Interventional radiology

It is a pinhole surgeon. It is a modern branch of medicine that has been rapidly developing and becoming widespread in recent years, combining Radiology and Surgical procedures. As we know, Radiology is the art of diagnosing diseases by viewing the inside of a person. On the other hand, Interventional Radiology; It is the art of increasing the diagnostic detail or treating the displayed disease by entering and reaching through a pinhole through the skin. While trying to diagnose a disease by using the latest technology imaging devices is the subject of Radiology, applications of detailing or treating the diagnosis made by entering the body through the needle hole and reaching the disease area under the guidance of the images of the same devices are the subjects of Interventional Radiology.

While there is no treatment in radiology, in Interventional Radiology; Obtaining the details of the diagnosis in the necessary diseases and treating the appropriate patients are also included. Diagnostic or treatment procedures performed under the guidance of Ultrasonography, Tomography, Angiography or MRI, which we have used in recent years, are Interventional Radiological procedures, which are generally performed with the help of needles, wires, stents, balloons and catheters, without the patient being operated on.

In recent years, the technology of these materials has been developing in parallel with imaging technology. These procedures save the patient from open surgery, do not require a large incision in the body, do not require general anesthesia or operating room environment in most patients, the patient does not have to stay in the hospital for days, and does not have to lose work and strength. Undesirable risks that may occur in the body due to surgery are minimized, and expensive costs are not paid. Recovery happens very quickly and the patient returns to his normal life much faster. In most procedures, the patient comes to the Interventional Radiologist on an outpatient basis, and after a short procedure, he returns to his normal life and work power.

Biopsies are the most common interventional radiological applications. An abnormality detected radiologically and demonstrated by imaging sometimes provides a definitive and adequate diagnosis. However, in diseases where a precise or detailed diagnosis cannot be obtained by imaging, samples from abnormal cells or tissues should be taken and microscopic and chemical examinations should be performed by the Pathology department. A biopsy is performed to diagnose such patients.

Biopsies were performed surgically before the development of Interventional Radiological methods. If a biopsy is required for the diagnosis of a disease or mass formation seen in MRI, Tomography, X-ray or Ultrasonographic examinations, without the need for surgery, the needle is inserted into the relevant organ of the body (such as thyroid, breast, lymph node, liver, kidney, soft tissue, bone and lung). ) biopsy can be performed and the diagnosis of patients can be made in the most effortless, risk-free, accurate, fast and inexpensive way.

Apart from biopsies, many diseases that could only be treated with surgery in the past can now be done without surgery with the development of Interventional Radiological treatment methods. These methods are becoming increasingly widespread due to the many advantages mentioned above.

When we group the methods used in Interventional Radiology; We can classify them under two main headings as vascular (vascular) problems and non-vascular (nonvascular) problems.

Among the vascular problems; unstoppable bleeding, aneurysm (bubble), vascular clump and abnormal vascular connections (arterial, venous, arteriovenous malformations, fistula and hemangioma), endovascular tumor embolizations, intra-arterial chemotherapy and vascular occlusions. In these patients, problematic vessels or tumors are tried to be treated with Interventional Radiological methods, using vascular occlusive (embolization) materials (coil, gelfoam, onyx, etc.), balloon, stent or vascular plug.

Among the non-vascular diseases; urinary tract obstructions, biliary tract obstructions, venous diseases such as abscess, varicose veins, hydatid cyst and many tumor diseases can be counted. In these patients, the Interventional Radiologist evaluates the patient’s age, general condition, related diseases, conditions that prevent anesthesia, laboratory results and previous surgeries, makes a decision by analyzing the effectiveness, harmlessness, usefulness, reliability and cost, and applies the Interventional Radiological procedure.

Biopsies:

It is the process of taking a part from an organ or mass in order to make a pathologically precise and detailed diagnosis. The procedure does not require general anesthesia, it is performed with local anesthesia only by anesthetizing the area to be entered through the skin and from which the piece will be taken. It is not a difficult and troublesome procedure for an experienced Interventional Radiologist. Biopsy is performed using thin or thick needles of different types, lengths and diameters, selected according to the patient and the disease.

