Introduction to Interventional Therapy

Interventional therapy is an emerging treatment method between surgical and medical treatment, including intravascular interventions and non-vascular interventions. After more than 30 years of development, it is now known as one of the three pillar disciplines along with surgery and internal medicine. Simply put, interventional therapy is the least invasive treatment method that involves making tiny channels of a few millimeters in diameter in blood vessels or skin, or through the body’s original pipelines, and treating the lesion locally under the guidance of imaging equipment (angiography, fluoroscopy, CT, MR, B ultrasound) without opening an incision to expose the lesion. For diseases requiring medical treatment, the advantages of interventional therapy compared to medical treatment are: Interventional therapy is characterized by less trauma, simplicity, safety, effectiveness, fewer complications and significantly shorter hospital stays. The drug can be directly applied to the lesion, which not only can greatly increase the concentration of the drug at the lesion, but also can greatly reduce the dosage of the drug and reduce the side effects of the drug. For diseases requiring surgical treatment, the advantages of interventional therapy compared to surgical treatment are: it does not require an incision to expose the lesion, and generally only a few millimeters of skin incision is needed to complete the treatment, with little epidermal damage and aesthetic appearance. Most patients only need local anesthesia rather than general anesthesia, thus reducing the risk of anesthesia. Less damage, faster recovery, satisfactory results, and less impact on normal body organs. For malignant tumors that are difficult to treat at present, interventional therapy can confine the drugs to the lesions as much as possible, while reducing the side effects on the body and other organs. Some tumors are equivalent to surgical resection after interventional treatment. Because of these many advantages, many interventional treatment methods have become one of the most important treatment methods for some diseases (such as: liver cirrhosis, liver cancer, lung cancer, lumbar disc herniation, aneurysm, vascular malformation, uterine fibroids, etc.). 1.Commonly used techniques: According to the path of the device into the lesion, it is divided into: intravascular intervention and non-intravascular intervention. (1) Intravascular intervention refers to the use of a 1-2mm thick puncture needle to enter the human vascular system by puncturing the superficial arteries on the human body surface, and the doctor, with the knowledge of vascular anatomy, delivers the catheter to the location of the lesion under the guidance of the angiography machine, injects the contrast agent through the catheter to show the vascular condition of the lesion, and treats the lesion in the vasculature. Commonly used body surface puncture points include femoral artery, radial artery, subclavian artery, and jugular artery. Vascular diseases: including percutaneous endoluminal angioplasty, vascular stenting, thrombolytic therapy, non-thrombotic ischemia, control of bleeding (acute and chronic trauma, postpartum, inflammation, varicose veins, etc.), vascular malformations, and arteriovenous fistula and angioma embolization treatment, inferior vena cava filters, TIPSS, revascularization, various angiographic diagnostics, venous blood sampling diagnostics, etc. For oncological diseases: including tumor blood supply embolization and drug perfusion, intra-arterial irradiation, prevention of radiation damage, chemotherapy, preoperative embolization of tumor vessels, vascular action drugs and alcohol perfusion, etc. (2) Non-vascular intervention refers to: simply speaking, it is a method of treating the lesion without entering the human vascular system and directly puncturing through the skin to the lesion or entering the lesion through the human embodied channel under the monitoring of imaging equipment. Various percutaneous biopsies, various non-vascular lumpectomies (including dilation and stenting of urinary tract, digestive tract, respiratory tract, biliary tract and other stenoses), local extirpation of solid tumors (percutaneous percutaneous intratumoral injection, radiofrequency ablation), drainage, fistula embolization with fistulae (stomach, bladder, etc.), tubal adhesion and recanalization, interventional treatment of herniated discs, vertebroplasty, plexus block for chronic pain, etc. In addition, there are treatments that use puncture needles to puncture directly through the body surface to the artery supplying the lesion. For the time being, we classify them as non-vascular interventions. (1) Esophageal stent: When patients with advanced esophageal cancer have difficulty in eating, esophageal stent can be placed into the lesion through the oropharynx to improve the patient’s eating condition, and at the same time, the stent has a certain compression effect on the tumor, causing tumor ischemia and delaying tumor growth. (2) Biliary stent: It is suitable for obstructive jaundice caused by tumor compression of the bile ducts in the hepatic hilar and pancreatic areas, and percutaneous hepatic puncture is adopted to place the biliary stent in the stenotic segment so that the bile can enter the duodenum directly, which is currently the preferred method to solve obstructive jaundice. Embolization therapy: (1) Tumor embolization: Liver cancer, lung cancer, pelvic tumor and other parts of the tumor can be injected through the catheter into the blood supply artery to block its blood flow, so as to achieve the purpose of “starving the tumor”. (2) Embolization of bleeding: late stage tumors often cause hemorrhage, which often leads to other complications and death if not controlled in time. For example, lung cancer, bladder cancer, rupture of esophageal varices in the fundus of stomach, etc. These patients should undergo emergency intervention to embolize their blood supply vessels to control bleeding. Such as bronchial artery, internal iliac artery, gastric coronary vein, etc.