Interventional Radiologists perform rapid, minimally invasive procedures, 24/7, for critical injuries of vital organs, acute haemorrhages and vascular injuries. They collaborate with other acute care specialists to improve patient outcomes in emergency cases and essentially save patients in life-threatening or critical conditions.
The following cases are real cases performed at the American Medical Centre just in the last month demonstrating the value of interventional radiology. All of the procedures described were performed in the catheterization lab under x-ray guidance with tiny skin incisions, local anaesthesia with minimal sedation and short duration typically less than 2 hours.
Case 1 – Arterial thrombolysis
A female patient presented with arterial embolism and acute ischaemia (cold pulseless arm) of the left arm due to thrombus in the artery at the elbow joint level – this was treated with a small catheter inserted from the artery of the right groin to the site of thrombus and thrombolysis infusion (blood clot dissolving medication) over 24 hours. The thrombus cleared completely and the pulses and perfusion of the hand restored.
Case 2 – Biliary drain and stent insertion
A female patient presented with severe sepsis (blood infection) requiring intensive care support and investigations showed acute blockage of the liver bile ducts (tubes) draining the bile to the bowel due to a large stone in the main bile duct. This was treated with a tiny pinhole skin incision above the liver and small catheters and wires were used to unblock the obstruction and insert a small plastic stent to allow the bile to drain to the bowel and also another plastic tube draining the infected bile to a bag. This allowed the infection to be treated and full recovery of the patient.
Case 3 – Emergency embolization for haemorrhage
A male patient presented with acute severe bleeding from the stomach with very low haemoglobin requiring multiple blood transfusions. CT angiogram demonstrated the site of bleeding from a gastric ulcer and a small branch of the artery supplying the upper part of the stomach (branch of the left gastric artery). This was treated with a small catheter inserted from the right groin artery to the branch of the artery that was bleeding and the bleeding was stopped with blocking that branch with a combination of embolic material (tiny gelatin particles and metallic coils). Again, the patient made a full recovery.
Case 4 – IVC filter insertion to prevent recurrent pulmonary embolism
A young patient presented with severe acute pulmonary embolism (blood clot in the vessels supplying the lungs) and despite treatment with anti-coagulation (blood thinning medication to dissolve the clot) she developed a new large clot in the left leg (DVT deep vein thrombosis). To prevent the clot from the leg detaching and reaching the lungs via the veins and therefore worsening her condition, a filter (essentially an umbrella type device) was inserted in her main vein in the abdomen (inferior vena cava) from a small catheter in the vein in the right groin.