Bergh: Interventional treatments can speed recovery

Radiology has come a long way since the first X-rays were discovered in 1895. While X-rays are still used today, imaging techniques have expanded to include mammography, ultrasound, computed tomography (CT scan), magnetic resonance imaging (MRI), nuclear medicine, fluoroscopy and more. These advances have helped us see what’s happening inside one’s body, and has allowed us to treat a multitude of diseases and conditions unimaginable just a few decades ago.

A specialty within radiology is interventional radiology. With the advanced imaging available today, interventional radiologists can treat many conditions using minimally invasive techniques. Using imaging, we “see” inside the body, then using an incision about the size of a point of a pencil, guide instruments through the body’s veins and arteries to get to the treatment area. These procedures, because they are minimally invasive, have lower risk, less pain and a shorter recover time compared to conventional, open surgery. Interventional radiologists work with many specialists in treating a variety of conditions. In fact, St. Mary’s opened its Endovascular Center to bring interventional radiologists, interventional cardiologists, vascular surgeons and wound care specialists together. The team works on a case-by-case basis to diagnose, manage and follow patients with a variety medical conditions.

 While interventional cardiologists do angioplasty and stenting in matters relating to the heart, interventional radiologists work in the other areas of the body. When the arteries to the legs become clogged, peripheral artery disease (PAD) develops. PAD affects about 8 million Americans, but many mistake the symptoms as something else.

The most common symptoms are leg pain, cramping or tiredness in the leg or hip muscles while walking or climbing stairs. The pain often goes away only to return when you walk again. When severe, PAD may result in wounds or ulcers on feet or toes that heal slowly, or not at all.

One way to screen for PAD is the ankle-brachia index. It is a simple and painless screening much like having a blood pressure reading. Cuffs are put around your upper arm and your ankles to measure the ratio between the pressure in your arms and legs. This ratio indicates how well blood flows.

Interventional radiologists have been using vertibroplasty and kyphoplasty for many years to bring pain relief to those with compression fractures caused by osteoporosis. During the procedures, a needle is inserted through the skin into the fractured vertebrae to place surgical bone cement. It works as an internal splint, strengthening the collapsed vertebrae and relieving the pain. Kyphoplasty is much like vertibroplasty, but it also places a balloon into the collapsed vertebra to help lift it into its normal position and create space before the cement is injected. The advantage is that some, if not all, of the height is restored, but only if the fracture is fairly recent.

A procedure called uterine fibroid embolization has helped countless women suffering with fibroids. Uterine fibroids are non-cancerous growths that develop in the walls of the uterus. Often fibroids are small and cause no problems, but for some women, they cause pain and heavy bleeding. Uterine fibroids are the most frequent indication for hysterectomy in pre-menopausal women. About one third of hysterectomies performed each year in the U.S. are due to fibroids.

 As long as a woman with fibroids menstruates, the fibroids will generally continue to grow. But an interventional procedure called uterine fibroid embolization works by cutting off the blood supply to the fibroid causing it to shrink. At St Mary’s, the interventional radiologist performs the procedure through a small puncture in the wrist.

Patients are able to walk sooner and have less discomfort. St Mary’s is the only hospital in the area offering this service.

Another procedure done by an interventional radiologist is used to help treat some cancer patients. We use radiofrequency ablation to treat tumors in the lungs, kidneys, liver or and bones. During radiofrequency ablation, a needle electrode is guided into the tumor. High-frequency currents are generated, creating heat that essentially melts the tumor. Even though the treatment doesn’t cure cancer, the tumor may eventually grow back, but it does prolong life, is much less invasive than surgery, and it decreases the pain and discomfort in patients.

Often, procedures done by interventional radiologists provide treatment options for patients. While open surgery will likely never be replaced, there are many less invasive treatments bringing great results with fewer complications.