英: IVR

血管造影・超音波・CTなどの画像診断装置を用いて画像ガイド下に経皮的手技を行う

WordNet

the branch of medical science dealing with the medical use of X-rays or other penetrating radiation

PrepTutorEJDIC

X線学,放射線学,(特に)放射線医学

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/04/04 10:49:17」(JST)

wiki ja

[Wiki ja表示]

Interventional Radiology（インターヴェンショナルラジオロジー、略語:IVR）は、放射線医学の一部で画像診断機器を用いて行う低侵襲医療の1つである。

日本語訳として一般的に「放射線診断技術の治療的応用」という言葉が用いられているが、「血管内治療」、「血管内手術」、「低侵襲治療」、「画像支援治療」もほぼ同義語として使われてる。エックス線透視や超音波像、CTを見ながら体内に細い管（カテーテルや針）を入れて病気を治す新しい治療分野である。"IVR"は日本独自の造語であり、海外ではIRと略されることが多い^[1]^[2]。

概要

IVR（Interventional Radiology・インターベンショナルラジオロジー）は管腔臓器を介して、あるいは穿刺により体内に器具を挿入し、画像誘導下（X線（レントゲン）透視像、血管造影像、US（超音波）像、CT像など）に、外科手術なしで、できるかぎり体に傷を残さずに病気を治療する方法である。低侵襲、迅速に処置・治療が行えることが特徴で、具体的には、詰まった血管や胆管を拡げる（血管形成術（PTA）、胆管ステント留置）、出血した血管を詰めて止血する（血管塞栓術）、体に溜まった液体を吸引・排出する（膿瘍ドレナージ、経皮経肝胆道ドレナージ（PTBD））がんを死滅させる（ラジオ波凝固療法（RFA）、肝動脈化学塞栓療法（TACE）、動注化学療法）など、様々な治療がこれに含まれる。また最近では骨転移に対する除痛を目的としたラジオ波凝固療法^[3]や骨セメント注入療法^[4]など、緩和医療の分野にも応用されるようになってきている。
治療を行っていることから放射線治療の一部と誤解されがちであるが、放射線診断技術を応用していることから、正式には（日本医学放射線学会の分類では）放射線診断の一部と位置づけされている。なお海外では放射線診断でも放射線治療でもない、独立したカテゴリーとして扱う風潮もある。

沿革

Interventional radiologyは20世紀後半から低侵襲治療法のひとつとして発達し、画像診断法の進歩とともに急速に普及した。Interventional radiologyという用語は、1967年 Margulis^[5]によって医学学術雑誌American Journal of Roentogenologyのeditorialとして記述した「Interventional diagnostic radiology: a new subspeciality」の中で初めて用いられ、画像診断の低侵襲治療への応用と発展が期待される新たな分野をInterventional radiologyという用語で総括した。更に、1976年 Wallace^[6] が医学学術雑誌Cancerに「Interventional radiology」のタイトルで総説を記載し、欧米医学界で認知されるに至った。
　Interventional radiologyの端緒は1960年 Luessenhop^[7])が脳動静脈奇形に対して行った動脈塞栓術とされているが、臨床的な評価を得た業績は、1964年にDotter^[8]が下肢動脈閉塞症に対して導入した血管形成術が第一歩である。1974年にGrüntzig^[9]がバルーンカテーテルを用いた血管拡張術を考案し、経皮的冠動脈形成術が普及した。Interventional radiology創始者の一人として、1968年にPorstmann^[10] が動脈管開存症の閉鎖術に成功した功績も大きい。血管形成術は、その後、Gianturco、Wallsten、Strecker、Palmatzらにより各種のステントが開発され、様々な領域に応用された。また、1991年にParodi^[11]が腹部大動脈瘤に対するステントグラフト内插術を報告し、ステントグラフトは血管外科分野に広く普及している。
消化管出血に対する治療は、1971年 Baum^[12]の消化管大量出血に対する血管収縮剤の選択的持続動注療法に始まる。1972年にはRösch^[13]により急性大量消化管出血に対する動脈塞栓術が報告され、緊急止血術の分野でもInterventional radiologyが応用されるに至った。
門脈圧亢進症に対する治療は、経静脈的肝内静脈門脈短絡術（TIPS）が1969年 Rösch^[14]により動物実験で提唱され、その後Richterら^[15]により臨床応用された。本邦からも、1983年に山田ら^[16]によりBudd-Chiari症候群に対する血管拡張術が報告されている。消化管静脈瘤破裂に対する塞栓術としては、1974年 Lunderquist^[17]が経皮経肝静脈瘤塞栓術を報告し、1991年には金川ら^[18] が胃静脈瘤に対するバルーン閉塞下逆行性静脈塞栓術（B-RTO）を報告している。
　肝癌に対する肝動脈塞栓術は、1974年 Doyon^[19]、1976年 Goldstein^[20]により報告され、本邦においても、肝細胞癌に対して1970年代後半から山田、打田らにより積極的に導入された。肝細胞癌に対する肝動脈塞栓術は、1983年に山田ら^[21]が医学学術雑誌Radiologyに報告した肝癌に対する肝動脈塞栓術の治療成績をもって有効な治療法として定着し、現在も標準治療法の一つと位置づけられている。肝腫瘍焼灼術としては、1983年に杉浦ら^[22]が経皮的エタノール注入療法を開発し、1996年にRossiら^[23]がラジオ波凝固療法の有効性を報告して広く普及した。肝動注化学療法は、1970年代からWatkins^[24] や三浦ら^[25] が大腸癌肝転移を中心に有効な治療成績を報告し、その後、体内埋め込み型動注システムが開発された。
　胆道系治療では、1964年にWiechel^[26]により経皮経肝胆道造影が初めて行われ、1969年にKaudeら^[27]による経皮経肝胆道ドレナージによる減黄術が行われた。1974年にMolnarら^[28]、1975年に打田ら^[29]が、経皮経肝胆道ドレナージと内瘻化に成功し、現在の胆道ドレナージ術の礎を築いた。

