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Dr. Marc Hamet uses a combination of ultrasound and fluoroscopy to place a catheter, demonstrating the first step in an interventional radiology procedure.
The field of interventional radiology encompasses a variety of minimally invasive procedures that use imaging modalities such as X-rays, CT, and ultrasound to provide guidance for treatment of a disease. During the procedures, tiny catheters and miniature instruments are threaded through the body's network of arteries, veins or other tubular structures, allowing physicians to perform a variety of complex diagnostic and treatment procedures related to virtually all parts of the body.
The procedures are performed by interventional radiologists, board-certified physicians with advanced training in diagnostic radiology, followed by additional training in vascular and interventional procedures. Interventional radiology techniques are used to treat many conditions that once required an operation.
"It starts with a needle and ends with a bandaid," says interventional radiologist Marc Hamet, MD. "Patients benefit from lower risk, less pain and a quicker recovery than with open surgery. They also enjoy an improved quality of life." The procedures are generally performed on an outpatient basis, so hospitalization is not required.
Interventional radiologists are trained to do diagnostic studies in addition to interventional procedures. Here, Dr. Hamet dictates a report on the results of a diagnostic study.
Why Women Should Know About Interventional Radiology
Although interventional radiology procedures are commonly used to treat conditions in both sexes, a number of procedures are for medical conditions that occur solely or predominantly in women. They include: uterine fibroids, pelvic congestion syndrome, varicose veins, and spine fractures resulting from osteoporosis.
Uterine Fibroid Embolization
Uterine fibroids are smooth-muscle, non-cancerous tumors that develop in the uterus. Eighty percent of women develop fibroids, but only about 25 percent experience symptoms.
Uterine fibroids may cause severe menstrual cramping, abdominal swelling, and excessive bleeding, which can lead to anemia and even a need for emergency surgery. A uterus with fibroids may push on the bladder and cause more frequent urination. It may also create pressure on the colon or the back. One of the major reasons for hysterectomy is the presence of symptomatic uterine fibroids.
Fibroids cannot exist without an adequate supply of blood. To ensure their continued growth, fibroids stimulate the formation of new blood vessels that bring in additional blood. The goal of the interventional radiology procedure known as uterine fibroid embolization is to cut off the blood supply. The procedure involves the insertion of a thin, flexible catheter through the femoral artery in the groin to deliver PVA (polyvinyl alcohol) particles into the blood vessels that supply the fibroids. The interventional radiologist performs the embolization while viewing the blood vessels using X-rays with the aid of contrast, or X-ray dye. Blocking the arteries that feed fibroids and filling them with particles eliminates the source of blood, which starves the fibroids and causes them to shrink and disappear. With this technique, all of the fibroids present are treated simultaneously.
Pelvic Congestion Syndrome
The condition known as pelvic congestion syndrome (PCS) is complex and is often misdiagnosed. When other causes of pelvic pain have been ruled out by specialists such as OB/GYNs, gastroenterologists and urologists, an interventional radiologist is often consulted for further evaluation and treatment.
The syndrome, which primarily affects pre-menopausal women, comes about when reflux occurs in the left gonadal vein (the blood vessel that carries blood away from the ovary toward the heart), causing blood to back up into the pelvis. This reflux results in hemorrhoids or varicose veins in the thighs, buttocks or vaginal area. A woman with pelvic congestion syndrome can experience severe dull, aching pain from ovarian and pelvic varicose veins, much like the leg pain associated with lower-extremity varicose veins. This chronic pain is worse when sitting or standing, and makes it painful to ride a bike and uncomfortable to walk.
A CT scan with contrast is done to diagnose pelvic congestion syndrome.
To treat pelvic congestion syndrome, the interventional radiologist inserts a thin catheter into the femoral vein at the top of the right leg and guides it into the affected gonadal vein using imaging for guidance. To seal the faulty, enlarged vein, the interventional radiologist blocks it off by placing tiny mechanical devices at the bottom and top of the vein and injects a solution in the area between the two blocking devices, thus eliminating the varicosity and reducing the associated painful pressure.
Pelvic congestion syndrome in women is the same as a condition called varicocele in men, which can be treated in exactly the same way.
Veins have one-way valves that are supposed to keep blood flowing from the legs up toward the heart. If a valve stops working correctly, reflux occurs - the blood goes in two directions. With every movement, the veins squeeze, the blood goes up and comes right back down. As a result, blood collects in the vein, pressure builds, and the vein becomes weak and enlarged. This "varicose vein" appears twisted and bulging near the surface of the skin, most commonly on the legs or feet. Age, pregnancy, being overweight or working at a job that requires standing for long periods all contribute to the development of varicose veins. Women are more likely than men to have varicose veins, and the condition tends to run in families.
Other than their dark purple/blue or bulging appearance, varicose veins often do not have any symptoms. Sometimes they cause an achy or heavy feeling in the legs or a burning and throbbing sensation. Injury to the vessels can cause excessive bleeding. Painful clots may develop which sometimes become infected, a condition called thrombophlebitis. In severe circumstances, skin breakdown (venous stasis ulcers) or severe infections of the toes and feet may occur.
To treat varicose veins, the interventional radiologist uses ultrasound and X-ray as a guide to insert a tube into the vein that isn't functioning properly. A laser is guided through the tube and used to destroy the vein. This breaks the reflux cycle and allows the blood to go where it is supposed to go. Destroying the vein doesn't affect circulation because there are other veins located deeper in the leg that take care of larger volumes of blood.
Osteoporosis and Spine fractures
People with osteoporosis often experience back pain that is caused by spinal fractures, also called vertebral compression fractures. Women over 50 are at the greatest risk for these fractures, and by age 80, 40 percent of women will have one. In addition to back pain, symptoms of spinal fracture include loss of height and deformity of the spine.
A nonsurgical treatment for spinal fracture called vertebroplasty can be performed by an interventional radiologist. During the procedure, the physician uses imaging guidance to inject strengthening material into the bone that has collapsed. The treatment reduces pain, restores the bone's strength and helps to prevent further collapse of the vertebra. Evaluation prior to the procedure involves an MRI of the spine. Sometimes areas of abnormal bone are found, which may be treated prior to collapse, thus preventing curving of the spine.
|Marc Hamet, MD, interventional radiologist, is board certified in radiology, neuroradiology and vascular and interventional radiology. He received his medical degree from the University of Maryland Medical System, where he completed a residency in diagnostic radiology, followed by fellowship training in vascular and interventional radiology at Johns Hopkins Hospital. He is an assistant clinical professor of radiology at Columbia University. Dr. Hamet can be reached at 914-366-3430.|