The most widely used guide imaging method is ultrasonography. Sometimes tomography is used for lung masses and mammography is also used for microcalcifications in the breast. The procedure time does not exceed a few minutes in most biopsies. The experience of the doctor performing the procedure is the most important factor affecting the duration and difficulty of the biopsy procedure.

Fine needle biopsies for fluid or cell sampling; Thick needle biopsies are performed for tissue sampling. The sample or parts taken by biopsy are placed in special liquids and sent to the Pathology laboratory. Pathological examinations require a period of time for technical reasons and definitive diagnosis results can be obtained a few days after the procedure.

Catheterization, Drainage and Treatments:

In many different diseases; They are the methods used in the treatment of problems caused by blocked fluids that accumulate in the body or due to blockages in the body channels. For these purposes, plastic pipes called catheters, often 1-2 mm in diameter and about 30 cm long, or sometimes thin metallic tubes are used.

In this way, many processes are applied. For example, in the Nephrostomy procedure; Urine that accumulates in the kidney and swells the kidney because the urinary channels are blocked, is treated with a catheter placed in the kidney from the outside, that is, through the skin.

Similarly, fluid-containing diseases (gall, cyst, abscess, ascites, effusion, etc.) that accumulate all over the body or cause enlargement in the channels are treated by placing a catheter. In such treatment applications, the duration of the procedure varies according to the experience of the Interventional Radiologist, the patient and the condition of the disease, but it is about 5-20 minutes. These procedures are often performed under the guidance of ultrasonography, without the need for general anesthesia, following local anesthesia with local anesthesia.

Ablation and Pain Treatments:

They are the treatment methods applied in the treatment of many mass formations detected in any part of the body or when pain control is desired. It has application areas in thyroid nodules, fibroids, liver metastases, many mass and tumoral diseases of kidney, breast and other organs. In addition, it can be applied in the treatment of chronic pain that cannot be managed, to solve the problem by blocking the nerves responsible for pain transmission. The main purpose of the application in these processes; It is the damage of the area reached by targeting with the needle, under the guidance of imaging, by one of the methods of burning, freezing or chemical destruction. In such treatment applications, the duration of the procedure varies according to the experience of the Interventional Radiologist and the condition of the patient and the disease, but is approximately 20 minutes. These procedures are often performed under the guidance of ultrasonography, without the need for general anesthesia, following local anesthesia with local anesthesia.

EXAMPLES OF INTERVENTIONAL RADIOLOGICAL IMPLEMENTATION

BIOPSILAR (Thin (FNAB) or Thick Needle (Tru-Cut; Core) Biopsies)

Thyroid biopsy

breast biopsy

Liver biopsy

Mediastinal biopsy

Pancreas biopsy

Lung biopsy

prostate biopsy

Bone biopsy

Spleen biopsy

Gastrointestinal biopsy

Wire marking of breast lesion (with mammography or US guidance)

Streotactic breast vacuum biopsy (in microcalcifications)

Ultrasonography-guided paracentesis, thoracentesis

Sacroiliac joint steroid injection (CT or US guided)

CATHETERIZATION, DRAINAGE AND TREATMENTS

Percutaneous ascites, pleural effusion, empyema drainage (Abdominal and lung fluids)

Percutaneous collection/cyst treatment – ​​Liver, kidney, pancreas, thyroid, breast, etc.

Percutaneous abscess drainage

Percutaneous hydatid cyst treatment

Kidney cyst treatment

Percutaneous nephrostomy (Kidney catheter)

Antegrade ureteral catheter (Tube placement in the kidney-bladder tract)

Percutaneous cystostomy (Bladder catheter)

Percutaneous biliary drainage, percutaneous transhepatic cholangiography (Biliary duct catheter)

Percutaneous biliary stent placement (Tube placement in the biliary tract)

Percutaneous cholecystostomy (Gallbladder drainage)

ABLATIONS (Burning, freezing or chemical destruction of the tumor)

Alcohol ablation (burn with pure alcohol)

Radiofrequency (RF; Burning by heating with radio waves)

Microwave (Microwave heating)

Laser (laser burning)

Cryoablation (freeze damage)

PAIN TREATMENT

Nerve Blockages

Celiac ganglion blockade: (Treatment of pain due to tumors in the upper abdomen)

Hypogastric ganglion blockade: (Treatment of pain due to tumors in the lower abdomen)

Vertebroplasty

Pain Ablations

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