分類

IVRの分類法には様々な方法があるが、ここではヨーロッパ IVR学会（CIRSE）のプログラムに則って分類する。

血管系IVR

大動脈瘤に対するステント-グラフト挿入、末梢動脈閉塞に対するステント留置、頸動脈ステント、経頸静脈的肝内門脈大循環シャント形成、下大静脈フィルタ-などが含まれる。

血管塞栓術

子宮筋腫に対する子宮動脈塞栓術、外傷性出血に対する止血術（塞栓術）、産科的出血に対する止血術、動静脈奇形に対する塞栓術などが含まれる。

腫瘍IVR

肝細胞癌に対する肝動脈化学塞栓療法、肝細胞癌・腎癌・肺癌などに対するラジオ波凝固療法、肝腫瘍（原発性・転移性）・転移性肺腫瘍に対する動注化学療法（HAI・BAI）などが含まれる。

神経IVR

脳卒中に対する血栓溶解療法、脳動脈瘤に対する塞栓術、脳動静脈奇形に対する塞栓術などが含まれる。

非血管系IVR

胆道閉塞に対するドレナージやステント留置、深部膿瘍ドレナージ、経皮的椎体形成術、除痛のための骨軟部ラジオ波凝固療法などが含まれる。

参考文献

^ 日本IVR学会HP
^ 筑波大学放射線科HP
^ Goetz MP, Callstrom MR, Charboneau JW, Farrell MA, Maus TP, Welch TJ, Wong GY, Sloan JA, Novotny PJ, Petersen IA, Beres RA, Regge D, Capanna R, Saker MB, Grönemeyer DH, Gevargez A, Ahrar K, Choti MA, de Baere TJ, Rubin J.: Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol. 15:300-306.2004
^ Kobayashi T, Arai Y, Takeuchi Y, Nakajima Y, Shioyama Y, Sone M, Tanigawa N, Matsui O, Kadoya M, Inaba Y; Japan Interventional Radiology in Oncology Study Group (JIVROSG). Phase I/II clinical study of percutaneous vertebroplasty (PVP) as palliation for painful malignant vertebral compression fractures (PMVCF): JIVROSG-0202.:Ann Oncol.20:1943-7. 2009 .
^ Margulis AR: Interventional diagnostic radiology: a new subspeciality. Am J Roentogenol 99:761-762, 1967.
^ Wallace S: Interventional radiology. Cancer 37:517-531, 1976.
^ Luessenhop AJ, Spence WT: Artificial embolization of cerebral arteries. J Am Med Assoc 172:1153-1154, 1960.
^ Dotter CT, Judkins MP: Transluminal treatment of arteriosclerotic obstruction: description of a new technique and a preliminary report of its application. Circulation 30:654-670, 1964.
^ Grüntzig A, Hopff H: Perkutane Rekanalisation chronisher arterieller Veschlüsse mit einem neuen Dilatationskatheler. Dtsch Med Wochenschr 99:2502-2511, 1974.
^ Porstmann W, Weirny L, Wranke H: Der Versehluss des ductus arteriosus persistens ohne thoracotomy. Fortschr Geb Röentogenstr Nuklearmed 109:133-148, 1968.
^ Parodi JC, Palmaz JC, Barone HD.: Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:491-499, 1991.
^ Baum S, Nusbaum M: The control of gastrointestinal hemorrhage by selective mesenteric arterial infusion of vasopressin. Radiology 98:497-505, 1971
^ Rösch J, Dotter CT, Brown MJ: Selective arterial embolization. A new method for control of acute gastrointestinal bleeding. Radiology 102: 303-306, 1972.
^ Rösch J, Hanafee WN, Snow H: Transjugular portal venography and radiologic portacaval shunt: an experimental study. Radiology 92:1112-1114, 1969.
^ Richter GM, Palmaz JC, Nöldge G, Rössle M, Siegerstetter V, Franke M, Wenz W: Der transjugulae intrahepatische portosystemische stent-shunt (TIPSS). Radiologe 29:406-411, 1989.
^ Yamada R, Sato M, Kawabata M, Nakatsuka H, Nakamura K, Kobayashi N: Segmental obstruction of the hepatic inferior vena cava treated by transluminal angioplasty. Radiology 149:91-96, 1983.
