Interventional Radiologists- Where will they go next?

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Interventional Radiologists-Where will they go
next?

• Dr Simon Travis
• MB ChB FRCR
• Vascular/Interventional Radiologist
• Nottingham University Hospitals

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What is an Interventional Radiologist?
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Global Statement Defining Interventional
Radiology J Vasc Interv Radiol 2010
2111471149 1. Expertise in diagnostic imaging
and radiation safety. 2. Expertise in
image-guided minimally invasive procedures and
techniques as applied to multiple diseases and
organs. 3. Expertise in the evaluation and
management of patients suitable for the
image-guided interventions included in the scope
of IR practice. 4. Continual invention and
innovation of new techniques, devices, and
procedures.
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History

• 1964 Angioplasty
• 1966 Embolization therapy to treat tumors and
  spinal cord vascular malformations by blocking
  the blood flow
• 1967 The Judkins technique of coronary
  angiography, the technique still most widely used
  around the world today
• 1967 Closure of the patent ductus arteriosis, a
  heart defect in newborns of a vascular opening
  between the pulmonary artery and the aorta
• 1967 Selective vasoconstriction infusions for
  hemorrhage, now commonly used for bleeding
  ulcers, GI bleeding and arterial bleeding
• 1969 The catheter-delivered stenting technique
  and prototype stent
• 1960-74 Tools for interventions such as
  heparinized guidewires, contrast injector,
  disposable catheter needles and see-through film
  changer
• 1970s Percutaneous removal of common bile duct
  stones
• 1970s Occlusive coils
• 1972 Selective arterial embolization for GI
  bleeding, which was adapted to treat massive
  bleeding in other arteries in the body and to
  block blood supply to tumors

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• 1973 Embolization for pelvic trauma
• 1974 Selective arterial thrombolysis for arterial
  occlusions, now used to treat blood clots,
  stroke, DVT, etc.
• 1974 Transhepatic embolization for variceal
  bleeding
• 1977-78 Embolization technique for pulmonary
  arteriovenous malformations and varicoceles
• 1977-83 Bland- and chemo-embolization for
  treatment of hepatocellular cancer and
  disseminated liver metastases
• 1980 Cryoablation to freeze liver tumors
• 1980 Development of special tools and devices for
  biliary manipulation
• 1980s Biliary stents to allow bile to flow from
  the liver saving patients from biliary bypass
  surgery
• 1981 Embolization technique for spleen trauma
• 1982 TIPS (transjugular intrahepatic
  portosystemic shunt) to improve blood flow in
  damaged livers from conditions such as cirrhosis
  and hepatitis C

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• 1985 Self-expanding stents
• 1990 Percutaneous extraction of gallbladder
  stones
• 1990 Radiofrequency ablation (RFA) technique for
  liver tumors
• 1990s Treatment of bone and kidney tumors by
  embolization
• 1990s RFA for soft tissue tumors, i.e., bone,
  breast, kidney, lung and liver cancer
• 1991 Abdominal aortic stent grafts
• 1994 The balloon-expandable coronary stent used
  today
• 1997 Intra-arterial delivery of tumor-killing
  viruses and gene therapy vectors to the liver
• 1999 Percutaneous delivery of pancreatic islet
  cells to the liver for transplantation to treat
  diabetes
• 1999 Developed the endovenous laser ablation
  procedure to treat varicose veins and venous
  disease

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Why Interventional Radiology

• Shorter Hospital Stays
• Money Saving
• Reduction in Transfusion Requirements
• Better QoL for patients
• Faster Recovery
• High Intensity Localised treatments

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Whats Our Role in Chronic Care?Vascular

• Treatment of Ischaemic limbs
• Diabetic foot ulcers
• Management of Aneurysms of the Aorta and Visceral
  vessels
• Vascular Access Management for Renal Replacement
  Therapy
• Varicose Vein Ablation
• Renal Artery Disease
• AVM management

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Oncology

• Vascular Access (ports and lines)
• Image Guided Biopsy
• Tumour Ablation
• RF
• Cryo
• Microwave
• Focused U/S
• Tumour Embolisation with Chemotherapy
• SVC Stenting for SVCO
• Portal Vein Embolisation Prior to Hepatic
  Resection

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Gastrointestinal

• Percutaneous Bile Duct Management
• Colonic Stenting as a Bridge to Surgery (CREST
  trial)
• Oesophageal Stenting
• Gastrostomy Insertion
• TIPSS for Ascites Control in Hepatic Cirrhosis

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Other Conditions

• Uterine Fibroid Embolisation for Symptom Relief
• Vertebroplasty for Pain Relief
• Tunnelled Pleural and Ascitic Drains

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Whats Our Role in Acute Medical Care?

• Control of Haemorrhage
• Uterine Postpartum (Health Commission report on
  Northwick Park)
• Acute Aneurysm Rupture
• Acute Aortic Dissection
• Post Traumatic Vascular and Visceral Injury
• GI Haemorrhage
• Acutely Ischaemic Limbs
• DVT and PE management
• Emergency Venous Access in Dialysis Patients

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Whats New?

• Renal Artery Denervation for Difficult to Control
  Hypertension
• Prostate Embolisation
• Desolving Stents

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Renal Artery Denervation

• Transarterial Catheter directed RF Ablation of
  Renal Sympathetic Nerves
• Good results from proof of principal cohort study
  (45 patients with drug resistant hypertension)

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Prostate Embolisation for BPH

• Injection of micro particles (100-200 micron)
  into the prostatic arteries to shrink the organ
• Promising results in animal and human studies
• Day case procedure with the potential for a
  return towards normal micturition with out
  medication (better QoL and cost saving)

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How Will We Affect Health Care in The Future

• Save Money
• Reduced Bed stays
• Reduced Transfusion Requirements
• More Rapid Patient Recovery
• More Rapid Return to Normal Life/Work
• Improve QoL for Patients
• More Procedures by the month
• Better Cancer Outcomes

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Interventional Radiology

• Has been recognised as a distinct subspeciality
  by the Royal Colleges
• We now have our own training program
• We have our own syllabus
• 3 years of Radiology Training followed by 3 years
  of Interventional Training

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Finally
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Train Patients to do Their Own Procedures?
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