Editing Interventional radiology (section)

== Types ==
===Common elements===
Interventional radiology is a set of techniques that allows access to the internal structures of the body through [[body orifice]]s or very small incisions and guidance with [[medical imaging]].  Regardless of the reason for the intervention, the procedure will likely use common elements such as a [[Hypodermic needle|puncture needle]] (to pass through the skin), [[Seldinger technique|guidewires]] (to guide through structures such as blood vessels or the biliary or urinary systems), a sheath (which slides over the guidewire and holds the path open without injuring it), and [[catheter]]s (that allow fluids to be pushed through them).<ref name=Taslakian>{{Cite journal|last1=Taslakian|first1=Bedros|last2=Ingber|first2=Ross|last3=Aaltonen|first3=Eric|last4=Horn|first4=Jeremy|last5=Hickey|first5=Ryan|date=2019-08-30|title=Interventional Radiology Suite: A Primer for Trainees|journal=Journal of Clinical Medicine|volume=8|issue=9|pages=1347|doi=10.3390/jcm8091347|issn=2077-0383|pmc=6780384|pmid=31480308|doi-access=free }}</ref>

Also common to all intervention radiology procedures are the medical imaging machines that allow the healthcare provider to see what is occurring within the body.  Some use X-rays (such as [[CT scan|CT]] and [[fluoroscopy]]) and some do not (such as [[ultrasound]] and [[Magnetic resonance imaging|MRI]]).<ref name=Taslakian/>  In each case, the images created may be modified by computer to better visualize the structures as is in the case with [[digital subtraction angiography]], CT and MRI, or the display of the images improved with [[virtual reality]] or [[augmented reality]] presentation.<ref>{{Cite journal|last1=Midulla|first1=Marco|last2=Pescatori|first2=Lorenzo|last3=Chevallier|first3=Olivier|last4=Nakai|first4=M.|last5=Ikoma|first5=A.|last6=Gehin|first6=Sophie|last7=Berthod|first7=Pierre-Emmanuel|last8=Ne|first8=Romaric|last9=Loffroy|first9=Romaric|last10=Dake|first10=Michael|date=2019-01-28|title=Future of IR: Emerging Techniques, Looking to the Future...and Learning from the Past|journal=Journal of the Belgian Society of Radiology|volume=103|issue=1|pages=12|doi=10.5334/jbsr.1727|issn=2514-8281|pmc=6396039|pmid=30828696 |doi-access=free }}</ref>

===Diagnostic interventional radiology===
* [[Angiography]]: Imaging the blood vessels to look for abnormalities with the use of various contrast media, including iodinated contrast, gadolinium based agents, and {{CO2}} gas.<ref name="Uberoi 2009 chpt4">{{cite book | last=Uberoi | first=Raman | name-list-style = vanc | title=Interventional radiology | publisher=Oxford University Press | location=Oxford New York | year=2009 | isbn=978-0-19-157556-3 | chapter=4 Imaging | pages=49–77}}</ref>
* [[Cholangiography]]: Imaging the bile ducts within the liver to look for areas of blockage.
* [[Biopsy]]: Taking of a tissue sample from the area of interest for pathological examination from a percutaneous or transvenous approach.<ref name="Uberoi 2009 chpt19">{{cite book | last=Uberoi | first=Raman | name-list-style = vanc | title=Interventional radiology | publisher=Oxford University Press | location=Oxford New York | year=2009 | isbn=978-0-19-157556-3 | chapter=19 Biopsy and drainage| pages=387–402 }}</ref>
* [[Fine-needle aspiration]]: obtaining cells from a tissue or organ under ultrasound guidance.