^ Lunderquist A, Vang J: Sclerosing injection of esophageal varices through transhepatic selective catheterization of the gastric coronary vein. A preliminary report. Acta Radiol Diagn 15:546-550, 1974.
^ 金川博史, 美馬聡昭, 香山明一, 他: バルーン下逆行性経静脈的塞栓術（B-RTO）による胃静脈瘤治療. 肝臓 32: 442-444, 1991.
^ Doyon D, Mouzon A, Jourde AM, Regensberg C, Frileux C: L’embolisation artérielle hépatique dans les tumeurs malignes du foie. Ann Radiol 17:593-603, 1974.
^ Goldstein HM, Wallace S, Anderson JH, Bree RL, Gianturco C: Transcatheter occlusion of abdominal tumors. Radiology 120:539-545, 1976.
^ Yamada R, Sato M, Kawabata M, Nakatsuka H, Nakamura K, Takashima S: Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology 148:397-401, 1983.
^ Sugiura N, Takara K, Ohto M, et al: Percutaneous intratumoral infection of ethanol under ultrasound imaging for treatment of small hepatocellular carcinoma. Acta Hepatol Jpn 24: 920-923, 1983.
^ Rossi S, Di Stasi M, Buscarini E, Quaretti P, Garbagnati F, Squassante L, Paties CT, Silverman DE, Buscarini L: Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer. Am J Roentogenol 167:759-768, 1996.
^ Watkins E Jr, Khazei AM, Nahra KS: Surgical basis for arterial infusion chemotherapy of disseminated carcinoma of the liver. Surg Gynecol Obstet 130:581-605, 1970.
^ 三浦建、他: 肝癌に対する肝動脈内注入化学療法の治療現況. 手術 33:1131-1146, 1979.
^ Wiechel KL: Percutaneous transhepatic cholangiography. Technique and application. With studies of the hepatic venous and biliary duct pressures, the chemical changes in blood and bile and clinical results in a series of jaundiced patients. Acta Chir Scand Suppl. 11:Suppl 330:1-99, 1964.
^ Kaude JV, Weidenmier CH, Agee OF: Decompression of bile ducts with the percutaneous transhepatic technique. Radiology 93:69-71, 1969.
^ Molnar W, Stockum AE: Relief of obstructive jaundice through percutaneous transhepatic catheter: a new therapeutic method. Am J Roentgenol Radium Ther Nucl Med 122:356-367, 1974.
^ 打田日出夫, 黒田知純, 中村仁信, 他: 経皮的胆管ドレナージとその内瘻化: 特に手技と経時的造影の診断価値. 日本医放会誌 35:53-67, 1975.

外部リンク

学会

日本IVR学会
米国IVR学会（SIR）
ヨーロッパ IVR学会（CIRSE）
日本医学放射線学会

研究会・委員会

日本Metallic Stents & Grafts研究会
リザーバー研究会
血管腫・血管奇形IVR研究会
肝動脈塞栓療法研究会
RFA談話会
ステントグラフト実施基準管理委員会
日本血管撮影・インターベンション専門診療放射線技師認定機構
IVR看護研究会

wiki en

[Wiki en表示]

Interventional radiology (abbreviated IR or VIR for Vascular and Interventional Radiology, also referred to as Surgical Radiology) is a medical sub-specialty of radiology which utilizes minimally-invasive image-guided procedures to diagnose and treat diseases in nearly every organ system. The concept behind interventional radiology is to diagnose and treat patients using the least invasive techniques currently available in order to minimize risk to the patient and improve health outcomes.

