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

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

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

4. Computed tomography
X-ray images
Bullet
Bleeding
Unborn
Fracture

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

6. Magnetic Resonance Imaging

7. Ultrasonography (ultrasound)
unborn
gallbladder

8. 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

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

10. 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

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

12. IR knowledge – pathology (disease) Arteries Veins Bile ducts

13. IR knowledge Materials Methods How to do it
Catheter
Stent

14. 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

15. 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

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

17. 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)

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

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

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

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

22. 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)

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

24. 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)

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

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

27. 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)

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

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

30. And much, much more…...

31. THANK YOU!