Interventional radiology is a modern field of medicine that enables simultaneous diagnosis and treatment under the guidance of imaging modalities, requiring no surgical incisions or only minimal entry sites. This approach is applied across a wide spectrum, ranging from vascular diseases and tumor treatments to hemorrhage control and pain management.
What is Interventional Radiology?
Interventional radiology is a modern medical field that offers diagnostic and therapeutic opportunities guided by imaging modalities such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and angiography, without the need for surgical incisions.
These procedures are typically performed using needles or thin catheters advanced through the vasculature. The objective is to directly access the diseased area to provide a safe and controlled intervention with minimal tissue damage. Most procedures can be performed under local anesthesia or mild sedation, and patients can generally return to their daily activities within a short period.
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What Diseases Does Interventional Radiology Cover?
Diagnostic and therapeutic procedures performed in interventional radiology are not limited to a single disease. They can be utilized in many areas, from vascular diseases to tumor treatments, hemorrhage control, and organ or biliary tract disorders. These disease categories include:
Vascular diseases and circulatory problems
Vascular occlusions and stenoses (lower extremity vascular occlusion, peripheral arterial disease)
Varicose veins and venous insufficiency
Deep vein thrombosis (DVT) and thrombus therapies
Aneurysm (vascular dilation/ballooning) and certain vascular malformations/dilations
Vascular access issues in dialysis patients (such as fistula stenosis/occlusion)
Hemorrhages and emergencies requiring immediate intervention
Trauma-induced internal bleeding
Gastrointestinal bleeding (certain gastrointestinal hemorrhages)
Postpartum hemorrhage and certain gynecological bleeding conditions
Tumor-induced bleeding
Tumors and cancers
Procedures targeting tumor vasculature
Disabling of tumor foci with heat/cold using ablation techniques
Intravascular targeted therapies in cancer treatment
Conditions related to the liver, biliary tract, and pancreas
Biliary tract obstructions
Bile leaks or biliary tract stenoses
Diagnosis and treatment planning of hepatic lesions
Conditions in and around the pancreas requiring drainage
Renal and urinary tract diseases
Urinary tract obstruction (hydronephrosis) and conditions requiring renal decompression (such as nephrostomy)
Biopsy of renal masses
Renal vascular disorders
Pulmonary and thoracic diseases
Biopsy of lung nodules/masses
Pleural effusion and, in certain cases, drainage procedures
Hemorrhage or vascular issues
Certain conditions in obstetrics and gynecology
Uterine fibroids (myomas)
Vascular-targeted procedures in acute hemorrhagic scenarios, such as postpartum hemorrhage
Certain circulatory problems, such as pelvic venous congestion
Benign prostatic hyperplasia (BPH)
Pain management and spine-related interventions
- Spinal fractures (such as osteoporotic fractures)
- Image-guided injections and nerve blocks for nerve root or joint-related pain
Infections and fluid collections requiring drainage
- Abscess (infectious focus) drainage
- Intra-abdominal fluid collections
- Evacuation of cysts and similar fluid formations in eligible cases
What Are the Procedures Performed in Interventional Radiology?
Procedures performed in interventional radiology are minimally invasive diagnostic and therapeutic applications conducted using needles, catheters, and thin tubes under the guidance of imaging modalities such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and angiography. These procedures are generally categorized as extravascular, intravascular, and drainage/supportive interventions.
Diagnostic Interventional Radiology Procedures
Diagnostic interventional radiology is a field where targeted sampling and diagnostic procedures are performed under the guidance of imaging modalities to establish a definitive diagnosis of diseases. It enables direct sampling from suspicious lesions without the need for surgery.
- Liver biopsy: Enables definitive diagnosis by obtaining tissue samples from suspicious hepatic lesions under imaging guidance using a needle.
- Lung biopsy: Enables sampling of lung nodules or masses under imaging guidance, without the need for surgery.
- Renal biopsy: Provides targeted tissue sampling for the diagnosis of kidney diseases or masses.
- Pancreatic biopsy: Allows sampling of pancreatic masses to determine their nature without requiring surgical intervention.
- Thyroid nodule biopsy: Helps determine whether nodules in the thyroid gland are benign or malignant.
- Bone biopsy: Enables tissue sampling through direct targeting for the diagnosis of lesions detected in bone tissue.
- Soft tissue biopsy: Performs tissue sampling with minimal intervention for the diagnosis of masses originating from muscle and connective tissue.
- Angiography: Assists in the diagnosis of vascular diseases by providing detailed imaging of arteries and veins.
- Hormone sampling procedures: Involves collecting blood samples from specific veins to clarify diagnoses in endocrine disorders.