As the inventors of angioplasty and the catheter-delivered stent, interventional radiologists pioneered modern minimally-invasive medicine. Using X-rays, CT, ultrasound, MRI, and other imaging modalities, interventional radiologists obtain images which are then used to direct interventional instruments throughout the body. These procedures are usually performed using needles and narrow tubes called catheters, rather than by making large incisions into the body as in traditional surgery.

Many conditions that once required surgery can now be treated non-surgically by interventional radiologists. By minimizing the physical trauma to the patient, peripheral interventions can reduce infection rates and recovery time, as well as shorten hospital stays.^[1]

History

Interventional radiologists are minimally invasive specialists. The landscape of medicine is constantly changing, and for the past 30 years, interventional radiologists have been responsible for much of the medical innovation and development of the minimally invasive procedures that are commonplace today. Interventional radiologists pioneered modern medicine with the invention of angioplasty and the catheter-delivered stent, which were first used to treat peripheral arterial disease. By using a catheter to open the blocked artery, the procedure allowed an 82-year-old woman, who refused amputation surgery, to keep her gangrene-ravaged left foot. To her surgeon’s disbelief, her pain ceased, she started walking, and three "irreversibly" gangrenous toes spontaneously sloughed. She left the hospital on her feet—both of them. The growth of interventional radiology was fueled by ties between interventionalists such as Charles Dotter and innovative device manufacturers like Bill Cook. Interventional radiologist Charles Dotter, MD, known as the "Father of Interventional Radiology" for pioneering this technique, was nominated for the Nobel Prize in Physiology or Medicine in 1978.

Alexander Margulis coined the term "interventional" for these new, minimally invasive techniques. He emphasized that to continue to be on the forefront of innovation, interventional radiologists must possess special training, technical skill, clinical knowledge, ability to care for patients, and closely collaborate with surgeons and internal medicine subspecialists.

Development of stents began slowly. In 1969, Dotter conceived the idea of expandable stents with an intra-arterial coil spring. The first stents developed by Dotter and Andrew Craig were made of nitinol. Gianturco introduced his self-expandable Z stent. Hans Wallsten introduced a self-expandable mesh stent, Ernst Strecker a knitted tantalum stent and Julio Palmaz his balloon expandable stent, which was later perfected and introduced to clinical practice. Angioplasty and stenting revolutionized medicine and led the way for the more widely known applications of coronary artery angioplasty and stenting that revolutionized the practice of cardiology.

Treatment of GI bleeding has a storied tradition. After introduction of selective vasoconstrictive infusions by Baum, Josef Rösch introduced selective arterial embolization for treatment of uncontrollable bleeding in the early 70s. Anders Lundequist treated variceal bleeding with the technique of transhepatic variceal embolization in the mid 70s. Interventions in the biliary tract were developed by several pioneers. Interventional Radiologist Joachim Burrhenne invented and perfected the technique of percutaneous removal of retained billiary stones. Plinio Rossi and Hall Coons enriched biliary interventions with their work using biliary stents. The innovative interventionalists Kurt Amplatz, Willi Castaneda and Dave Hunter pioneered percutaneous uroradiologic interventions. They popularized nephrostomy drainage, percutaneous stone extraction, and urethral stenting.

The field of interventional oncology was pioneered by IR legends. Bob White pioneered embolization techniques for pulmonary AVMs. Sid Wallace was one of the first to treat bone and kidney tumors by embolization and treatment of disseminated liver metastases.

Today many conditions that once required surgery can be treated nonsurgically by interventional radiologists. Through a small nick in the skin, they use tiny catheters and miniature instruments so small they can be run through a person’s network of arteries to treat at the site of illness internally, saving the patient from open invasive surgery. While no treatment is risk free, the risks of interventional procedures are far lower than the risks of open surgery, and are a major advance in medicine for patients.

Milestones Pioneered by Interventional Radiologists

• 1964 Angioplasty

• 1966 Embolization therapy to treat tumors and spinal cord vascular malformations by blocking the blood flow

• 1967 The Judkins technique of coronary angiography, the technique still most widely used around the world today

• 1967 Closure of the patent ductus arteriosis, a heart defect in newborns of a vascular opening between the pulmonary artery and the aorta

• 1967 Selective vasoconstriction infusions for hemorrhage, now commonly used for bleeding ulcers, GI bleeding and arterial bleeding

• 1969 The catheter-delivered stenting technique and prototype stent

• 1960-74 Tools for interventions such as heparinized guidewires, contrast injector, disposable catheter needles and see-through film changer

• 1970s Percutaneous removal of common bile duct stones

• 1970s Occlusive coils

• 1972 Selective arterial embolization for GI bleeding, which was adapted to treat massive bleeding in other arteries in the body and to block blood supply to tumors

• 1973 Embolization for pelvic trauma

• 1974 Selective arterial thrombolysis for arterial occlusions, now used to treat blood clots, stroke, DVT, etc.

