L18: Interventional Radiology – Body

Question 1

What are some applications of interventional radiology?

Answer 1

• cancer
• fertility
• pain management
• removal of blood clots (thrombectomy)
• opening up diseased vessels (stents or grafts)

Question 2

What are the indications for interventional radiology?

Answer 2

variable, but often for:

• patients that cannot tolerate sedation for surgery (comorbidities, etc.)
• focused procedure (ie. stent in a leg artery to open it up)
• biopsy/tissue-sample – CT or ultrasound to help targeting
• cancer treatments

Question 3

What are the benefits of interventional radiology procedures?

Answer 3

• minimally invasive nature
• reduced risk compared to traditional surgery
• shorter recovery times
• improved patient outcomes
• potential cost savings

Question 4

What is peripheral vascular disease (PVD)?

Answer 4

slow and progressive circulation disorder that can be caused by narrowing, blockage, or spasms in any blood vessel outside of the heart (arteries, veins, or lymphatic vessels)

Question 5

What is ischemia?

Answer 5

condition in which blood flow (and therefore oxygen) is restricted or reduced in a part of the body

Question 6

What are the 3 ‘stages’ of progression of lower limb PVD?

Answer 6

• peripheral vascular disease – asymptomatic
• symptomatic disease
• critical limb ischemia (CLI)

Question 7

Describe the clinical presentation of each of the 3 ‘stages’ of progression of lower limb PVD.

Answer 7

• PVD: ‘silent’ – plaque formation and thrombus impedes blood flow to peripheral vasculature (ischemia)
• symptomatic disease: intermittent claudication (muscle pain), cell death, physical impairment
• critical limb ischemia (CLI): pain at rest, gangrene, ulceration / life-threatening infection

Question 8

Describe the progression rate between the 3 ‘stages’ of progression of lower limb PVD.

Answer 8

• PVD to symptomatic disease: 27% within 5 years
• symptomatic disease to critical limb ischemia (CLI): 15-20% over lifetime
• progression is much faster in diabetic and end stage renal disease populations

Question 9

Describe the mortality rate at each of the 3 ‘stages’ of progression of lower limb PVD.

Answer 9

• PVD: 30% within 5 years
• symptomatic disease: 30% within 5 years
• critical limb ischemia (CLI): 20% of CLI patients die within 6 months of diagnosis

Question 10

What is a uterine fibroid?

Answer 10

benign growth on uterus

Question 11

What is uterine artery embolization (UAE)?

Answer 11

• alternative to hysterectomy for uterine fibroids
• often done before surgery to reduce bleeding

Question 12

What is uterine artery embolization (UAE) used for?

Answer 12

• symptomatic fibroids
• postpartum hemorrhage
• post-abortion, C-section
• bleeding ectopic pregnancy
• post-surgical hemorrhage
• trophoblastic disease

(high rate of success – 86-100% for all indications)

Question 13

What are the other options for treating uterine fibroids?

Answer 13

• hysterectomy: curative, but irreversible
• myomectomy: maintains fertility potential, but higher morbidity, significant blood loss, and may not treat culprit fibrois
• hormonal therapy: fibroids recur after discontinuation