FM JANUARY 2019 - digital edition

when catheters were the mainstay of
interventional procedures, IRs currently
employ a variety of devices and
techniques to tackle complex anatomies
like the brain. IR itself is getting further
diversified into subspecialties focusing
on areas like the brain or abdomen
exclusively.
IR, presently, allows procedures
including angioplasty, endovascular
aneurysm repair, embolisations,
ablations, biliary intervention,
placement of central venous catheters,
nephrostomy, pleural aspiration and
vertebroplasty. The list of indications
is likely to expand with advances in
technology.
In situations where a patient is
contraindicated for a surgical procedure
due to a highly complicated condition,
the intervention by an IR can often make
a dramatic difference.
Even though percutaneous
interventions usually represent a safer
approach compared with traditional
surgical alternatives, IR procedures
can lead to iatrogenic interventional
complications. Inadvertent injury to
blood vessels represents one of the
most common among them. Such
complications can range from minor to
catastrophic.
Biopsy to
diagnose cancer
• Angioplasty and stent
insertion
• Ascitic tap
• Biliary drainage
• Bursal injection
• Carotid stenting
• Carpal tunnel ultrasound
and injection
• Image-guided cervical
nerve root sleeve
corticosteroid injection
• Image-guided liver biopsy
• Image-guided lumbar
epidural corticosteroid
COMMON IR PROCEDURES
Treatment of
Primary Tumors
injection
• Image-guided lumbar
nerve root sleeve injection
• Nephrostomy
• Pleural aspiration
• Radiofrequency ablation
• Radioembolisation
• Cryoablation
• Joint injection
• Thyroid fine needle
aspiration (FNA)
• Inferior vena cava filters
• Uterine fibroid
embolisation
Treatment of
symptoms such as
pain, infection of
swelling caused from
spread of cancer
Placement of devices
such as catheters,
feeding tubes and
ports to deliver
medications
• Varicose vein ablation
• Vascular closure devices
• Venous access
• Vertebroplasty
• Subarachnoid
hemorrhage vasospasm
endovascular treatment
• Selective internal radiation
therapy (SIRT)
• Spinal cord embolisation
(AVM/DAVF)
• Transarterial
chemoembolisation (TACE)
ABLATING
UNRESECTABLE
TUMOURS
RFA is more effective than any
other modality for
unresectable liver cancer
Radio Frequency Ablation (RFA)
has been found highly useful in
liver tumours. With the help of this
outpatient procedure, clinicians can
change the inoperable status of a
patient to operable in many cases.
Its effectiveness, however, greatly
depends upon the size of the growth.
“The size of the liver tumour is an
important determining criterion as far
the outcome of RFA is concerned,’’
said Dr S Kalpana, Professor at Barnard
Institute of Radiology, Chennai, making
a presentation titled “RFA for Liver
Tumours” at the recent TNPY IRIA,
at Chennai. According to her, RFA is
a safe, cost-effective and promising
option for recurrent, unresectable
hepatocellular carcinoma (HCC). The
procedure is more effective than other
modalities in HCC.
Microwave tumour ablation
provides a potentially curative
treatment option for various
neoplasms. Tried and tested for over
15 years, the safety and efficacy of
colorectal liver metastasis (CRLM)
ablation has been demonstrated in
52 / FUTURE MEDICINE / JANUARY 2019