• 1974 Transhepatic embolization for variceal bleeding

• 1977-78 Embolization technique for pulmonary arteriovenous malformations and varicoceles

• 1977-83 Bland- and chemo-embolization for treatment of hepatocellular cancer and disseminated liver metastases

• 1980 Cryoablation to freeze liver tumors

• 1980 Development of special tools and devices for biliary manipulation

• 1980s Biliary stents to allow bile to flow from the liver saving patients from biliary bypass surgery

• 1981 Embolization technique for spleen trauma

• 1982 TIPS (transjugular intrahepatic portosystemic shunt) to improve blood flow in damaged livers from conditions such as cirrhosis and hepatitis C

• 1982 Dilators for interventional urology, percutaneous removal of kidney stones

• 1983 The balloon-expandable stent (peripheral) used today

• 1985 Self-expanding stents

• 1990 Percutaneous extraction of gallbladder stones

• 1990 Radiofrequency ablation (RFA) technique for liver tumors

• 1990s Treatment of bone and kidney tumors by embolization

• 1990s RFA for soft tissue tumors, i.e., bone, breast, kidney, lung and liver cancer

• 1991 Abdominal aortic stent grafts

• 1994 The balloon-expandable coronary stent used today

• 1997 Intra-arterial delivery of tumor-killing viruses and gene therapy vectors to the liver

• 1999 Percutaneous delivery of pancreatic islet cells to the liver for transplantation to treat diabetes

• 1999 Developed the endovenous laser ablation procedure to treat varicose veins and venous disease ^[2]

Training

Traditional

As in most medical specialties, training varies depending on varying rules and regulations from country to country. In the United States, interventional radiologists are physicians whose education and training traditionally includes completing a college degree, four years of medical school, a year of training in general medicine and/or surgery (internship), a four year diagnostic radiology residency program, and then a one or two year fellowship in vascular & interventional radiology.

With the evolving need to train more clinically oriented interventionists, two alternative pathways to achieve certification in IR have been established through the leadership of the Society of Interventional Radiology (SIR): The DIRECT and Clinical pathways.^[3] For both pathways, the SIR states that the trainee must become proficient in management of inpatient and outpatient pre-procedure, post-procedure, and follow-up clinical care for all disease processes pertinent to the practice of VIR.

DIRECT

The DIRECT (Diagnostic and Interventional Radiology Enhanced Clinical Training) pathway allows for up to two years of clinical training prior entering the program. Therefore, residents may enter the new pathway from medical school or after two or more years of clinical training in other specialties such as internal medicine or vascular surgery. The core diagnostic training is 27 months in duration, with 21 total months of VIR training for a total of 48 months (four year) duration. The advantage of the DIRECT pathway is that upon successful completion of the program and 12 months of clinical practice, a clinician can achieve both a Diagnostic Radiology board certification and a subspecialty vascular IR certificate. The American Board of Radiology offers a complete list of programs that offer this pathway at: http://theabr.org/ic/ic_other/ic_direct.html.

Clinical

An integrated Clinical Pathway has been created to provide breadth and depth of clinical experience for trainees who desire a primary career focusing on VIR rather than diagnostic radiology. The 6 year program allows for 29 months of Diagnostic Radiology training, 19 months of clinical training (including a medicine or surgery intern year) and research, and 21 months of VIR fellowship training. The Clinical Pathway is offered by institutions such as UVA, Northwestern and Brigham and Women's Hospital. The Clinical Pathway allows for certification in VIR and for board certification in diagnostic radiology.

Dual Certificate

A newer Dual Certificate program has just been approved for implementation which is a six year curriculum, similar to the Clinical Pathway, that provides training for Board Certification in both Diagnostic and Interventional Radiology.^[4]

Pediatric

A handful of programs currently offer interventional radiology fellowships that focus on training in the treatment of children.^[5]

Imaging Modalities

Common interventional imaging modalities include fluoroscopy, computed tomography (CT), ultrasound (US), and magnetic resonance imaging (MRI) including plane Radiograph:

• Fluoroscopy and computed tomography use ionizing radiation that may be potentially harmful to the patient and the interventional radiologist. However, both methods have the advantages of being fast and geometrically accurate.

• Ultrasound is frequently used to guide needles during vascular access and drainage procedures. Ultrasound offers real-time feedback and is inexpensive. Ultrasound suffers from limited penetration and difficulty visualizing needles, catheters and guidewires.

