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Interventional Radiology Continues to Expand       written on 2000/06/12 In this article, Dr. Stephen Stine, an Interventional Radiologist at Wausau Hospital, discusses advances in the field of interventional radiology which the Department of Radiology at Wausau Hospital offers to physicians in the region. For example, newer minimally invasive techniques are being used to treat cardiovascular disorders such as aortic aneurysms and to diagnosis and treat liver conditions. The subspecialty of Vascular and Interventional Radiology experienced tremendous growth in the 1980’s and 1990’s. In the formative years, interventional radiologists basically performed diagnostic arteriograms to evaluate vascular emboli, traumatic injury to organs, or parenchymal tumors. In the 1970’s, physicians Charles Dotter at the University of Oregon and Andreas Gruentzig from Emory University transformed vascular medicine with the development of new steerable guidewires and angioplasty balloons. Minimally invasive techniques used in the vascular system were then applied to treatment of disease in other organ systems, such as the genitourinary tract and biliary tree. Today, interventional radiology can provide a comprehensive service of minimally invasive procedures performed with small skin incisions, local anesthesia, intravenous sedation and short postprocedure hospitalizations. The interventional radiologist works closely with referring clinicians to provide rapid diagnosis of medical disorders and offers effective therapeutic treatments. The following is a brief summary of advances in the field of interventional radiology available at Wausau Hospital. Diagnostic Angiography and Venography Arteriograms and venograms have typically been performed by injection of a contrast agent [X-ray dye] into the blood vessel through a small catheter. In patients with renal failure or renal insufficiency, carbon dioxide gas or gadolinium dye [MRI contrast agent] can now be used on selected patients to eliminate or reduce the amount of regular contrast required for an examination. The main application has been with renal and peripheral vascular arteriography. Carbon dioxide venography has also been used for IVC filter placement at Wausau Hospital. Vascular Recannulation Over the past two decades, interventional radiologists have gained considerable experience with peripheral vascular intervention. Angioplasty or stent placement in leg arteries is routinely performed to restore or increase blood flow in cases of incapacitating claudication, threatened limb ischemia or adjunct to vascular surgery. In the renal arteries, both fibromuscular dysplasia and atherosclerotic lesions have been treated to maintain renal function and improve blood pressure control. Thrombosed peripheral vascular grafts or dialysis grafts can be “declotted” or salvaged with thrombolysis medications or thrombectomy devices. Recently, carotid stenting has been performed for difficult selected nonsurgical cases. Aortic Aneurysm Repair Through the collaborative effort of Dr. Mark Asplund of Surgery and Dr.Craig Hackworth of Radiology, aortic stent grafts are now being placed in patients who meet appropriate guidelines. The abdominal aortic aneurysm is repaired through endovascular placement of a stent graft via femoral or distal iliac access. The procedure is performed in the operating room, with advantages including shorter hospital stay and shorter recovery time for patients. Uterine Artery Embolization Embolization is the “blocking” of blood flow by placement of a synthetic material [coil or small particle] into an artery. Embolization has been used by radiologists for treatment of traumatic arterial injury, hemoptysis,epistaxis, and gastrointestinal bleeding. A new radiology procedure utilizing arterial embolization is Uterine Artery Embolization [UAE]. Embolization of the uterine arteries has been performed for approximately 20 years to stop significant bleeding after childbirth. Dr. Jacques Ravina of France first performed UAE for fibroid disease in the late 1980’s. Uterine artery embolization to treat fibroid tumors of the uterus has been performed for approximately six years in the United States. The uterine artery is embolized bilaterally with polyvinyl alcohol particles to decrease blood flow to the fibroids. The patient is hospitalized overnight for pain control and observation, with usual discharge the next day. Complex Vascular Access Interventional radiology assists patient care by placement of central venous catheters in difficult access cases. Thrombocytopenia, coagulopathy, venous stenosis, or a difficult body habitus may complicate venous access. In patients with severely limited venous access options, transhepatic or translumbar catheters may be placed as a last resort. Venous catheters are available for antibiotic delivery, total parenteral fluid therapy, hemodialysis or chemotherapy. The catheter may be placed directly into the vein or tunneled under the skin, depending on the length of treatment. Hepatic Biopsy Traditional liver biopsy is performed percutaneously with low complication rates. In patients demonstrating portal hypertension, ascites, coagulopathy, or thrombocytopenia, an alternative approach is transjugular liver biopsy. A vascular sheath is advanced into the inferior vena cava via the right internal jugular vein with fluoroscopic guidance. A biopsy needle is advanced into the right or middle hepatic vein, and core biopsy samples are obtained from the right hepatic lobe. The biopsy is performed with marked decreased risk of bleeding to the patient. Portal Hypertension Treatment with TIPS Another liver procedure available at Wausau Hospital is the transjugular intrahepatic portosystemic shunt [TIPS]. The TIPS procedure was developed as a nonsurgical treatment for portal hypertension. An intrahepatic connection is made between a large hepatic vein and a large portal branch, utilizing a large metallic stent. Blood flows through this intrahepatic shunt, lowering the portal pressure. New studies are evaluating the placement of stent grafts when creating the shunt. TIPS may be considered in patients with acute variceal bleeding refractory to sclerotherapy or banding, inaccessible gastric or intestinal varices, recurrent variceal bleeding after sclerotherapy or banding, or refractory ascites/hydrothorax.