Basic presentation I gave to new nursing grads, 9/10.

1. Arun Jagannathan MD
Vascular and Interventional Radiology
Central Illinois Radiological Associates
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2. What is an Interventional
Radiologist?
Interventional radiologists are board-certified
physicians who specialize in minimally invasive,
targeted treatments
Training
Undergraduate 4 yrs
Medical School 4 yrs
Residency 5 yrs
Fellowship 1 yr
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3. Is this a new specialty?
Interventional radiologists pioneered modern medicine
with the invention of angioplasty and the catheter-
delivered stent, which were first used to treat peripheral
arterial disease. By using a catheter to open the blocked
artery, the procedure allowed an 82-year-old woman, who
refused amputation surgery, to keep her gangrene-ravaged
left foot. To her surgeon’s disbelief, her pain ceased, she
started walking, and three "irreversibly" gangrenous toes
spontaneously sloughed. She left the hospital on her feet
—both of them. Charles Dotter, MD, the interventional
radiologist that pioneered this technique, is known as the
"Father of Interventional Radiology" and was nominated
for the Nobel Prize in medicine in 1978.
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4. Milestones Pioneered by IR
 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
 1970’s Percutaneous removal of common bile duct stones
 1970’s 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
 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
 1980’s 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
 1982 Dilators for interventional urology, percutaneous removal of kidney stones
 1983 The balloon-expandable stent (peripheral) used today
 1985 Self-expandable stents
 1990 Percutaneous extraction of gallbladder stones
 1990 Radiofrequency ablation (RFA) technique for liver tumors
 1990’s Treatment of bone and kidney tumors by embolization
 1990’s 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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5. A failure of marketing!
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6. Oncology
Catheter directed chemo/radio/bland hepatic artery
embolization
HCC
Metastatic Liver Lesions
Majority are done for palliation but can also be used
(often in conjunction with thermal ablation) to bridge
to curative transplant
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7. TACE
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8. Oncology
Percutaneous image guided thermal ablation (RFA,
microwave, or cryoablation)
Liver
Lung
Kidney
Bone
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9. Case Study (GR)
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10. Case Study (GR)
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11. Case Study (GR)
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12. Case Study (GR)
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13. Case Study (HT)
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14. Case Study (HT)
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15. Case Study (HT)
Pre Ablation CT Post Ablation MR
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16. Deep Vein Thrombosis
Catheter directed thrombolysis/thrombectomy
Can be done with a combination of mechanical and
pharmacologic methods
Patients with contraindications to pharmacologic lytics
can be treated with mechanical lysis alone
Often underlying anatomic etiologies are uncovered
that can subsequently be treated (such as May-Thurner
syndrome)
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17. DVT
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18. Case Study (DB)
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19. Case Study (DB)
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20. Pulmonary Embolism
IVC Filter Prophylaxis
Retrievable Option (up to 1 yr later with G2)
Can be placed in ICU at bedside with IVUS for critically
ill patients
Catheter based thrombolysis/thrombectomy for
hemodynamically compromised patients with saddle
embolus
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21. PE Lysis
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22. Varicoceles
Dx with provocative scrotal US
Tx with catheter directed testicular vein embolization
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23. Pelvic Congestion Syndrome
Dx with MR Venography
Tx with catheter directed ovarian vein embolization
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24. Venous Access
Crucially important to preserve arm veins and
subclavian veins for future fistula/graft creation
Implantable Access Ports
Chest (IJV), lumbar (IVC), and arm
Tunneled Central Lines for long term access
Tunneled IJV HD Catheters
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25. Other
Fibroids – UFE
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26. Biliary obstruction – PTC, biliary drain/stent
Urinary obstruction – nephrostomy, ureteral stents
Portal HTN – TIPS
Varicose veins – endovenous ablation
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27. Vertebral Compression Fx or Sacral Insufficiency Fx –
augmentation cementoplasty
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28. Case Study (PA)
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29. Case Study (PA)
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30. Other
Trauma – Arterial permanent/temporary
embolization
GI Bleeding – Arterial embolization or pharmacologic
Tx with vasopressin
Hemoptysis – Embolization or Thermal Ablation
Gastrostomy, Gastrojejunostomy, or Jejunostomy
Feeding/Suction Tubes
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31. Other
PAD – PTA/stent
Aortic aneurysms –EVAR
Diagnostic Image Guided Needle Bx
Image Guided Abscess Drainage
Thorocostomy tubes
Implantable Option
Pleurodesis
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32. Case Study (JH)
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33. Case Study (JH)
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