Interventional Radiology, Interventional Neuroradiology and Interventional Oncology

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Interventional Radiology, Interventional Neuroradiology and Interventional Oncology

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Interventional Radiology

Interventional Radiology is a sub-specialty of the radiology which implements various minimal invasive procedures using medical imaging guidance, such as X-ray-fluoroscopy, computer tomography, magnetic resonance imaging or ultrasound. Interventional Radiology incorporates the techniques used for diagnostic and treatment in most medical fields. It is divided into two parts: diagnostic (angiography, venography, cholangiography, biopsy) and therapeutic.

An Interventional Radiologist, first of all, is a diagnostic radiology specialist. Therefore, he/she knows well how to assess the images taken with ultrasound examination, computer tomography, magnetic resonance imaging and other diagnostic examination techniques.

Angiography is a visual imaging of the blood vessels in the human body by administering a contrast agent (colouring agent). It is not only used for diagnostic, but for therapeutic purposes with DSA, Fluoroscopy, Ultrasound device, Computer Tomography and other imaging techniques. As it is used in vascular occlusions, it can be used for several purposes, such as aneurysm, vascular malformations, embolization or treatment of masses.

Not surgical, but interventional treatment of the vascular diseases is called endovascular treatment. This is one of the most important techniques in the present day, because vascular disease is the most common type of disease throughout the world, and the half of the deaths in our country is due to the cardiovascular diseases.

Endovascular operation is easy for the patients, since it is less painful, requires a small incision and recovers within a short period of time. These operations are performed under local or general anaesthesia; therefore, the patients do not feel a pain in any stage of the intervention.

  • Interventional Neuroradiology

Interventional neuroradiology angiography technique is used in the treatment of the regions of the head-neck and brain, as well as vascular disease of the spinal cord.

Vascular disease observed in the outermost portion of the brain is mostly treated by a technique of interventional neuroradiology through inserting tiny instruments (in a size of the eye of needle) into the groin area, threading through the vascular lumen leading into the brain.

  • Endovascular treatment of aneurysm (vascular ballooning)

One of the most common fields of the interventional neuroradiology is the treatment of the structures like a bulge called aneurysm occurring in a weak point of the cerebral arterial wall. Since a ballooning in the wall of blood vessel is not as resistant as healthy vascular walls, it may cause a bleeding by rupturing under a pressure of the blood pumped from the heart. If aneurysm or fistula exist in the cerebral vessels, we treat them by occluding with a technique of interventional neuroradiology.

  • Treatment of carotid artery stenosis

As it may occur in all vessels of the body, a stenosis and occlusion of carotid artery (the main artery of the brain) may develop. Temporary or permanent loss of brain functions and hemiplegia and paraplegia (stroke) may occur as a result of stenosis and occlusion developing in the carotid artery. The main reason of the disease is an atherosclerosis disease. It can also be treated with angiography and stent placement procedures in addition to the open surgery.

  • Vascular occlusions

Formation of a blood clot in a vessel, atherosclerosis or occlusions formed in the vessels due to various reasons may cause life-threatening serious health problems depending on the area it occurs. High-density agent is injected into the vessels by using interventional radiology techniques, and this allows the visualization of the desired areas. A barrier or stenosis can be detected and treated in this way.

  • Occlusion of lower extremity vessels

Occlusion of lower extremity vessels, which mostly develops due to the atherosclerosis and is more common at later ages, may cause a pain in the calf bone while walking, numbness in the tip of the toes, as well as wounds and gangrene of the toes in more advanced cases. Occlusion and stenosis developed in the lower extremity vessels can be treated successfully by means of techniques such as angiography, balloon, stent, atherectomy, thrombolysis and removal of a blood clot.

  • Interventional Oncology

Another field where the techniques of the interventional radiology gives a result is oncology. A needle biopsy encompasses a sampling technique by means of inserting a needle into the organ under image-guided techniques. Taken samples can be examined pathologically. By this way, it is possible to take an incisional biopsy from several organs, such as liver, breast, lymph nodes, prostate.

There are techniques which directly treat the cancer in addition to the techniques of the interventional radiology used with the aim of diagnostic in oncology. The techniques, such as microwave ablation, chemoembolization, intraarterial chemotherapy, radioembolization are interventional radiology procedures to kill cancer cells directly.

