Improving the status of interventional radiology in emergency medicine

  Emergency medicine is a rapidly developing discipline in recent years, and interventional radiology is also a rapidly developing emerging discipline that is increasingly showing its important role in various clinical fields. Interventional radiology has its own technical advantages when applied to emergency medicine. First of all, interventional techniques are less invasive and more effective, which is especially important in emergency resuscitation. For example, for all kinds of acute bleeding diseases, the accurate localization and embolization of interventional techniques can often play a decisive role in the whole emergency process. Interventional radiology includes both diagnosis and treatment, reflecting the perfect combination of diagnosis and treatment. This feature of interventional radiology originates from its own origins as diagnostic x-ray. This feature is fully reflected in the oldest interventional technique, “air enema repositioning of pediatric intussusception”. Interventional techniques are less demanding on the patient’s own vital conditions and have fewer absolute contraindications. Compared with most open procedures, hypertension, diabetes, mild cardiac, pulmonary, hepatic and renal insufficiency and mild coagulation disorders are not absolute contraindications.  Interventional therapy has been used in emergency medicine and has increasingly shown its superiority, especially in the treatment of hemorrhagic and vascular embolic diseases, and has become an important tool in emergency treatment.1 In the treatment of acute myocardial infarction, unstable angina, and malignant arrhythmia, interventional therapy has become the most important means of emergency treatment, which can rapidly improve clinical symptoms and save patients’ lives.2-5 In acute pulmonary embolism, interventional therapy can not only improve pulmonary circulation obstruction by thrombolysis and thrombus fragmentation, but also treat deep vein thrombosis by placing vena cava filters to achieve causal treatment.6,7 In cerebrovascular disease, interventional therapy has become the first choice for aneurysm treatment, and acute arterial thrombolysis has gradually shown good clinical efficacy in the treatment of acute cerebral infarction.8,9 It is believed that It is believed that with the establishment of stroke units and good collaboration between different departments, its application will become more and more widespread. In the acute treatment of bronchial haemoptysis, gastrointestinal bleeding, nasal bleeding, postpartum haemorrhage, and traumatic hepatic, splenic, and renal rupture, interventional therapy can identify the responsible lesion and embolize it within a short time, stabilizing the patient’s vital signs.10-13 In the acute occlusion of various peripheral vessels, interventional therapy can rapidly improve the symptoms of ischemia in the limbs and organs, saving the patient from surgery and amputation.  Interventional techniques can also be useful in clinical emergencies other than bleeding and embolism. Airway stenting can rapidly relieve airway obstruction caused by advanced chest tumors and improve patients’ ventilation function; colon stenting can rapidly relieve intestinal obstruction, remove accumulated feces, improve intestinal blood flow and electrolyte disorders, and turn the second-stage surgery into first-stage surgery15; for patients with high-risk acute cholecystitis, percutaneous puncture and drainage can rapidly improve patients’ systemic toxemia, reduce the acute mortality rate, and provide an opportunity for second-stage surgery; trauma or bone stasis can be treated with a percutaneous puncture and drainage. In patients with acute and severe pancreatitis, continuous regional infusion of pancreatic enzyme inhibitors and other drugs can control the development of pancreatitis and reduce the morbidity and mortality rate, which is an important part of comprehensive treatment.16 Meanwhile, basic research related to interventional radiology has been rapidly increasing. These researches mainly focus on the establishment of animal models, the development of embolic materials and the improvement of the design of interventional devices. Currently, aneurysm models, subarachnoid hemorrhage models, and models of cerebral and pulmonary infarction have matured and are widely used in interventional experiments, and mesenteric artery embolization models have also been reported. The development of embolic materials is mainly focused on granular, mechanical and liquid embolic materials.17 The research on granular embolic materials is developing rapidly; mechanical embolic materials are mainly the development of various spring coils, with biological coated spring coils and absorbable spring coils becoming the current research hotspots; the development of liquid embolic materials is mainly focused on non-adhesive, non-toxic or low toxicity polymers such as ethylene vinyl alcohol Copolymers (EVAL) and temperature-sensitive polymers, etc. The research hotspots of interventional devices mainly focus on the development of various stents and embolization devices, and the development of embolization devices is expected to replace arterial thrombolysis in the treatment of acute cerebral infarction.  However, the role of interventional therapy is still far from being played in the rescue and treatment of acute patients. Most emergency physicians only have a conceptual understanding of interventional therapy and know little about its specific scope of application. To change this situation, first of all, we should strengthen the communication with the relevant clinical departments, especially the emergency physicians, and promote the knowledge of emergency intervention through various channels, so that they can realize the superiority of interventional therapy in emergency treatment. Secondly, we should strive to improve our own business level and improve the efficacy of interventional treatment, and good clinical efficacy is the best publicity. Interventional physicians should strengthen emergency duty and actively participate in resuscitation treatment for patients with indications for interventional treatment.  The application of interventional radiology in emergency medicine is still at a young stage, but it has shown great potential and tenacity, and the technology of emergency interventional treatment still needs to be improved. We believe that through our joint efforts, emergency interventional radiology will definitely become a wonder in the field of medicine.  