Interventional Radiology Changes the Face of Medicine

Interventional radiology, the medical specialty that provides minimally invasive image-guided diagnosis and disease treatment, has been called “the surgery of the new millennium.”

By using such technologies as digital subtraction flouroscopy, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound, interventional radiologists can often eliminate the need for open surgery and allow for shorter recovery times.

“The thing that I love most about interventional radiology is that it’s very creative and we have a way to help with virtually every issue a patient might have,” says Dr. B. Bobby Chiong, an interventional radiologist and chair of the Department of Radiology at SBH. “There are pain procedures that we do, like steroid injections for the spine and joints. There are nerve injections for neuropathic pain from migraine headaches. We can treat fibroids that can cause heavy menstrual bleeding. For men’s health, we treat enlarged prostates. And, we treat cancers.”

The procedures are performed minimally invasively – such as placing a catheter the size of an IV line into the vein for dispensing medication. This means using far smaller portals than the laparoscopic surgeries that arrived with much acclaim into the surgical arena two decades ago.

“People know about the bread and butter procedures, putting in the IV access or ports for chemotherapy or antibiotics or for doing biopsies,” says Dr. Chiong. “That’s what most, even medical professionals, think of as interventional radiology.”

Here is a closer look at some of the other conditions supported by interventional radiology:

Joint pain. Osteoarthritis affects nearly 30 million people in the U.S., with the knee being the most common site. Many patients are not ready for knee replacement and depend on daily NSAIDs, narcotics, or knee injections for pain control. While NSAIDs are the mainstay for medical management of osteoarthritis, over 100,000 people are hospitalized annually for NSAID-related gastrointestinal bleeding, and there are over 16,000 annual NSAID-related deaths among arthritis patients. As such, there has long been a need for better treatment options for this “in between” population – who are not ready for surgery, but are also not adequately managed with medication or injections.

“We’ve entered a new frontier in treating people with osteoarthritis of the knee,” says Dr. Chiong. “We put dissolvable particles into the knee to reduce the blood flow, which might seem counterintuitive. But the data coming out has shown a lot of improvement in treating that kind of pain.”A geniculate artery embolization (GAE) for knee pain is performed by inserting catheters through pinhole-sized incisions and injecting tiny particles to shut down the abnormal hypervascularity, decrease inflammation and stop the cycle of pain. GAE does not require open surgery or physical therapy, and takes 45 – 90 minutes to perform under moderate sedation.

Enlarged prostate. Interventional radiologists treat benign prostate hyperplasia (BPH) with prostate artery embolization (PAE). BPH, according to the National Institutes of Health, is a condition occurring in more than half of men in their 60s and 90 percent of men in their 70s and 80s. Symptoms include difficulty urinating, more frequent and urgent urination, especially at night and a weak urine flow. Alternatives to treating BPH include drug therapy, which is the safest but less effective option, or Transurethral resection of the prostate (TURP), which is partial removal of the prostate through the urethra in the penis. PAE, meanwhile, is a non-surgical, minimally invasive procedure that injects small beads into the arteries surrounding the prostate. The beads block the prostate’s blood supply causing the prostate to shrink. The patient stays in the hospital for one night and can usually return to regular activities within several days.

Fibroids. Uterine fibroid embolization (UFE) is a minimally invasive procedure used to treat fibroid tumors of the uterus which can cause heavy menstrual bleeding, pain, and pressure on the bladder or bowel. These agents block the arteries that provide blood to the fibroids, causing them to shrink.

According to Dr. Chiong, particle embolization for fibroids has a long lasting effect, more than 90 percent durability even after five years. UFE is also used to treat adenomyosis, a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus causing menstrual cramps, heavy bleeding, lower abdominal pressure, and bloating before menstrual periods. An interventional radiologist addresses the problem by inserting particles through a tiny tube into the patient’s femoral artery. With blood supply cut off, the fibroids and adenomyosis shrink. Previous treatments have included hysterectomy.

Migraines. Migraine headaches are among the most common debilitating diseases in the United States. Image-guided, targeted intranasal sphenopalatine ganglion (SPG) blocks can give patients enough ongoing relief that they require less medication to relieve migraine pain.

During the procedure, which is minimally invasive and does not involve needles touching the patient, a spaghetti-sized catheter is inserted through the nasal passages to administer a 4 percent lidocaine solution to the SPG, a nerve bundle just behind the nose associated with migraines. Studies have shown that patients reporting a score of 8.25 on the severity of their headaches on a visual analogue scale ranging from 1 to 10, had their scores cut in half after the SPG block. Additionally, 88 percent of patients indicated that they required less or no migraine medication for ongoing relief. SPG blocks are not a cure for migraines, but a temporary solution.

Cancers. Dr. Chiong says that liver cancer is the cancer most commonly treated by interventional radiology. A range of minimally invasive procedures is used to treat both local and metastatic cancers. These procedures use X-rays, CT scans, MRIs and other image-guided technologies to place a catheter inside the body and treat patients non-surgically. Chemoembolization, for example, delivers chemotherapy directly to a tumor while also cutting off the tumor’s blood supply. During chemoembolization, a catheter is used to deliver chemotherapy microspheres directly into a tumor using image guidance. The chemotherapy drugs are released from the microspheres into the tumor, blocking the flow of blood to the tumor. Intra-arterial chemotherapy (IAC) delivers chemotherapy drugs directly into the liver tumor through a catheter. This procedure is designed to allow a more potent dose of chemotherapy to reach the tumor while reducing systemic side effects. Radiofrequency ablation (RFA) can be used to treat small tumors. This technique may offer faster, more targeted liver cancer treatment with fewer side effects and shorter hospital stays compared with standard

“The chemotherapy we use for liver cancer is doxorubicin, which can be very toxic to the heart,” he says. He injects the beads directly into the hepatic artery, at the site of the cancer. By doing it this way, the treatment doesn’t have the systemic chemotherapy side effects causing hair loss, nausea and heart damage. “These procedures are generally not considered a cure,” he adds. “The cure is a liver transplant. But, if your liver cancer is too big they won’t transplant you. By doing an embolization for liver cancer, it can make it so you become a transplant candidate.”