• Magnetic resonance imaging provides superior tissue contrast, at the cost of being expensive and requiring specialized instruments that will not interact with the magnetic fields present in the imaging volume.

Disorders

Vascular

Varicose veins

Pooling of blood in the veins from weak valves resulting in enlarged, swollen vessels causing pain and cosmetic complaints. Interventional endovenous laser treatment or sclerotherapy may be used to heat the vein from the inside, sealing it closed. Other healthy veins carry blood from the leg to reestablish normal flow.

Peripheral artery disease (PAD)

Most commonly a result of atherosclerosis, occlusion of normal blood flow in the upper and lower extremities may result in pain, skin ulcers, or gangrene. Stenting, angioplasty, and mechanical atherectomy are available interventional treatments.

Deep vein thrombosis (DVT)

The formation of a thrombus, or blood clot, in the deep leg veins which may lead to swelling, discoloration, and pain. DVTs can result post-thrombotic syndrome and pulmonary embolism. Post-thrombotic syndrome is irreversible damage from a long standing DVT in the affected leg veins and valves, leading to chronic pain, swelling, and severe skin ulcers. Pulmonary embolism is a life-threatening condition which occurs when a deep vein thrombus (DVT) breaks off and travels to the lungs, resulting in difficulty breathing. Catheter-directed thrombolysis, balloon angioplasty, or stenting may be performed in the affected vein to dissolve the clot and restore normal blood flow.

Pulmonary embolism

A potentially life-threatening occlusion of the arteries supplying the lungs with blood clots, manifesting in shortness of breath, fatigue, palpitations, and fainting. Catheter-directed thrombolysis may be performed for this condition, where a catheter is inserted into the leg, threaded up to the lung, and then used to infuse "clot-busting" drugs into the occlusion.

IVC filter placement

Patients who have a history of, or are at risk for, pulmonary embolism may receive temporary or permanent inferior vena cava (IVC) filters to prevent the migration of blood clots to the lungs, and consequently prevent recurrence of pulmonary embolism.

Abdominal aortic aneurysms (AAA)

A weakening and dilatation of the abdominal aorta wall that can result in abdominal or back pain, and potentially life-threatening bleeding if it ruptures. Interventional treatment of this condition via non-surgical means is endovascular aneurysm repair, using angiography and stenting to occlude the AAA and prevent its continued growth.

Thoracic aortic aneurysms (TAA) and Aortic dissection

Anuerysms, or dilatations, of the thoracic (chest cavity) aorta may be caused by atherosclerosis, syphilis, trauma, or multiple other conditions. Aortic dissections are tears in the thoracic aorta resulting from trauma or weakening of the aortic vessel walls from conditions such as hypertension, atherosclerosis, and congenital conditions such as Marfan syndrome. Interventional treatments for TAAs and aortic dissections utilize stent grafts, sometimes in combination with surgery, to prevent blood flow from enlarging the diseased area or rupturing the aorta.

Acute limb ischemia

The sudden disruption of blood flow to an arm or a leg due to arterial occlusion by a blood clot or other debris, potentially treated with catheter-directed thrombolysis or mechanical thrombectomy.

Acute mesenteric ischemia

A medical emergency resulting from interruption of the blood supply to the abdominal organs due to blockage of the mesenteric arteries or veins by thrombus, embolus, or aortic dissection. Treatment varies by etiology of the ischemia, but may include thrombolysis, stenting, or angioplasty.

Aneurysms of visceral arteries

Dilatation of visceral arteries supplying organs such as the spleen, liver, or gastrointestinal tract can result in pain and life threatening bleeding. Stenting, embolization, liquid occlusion, and thrombin injection are the available interventional therapies for these disorders.

Arteriovenous malformations (AVMs)

Aberrations in normal vascular anatomy treatable by embolization which may cause pain, bleeding, heart problems, or cosmetic concerns.

Oncologic

Various interventional therapies exist to treat cancers. Tumor type, size, extent of disease, operator experience, and involvement of anatomical structures all factor into deciding which therapy is most appropriate. Some therapies, such as transarterial chemoembolization, block the blood supply to tumors. Other techniques--radiofrequency ablation (RFA), microwave ablation, cryoablation, irreversible electroporation (IRE), and high-intensity focused ultrasound (HIFU)-- directly damage the cancerous tissue. All of these treatments are delivered locally, minimizing damage to nearby tissue and avoiding the systemic side-effects of chemotherapy.