===Therapeutic interventional radiology===
''Vascular''
* [[Angioplasty|Balloon angioplasty/stent]]: Opening of narrow or blocked blood vessels using a balloon, with or without placement of metallic stents to aid in keep vessel patent.<ref name="Uberoi 2009 chpt7">{{cite book | last=Uberoi | first=Raman | name-list-style = vanc | title=Interventional radiology | publisher=Oxford University Press | location=Oxford New York | year=2009 | isbn=978-0-19-157556-3 | chapter=7 Angioplasty and stenting | pages=123–147 }}</ref>
* [[Endovascular aneurysm repair]]: Placement of endovascular stent-graft across an [[aneurysm]] to prevent expansion or progression of the defective vessel.<ref name="Uberoi 2009 chpt9">{{cite book | last=Uberoi | first=Raman | name-list-style = vanc | title=Interventional radiology | publisher=Oxford University Press | location=Oxford New York | year=2009 | isbn=978-0-19-157556-3 | chapter=9 Stentgrafting| pages=171–186 }}</ref>
* [[Embolization]]: Placement of a metallic coil or embolic substance (gel-foam, poly-vinyl alcohol) to block blood through to a blood vessel, either to stop bleeding or decrease blood flow to a target organ or tissue.<ref name="Uberoi 2009 chpt17">{{cite book | last=Uberoi | first=Raman | name-list-style = vanc | title=Interventional radiology | publisher=Oxford University Press | location=Oxford New York | year=2009 | isbn=978-0-19-157556-3 | chapter=17 Embolization techniques| pages=341–360 }}</ref>
** [[Uterine artery embolization]] (UAE) or uterine fibroid embolization (UFE)
** [[Prostate artery embolization]] (PAE)
** [[Pulmonary arteriovenous malformation]] (PAVM) embolization<ref>{{cite journal | vauthors = Cusumano LR, Duckwiler GR, Roberts DG, McWilliams JP | title = Treatment of Recurrent Pulmonary Arteriovenous Malformations: Comparison of Proximal Versus Distal Embolization Technique | journal = CardioVascular and Interventional Radiology | volume = 43 | issue = 1 | pages = 29–36 | pmid = 31471718 | doi = 10.1007/s00270-019-02328-0 | year = 2020 | s2cid = 201675132 }}</ref>
** [[Hemorrhoidal artery embolization]] (HAE)
** Splenic artery embolization (SAE)<ref>{{Cite journal |last=Ahuja |first=Chaitanya |last2=Farsad |first2=Khashayar |last3=Chadha |first3=Meghna |date=October 2015 |title=An Overview of Splenic Embolization |url=https://ajronline.org/doi/10.2214/AJR.15.14637 |journal=American Journal of Roentgenology |volume=205 |issue=4 |pages=720–725 |doi=10.2214/AJR.15.14637 |issn=0361-803X|url-access=subscription }}</ref>
* [[Thrombolysis]]: Catheter-directed technique for dissolving blood clots, such as pulmonary embolism and deep venous thrombosis, with either pharmaceutical (TPA) or mechanical means.
* [[IVC filters]]: Metallic filters placed in the vena cava to prevent propagation of deep venous thrombus.
* [[Kidney dialysis|Dialysis]]-related interventions: Placement of tunneled hemodialysis catheters, peritoneal dialysis catheters, and revision/thrombolysis of poorly functioning surgically placed AV fistulas and grafts.<ref name="Uberoi 2009 chpt12">{{cite book | last=Uberoi | first=Raman | name-list-style = vanc | title=Interventional radiology | publisher=Oxford University Press | location=Oxford New York | year=2009 | isbn=978-0-19-157556-3 | chapter=12 Haemodialysis fistula| pages=253–268 }}</ref>
* [[File:Tips schematic.JPG|thumb|TIPS procedure schematic]] [[Transjugular intrahepatic portosystemic shunt|TIPS]]: Placement of a transjugular intrahepatic porto-systemic shunt (TIPS) for select indications in patients with critical end-stage liver disease and portal hypertension.<ref name="Keller Farsad Rösch 2016 pp. 2–9">{{cite journal | vauthors = Keller FS, Farsad K, Rösch J | title = The Transjugular Intrahepatic Portosystemic Shunt: Technique and Instruments | journal = Techniques in Vascular and Interventional Radiology | volume = 19 | issue = 1 | pages = 2–9 | date = March 2016 | pmid = 26997084 | doi = 10.1053/j.tvir.2016.01.001 | publisher = Elsevier BV }}</ref>
* [[Endovenous laser treatment]] of varicose veins: Placement of thin laser fiber in varicose veins for non-surgical treatment of venous insufficiency.
* [[Chemoembolization]]: Combined injection of chemotherapy and embolic agents into the arterial blood supply of a tumor, with the goal of both local administration of chemotherapy, slowing "washout" of the chemotherapy drug, and also decreasing tumor arterial supply
* [[Radioembolization]]: Combined injection of radioactive glass or plastic beads and embolic agents into the arterial blood supply of a tumor, with the goal of both local administration of [[Radiation therapy|radiotherapy]], slowing "washout" of the radioactive substance, and also decreasing tumor arterial supply

