Interventional Radiology

What is Interventional Radiology?

In Germany and Switzerland, radiology is not just a purely imaging medical specialty. In addition to the specific non-invasive areas of sonography (ultrasound), X-rays, computed tomography, and magnetic resonance imaging, which are used to diagnose a wide variety of diseases, radiology is also involved various minimally invasive interventions within a therapeutic framework. This branch of diagnostic radiology is called interventional radiology.

The invention of balloon dilatation in 1972 and later of vasodilating stents led to using this radiological imaging, where X-rays were taken during minor surgeries. A narrowed area in the vascular system was dilated with a small inflatable balloon at the end of a wire inserted into the vessel. The X-ray image could monitor the balloon's correct position and the location of the treatment.

Fields of Application and Treatment Methods of Interventional Radiology

Several other procedures have been developed over the years, which can be carried out as minimally invasive, quick, and well-tolerated with modern imaging technology and have led to the broad spectrum of interventional radiology today.

These include interventions on the vascular system (in the area of the veins and arteries) and treatments of various diseases of the bile duct system and numerous tumor diseases.

Arteriosclerosis

Angioplasty is one of the most common applications: the dilation, as mentioned above, of narrowed vascular sites with a balloon's help. The cause of vascular constrictions is usually arteriosclerosis.

Thrombosis

Interventional radiology is also used for treating blood clots (thrombi). The radiologist can dissolve a fresh blood clot by injecting certain drugs locally (local intra-arterial fibrinolysis). Another option for slightly older thrombi is the mechanical destruction and suction of the blood clot (percutaneous aspiration thrombectomy).

Stents and Vena Cava Filters

It is also possible to insert various therapeutic aids into the vascular system. These include vascular endoprostheses (stents) or so-called vena cava filters, a small shield inserted into the vena cava to prevent parts of detached blood clots from the lower extremities reaching the brain.

The treatment of vascular malformations, such as vascular wall bulges in the brain, is another form of interventional radiology. By releasing coagulants locally, close vascular wall bulges, and avoid the risk of bleeding.

Embolization

Supplying vessels of benign and malignant tumors can be closed by embolization in the same way. Besides, the vessels of liver tumors can be located via vascular access under X-ray monitoring. After injecting a chemotherapeutic agent locally, the vessels are closed (chemoembolization). The chemotherapy drug remains in the tumor and can damage it as much as possible. The forms and areas of application of embolization are

- Myoma embolization

- Transpulmonary chemoembolization (TBCE)

- Transarterial chemoembolization (TACE)

Biopsies, Drainages and Feeding Tubes (PEG)

With the help of interventional radiology, the radiologist can also take targeted tissue samples (biopsies), lay drainages (small tubes) through which inflammatory secretions or blood can drain from the body, apply painkillers in the area of specific nerves, or place feeding tubes in the stomach or intestine. All this is done under image-based monitoring (MRT, computer tomography, or ultrasound).

Side Effects and Risks of Interventional Radiology

As with any invasive treatment, even if it is minimally invasive, the procedure of interventional radiology can result in injuries to surrounding structures. These risks vary depending on the treatment and can range from bleeding, tearing of blood vessels, damage to nerves, blood clot formation, to the need for major surgery if the injury cannot be treated in a minimally invasive way.

However, the risk of such injuries is minimal. After all, the simultaneous use of imaging techniques is intended to monitor the optimal fit and location of instruments and treatment and prevent accidental damage to other structures.

Advantages of Interventional Radiology

Interventional radiology enables essential and sometimes life-saving measures, being as non-invasive as possible, short duration, and minimal stress for the patient. This type of therapy is also possible in cases of poorer general conditions or advanced age. It involves far fewer risks than open surgery and leads to a quick recovery.

If you have any further questions regarding the possibilities of interventional radiology, or if you would like to be informed about the exact risks of the treatment or treatment alternatives specifically for your disease, please contact your treating radiologist confidently.

Sources:

www.medizin-mit-durchblick.de

Vogl, Thomas J.; Rummeny, Ernst J.; Reith, Wolfgang; Balzer, J. O. (2011): Diagnostic and Interventional Radiology. Berlin: Springer.

Reiser, Maximilian; Kuhn, Fritz-Peter; Debus, Jürgen (2011): Radiology. 3rd, fully revised and acquired edition Stuttgart: Thieme (dual series).

Kauffmann, Günter Werner; Moser, Ernst (2011): Radiology. Imaging techniques, radiotherapy, nuclear medicine and radiation protection. 4th, completely revised edition. Munich: Elsevier, Urban & Fischer.