The management of vascular diseases, covering a spectrum of conditions that impact blood vessels, used to be elaborate and complicated as it required major surgeries that confined patients in the ICU at least for five days, apart from the substantial post surgery healing period. The evolution in interventional radiology has resulted in a transformative shift in treatment as patients now experience minimally invasive procedures which require a minute puncture less than 1mm, resulting in enhanced outcomes and quicker recovery times. Interventional radiologists are integral in diagnosing and guiding interventions for diverse vascular conditions.
Interventional radiology, equipped with advanced imaging modalities such as magnetic resonance angiography (MRA), computed tomography angiography (CTA) and ultrasound have revolutionised the precision of vascular disease diagnoses. These technologies provide detailed and non-invasive insights into the vascular system, allowing healthcare professionals to pinpoint the location, severity and nature of vascular abnormalities.
“Advancements in interventional radiology have contributed to reducing procedure complications and hospital stays, leading to significant improvement in outcomes,” said Dr Rohit PV Nair, senior consultant-vascular and interventional radiologist at Aster Medcity, Kochi.
Treatments for vascular diseases include unblocking blood vessels to inserting a stent-graft to prevent vessel rupture. Interventional radiologists collaborate closely with endocrinologists, podiatrists and vascular surgeons for procedures like angioplasty stent placement to treat peripheral vascular diseases (PAD), commonly found in individuals with diabetes, smokers and those with high cholesterol. Collaboration also extends to cardiothoracic vascular surgeons for addressing artery bulges or or aneurysms.
Interventional radiology has refined techniques for treating deep vein thrombosis, caused by vein clots, offering a more effective alternative to year-long medication. The disease is found in people who often go on long journeys, women, obese etc. The patients have difficulty in wearing pants because of the unusual swelling in one of the legs. “We suck all the clots from the veins and sometimes put a temporary filter to prevent the clot from going into the lungs,” said Dr Nair.
When it comes to clots, health experts are concerned about 20-25% increase in blood clotting incidents after Covid-19 pandemic. “The pathogenesis of the Covid-19 virus has some effect on blood clotting. We are seeing more patients with heart attack, blocks in blood vessels to the bowels, legs etc,” added Dr Nair.
Dr. Manish Kumar Yadav, senior consultant, neuro interventional radiology imaging and interventional radiology, KIMS Health, Thiruvananthapuram, said interventional radiology targets many of today’s toughest medical cases, including vascular disease with minimal complications and utmost precision.
“A 48-year-old patient who suffered a severe stroke due to significant narrowing of a brain artery was presented at the hospital. Traditionally, complex carotid endarterectomy is the norm for such conditions, involving a long surgical procedure, anaesthesia, a scar on the neck and a lengthy hospital stay. Considering the complexities, the patient, who was a working professional, underwent a swift and efficient one-hour interventional procedure known as carotid stenting. This minimally invasive approach involves placement of a small metal stent into the narrowed artery through a minor incision made in the groin, allowing the patient to return home the same day and resume normal life at the earliest. The small incision healed quickly within days,” said Dr Yadav.
Despite the sophistication involved, the treatments are cost-effective as the patients save on open surgery procedures, ICU and hospital stay. According to Nair, advancements in interventional radiology such as endovascular robotic system for endovascular aortic repair or percutaneous endovascular abdominal aortic aneurysm repair (Pevar) would further reduce the treatment to daycare procedures. Artificial intelligence is expected to improve the plan for procedures.
Vascular Diseases and Treatments
1. Peripheral Arterial Disease: Narrowing and hardening of arteries in the limbs
– Traditional treatment: Surgical bypass common for severe cases
– Interventional radiology: Angioplasty and stenting have become preferred options. They are less invasive, often performed through small incisions, reducing recovery times and complications
2. Aneurysms: Weakening and bulging of blood vessel walls, potentially leading to rupture
– Traditional treatment: Open surgical repair involving significant incisions and longer hospital stay
– Interventional radiology: Endovascular repair using stent-grafts has become the standard. It reduces risk of complications associated with open surgery
3. Deep vein thrombosis: Blood clotting in deep veins, often in the legs
– Traditional treatment: Anticoagulant medications and in severe cases surgical
