Interventional radiology, as an emerging discipline combining medical imaging and clinical therapeutics, is a science that uses percutaneous puncture and catheter technology to diagnose and/or treat diseases under the guidance of imaging, using certain drugs or instruments. It was founded in the 1960s abroad and started in the early 1980s in China. In recent years, due to the progress of basic disciplines and imaging equipment, interventional radiology has developed rapidly and has penetrated into almost every field of clinical disciplines. Interventional therapy has become the main treatment for some diseases, and even replaced some surgeries as the only treatment method of choice. Interventional radiology has been recognized as one of the three major medical disciplines along with medicine and surgery.
Since interventional radiology involves a wide range of methods, it is briefly introduced according to the interventional route by transvascular intervention and non-vascular intervention.
I. Percutaneous transvascular interventional techniques
1.Diagnostic application: Using our large flat panel DSA, we can well perform selective or super-selective angiography of various parts of the body. It is mainly applied to.
①Diagnosis of vascular lesions per se, such as stenosis, aneurysm, arteriovenous malformation, arteriovenous fistula, etc. Angiography is unanimously regarded as the gold standard for the diagnosis of vascular lesions.
②Diagnosis of ischemic lesions, such as various kinds of emboli (thrombus, cancer emboli, attached emboli), and vascular occlusive lesions.
③Diagnosis of hemorrhagic lesions, such as trauma, medical origin and various pathological bleeding.
④Diagnosis of neoplastic lesions, such as malignant solid tumors, meningiomas, nasopharyngeal fibrovascular tumors, etc., while understanding their blood supply, so as to provide objective basis for interventional treatment or for surgical treatment.
2.Therapeutic applications.
① Treatment of malignant solid tumors: Since their treatment mainly depends on the concentration and duration of action of drugs, at the same time, the blood supply vessels of the tumor can be embolized and the source of nutrition can be blocked. Therefore, using advanced imaging equipment and puncture catheter technology, the drug can be directly administered in the blood supply artery of tumor, and its drug concentration is 10 times or even several 10 times higher than that of intravenous, and can be administered continuously. It is widely used in liver cancer, lung cancer, pancreatic cancer, colon cancer, ovarian cancer, cervical cancer, laryngeal cancer, nasopharyngeal cancer (sensitization for radiotherapy) and so on. In particular, it is combined with direct percutaneous puncture of the tumor under CT guidance to perform drug injection, i.e. chemical ablation. Thus, it is a three-dimensional and multi-faceted comprehensive treatment that can be achieved by both transvascular drug delivery (anti-cancer drugs) and embolization, and chemical ablation.
②Treatment of ischemic lesions: through transvascular continuous high concentration injection of thrombolytic agents or antispasmodic agents, such as early thrombolytic femoral head of cerebral infarction, ischemic necrosis and other treatments, the effect is remarkable.
③ Treatment of hemorrhagic lesions: mainly through vascular injection of embolic agents or vasoconstrictive drugs to achieve hemostasis, commonly used for gastrointestinal bleeding, hemoptysis, pelvic hemorrhage, biliary bleeding, etc.
Dilatation and stenting of vascular stenosis: Various causes of vascular stenosis, such as renal artery, common iliac artery, subclavian artery, aorta, coronary artery, etc., can be dilated and shaped by balloon catheter.
⑤ Cardiac disorders: such as arteriovenous catheter failure, atrial and ventricular septal defect sealing, mitral valve stenosis dilation and shaping, etc.
(6) Extinction therapy: such as hyperthyroidism, hypersplenism, and partial loss of function can be achieved by embolization to achieve partial endoscopic resection to restore its function to normal. This method can also be implemented for hemangioma.
II. Non-vascular interventional techniques
1.Percutaneous puncture biopsy: Under the guidance of CT, puncture biopsy of unexplained masses in the lung and mediastinum, abdomen, pelvis, neck, etc. is feasible to obtain direct pathological diagnosis.
2.Percutaneous puncture and drainage and treatment: under CT guidance, percutaneous puncture and aspiration of cysts (abscesses) of liver, kidney, pancreas, ovary, abdominal cavity, lung and mediastinum is feasible, and sclerotherapy (anhydrous ethanol) or antibiotics can be given to avoid or reduce surgical treatment and alleviate patient pain.
3.Fistula and drainage of physiological cavity: under the guidance of X-TV or CT, percutaneous biliary puncture and drainage or placement of metal stents; percutaneous puncture of stomach and renal pelvis fistula and drainage; dilatation and shaping of esophageal and ureteral stenosis or placement of stents, etc.
4.Percutaneous puncture of the intervertebral disc nucleus pulposus for chemical lysis or aspiration and decompression.
5.Selective tubal angiography and recanalization.
Interventional radiology is widely used in clinical practice because, on the one hand, modern highly sophisticated imaging equipment provides us with an “eagle eye”; on the other hand, it has many advantages that are recognized by people: easy and safe method, small incision, no suture and blood transfusion; no pain or very slight, easily accepted by patients; most of them can get out of bed the next day. Most of them can be out of bed the next day. Many diseases are treated with good results, and some of them have immediate effects. The complications of interventional treatment are few and mild, and very few serious complications arise.