Interventional radiology

Interventional Radiology is a specialty in which minimally invasive procedures are performed using image guidance(X-ray fluoroscopy-DSA suite, ultrasound, computed tomography [CT]). Procedures are done for either diagnostic purposes like angiography or for therapeutic purposes.

IR treatments are minimally invasive alternatives to surgery and most of procedures start with passing a needle through the skin(pinhole surgery).

IR includesvascular and non- vascular procedures. In vascular procedures either arterial or venous access is taken for diagnostic or therapeutic purpose like angiography, tumor embolization while non-vascular procedures doesn’t require any vascular access

Non vascular procedures

• Image (Ultrasound /CT)guided tissue or organ FNAC/ Biopsies including bone biopsies.
• Image guided catheter/pigtail drainage of simple or complex collection/abscess.Ascitic and pleural fluid drainage
• Percutaneous Nephrostomy and antegrade DJ stenting for obstructive nephropathy.
• Biliary procedures in obstructive biliopathy includingpercutaneous transhepatic biliary drainage (PTBD) , Bile duct stenting, percutaneouscholecystostomy, Biliary stricture balloon dilatation,Hepatico-jejunostomy stricture dilatation.

Liver Directed Procedures and Therapies

• Trans arterial chemoembolization(TACE) for liver tumors like HCC
• Trans arterial radio embolization(TARE)  for liver tumors
• Ablative procedures for liver tumors- Radiofrequency ablation(RFA) and microwave ablation( MWA)
• Percutaneous acetic acid and alcohol installation for small liver tumors
• Portal vein embolization
• Percutaneous plugged liver biopsy and Transjuglar liver biopsy(TJLB) in patients with disarranged coagulation profile
• PAIR for hepatic hydatid cyst treatment

Interventions in Portal Hypertension

• Transjuglar intrahepatic Porto systemic shunt (TIPS) in liver disease patients for secondary variceal bleed control or treatment of recurrent uncontrolled  ascites and pleural effusion
• Direct intrahepatic Porto systemic shunt(DIPS) in patient with Budd Chiari syndrome
• Hepatic venous / IVC angioplasty and stenting
• Balloon/Plug occluded retrograde  trans venous obliteration of gastric varices (BRTO/ PARTO)
• HVPG for measuring portal hypertension

Embolization Procedures for Bleeding

• Bronchial artery embolization(BAE) for hemoptysis
• Uterine artery embolization for Post-partum hemorrhage , uterine AVM, fibroid size reduction
• Visceral artery embolization for GI bleed ,aneurysm /pseudoaneurysms bleed , tumor bleed , uncontrolled  hematuria.

Oncointerventions

• Image guided tissue /tumor FNAC and Biopsy
• PICC line and Hickman line insertion for long term chemotherapy
• Embolization for  uncontrolled life threatening tumor bleed
• Percutaneous gastrostomy in patients with upper digestive tract obstruction
• Image guided hook wire localization/Fiducial marker placement for breast cancer patients 
• Ablative procedures like RFA/MWA for solid organ tumors
• Radiofrequency ablation (RFA)  for benign bony tumors (osteoid osteoma)
• Chemical ablation of aneurysmal bone cyst

Peripheral and abdominal vascular intervention

• Diagnostic angiography and venography.
• Mesenteric artery(Celiac/SMA) angioplasty and stenting for chronic mesenteric ischemia
• Renal artery angioplasty and stenting for uncontrolled hypertension
• Mechanical and chemical thrombolysis for acute arterial thrombus involving limb arteries, mesenteric arteries and in acute  deep venous thrombosis
• Upper and lower limb arterial angioplasty and stenting for impending limb gangrene, embolic/thrombotic vascular occlusion, diabetic foot for wound healing
• Central venous stenosis/ SVC obstruction angioplasty and stenting.
• AV fistula access  maturation and venoplasty in kidney disease patients
• Peripheral limb Arterio-venous vascular malformation embolization
• Sclerotherapy for venous, venolymphatic malformations and hemangiomas.
• Varicose vein laser ablation
• Thoracic duct embolization for lymphatic leaks