[[File:Biliary stenosis.tif|thumb|Biliary stenosis]]
''[[Biliary intervention]]''<ref name="Uberoi 2009 chpt13">{{cite book | last=Uberoi | first=Raman | name-list-style = vanc | title=Interventional radiology | publisher=Oxford University Press | location=Oxford New York | year=2009 | isbn=978-0-19-157556-3 | chapter=13 Hepatobiliary intervention| pages=269–282 }}</ref>
* Placement of catheters in the biliary system to bypass biliary obstructions and decompress the biliary system.
* Placement of permanent indwelling biliary stents.
* [[Cholecystostomy]]: Placement of a tube into the gallbladder to remove infected bile in patients with cholecystitis, an inflammation of the gallbladder, who are too frail or too sick to undergo surgery.

''Catheter placement''
* [[Central venous catheter]] placement: Vascular access and management of [[intravenous]] devices (IVs), including both tunneled and non-tunneled catheters (e.g., [[PIC line|PIC]], [[Hickman line|Hickman]], [[Port-a-Cath|port catheters]], hemodialysis catheters, translumbar and transhepatic venous lines).
* [[Drain insertion|Drainage catheter placement]]: Placement of tubes to drain pathologic fluid collections (e.g., abscess, pleural effusion). This may be achieved by percutaneous, trans-rectal, or trans-vaginal approach. Exchange or repositioning of indwelling catheters is achieved over a guidewire under image guidance.
* [[Radiologically inserted gastrostomy]] or jejunostomy: Placement of a feeding tube percutaneously into the stomach and/or jejunum.<ref>{{cite book | last=Uberoi | first=Raman | name-list-style = vanc | title=Interventional radiology | publisher=Oxford University Press | location=Oxford New York | year=2009 | isbn=978-0-19-157556-3 | chapter=14 Gastro-intestinal intervention | pages=290–295}}</ref>

''Ablative''<ref name="Uberoi 2009 chpt18">{{cite book | last=Uberoi | first=Raman | name-list-style = vanc | title=Interventional radiology | publisher=Oxford University Press | location=Oxford New York | year=2009 | isbn=978-0-19-157556-3 | chapter=18 Tumour ablation | pages=361–386}}</ref><ref name="Wah 2017 pp. 636–644">{{cite journal | vauthors = Wah TM | title = Image-guided ablation of renal cell carcinoma | journal = Clinical Radiology | volume = 72 | issue = 8 | pages = 636–644 | date = August 2017 | pmid = 28527529 | doi = 10.1016/j.crad.2017.03.007 | publisher = Elsevier BV }}</ref>
* [[Radiofrequency ablation]] (RF/RFA): Local treatment in which a special catheter destroys tissue with heat generated by medium frequency alternating currents
* [[Cryoablation]]:  Local treatment with a special catheter that destroys tissue with cold temperature generated by rapid expansion of compressed [[argon]] gas—used mostly to treat small renal cancers and for the palliation of painful bone lesions<ref>{{Cite book|title=Percutaneous Tumor Ablation|date=2011|publisher=Thieme Verlag|isbn=9781604063066|doi=10.1055/b-0034-81500|chapter = 2 Cryoablation: Mechanism of Action and Devices|editor1-last=Hong|editor1-first=Kelvin|editor2-last=Georgiades|editor2-first=Christos S}}</ref>
* [[Microwave ablation]]:  Local treatment with a special catheter that destroys tissue with heat generated by [[microwave]]s

''Genitourinary''<ref name="Uberoi 2009 chpt11">{{cite book | last=Uberoi | first=Raman | name-list-style = vanc | title=Interventional radiology | publisher=Oxford University Press | location=Oxford New York | year=2009 | isbn=978-0-19-157556-3 | chapter=11 Interventional uro-radiology | pages=221–225}}</ref>
* [[Nephrostomy|Percutaneous nephrostomy]] or nephroureteral stent placement: Placement of a catheter through the skin, directly into the kidney to drain from the collecting system. This is typically done to treat a downstream obstruction of urine.
* Ureteral stent exchange: indwelling double-J type [[Ureteric stent|ureteral stents]], typically placed by urologist using cystoscopy, may be exchanged in retrograde fashion through the female urethra. The IR uses a thin wire snare under fluoroscopy to capture the distal portion of the stent. After partially extracting the distalmost stent, exchange for a new stent can be accomplished over a guidewire.