Interventional Radiology

Interventional radiologists specialize in minimally invasive, targeted treatments. They use image guidance, including fluoroscopy, ultrasound, CT or magnetic resonance imaging, to perform minimally invasive procedures that would otherwise be unavailable or would require open surgery. Thus, interventional radiology (IR) offers care with less risk, less pain, and less recovery time compared with traditional treatments.

The most rapidly expanding subset of interventional radiology treatments both in terms of popularity and in procedures available is in the treatment of cancer, better known as, Interventional Oncology.

IR specialists are an integral part of any comprehensive multidisciplinary cancer program. This is certainly true at NewYork-Presbyterian where interventional radiologists perform thousands of procedures each year. NYP has all of the necessary imaging and procedural facilities to perform the most comprehensive, cutting edge care in the world of Interventional Oncology. These include not only specialized, sophisticated angiography suites and dedicated CT scanners, but GPS guidance systems, sophisticated targeted tumor destruction devices, and new cancer killing agents that are injected directly into arteries feeding tumors.

Embolization

Embolization is a minimally invasive image guided technique to block or stop flow in blood vessels in order to bring therapeutic benefit to the patient. This technique is performed while the patient is conscious, but sedated and feeling no pain. It does not require general anesthesia. Further, there are many applications that allow for this technique to be employed in a wide variety of situations.

Embolization is especially useful in the treatment of tumors which rely on their blood supply to grow. The technique has brought therapy to millions of patients with tumors that are difficult or impossible to remove surgically.

The interventional radiologist makes a tiny nick in the skin in the groin and inserts a catheter into the femoral artery. Using real-time imaging, the physician guides the catheter through the artery and into the desired location. Contrast is injected to highlight the vessels for targeting. Multiple agents are available to facilitate the embolization. This allows for a tailored approach for each patient, allowing the greatest therapeutic benefit. Tumors can be embolized using synthetic materials called beads to deprive the tumors of blood. The beads most often have high doses of chemotherapy or radiation incorporated into them to most effectively treat the tumor. These treatments may also facilitate future surgical removal and cure once the tumors have shrunk.

Embolization can also be used when not treating tumor vessels. It is extremely useful in emergency and trauma situations where there may be uncontrolled bleeding from an injured blood vessel. Techniques similar to tumor embolization are used to gain access to the bleeding vessel and to control or stop the bleeding in a minimally invasive fashion.

Biopsy

The treatment of cancer begins with its diagnosis. This most often requires a biopsy. In a biopsy, a sample of tissue from the tumor or other abnormality is obtained and examined by a pathologist. By examining the biopsy sample, pathologists and other experts can also determine what kind of cancer is present and whether it is likely to be fast or slow growing. This information is of the utmost importance in deciding the best type of treatment. In fact, high-quality treatment begins with a high-quality biopsy. Open surgery is sometimes performed to obtain a tissue sample for biopsy. But in most cases, tissue samples can be obtained without open surgery with interventional radiology techniques. Thus, the diagnosis can be obtained with minimal discomfort and little required recovery time.

Needle biopsies, also called image guided biopsies, are performed most commonly using computed tomography (CT) or ultrasound guidance. These techniques allow for the targeted area to be visualized from multiple angles. This "stereotactic" imaging equipment allows for the interventional radiologist to pinpoint the exact location of the abnormal tissue. Further it allows the radiologist to avoid important nearby structures such as blood vessels and vital organs. Needle biopsies are typically an outpatient procedure with very infrequent complications. In well over 90% of patients, a needle biopsy provides enough tissue for the pathologist to determine the cause of the abnormality.

Venous access

Many patients who receive regular treatments with chemotherapy, or other intravenous medications, or who require blood transfusions, as well as those patients that frequently require blood to be drawn for analysis may benefit from a central venous catheter. A central venous catheter is a tube that is inserted beneath the skin to allow for a simple, pain-free way for doctors or nurses to draw blood or give medications or nutrients. These catheters also spare patients the irritation and discomfort of repeated needlesticks. More than 3.4 million central venous catheters are placed each year in the United States, and doctors increasingly recommend their use. There are several types of central venous catheters, including tunneled catheters (Hickman or Broviac), peripherally inserted central catheters (picc lines), dialysis catheters, and implantable ports. The latter is most commonly used when patients are receiving extended chemotherapy treatments. The device consists of a catheter attached to a small reservoir, both of which are placed completely under the skin. Interventional radiologists implant the port under the skin on the chest and insert the catheter in a large central vein in the chest. It can be done with local anesthetic or a small amount of intravenous conscious sedation.

Tumor Ablation

Ablation is an image guided technique in which interventional radiologists pass a needle into a tumor and deploy various types of energy to destroy the tumor while sparing surrounding healthy tissue. These techniques are especially valuable in inoperable tumors or in patients for whom surgery is not an option. Various types of energy can be used. The most common is destruction of tumor tissue using heat, either through application of microwave or radiofrequency energy. Alternatively tumors can be frozen and thus destroyed as well. Finally, cutting-edge work is being done at New York Presbyterian using a new type of ablation called irreversible electroporation (IRE) where energy is used to punch holes in tumor cell membranes selectively destroying tumor tissue in even the most delicate of organs. In all of these techniques there is minimal recovery required. In fact, patients usually resume their daily activities within 24 to 48 hours.

Thrombosis/Pulmonary Embolism

One common side effect of cancer or cancer treatments is the development of blood clots, or emboli, that can be life-threatening if they travel to the brain, lungs or heart. There are easily tolerated minimally invasive interventional radiology procedures that can reduce the risks posed by blood clots.

Intra-arterial thrombolysis is a technique whereby an interventional radiologist guides a catheter through blood vessels to the site of an arterial blood clot. Clot-busting drugs are infused through the catheter to break up the clot.

Many cancer patients develop a condition called deep vein thrombosis (DVT) where clots form in the veins of the leg or pelvis which can travel to the lungs and cause a life-threatening pulmonary embolus. Interventional radiologists can prevent these large, potentially fatal clots from traveling to the lungs by placing an umbrella like device called an IVC filter in the vein between the clot and the lung. Further, interventional radiologists can perform procedures to remove the clot from the legs and restore normal blood flow preventing long-term pain and swelling.

Non-Cancer Related Procedures

New York Presbyterian interventional radiologists perform many other types of procedures to treat noncancerous conditions. These include the non-surgical repair of potentially fatal aortic aneurysms in the abdomen, dilation or narrowings in the arteries to the kidney that are causing high blood pressure or renal failure, minimally invasive long-term treatment of symptoms from enlarging fibroids and other causes of pelvic pain in women, nonsurgical elimination of symptomatic and unsightly varicose veins, as well as many other specialized procedures for many other conditions.