| Interventional Radiology and Endovascular Therapy |
The Specialty of the Future : The medical specialty of Vascular/Interventional Radiology (VIR) emphasizes the use of minimally invasive practices in as effective and safe treatment options, which are also more convenient to patients. Over the past two decades, VIR evolved into a recognized subspecialty with a valued place in the management of a wide variety of clinical problems. VIR is one of the most complex and patient-care oriented fields in Radiology. It is a medical specialty that uses image-guided, minimally invasive techniques for the diagnosis and/or treatment of a variety of medical conditions, and often represents a viable alternative to surgery. A vascular/interventional radiologist is a highly trained physician with special expertise in the diagnosis and treatment of a variety of vascular and non-vascular conditions using tiny, miniaturized tools while watching their progress using moving X-rays or other imaging techniques. Safety and cost-effectiveness dictate that interventional procedures are increasingly replacing traditional surgery.
Facilities available in AMRI Hospital – It has state of art biplane neuro and peripheral angiography system (LCN, GE) |
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| Diagnostic Angiogram : |
| Cerebral Angiogram – 4-vessel angiogram |
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| Peripheral Angiogram – upper and lower limb angiogram |
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| Renal Angiogram – for Renovascular hypertension and for renal donor patients |
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| Visceral angiogram – for detection of GI vascular abnormalities |
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| INTERVENTIONAL TREATMENT : |
| Interventional radiology is that field of medicine that uses minimally invasive techniques and imaging guidance to perform procedures that can replace conventional surgery. |
| Neurointervention |
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Intracranial thrombolysis for acute stroke |
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| Stroke (brain attack) represents one of the most serious causes of mortality and morbidity throughout the world. Each year, 150,000 patients die as a direct result of a cerebrovascular accident (CVA), while 600,000 patients experience the morbidity of aphasia, blindness, or paralysis. Among patients with stroke, extracranial carotid disease represents the cause of approximately one half of cases. Intervention in patients with acute CVA is usually based on an attempt to relieve the intracranial thrombosis or an embolization by using thrombolytic agents using recombinant tissue-type plasminogen activator (rTPA) or another thrombolytic agent.. The success of such treatment depends on early intervention (during the first 4 h) after the onset of the ischemic event. |
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Carotid and vertebral artery stenting for stroke prevention |
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| Another important area of primary intervention of stroke is the treatment of ICA stenosis by using an endovascular stent across the stenotic vessel segment. This treatment results in improved vascular flow rates across the stenotic segment and it prevents stroke. The increased application of carotid stent placement is now replacing the conventional surgical treatment for carotid stenosis (endarterectomy). |
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| Embolization of cerebral arteriovenous malformation (AVM) |
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| Embolization of spinal arteriovenous malformation (AVM) |
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| Embolization of craniofacial vascular malformation and hypervascular tumors |
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| Embolization is an excellent therapy for treating arteriovenous malformations (AVMs). They present with bleed and seizure. AVMs are treated because the abnormal connection of the artery and vein has the effect of a "short circuit." AVMs are commonly treated by embolization because of potentially severe complications of surgical treatment. |
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Embolization of carotid cavernous fistula (CCF) |
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Embolization is the best mode of treatment for these lesions |
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Coiling of cerebral aneurysm |
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| Detachable coil embolization offers a new approach to treating aneurysms and other blood vessel malformations in the brain and other parts of the body. A brain aneurysm, or weakness in the arterial wall, is a serious medical condition. If a brain aneurysm ruptures, internal bleeding may cause a stroke or loss of life. In less severe cases, a bulging aneurysm may compress surrounding nerves and brain tissue resulting in nerve paralysis, headache, neck and upper back pain as well as nausea and vomiting. Coil embolization is most frequently used to treat aneurysms and fistulas in the brain where open surgery is risky. Now worldwide coiling is accepted as an alternate to more risky surgical procedure (clipping). |
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Percutaneous vertebroplasty for vertebral hemangioma, osteoporotic compression fracture and spinal metastasis |
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| Peripheral intervention |
| Thoracic Intervention : |
| Bronchial artery Embolization for Hemoptysis |
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| Embolization of pulmonary arteriovenous malformation |
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| Embolization of pulmonary arteriovenous fistula |
