What is interventional radiology?
Interventional radiology utilizes x-rays, ultrasound, CT, or other medical imaging guidance to perform minimally invasive procedures that formerly required larger surgical incisions and long recovery times. Interventional radiology, in contrast, offers an alternative to the surgical treatment of many conditions and can eliminate the need for hospitalization in most cases.
Uterine Artery Fibroid Embolization
A common type of interventional radiology procedure, termed angiography, studies the blood vessels in the body in exquisite detail. Angiograms are performed by injecting an iodinated x-ray dye into the blood vessel of interest, and acquiring rapid sequential x-ray images. Among the procedures performed by an interventional radiologist are: cerebral angiography (brain), aortic angiography, visceral angiography (liver, spleen, kidney, stomach, intestine), extremity angiography, and pulmonary angiography (lung). This can often reveal the cause of blockage, bleeding, or swelling, and can be valuable in the evaluation of certain tumors. When appropriate, interventional radiologists may treat blood vessel disease with angioplasty or endovascular stent placement.
Interventional radiology also involves the percutaneous diagnostic evaluation and treatment of tumors, abnormal fluid collections, hemodynamic disorders, and acute vertebral compression fractures. Pain management is another arena where imaging-guidance is critical, facilitating selective nerve root block injections, epidural steroid injections, sacro-iliac joint injections, and intra-articular steroid joint injections in patients with chronic, unrelenting pain.
What are the advantages of interventional radiology?
- Most procedures can be performed on an outpatient basis or require only a short hospital stay.
- General anesthesia usually is not required.
- Risk, pain, and recovery time are usually significantly reduced.
- The procedures are often less expensive than surgery or other alternatives.
One of the most common interventional radiology procedures performed to diagnose or exclude cancer is imaging-guided biopsy.
Under fluoroscopic, CT, or ultrasound guidance, small needles can be placed in areas of abnormality, and samples can be taken for cytologic or pathologic testing.
With imaging guidance, biopsies of an abnormality can be obtained while important adjacent structures, such as blood vessels or bowel, may be avoided. Often, imaging-guided biopsy is performed instead of a surgical or open biopsy, to spare the patient a much more invasive procedure with its associated inherent risks.
Similar CT biopsy techniques can also be used to access abscess collections and ultimately permit drainage catheter placement.
Uterine artery fibroid embolization (UFE) has received increasing attention in both clinical and research settings as a minimally invasive, non-surgical alternative treatment of symptomatic uterine leiomyomas, or fibroid tumors.
Uterine leiomyomas represent the most common pelvic tumors in women of child-bearing age and older, with an incidence of 20-25%. While many women with fibroids are asymptomatic, uterine leiomyomas may produce a variety of symptoms including pelvic pain, abnormal or dysfunctional menstrual bleeding, urinary frequency, stress incontinence, and other bulk-related symptoms. Symptomatic fibroids account for approximately one third of the estimated 600,000 hysterectomies performed annually in the U.S. alone.
UFE services are available through Advanced Medical Imaging Consultants and performed at Poudre Valley Hospital (Ft. Collins, Colorado), Medical Center of The Rockies (Loveland, Colorado), and McKee Medical Center (Loveland, Colorado), serving patients in Northern and Eastern Colorado, Southern Wyoming, and Southwest Nebraska. The procedure is performed by one of several qualified interventional radiologists each experienced in transcatheter embolization techniques.
Uterine artery embolization has been safely performed for a variety of indications for over 25 years, including postpartum hemorrhage, post-operative hemorrhage, and uterine vascular malformations. Uterine artery embolization for treatment of symptomatic fibroids was first reported as part of a multi-center series in 1992, and several thousand cases have since been reported in the medical literature. 88-94% of patients questioned describe being satisfied with the results of UFE, and 84% would choose the procedure again if symptoms recurred. 88-90% of women with dysfunctional menstrual bleeding secondary to uterine fibroids report significant symptomatic improvement following UFE. Fewer than 10% of patients fail to experience symptom improvement, and an even smaller percentage may ultimately require surgery.
Potential candidates are required to undergo a complete evaluation by a gynecologist prior to consideration of UFE as a treatment option, and a pre-procedure ultrasound or MRI is needed to confirm the diagnosis and monitor treatment outcome. If not under the care of a gynecologist, we can offer referral assistance to a specialist in your community.
The UFE procedure is non-surgical in nature, and does not require general anesthesia, major abdominal or pelvic surgical incisions, or a prolonged recovery time. It generally takes 60-90 minutes to complete, utilizes IV sedation, and requires a 1- or 2-night hospitalization for observation and supportive care prior to discharge. Most patients return to work or other normal activity within 7 days.
If interested in more information regarding UFE, please contact John R. Bodenhamer, M.D., Amy S. Hayes, M.D., or Steven H. Peck, M.D., subspecialty interventional radiologists with Advanced Medical Imaging Consultants.
Pain management procedures, performed by experienced radiologists, are generally prescribed by your doctor when other treatments have not satisfactorily controlled pain. Pain management techniques use imaging guidance and selective needle placement to locally administer one or more potent medications in a specific anatomic location, generally a steroid anti-inflammatory medication and a long-lasting local anesthetic. This is not surgery, and no tissue is removed. These injections may be repeated several times per year if necessary.
Epidural steroid injections represent one of the most common pain management procedures perfomed in both hospitals and outpatient settings. Injections in the lower back (lumbar region) is often useful for pain that radiates from the lower back into one or both legs, caused by disc herniation or spinal stenosis (narrowing around nerves) which triggers nerve root irritation. Other injections can be very useful in the neck (cervical spine), where the symptoms will extend into the neck or arms. Mid-back or thoracic, epidural steroid injections are commonly used to reduce the pain associated with herpes zoster (shingles) infections.
The facet joints of the spine can also cause chronic back pain. Injections into the facet joints or selective blockade of the nerves that go to the facets can often be very helpful as well. This problem is more common in the lumbar spine, but can also occur in the neck.
Discograms (intradiscal injections of contrast under fluoroscopy or CT imaging) can determine if and which disc might be the source of a patient’s pain. Generally, a needle is inserted through the skin and into one or more intervertebral discs under fIuoroscopy. A radiopaque dye is then injected into the disc or discs if more than one disc is being examined. A CT scan is performed in the painful region after the dye is injected to obtain images of the dye distribution within and around the intervertebral disc. This will demonstrate abnormalities of the given disc, including annular tears, disc bulges or herniations, disc scarring , and other changes in the nucleus of the disc. A steroid and long-lasting anesthetic are often injected into the symptomic disc itself at the conclusion of this type of procedure.
Joint injections similarly involve the careful placement of a small needle utilizing x-ray guidance for purposes of injecting a potent anti-inflammatory steroid and long-lasting anesthetic directly into a painful extremity joint, such as the hip, shoulder, or knee.
Patients with osteoporosis and severe back pain from a vertebral body compression fracture can significantly benefit from Kyphoplasty. During this procedure, an interventional Radiologist slowly injects cement into a fractured vertebrae while the patient is under general anesthesia. The cement stabilizes the fracture and relieves or reduces pain in 75 – 90% of all patients treated – usually within 24-48 hours.