drainage through the catheter (tube) - recanalization (opening of the close bile duct) - stent placement Gallbladder - drainage catheter placement (to drain out infected bile)

Bile duct opening with stent Bile ducts closed by tumor Bile ducts reopen with the multiple stents

Bile duct stone removal Big stone in bile duct Big stone in the basket Stone crushed

IR in liver cirrhosis Symptoms - bleeding from varices in esophagus/stomach ascites (abnormal fluid in the belly) IR treatment Embolization (closure of varices) TIPS (new blood channel through the liver)

IR in liver cirrosis - TIPS Puncture through the liver Stent in channel through the liver

IR in liver cirrosis - TIPS Varicose veins, bleeding Flow to the heart through the TIPS

And much, much more…...

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