Interventional Radiology: Less-Invasive Alternatives to Surgery
Friday, September 24, 2010
Surgery doesn't always have to be the answer to many serious conditions. Interventional radiology can be a less invasive alternative for many patients.
Contemplating medical treatment can be a daunting task. Tabatha Anderson, a local performer, faced a tough medical decision when symptoms of uterine fibroids began interfering with her life, her marriage and her career. She was diagnosed with uterine fibroids (benign tumors in the uterus that caused her severe pain and excessive bleeding) by her OB/GYN. She was tired, in pain and ready to feel normal again. Her physician recommended a hysterectomy to treat her condition. As an active mother and performer she didn’t have time to take six weeks to recover from surgery.
When she expressed her concerns about having a hysterectomy, her physician offered a second option: uterine fibroid embolization (UFE) — a minimally invasive procedure that could treat her symptoms without major surgery. Her physician then referred her to an interventional radiologist. “When I saw that there’s no major cutting, they don’t have to put you to sleep to do the procedure and that the recovery time to be off of work was only 10 days, I thought yes, I can do this — this might actually work,” Anderson says of the procedure. She was treated with UFE by James T. Traiforos, M.D., of Professional Radiology, Inc., the Director of Interventional Radiology at Jewish Hospital.
UFE is an image-guided procedure that diminishes troubling fibroid-associated symptoms, including excessive bleeding, pelvic pain and pressure, and bulk-related discomfort without surgery. “There wasn’t a whole lot of pain, and after five days I was ready to get up and go back to work. It immediately stopped the pain, and that was a blessing,” says Anderson. Under a local anesthetic, the physician guides a catheter into the artery that feeds the fibroid. Tiny microspheres are injected and block the blood flow to the fibroid, which causes it to shrink. UFE preserves the uterus and offers relief of symptoms within one or two menstrual cycles.
UFE is just one of the minimally invasive, image-guided treatments performed by specialists like Dr. Traiforos. The interventional team of Professional Radiology treat patients using ultrasound, X-ray, MRI and other imaging modalities at Christ Hospital, Jewish Hospital, Fort Hamilton Hospital and West Chester Medical Center. “We are able to treat patients with less pain, shorter recovery times and without the use of general anesthesia, reducing the risk of complications. Many traditional surgical procedures can be replaced by a minimally invasive procedure that is equally as beneficial to the patient,” says Dr. Traiforos. Interventional procedures usually require only a tiny incision and then use medical imaging to guide catheters, needles, lasers and other devices into the body to insert stents into arteries, freeze or burn tumors, break up and aspirate blood clots, and treat back and joint pain.
Some of the treatments include:
- Isolated catheter directed thrombolysis: Pulmonary embolism is one of the most dangerous conditions seen in hospital ERs and in postsurgical patients. Blood clots that begin as deep vein thrombosis in leg veins can break off and travel to the lungs, blocking the oxygen supply and causing respiratory failure. In addition, chronic blood clots in the veins can result in severe leg swelling, pain and even nonhealing ulcers. Using imaging guidance, a physician can feed a catheter into the vein and gain access to the blood clot. The blood clot is isolated between two balloons and clot-busting drugs are administered. A special catheter — called a Trellis — then breaks up the clot, and the resulting material and drugs are then removed through the catheter. The patient has limited exposure to the thrombolytic drug.
- Pain management and epidural steroid injections: Inflammatory reaction in the body resulting from an injury or trauma, or caused by inflammatory joint disease such as rheumatoid arthritis, gout, tendonitis, bursitis and osteoarthritis, serves an important purpose in that it reminds the patient to protect the injured area. Eventually, inflammation becomes counterproductive and may lead to chronic pain, stiffness and decreased mobility of the joint. A common treatment for this type of joint pain is to inject a corticosteroid into the inflamed joint. The treatment has two distinct benefits. First, the patient receives immediate relief from the anesthetic included in the injection. It then reduces the inflammation, which gives the body a chance to heal. Using image guidance for precision, the physician advances a needle into the injured joint space (or in the case of back pain into the epidural space) and injects the steroid into the injured area.
- Vertebroplasty/kyphoplasty: Kyphoplasty, vertebroplasty and vertebral augmentation are minimally invasive treatments for patients with osteoporotic or cancer related vertebral compression fractures (VCFs). The clinical benefits of all three procedures include pain relief, angular deformity correction, sustained and considerable improvement in quality of life, and a low complication rate. The goal of treating VCFs with interventional procedures is to relieve pain and to partially restore vertebral body height at the site of fracture by injecting bone cement into the fracture site.
- Targeted hepatic arterial therapy and ablation of tumors: Liver tumors are often nonoperable and are resistant to traditional forms of chemotherapy. Much like the UFE procedure, targeted arterial therapy procedures use imaging guidance to feed a catheter through a small nick in the skin to the arteries feeding the tumor in the liver. Small particles that are either mixed with chemotherapy medication (referred to as a chemoembolization procedure) or are sources of focal radiation therapy (referred to as a radioembolization procedure) are then injected into the arteries that supply blood to the tumor. An alternative procedure that targets tumors in a variety of locations (kidney, liver and lung among others), involves advancing a special needle into the tumor under imaging guidance. This special needle is then used to ablate the cancer with either cold (cryoablation) or heat (radiofrequency ablation).
Interventional procedures are becoming increasingly popular because they generally do not require general anesthesia, long hospital stays or long recoveries. Patients with comorbidities that can make surgery dangerous can be safely treated, the lives of cancer patients can be extended and improved, and patients can save on long-term health costs.
For more information about Interventional Radiology, visit www.professionalradiology.com or call (513) 527-9999.
MD News September 2010