Therapeutic Interventional Radiology Procedures
Therapeutic interventional radiology aims to treat diagnosed conditions using methods that serve as alternatives or adjuncts to surgery. Because these procedures directly access the targeted region, they offer high efficacy and patient comfort.
Peripheral Vascular Procedures (Lower and Upper Extremity Vascular Occlusions)
- Balloon angioplasty: Enables the dilation of vascular stenoses using a balloon.
- Stent placement: Metallic devices placed within the vessel to prevent restenosis of the dilated lumen.
- Atherectomy: The process of removing calcified or hard plaques within the vessel lumen using specialized devices.
- Thrombectomy: The process of removing an occlusive thrombus using mechanical techniques.
- Intravascular lithotripsy: Facilitates the opening of calcified vascular stenoses by disrupting plaque with acoustic shockwaves.
- IVUS (Intravascular Ultrasound): Allows for a detailed evaluation of the internal vessel wall structure.
- Carbon dioxide (CO₂) angiography: A safe intravascular imaging modality that allows visualization of vessels without the use of iodinated contrast media, particularly in patients with impaired renal function.
Varicose Vein and Venous Procedures
- Varicose vein therapies: Dilated veins are treated using laser, radiofrequency, or sclerotherapy techniques.
- Deep vein thrombosis (DVT) interventions: Aims to remove thrombi formed in veins or reduce thrombus burden using image-guided endovascular techniques.
Neurovascular Procedures
Cerebral aneurysms: Enables the treatment of ballooning brain arteries using endovascular, minimally invasive techniques without surgery.
Arteriovenous malformations (AVMs): The process of occluding abnormal vascular connections from within the vessel lumen (embolization).
Acute ischemic stroke interventions (mechanical thrombectomy): Aims to restore cerebral blood flow in arterial occlusions by extracting the thrombus using endovascular methods.
Cerebral arterial stenoses (intracranial stenoses): Can be managed with endovascular methods in selected cases.
Carotid Artery Procedures
Carotid stenting and angioplasty: Interventional methods aimed at treating carotid artery stenoses by balloon dilation and stent placement, designed to reduce the risk of stroke—particularly in patients with a history of stroke or transient ischemic attack (TIA) or those at high risk for open surgery—utilizing embolic protection filters.
Oncological Interventional Radiology Procedures
- Tumor embolization: Aims to shrink the tumor by occluding the vessels supplying it.
- Chemoembolization (TACE): The process of delivering chemotherapeutic agents directly into the tumor's supplying artery, followed by embolization of these vessels.
- Radioembolization (TARE/Y-90): The process of delivering radioactive microspheres directly into the blood vessels supplying the tumor.
- Tumor-related hemorrhage control (oncological embolization): Achieves bleeding control in active tumor-induced hemorrhages by occluding the bleeding vessels using endovascular methods.
Ablation Procedures
- Radiofrequency ablation (RFA): Aims to destroy small, localized tumors utilizing thermal energy.
- Microwave ablation: Controlled destruction of tumor tissue utilizing high-temperature thermal energy.
- Cryoablation: Aims to destroy tumor cells by freezing them under controlled conditions.
Thyroid Procedures
- Thyroid nodule biopsy: Enables the evaluation of thyroid nodules under imaging guidance to determine whether they are benign or malignant.
- Thyroid ablation procedures: Enables the shrinkage of selected benign thyroid nodules using thermal energy without requiring surgery.
- Thyroid artery embolization: Aims to occlude the thyroid arteries using interventional techniques in patients who are not suitable candidates for surgery or who prefer not to undergo an operation, thereby reducing the size of the enlarged thyroid gland.
Hepatobiliary and Pancreatic Procedures
- Biliary drainage and stenting: Helps restore bile flow in biliary tract obstructions.
- Hepatic ablations: Enables the treatment of liver tumors without the need for surgery.
- Liver biopsies: Provides tissue sampling under imaging guidance for the diagnosis of liver parenchymal diseases and lesions.
- Peripancreatic drainages: Ensures safe evacuation of pancreatic fluid collections.
- Portal vein interventions: Procedures aimed at regulating blood flow and reducing complications using endovascular methods in selected cases associated with portal vein thrombosis or portal hypertension.
Renal and Urinary Tract Procedures
- Nephrostomy: Provides urinary diversion by draining urine externally when the urinary tract is obstructed.
- Renal tumor ablations: Aims to treat selected kidney tumors without requiring surgical intervention.
- Renal biopsies: Provides tissue sampling under imaging guidance for the diagnosis of kidney diseases and masses.
- Interventions for renal artery stenosis (renal artery angioplasty/stenting): Treats hemodynamically significant arterial stenoses using endovascular methods to restore circulation.
- Renal artery embolization: Applied in selected cases for hemorrhage control or to support tumor therapy.
