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INTERVENTIONAL RADIOLOGY AS MINIMALLY INVASIVE PROCEDURES Radka Slipac

INTERVENTIONAL RADIOLOGY AS MINIMALLY INVASIVE PROCEDURES Radka Slipac Department of Radiology Brno, Czech Republic. What is Interventional Radiology?. Interventional radiology procedures are minimally invasive , targeted treatments.

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INTERVENTIONAL RADIOLOGY AS MINIMALLY INVASIVE PROCEDURES Radka Slipac

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  1. INTERVENTIONAL RADIOLOGY AS MINIMALLY INVASIVE PROCEDURES Radka Slipac Department of Radiology Brno, Czech Republic

  2. What is Interventional Radiology? • Interventional radiology procedures are minimally invasive, targeted treatments. • Interventional radiologists use imaging equipments such as X-rays, ultrasound, CT and MRI to guide small instruments such as catheters or wires through the blood vessels or other pathways to treat as well as diagnose diseases percutaneously.

  3. What are the Advantages of Interventional Radiology? • Interventional radiology procedures are generally easierfor the patient because: • no general anesthesia • no large incisions • outpatient basis • less risk • less pain • less blood loss • less recovery times • less expensive

  4. What Procedures do Interventional Radiologist Perform? • Balloon angioplasty • Biliary drainage and stenting • Chemoembolization • Embolization • Radiofrequency ablation (RFA) • Stenting • Stent-graft • Thrombolysis • TIPS (transjugular intrahepatic portosystemic shunt) • Cryotherapy • Blood clot filters

  5. CHEMOEMBOLIZATION • Used mostly to treat primary livercancers and metastases of the liver. In about two-third of cases the tumors are stoppedor shrunk. • Using this unique principle: • The liver receives about 85% of its blood supply through the portal vein and only 15% through the hepatic artery. • But the tumor receives almost all of its supply from the hepatic artery.

  6. How Does Chemoembolization Work? • Attacks the cancer in two ways: • very high concentration of chemotherapy in the tumor is achieved by direct delivery through the hepatic artery, sparing most of the healthy liver tissue • ischaemia of the tumor is caused by embolization of nourishing artery with embolic particles • This treatmentpreserves liver function and relatively normal quality of life.

  7. Superselective Chemoembolization of a Sole Liver Metastasis

  8. Chemoembolization of LiverMetastases of Gastric Cancer 1. before TCE 2. regression after 6 months 3. stabilized after 9 months

  9. EMBOLIZATION • Highly effective way of controlling bleedingfrom injury, esp. in abdomen or pelvis, or stomach ulcer, in an emergency situation. • Worldwide succesful treatment of uterine fibroids with reduced menstrual bleeding, pelvic pain and other complaints as an alternative to the surgical removal of the uterus. • Effective treatment of tumors that either cannot be removed surgically or would involve great risk of surgery.

  10. How Does Embolization Work? • Delivery of clotting agents directly to a bleeding or problematic area. • Temporary embolic agents such as Gelfoam (a gelatin sponge material) block vessels for enough time (days to weeks) for the body to heal the problem causing the bleeding, f.e. injury or gastric ulcer. • Permanent embolic agents such as Polyvinyl alcohol (PVA) occlude vessels parmanently, f.e. are used to embolize uterine fibroid tumors.

  11. Bleeding from a Stomach Ulcer Selective arteriography Stopped after of left gastric artery Gelfoam embolization

  12. Bleeding from Jejunum Arteriography of superior Stopped after superselective mesenteric artery metal coils embolization

  13. Uterine Fibroid Embolization Angiography of right uterine artery and embolization MRI of uterine fibroid visible before and invisible 6 months after embolization

  14. AORTIC STENTGRAFTS • Endovascular repair of abdominal aorta aneurysm (AAA) with a fabric-wrapped flexible mesh tube. • Prevention of enlargement or life-threatening rupture of AAA. • Less invasive, less blood loss, effective and safe alternative especially for patients with great risk of surgery.

  15. How Does Aortic Stentgrafts Work? • An appropriate type of self-expanding stentgraft is inserted through the femoral artery and placed at the site of the aneurysm of abdominal aorta. • Stentgraft bridges the aneurysm inside and eliminates the blood flow in aneurysmal sac. • Reduction of the aneurysmal sacand decrease of the pressure on the aortic wall as an effective prevention of rupture.

  16. Various Aortic Stentgrafts

  17. Aortic Stentgrafts

  18. Subrenal Abdominal Aortic Aneurysm Angiography before and after implantation of stentgraft

  19. Implantation of Bifurcated Aortic Stentgraft Aortography before CT after 6 months CT after one year

  20. CONCLUSIONS Interventional radiology procedures are an advance in medicine that often replace open surgical procedures. These minimally invasive procedures involve less blood loss and thus play an important role in bloodless medicine.

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