Liver cancer

Hepatocellular carcinoma, the most common form of liver cancer, begins in liver cells known as hepatocytes. Other cancers that affect the liver are known as metastatic liver disease and include colon cancer and neuroendocrine tumors. Curative treatment is liver resection or liver transplant; however, cryoablation, radiofrequency ablation, percutaneous ethanol injection, chemoembolization, and radioembolization are options for patients that are poor candidates for resection or transplantation.

Lung cancer
Kidney Cancer
Bone Cancer
Breast Cancer
Prostate Cancer

Neurologic

Stroke

A neurological condition occurring when the brain is starved of oxygen and nutrients resulting from the blockage of blood vessels supplying it (ischemic stroke) or from bleeding (hemorrhagic stroke). Symptoms include language, motor, sensory, and vision deficits. Interventional neuroradiologists play a critical role in determining the type of stroke (ischemic or hemorrhagic) using non-contrast computed tomography (CT) imaging or magnetic resonance imaging (MRI), and then treating the stroke using minimally-invasive treatment, if possible. Strokes caused by blood clots can be treated by intra-arterial thrombolysis or by mechanical thrombectomy. Strokes caused by bleeding resulting from ruptured aneurysms may be treated by embolization, most commonly using tiny metal coils.

Carotid artery stenosis

A narrowing of the carotid artery supplying the brain which can lead to stroke and disability. Carotid artery stenting (CAS) is an alternative to surgical carotid endarterectomy (CEA) which may be performed in patients who have symptomatic carotid atherosclerotic disease but who are poor candidates for open surgery.

Multiple Sclerosis

Angioplasty of the cervical veins has been suggested as an interventional treatment of chronic cerebrospinal venous insufficiency (CCSVI) that, hypothetically, contributes to the pathogenesis of multiple sclerosis.^[6] This hypothesis is highly controversial ^[7] and treatment of CCSVI by methods of interventional radiology is encouraged only in context of research.^[8]

Spine

Spinal fractures

Vertebroplasty and kyphoplasty, the percutaneous injection of biocompatible cement into fractured vertebrae, are two available treatments for vertebral fractures.^[9]

Hepatobiliary

Portal hypertension

A condition in which the normal flow of blood through the liver is slowed or blocked by scarring (cirrhosis) or other damage (e.g. hepatitis). Patients with the condition are at risk of internal bleeding or other life-threatening complications. Transjugular intrahepatic portosystemic shunt (TIPS) formation is a minimally-invasive treatment to alleviate this impaired blood flow.

Bile Duct Obstruction

Patients with liver cancer, bile duct cancer, cholecystitis, cholangitis, or other hepatobiliary pathology may experience obstruction of bile ducts. Interventional radiologists commonly perform procedures such as percutaneous transhepatic cholangiography (PTHC or PTC) to image these obstructions, and may treat these conditions using percutaneous transhepatic biliary drainage (PTBD), wherein catheters or stents are placed through the skin and into the bile ducts to drain the bile for prolonged periods of time or until surgery.

Women’s Health

Uterine fibroids

Uterine fibroids are non-cancerous growths of the muscular portion of the uterus which may cause pain and heavy bleeding. Interventional radiologists are able to perform non-surgical, minimally-invasive treatments of uterine fibroids, called uterine fibroid embolization (UFE), or uterine artery embolization (UAE), using real-time imaging. In this procedure, the interventional radiologist makes a tiny nick in the skin in the groin and inserts a catheter into the femoral artery. The physician guides the catheter into the uterine arteries that supply blood to the fibroid and then releases tiny particles through the catheter to occlude the blood supply of the tumor, causing it to shrink and die.

Fibroid embolization typically requires a hospital stay of one night. On average, 85-90 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and/or bulk-related symptoms. Recurrence of fibroids treated by UFE is very rare.

Pelvic congestion syndrome

A condition caused by pooling of blood in the pelvic veins, possibly resulting in pelvic pain and lower extremity varicose veins. Interventional vein embolization is possible in some cases, eliminating the need for surgical removal of the ovaries and/or uterus.

Infertility

One cause of female infertility is the blockage or narrowing of the fallopian tubes through which eggs pass from the ovary to the uterus. This cause of infertility may be diagnosed using selective salpingography and treated by opening the narrowing using a minimally invasive device such as a balloon.

Kidney

Renal artery stenosis

A narrowing of the arterial supply of the kidneys which may result in high blood pressure (hypertension) or renal insufficiency. Diagnosis of these conditions is made by measuring the diameter of stenosis, the blood pressure across the area of stenosis, renal vein renin sampling, and captopril challenge testing. Stenosis may be treated by balloon angioplasty or stenting.