Emergency medicine is a rapidly developing discipline in recent years, and interventional radiology is also a rapidly developing emerging discipline, which shows its important role in various clinical fields more and more. Interventional radiology has its own technical advantages when applied to emergency medicine. First of all, interventional techniques are less invasive and more effective, which is especially important in emergency resuscitation. For example, for all kinds of acute bleeding diseases, the accurate localization and embolization of interventional techniques can often play a decisive role in the whole emergency process. Interventional radiology includes both diagnosis and treatment, reflecting the perfect combination of diagnosis and treatment. This feature of interventional radiology originates from its own origins as diagnostic x-ray. This feature is fully reflected in the oldest interventional technique, “air enema repositioning of pediatric intussusception”. Interventional techniques are less demanding on the patient’s own vital conditions and have fewer absolute contraindications. Compared with most open procedures, hypertension, diabetes, mild cardiac, pulmonary, hepatic and renal insufficiency and mild coagulation disorders are not absolute contraindications.  Interventional therapy has been used in emergency medicine and has increasingly shown its superiority, especially in the treatment of hemorrhagic and vascular embolic diseases, and has become an important tool in emergency treatment.1 In the treatment of acute myocardial infarction, unstable angina, and malignant arrhythmia, interventional therapy has become the most important means of emergency treatment, which can rapidly improve clinical symptoms and save patients’ lives.2-5 In acute pulmonary embolism, interventional therapy can not only improve pulmonary circulation obstruction by thrombolysis and thrombus fragmentation, but also treat deep vein thrombosis by placing vena cava filters to achieve causal treatment.6,7 In cerebrovascular disease, interventional therapy has become the first choice for aneurysm treatment, and acute arterial thrombolysis has gradually shown good clinical efficacy in the treatment of acute cerebral infarction.8,9 It is believed that It is believed that with the establishment of stroke units and good collaboration between different departments, its application will become more and more widespread. In the acute treatment of bronchial haemoptysis, gastrointestinal bleeding, nasal bleeding, postpartum haemorrhage and traumatic hepatic, splenic and renal rupture, interventional therapy can identify the responsible lesion and embolize it within a short period of time, stabilizing the patient’s vital signs.10-13 In acute occlusion of peripheral vessels, interventional therapy can rapidly improve the symptoms of ischemia in the limbs and organs, saving the patient from surgery and amputation.14 In some cases other than haemorrhage and embolism, interventional therapy can improve the symptoms of ischemia in the limbs and organs. interventional techniques are also useful in clinical emergencies other than hemorrhage and embolism. Airway stenting can rapidly relieve airway obstruction caused by advanced chest tumors and improve patients’ ventilation; colon stenting can rapidly relieve intestinal obstruction, remove accumulated feces, improve intestinal blood flow and electrolyte disorders, and turn second-stage surgery into first-stage surgery15; for patients with high-risk acute cholecystitis, percutaneous puncture and drainage can rapidly improve patients’ systemic toxemia, reduce the acute mortality rate, and provide an opportunity for second-stage surgery; trauma or bone stenosis can also be used to improve the patient’s blood flow. In patients with acute and severe pancreatitis, continuous regional infusion of pancreatic enzyme inhibitors and other drugs can control the development of pancreatitis and reduce the morbidity and mortality rate, which is an important part of comprehensive treatment.16 Meanwhile, basic research related to interventional radiology has been rapidly increasing. These researches mainly focus on the establishment of animal models, the development of embolic materials and the improvement of the design of interventional devices. Currently, aneurysm models, subarachnoid hemorrhage models, and models of cerebral and pulmonary infarction have been developed and are widely used in experimental studies related to interventions. The development of embolic materials is mainly focused on granular, mechanical and liquid embolic materials.17 The research on granular embolic materials is developing rapidly; mechanical embolic materials are mainly the development of various spring coils, with biological coated spring coils and absorbable spring coils becoming the current research hotspots; the development of liquid embolic materials is mainly focused on non-adhesive, non-toxic or low-toxic polymers such as ethylene vinyl alcohol (EVAL) and ethylene glycol (EVAL). Copolymers (EVAL) and temperature-sensitive polymers, etc. The research hotspots of interventional devices mainly focus on the development of various stents and embolization devices, and the development of embolization devices is expected to replace arterial thrombolysis in the treatment of acute cerebral infarction.  However, the role of interventional therapy is still far from being played in the rescue and treatment of acute patients. Most emergency physicians only have a conceptual understanding of interventional therapy and know little about its specific scope of application. To change this situation, first of all, we should strengthen the communication with the relevant clinical departments, especially the emergency physicians, and promote the knowledge of emergency intervention through various channels, so that they can realize the superiority of interventional therapy in emergency treatment. Secondly, we should strive to improve our own business level and improve the efficacy of interventional treatment, and good clinical efficacy is the best publicity. Interventional physicians should strengthen emergency duty and actively participate in resuscitation treatment for patients with indications for interventional treatment.  The application of interventional radiology in emergency medicine is still at a young stage, but it has shown great potential and tenacity, and the technology of emergency interventional treatment still needs to be improved. I believe that through our joint efforts, emergency interventional radiology will definitely become a wonder in the medical field.