Interventional Radiology

Yesterday I spent the day in the Interventional Radiology Department. The IR department is a pretty cool place where technology and medicine collide. In short, they use cutting edge imagining techniques to assist them in diagnosing, and more importantly, providing treatments in the form of various procedures.

I got pretty lucky yesterday since there were a wide array of cases. There was a femoral and aortic angiogram, a percutaneous drain placement in the gallbladder, a kidney biopsy, and very interesting catheter thrombolysis of 2 whopping Pulmonary Emboli. I was told by the Radiologist just how fortunate I was since they do not do too many of these procedures- he guessed maybe only a dozen or so last year- since clots of this magnatude are usually fatal.

The patient was a previously healthy woman in her early 70's hwo presented with shortness of breath. It was discovered that she had massive bilateral PE's; the one on the left was occluding just about 100% of the pulmonary vasculature. Basically only one of her lungs was working at all and it was pretty compromised at that.

The procedure we performed yesterday involved placing a long catheter in her femoral vein and threading it up through the right side of her heart and into the left pulmonary artery. Although I have known for a long time about the capabillities of IR, it was still nonetheless impressive to see it done right in front of me. The neat part involved using a specially designed catheter (threaded to the same place) that had the ability to 1) deliver TPA (a clot dissolving agent) directly to the clot and 2) consisted of a internal core wire that plugged into a machine the size of a small carry-on suitcase that caused the internal wire to emit very high frequency pulsations- in an effort to physically break op the clot. This was to be left in place for a number of hours and then another catheter would be used that alternates very rapidly shooting saline solution and suctioning it back out- in essence pressure washing and vaccuming out the clogged artery.

Although this procedure carries a fairly high mortality with it somewhere around 15-30%(given the very sick nature of the patients who need it along with the risk of complications etc.) the pateinet did well, at least until I left for the day- She was still in the letting the catheter vibrate out her clot phase of the treatment.

I was rather impressed with my day spent with the IR guys. I recommend it to anyone who has the opportunity during your rotations.

Below is a picture I snapped with my cell phone of the IR control room. In place of the standard white plastic light difusers you see all over the hospital that cover the flourescent ceiling lights this is what they have in IR. I guess they have a few more dollars in the old budget for "ambience".