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Perspectives in Interventional Radiology
Humboldt Kolleg - Limits and Interfaces in Science
Guilherme S. Nakiri
Division of Interventional RadiologyCCIFM – HC – FMRP - USP
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BIRTH OF A NEW SPECIALTY
●Charles Dotter MD
● 1963
● Czechoslovak Radiological Congress
● Therapeutic use of endovascular catheter
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BIRTH OF A NEW SPECIALTY
●Sven-Ivar Seldinger MD
● 1953
● Description of the Seldinger technique
● Safe access to blood vessels and other hollow organs
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SELDINGER TECHNIQUE
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SELDINGER TECHNIQUE
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FEMORAL ARTERY ACCESS
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FIRST STEP OF INTERVENTIONAL RADIOLOGY
●Charles Dotter MD
● 1964
● 82-year-old woman leg ischemia and gangrene
● Sucessfull dilatation of stenosis with guide wire and coaxial catheters
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INTERVENTIONAL RADIOLOGY TODAY
Interventional Radiology
Therapeutic Neuroradiology
Periphereal Vascular Interventional Radiology
Non Vascular Interventional Radiology
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THERAPEUTIC NEURORADIOLOGY
● Brain Aneurysms
● Arteriovenous Malformations
● Dural Arteriovenous Fistulas
● Cervical and Intracranial Atherosclerosis
● Preoperatory tumor embolization
● Spinal Cord Vascular Malformations
● Acute Stroke Treatment
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PERIPHEREAL VASCULAR IR
● Periphereal Arteries Stenosis/Occlusion
● Aortic Aneurysm
● Curative, preoperatory and paliative tumor
embolization
● Vascular Malformations
● Vascular Trauma
● Venous diseases (pelvic varices)
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NON VASCULAR IR
● Biopsies
● Nephrostomies
● Non Vascular Stents (biliary tract, colonic,
tracheal)
● Alcoholization
● Percutanous Gastrostomy
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INTERVENTIONAL RADIOLOGY
●Principle: to provide minimally invasive treatment to pathologies that would otherwise require open surgery or wouldn’t be accessible by conventional approach.
●Using imaging guidance by:- Computed Tomography CT- Ultrasound US- Digital Subtraction Angiography DSA- Radioscopy
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ARTERIOGRAPHY
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X-Ray
0s
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Mask
1s
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With Substraction
2s
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3s
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4s
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5s
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6s
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7s
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Rotational Angiography with3D Reconstruction
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Rotational Angiography with3D Reconstruction
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CT Like
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MATERIALS
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MATERIALS
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MATERIALS
Liquid Embolic Agents
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MATERIALS
Coils
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MATERIALS
Coils
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MATERIALS
Stents/Balloons
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Brain Aneurysm
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Arteriovenous Malformation (AVM)
Vascular malformation with arteriovenous shunts, that lack an intervening capillary bed
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Brain AVM
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Brain AVM
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Brain AVM
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Brain AVM
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Brain AVM
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Carotid-cavernous fistula
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Carotid-cavernous fistula
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Carotid-cavernous fistula
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Carotid-cavernous fistula
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Carotid-cavernous fistula
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Carotid-cavernous fistula
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contrast-enhanced CT
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Tumors
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Tumors
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Tumors
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Tumors
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Tumors
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Tumors
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Tumors
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Tumors
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Tumors
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Carotid Stenting
Avoid surgical trauma
Low rate of re-stenosis3-5%
Low rate of complications~3%
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PROTECTION SYSTEMS
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Carotid Stenting
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Acute Stroke
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Acute Stroke
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Acute Stroke
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Periphereal Stenosis
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Non Vascular IR
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Non Vascular IR
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Tumors
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Conclusions
Possibility of minimally invasive treatment of many diseases
Efficacy established
New materials
Improving technique
but...
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Conclusions
Interventional radiology has been established as a medical specialty, which overlaps with many other medical fields, thus depending on interdisciplinary accordance between the interventional radiologist and surgeon/clinician aiming always to provide minimally invasive treatments with proven safety and efficacy for the patient.