  • Transarterial embolization (TAE)

It is a procedure in which an embolic material (microparticles, glue, PVA) is injected into tumour feeding artery through a catheter in order to block a blood supply to the tumour (cancer or benign) cell and cause to the death of the cell, as well as stop bleeding. Example: Uterine artery embolization (during the bleeding of uterine fibroids or uterine masses), prostate artery embolization, embolization of the vessels of the bleeding masses, embolization of the haemangiomas in some regions.

  • Transarterial chemoembolization (TACE)

It is a procedure in which a chemotherapy drug through a catheter is injected into tumour feeding arteries together with microparticles. Meanwhile, it both gives a chemotherapy to the tumour cells and blocks a blood supply to the tumour causing the death of cell. TACE can be performed with different types of drugs. It is mostly used in the management of unresectable liver cancer (hepatocellular carcinoma).

In the meantime, placement of central venous catheter (Picc-line, port catheters) is also one of the techniques used by Interventional Radiology for smooth implementation of oncological treatments.

  • Drainage techniques, treatment of cyst, abscess

Stenosis in the bile ducts and ureters can be also treated through drainage operations used by a technique of Interventional Radiology. Ascites or abscess, cyst is prevented with a drainage operation.

  • Diagnostic and management of bone lesions

Management of aneurysmal bone cysts and osteoid osteoma with a technique of microwave ablation, and biopsy of the bone lesions are performed.

Procedures performed:

  1. Image-guided painless biopsy (sample taking) procedures of solid organs and tumors.
  2. Diagnosis of breast diseases (Ultrasound, Mammography, MRI, biopsy) and treatments of benign lesions like cysts and fibroadenomas without open surgery and incisions.
  3. Needle ablation of Cysts in kidneys, liver, breast, thyroid gland, ovaries and in other parts of body.
  4. Needle ablation of Tumors in the liver, kidney and lungs (Radiofrequency, Microwave and Cryoablation).
  5. Treatment of liver tumors through groin or wrist arteries (Chemoembolization, Radioembolization).
  6. Diagnosis of thyroid gland nodules and painless treatment with ablation needles (Radiofrequency, Microwave and Alcohol Ablation).
  7. Treatment of goiter by embolization (blocking its vessels).
  8. Establishing a vascular access in patients with vascular access problems especially dialysıs patients or patients with previously blocked veins (Temporary and permanent hemodialysis catheters, Picc catheter).
  9. Safe placement of chemotherapy ports under ultrasound and angiography guidance.
  10. Opening of narrowed, clogged carotid (neck) arteries, as well as arteries of kidneys, intestines, groin and legs (with balloon, stent and curettage methods).
  11. Treatment of Diabetic Foot.
  12. Endovascular therapy of varicocele in men through groin vein without open surgery.
  13. Treatment of Pelvic Congestion Syndrome in women (genital, pelvic and uterine varicose veins) through groin vein.
  14. Embolization(blocking) of uterine myomas (Fibroma) by blocking the arteries through groin without incision.
  15. Opening of blocked fallopian tubes (uterine tube).
  16. Embolization (blocking) of bleeding hemorrhoids without surgery.
  17. The diagnosis and treatment of vascular malformations and hemangiomas (vessel abnormalities coming from birth, and vascular tumors) without open surgery.
  18. Embolization of aneurysms (vessel ballooning) of the aorta and other vessels.
  19. Cerebral vascular diseases (Aneurysm, AVM / AVF, carotid stenting, balloon and stent treatment of narrowed and clogged  cerebral vessels).
  20. Opening of vessels in acute stroke (sudden emergencies associated with blockage of the cerebral arteries).
  21. Diagnosis and investigation of the thrombosis causes in the foot veins, clot removal, clot dissolution and stenting treatments. Treatments of acute and chronic deep venous thrombosis.
  22. Catheter and stent treatment of blockages and narrowing in bile ducts, diagnosis and treatment of gallstones and gallbladder sludge.
  23. Finding bleeding areas and blocking of the bleeding vessels (Gastric, intestinal, pulmonary hemorrhage, postpartum hemorrhage, post-traumatic hemorrhage, nasal hemorrhage).
  24. Treatment for prostatic hyperplasia without surgery (Prostatic artery embolization).
  25. Fusion biopsy in the diagnosis of prostate cancer (Targeted biopsy).
  26. Treatment of ureteral obstruction (Nephrostomy, balloon dilatation and stent placement).
  27. Interventional Pain Management: Needle therapy of back, foot, neck, shoulder, arm pains and pains related to cancer.
  28. Treatment of Benign Liver Hemangioma, Renal angiomyolipomas by embolization without open surgery.
  29. Permanent treatment of fluid collection in the abdomen and lungs.

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