3 Global Statement Defining Interventional Radiology J Vasc Interv Radiol 2010; 21:1147–11491. Expertise in diagnostic imaging and radiation safety.2. Expertise in image-guided minimally invasive procedures and techniques as applied to multiple diseases and organs.3. Expertise in the evaluation and management of patients suitable for the image-guided interventions included in the scope of IR practice.4. Continual invention and innovation of new techniques, devices, and procedures.
4 History1964 Angioplasty1966 Embolization therapy to treat tumors and spinal cord vascular malformations by blocking the blood flow1967 The Judkins technique of coronary angiography, the technique still most widely used around the world today1967 Closure of the patent ductus arteriosis, a heart defect in newborns of a vascular opening between the pulmonary artery and the aorta1967 Selective vasoconstriction infusions for hemorrhage, now commonly used for bleeding ulcers, GI bleeding and arterial bleeding1969 The catheter-delivered stenting technique and prototype stentTools for interventions such as heparinized guidewires, contrast injector, disposable catheter needles and see-through film changer1970’s Percutaneous removal of common bile duct stones1970’s Occlusive coils1972 Selective arterial embolization for GI bleeding, which was adapted to treat massive bleeding in other arteries in the body and to block blood supply to tumors
5 1973 Embolization for pelvic trauma 1974 Selective arterial thrombolysis for arterial occlusions, now used to treat blood clots, stroke, DVT, etc.1974 Transhepatic embolization for variceal bleedingEmbolization technique for pulmonary arteriovenous malformations and varicocelesBland- and chemo-embolization for treatment of hepatocellular cancer and disseminated liver metastases1980 Cryoablation to freeze liver tumors1980 Development of special tools and devices for biliary manipulation1980’s Biliary stents to allow bile to flow from the liver saving patients from biliary bypass surgery1981 Embolization technique for spleen trauma1982 TIPS (transjugular intrahepatic portosystemic shunt) to improve blood flow in damaged livers from conditions such as cirrhosis and hepatitis C1982 Dilators for interventional urology, percutaneous removal of kidney stones1983 The balloon-expandable stent (peripheral) used today
6 1985 Self-expanding stents 1990 Percutaneous extraction of gallbladder stones1990 Radiofrequency ablation (RFA) technique for liver tumors1990’s Treatment of bone and kidney tumors by embolization1990’s RFA for soft tissue tumors, i.e., bone, breast, kidney, lung and liver cancer1991 Abdominal aortic stent grafts1994 The balloon-expandable coronary stent used today1997 Intra-arterial delivery of tumor-killing viruses and gene therapy vectors to the liver1999 Percutaneous delivery of pancreatic islet cells to the liver for transplantation to treat diabetes1999 Developed the endovenous laser ablation procedure to treat varicose veins and venous disease
7 Why Interventional Radiology Shorter Hospital StaysMoney SavingReduction in Transfusion RequirementsBetter QoL for patientsFaster RecoveryHigh Intensity Localised treatments
9 What’s Our Role in Chronic Care? Vascular Treatment of Ischaemic limbsDiabetic foot ulcersManagement of Aneurysms of the Aorta and Visceral vesselsVascular Access Management for Renal Replacement TherapyVaricose Vein AblationRenal Artery DiseaseAVM management
17 What’s Our Role in Acute Medical Care? Control of HaemorrhageUterine Postpartum (Health Commission report on Northwick Park)Acute Aneurysm RuptureAcute Aortic DissectionPost Traumatic Vascular and Visceral InjuryGI HaemorrhageAcutely Ischaemic LimbsDVT and PE managementEmergency Venous Access in Dialysis Patients
19 What’s New?Renal Artery Denervation for Difficult to Control HypertensionProstate EmbolisationDesolving Stents
20 Renal Artery Denervation Transarterial Catheter directed RF Ablation of Renal Sympathetic NervesGood results from proof of principal cohort study (45 patients with drug resistant hypertension)
21 Prostate Embolisation for BPH Injection of micro particles ( micron) into the prostatic arteries to shrink the organPromising results in animal and human studiesDay case procedure with the potential for a return towards normal micturition with out medication (better QoL and cost saving)
22 How Will We Affect Health Care in The Future Save MoneyReduced Bed staysReduced Transfusion RequirementsMore Rapid Patient RecoveryMore Rapid Return to Normal Life/WorkImprove QoL for PatientsMore Procedures by the monthBetter Cancer Outcomes
23 Interventional Radiology Has been recognised as a distinct subspeciality by the Royal CollegesWe now have our own training programWe have our own syllabus3 years of Radiology Training followed by 3 years of Interventional Training
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