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| Embolization can be particularly effective in hemorrhage, regardless of whether the etiology is trauma, tumor, epistaxis, arteriovenous malformation, fistula, postoperative hemorrhage or of postinfective origin. With the availability of coaxial microcatheters, superselective embolizations can be performed. In most patients, embolization for hemorrhage is preferable to surgical alternatives and it is life saving in most cases. |
| Renal Intervention : |
| Embolization for renal bleed (post biopsy, trauma etc) |
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| Embolization of renal tumors |
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| Embolization of renal arteriovenous malformation and fistula |
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| All the above conditions are amenable for embolization. Open surgery in most of the cases is not necessary and hazardous. A large tumor usually need preoperative embolization and increases the chances of safe and effective surgery. |
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Renal artery angioplasty and stenting for renal hypertension |
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| Renal artery stenting is very effective for treating hypertension of renal artery origin. It is an alternative to conventional surgery. |
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| Gynecological Intervention : |
| Embolization of uterine arteriovenous malformation |
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| Embolization for postpartum bleed |
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| Embolization for uterine fibroid |
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| Fibroid tumors of the uterus, though not malignant (cancerous), may cause long menstrual periods or heavy menstrual bleeding. They also may produce pain in the pelvic area or the back, as well as pressure on the bladder or bowel. Embolization may prove to be an alternative to the surgical removal of the uterus (a hysterectomy). Because fibroids have a large blood supply they will tend to shrink or even disappear if this blood supply is interrupted. Multiple fibroids can be treated in the same session. Uterine arteriovenous malformation can be safely treated by the same technique. It saves the organ and helps the patients in gestational period. |
| Vascular Intervention : |
| Aortoiliac angioplasty and stenting for aortic stenosis |
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| Femoral and below popliteal angioplasty for Claudication |
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| Narrowing or blockage in the arteries is most often caused by atherosclerosis, also called hardening of the arteries. Although it is commonly thought of as a heart disease, atherosclerosis can affect arteries anywhere in the body, including the legs and the brain. In the angioplasty procedure, the interventionist threads a balloon-tipped catheter—a thin, plastic tube—to the site of a narrow or blocked artery and then inflates the balloon to open the vessel. Vascular stenting, which is often performed at the same time as an angioplasty, involves the placement of a small wire mesh tube called a stent in the newly opened artery. The stent is a permanent device that is left in the artery and may be needed to help the artery heal in an open position after the angioplasty. |
| Aortic stentgrafting for aortic aneurysm |
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| Stentgraft for peripheral arteriovenous fistula |
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| The Society for Vascular Surgery and the International Society for Cardiovascular Surgery laid guidelines for the repair of AAA. With the advent of endoluminal repair, patients who are poor surgical candidates have a possible alternative to open repair. Careful screening of these patients is critical for good outcomes. Endovascular repair, such as stent-graft placement, is evolving as an alternative to conventional, open surgical repair. |
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Embolization for peripheral arteriovenous malformation |
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It can be curative or conjunctive to surgery. |
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| Gastroenterological Intervention : |
| Embolization for upper and lower GI bleeds |
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| Embolization for hemobilia |
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| Chemoembolization for hepatocellular carcinoma |
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Chemoembolization is a way of delivering cancer treatment directly to a tumor. The liver is the most common part of the body for chemoembolization to be used, although it can be done in other areas. Occluding the blood vessels that feed a tumor can help control symptoms when the tumor cannot be removed or might be difficult and risky to remove, such as liver cancer. It now is possible to combine the embolic material with chemotherapy, which may better treat the tumor.
Embolization is life saving for gastrointestinal bleeding when open surgery is risky. It can find the exact site of bleeding and treat the lesion at the same time. |
| Skeletal Intervention : |
| Percutaneous vertebroplasty for vertebral hemangioma, osteoporotic compression fracture and spinal metastasis |
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| Preoperative embolization of hypervascular bone and soft tissue tumors |
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| Vertebroplasty is an image-guided, minimally invasive, nonsurgical therapy used to strengthen a broken vertebra (spinal bone) that has been weakened by osteoporosis. More than one-fourth of women over age 65 will develop a vertebral fracture due to osteoporosis. Vertebroplasty increases the patient's functional abilities, allow a return to the previous level of activity, and prevent further vertebral collapse. It alleviates pain within 2-3 days in most of the cases. It is very effective in aggressive painful vertebral hemangioma and vertebral metastasis. |
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