Pulmonary and Thoracic Diseases
- Lung biopsies: Enables image-guided sampling of pulmonary masses or nodules, as well as extrapulmonary masses located in the chest wall and mediastinum.
- Thoracentesis: Relieves respiratory distress by evacuating fluid accumulated within the pleural space.
- Lung ablation procedures: Enables the treatment of selected pulmonary nodules and masses under imaging guidance without requiring surgery.
- Treatment of pulmonary vascular hemorrhage (bronchial artery embolization): Provides endovascular treatment in cases presenting with hemoptysis (coughing up blood).
Gynecological Procedures
- Uterine fibroid embolization (UFE): Shrinks uterine fibroids (myomas) by reducing their blood supply, thereby eliminating clinical symptoms.
- Uterine artery embolization (non-fibroid indications): Enables non-surgical, endovascular management of hemorrhages and circulatory disorders associated with gynecological conditions.
- Pelvic venous congestion therapies: Treats pelvic pain associated with dilated pelvic veins using endovascular techniques.
Male-Specific Procedures
- Prostate artery embolization (PAE): Aims to reduce urinary symptoms associated with benign prostatic hyperplasia (BPH) using endovascular techniques, without the need for surgery.
- Varicocele treatments: Enables the treatment of dilated scrotal veins that adversely affect testicular function using interventional techniques.
Pain Management Procedures
- Nerve blocks: Administered to reduce pain transmission in chronic or cancer-related pain.
- Celiac plexus blockade: Primarily used in the management of pain originating from the pancreas and upper abdomen.
Spine Interventions
- Vertebroplasty: Aims to alleviate pain by injecting medical-grade bone cement directly into fractured vertebral bodies.
- Kyphoplasty: Helps partially restore the height of a collapsed vertebra and provides spinal stability.
Drainage Procedures
- Abscess drainage: The process of safely evacuating purulent fluid collections resulting from infection.
- Abdominal fluid drainage (paracentesis/ascites drainage): Aims to relieve the patient by draining fluid accumulated within the peritoneal cavity.
- Thoracentesis: Enables the evacuation of fluid accumulated within the pleural space using a catheter.
Supportive and Specialized Interventions
- Port catheter placement: Establishes a permanent venous access portal for long-term chemotherapy or pharmacotherapy regimens.
- Dialysis catheters and fistula interventions: Procedures aimed at placing temporary or permanent catheters, clearing catheter occlusions, and treating stenoses or occlusions in arteriovenous fistulas to ensure safe and uninterrupted dialysis therapy in patients with renal failure.
What Are the Devices Used in Interventional Radiology?
Devices used in interventional radiology encompass both imaging systems and therapeutic medical instruments required to perform procedures safely and with control. The goal is to clearly visualize the target region and guide equipment such as needles and catheters to the exact location to perform diagnosis or treatment with minimal intervention. In this context, the devices and equipment used include:
Imaging Devices
Ultrasound (US) machine: Provides real-time imaging. It is the most frequently utilized modality for procedures such as biopsies, drainages, and needle interventions.
Computed tomography (CT) scanner: Offers high spatial accuracy for deep-seated targets. It provides primary guidance, particularly for pulmonary, intra-abdominal, and musculoskeletal lesions.
Magnetic resonance imaging (MRI) scanner: Can be utilized in selected interventions due to its high soft-tissue resolution.
Angiography system (DSA): The primary platform for endovascular interventions. It enables real-time monitoring of catheter navigation and blood flow within the vasculature.
Fluoroscopy system: Operates on the principle of real-time, dynamic X-ray. It serves as a guide, particularly during stent, catheter, and certain drain placements.
Intravascular Interventional Instruments
- Catheters: Thin, flexible tubes utilized to navigate through the vasculature to reach and treat the target region.
- Guidewires: Steering wires that enable the safe and accurate advancement of catheters within the vessel.
- Introducer sheath: Protects the vascular access site and ensures safe insertion and exchange of catheters.
- Balloon catheters: Essential angioplasty tools utilized to dilate vascular stenoses.
- Stent systems: Intraluminal scaffold devices placed to maintain vessel patency.
Extravascular Interventional Instruments
- Biopsy needles and biopsy guns: High-precision targeting systems utilized to obtain tissue samples from suspicious lesions.
- Ablation systems (RFA, microwave, cryoablation): Devices used to destroy target tissue in eligible lesions utilizing thermal energy (heating or freezing).
- Micro-access sets (needles, cannulas, micro-introducer sets): Ancillary equipment used to initiate procedures and reach targets through minimal entry sites.
Drainage Instruments
- Drainage catheters: Primary drainage systems placed to evacuate abscesses or fluid collections.
- Nephrostomy and biliary drainage catheters: Primary drainage tubes used to restore flow when the kidneys or biliary tracts are obstructed.