I am Dr. Kiran V Naiknaware, So I will be speaking about the branch interventional radiology. This is an upcoming branch, one of the oldest branch which is there in the medicine since long. Charles Dotter is considered as the father of vascular and interventional radiology. He pioneered the branch of interventional radiology and basically we are radiologists who do super-specialization in vascular and interventional radiology, which is diagnostic as well as therapeutic branch. We mainly deal with vessels and our primary work is endovascular. On the other hand, the other branches like vascular surgery, gastroenterology, neurology, neurosurgery, gynaecology, general medicine these branches are the primary branches which deal with patients. Interventional radiology is the new branch which also deals directly with patients. I will be talking about different aspects of interventional radiology and their role in current day-to-day medical practice.
For example, a patient who is having cancer the initial diagnosis is done by biopsy so we also do the image guided biopsies. We are specialists in that ultrasound guided biopsy, CT scan guided biopsy, fluoro guided biopsy, these are the basic procedures that we do and you can also consider this the bread and butter of the interventional radiologist. Also, ultrasound guided process like thyroid efficacy, doing radio frequency ablation of liver, thyroid and other malignancies, these procedures can also be done by interventional radiologists. Coming to the endovascular work like peripheral angioplasty, carotid angioplasty, visceral angioplasty, stent placement, intracranial angioplasties as well as aneurysm coiling, AVM embolisation, these are the endovascular procedures done by the interventional radiologists.
There are multiple applications in gynaecology, one of which is fibroid embolization, every 7th woman harbours a fibroid after the age of 40 years and sometimes these fibroid are painful they can cause menorrhagia i.e. bleeding and this can be very well treated by embolisation, so basically we go from the femoral artery or the radial artery we go into the uterine arteries which supply the fibroid and we go inside and we do the embolisation, So this reduces the size of the fibroid tumor and eventually they vanish.
Another application I would like to particularly emphasize upon this is TIPS (Transjugular intrahepatic portosystemic shunt). Patients who are having liver disease, liver failure, liver cirrhosis with portal hypertension causing refractory ascites, refractory hydrothorax, hepatorenal syndrome, GI bleed, these patients they have portal hypertension and just because of liver failure the blood which comes to liver is turned back into the venous circulation and that causes all these symptoms like tense ascites, which is one of the most common symptoms.
So in TIPS, we go from jugular venous access, we go across the liver from IVC or hepatic veins, we go into the portal vein and we create a shunt between the portal vein and hepatic veins or IVC, so this causes diversion of blood flow from the portal vein into the systemic circulation so this is called as Transjugular intrahepatic portosystemic shunt. This procedure is mainly used a bail-out option in patients who are having GI bleed refractory to medical management, refractory to endoscopic management and also the patients who are on the waiting list for liver transplant, this is used as an alternative or breach to the liver transplant therapy. There was a study which was published many patients who are undergone TIPS prior to liver transplant, they did not need a liver transplant.
Coming to the other indications which are commonly practice is Diabetic foot, the patients who are having diabetes they have diabetic vasculopathy i.e. arteriopathy and microvascular disease which causes arterial blockage and which leads to arterial thrombosis and finally gangrene. So patients can have toe gangrene, foot gangrene, leg gangrene and it can be sometimes very dangerous for which we need an amputation. So what we do is, we go inside the vessels, we open up the blocked vessels we channelize the flow to the foot so that won’t seal and gangrene is prevented or if there is setting up of gangrene which can be very well managed by endovascular treatment.
There are other procedures which are also included in interventional radiology for example patients who are having acute deep vein thrombosis, these patients present to us with limbs swellings, swelling in the legs and these swelling causes tenderness, redness, blackness in the leg. They are very painful sometimes so what we do if the patient presents in the acute period we go inside the deep venous system we suck out the entire thrombus. We have new thrombectomy devices which are available like AngioJet which is one of the thrombolytic plus mechanical aspiration devices. Another one is Indigo which is available for peripheral devices. These devices can also be used for pulmonary arterial aspiration. Patients who are having a severe, massive pulmonary embolism, not responding to medical management and refractory to IV thrombolysis, patients who are having hypotension, right ventricular failure cor pulmonale and patients who are having severe respiratory distress.
Now coming to the varicose vein, varicose vein is the most common disease which is seen in population more than 50 years, one-third of the population suffers from varicose veins, varicose veins are nothing but dilatation of superficial venous system of the leg. In leg we have the deep venous system and superficial venous system, the deep venous system is bigger pipe located deeper inside the tissue structure and it is the main channel which takes blood away from the legs into the pulmonary circulation. Superficial venous system is superficial channel located beneath the skin, they communicate with the deep channels at multiple levels, the major site of communication is groin and in the upper calf region or back of the knee i.e. popliteal fossa.
Varicose veins have multiple reasons why they developed, one can be hereditary, weight gain then jobs which require standing for longer duration, these are the possible reasons for the development of varicose veins, so the patients who are having varicose veins generally presents with pain, swelling, edema, torn limb, tightness, color change, skin changes and also they can have ulcers which are healed regularly or they may not heal for longer duration, there are also skin changes, blackening and itching so varicose veins can be traditionally treated by surgery i.e. ligation varicose vein stripping.
Nowadays, a newer modality is available which is also called as varicose vein laser treatment or radiofrequency ablation treatment. In this laser treatment what we do is we with the help of small needle and a laser fiber with the 1417 nm laser which is the latest one, we go inside the vein and we burn the entire area. In surgery, we remove the diseased veins or phlebectomy compared to surgery laser has a better outcome, the pain is less in laser surgery, laser surgery is safer, does not require any major anesthesia like spinal anesthesia, it can be done under local or regional anesthesia.
Laser has advantages that it is a daycare procedure, patient comes walking and goes walking, patient can come in the morning and can go home in the evening, the patient can walk around. While open surgery has a success rate of 60% to 70%. laser has success rate of 90 to 95%, yes 5% failure rate is there because of the development of new venous collateral vessels or the vessels which are initially normal they get hypertrophied and they are the reason for the development of new varicose veins, so if you consider the safety, efficiency and profile of varicose vein laser treatment is far better than the open surgical treatment, the only difference between open surgery and laser is cost difference i.e. cost of the laser fiber and laser machine is higher than the open surgery.