Renal failure/Dialysis catheter placement

Patients in renal failure may require the placement of a hemodialysis catheter prior to initiating hemodialysis for renal failure.

Dialysis fistula/Arterio-venous graft clot

Dialysis fistulae and grafts may become occluded by blood clots, requiring an interventional “declot” procedure in which mechanical or chemical thrombolysis is performed to eliminate the clot.

Dialysis fistula/Arterio-venous graft failure

Dialysis fistulae and grafts may fail to “mature”, resulting in the need to image the fistula and potentially relieve any blockages using angioplasty.

Nephrostomy tube placement

In conditions where a blockage exists between the kidney and the urethra, such as with kidney stones, a tube may be placed into the kidney under imaging guidance to allow the drainage of urine and to prevent kidney damage.

Other

Gastric varices

A condition in which blood flow through the vessels around the stomach is slowed or stopped, potentially resulting in bleeding. Interventional treatments include embolzation and balloon-retrograde transverse obliteration (BRTO).

Varicoceles and male infertility

A dilatation in the veins of the scrotum which can result in pain, swelling, and infertility. It is potentially treated interventionally using embolization and sclerotherapy.^[10]

Central venous access

Vascular access and management of specialized kinds of vascular access devices (VADs). Vascular access devices include nontunneled catheters such as PICC lines, tunneled catheters such as Hickman lines, and fully implanted devices or subcutaneous ports. Access sites include arm/leg veins PICC lines as well as jugular, subclavian and femoral veins and in some cases the inferior vena cava is directly accessed by translumbar and transhepatic routes.^[11]

Percutaneous drains

Drainage of fluid from various body compartments using catheters and drains placed through the skin (e.g., abscess drains to remove pus, pleural drains).

Gastrostomy tube placement

In instances where patients are unable to take food by mouth, a feeding tube may be placed through the skin and into the stomach using imaging guidance.^[11]

Biopsies

Samples of tissue may be required to identify the cause of certain diseases. Using imaging guidance, interventional radiologists may minimally-invasively reach underlying tissue using a small needle to pierce the skin and retrieve tissue samples from the target organ.^[12]

Pediatric interventions

Minimally invasive procedures commonly performed in children include obtaining central venous access, gastrostomy tube placement, diagnostic angiography, biopsies, and percutaneous drainage.^[13]

Procedures

Common IR procedures are:

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.

Balloon angioplasty/stent:

Opening of narrow or blocked blood vessels using a balloon; may include placement of metallic stents as well (both self-expanding and balloon expandable).

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.

Drain insertions:

Placement of tubes into different parts of the body to drain fluids (e.g., abscess drains to remove pus, pleural drains).

Endovascular aneurysm repair

Embolization:

Blocking abnormal blood (artery) vessels (e.g., for the purpose of stopping bleeding) or organs (to stop the extra function e.g. embolization of the spleen for hypersplenism) including uterine artery embolization for percutaneous treatment of uterine fibroids. Various embolic agents are used, including alcohol, glue, metallic coils, poly-viny alcohol particles, Embospheres, encapsulated chemo-microsphere, and gelfoam.

Chemoembolization:

Delivering cancer treatment directly to a tumour through its blood supply, then using clot-inducing substances to block the artery, ensuring that the delivered chemotherapy is not "washed out" by continued blood flow.

Radioembolization:

Embolization of tumors with radioactive microspheres of glass or plastic, to kill tumors while minimizing exposure to healthy cells.

Thrombolysis:

Treatment aimed at dissolving blood clots (e.g., pulmonary emboli, leg vein thrombi, thrombosed hemodialysis accesses) with both pharmaceutical (TPA) and mechanical means.

Biopsy:

Taking of a tissue sample from the area of interest for pathological examination from a percutaneous or transjugular approach.

Radiofrequency ablation (RF/RFA):

Localized destruction of tissue (e.g., tumours) by heating.

Cryoablation:

Localized destruction of tissue by freezing.

Central venous catheter placement:

Vascular access and management of specialized kinds of intravenous devices (IVs) (e.g. PIC lines, Hickman lines, subcutaneous ports including translumbar and transhepatic venous lines).

Inferior vena cava filter

IVC filters:

Metallic filters placed in the inferior vena cavae to prevent propagation of deep venous thrombus, both temporary and permanent.

Vertebroplasty:

Percutaneous injection of biocompatible bone cement inside fractured vertebrae.

Nephrostomy placement:

Placing a catheter directly into the kidney to drain urine in situations where normal flow of urine is obstructed. NUS catheters are nephroureteral stents which are placed through the ureter and into the bladder.

Radiologically inserted gastrostomy or RIG:

Placement of a feeding tube percutaneously into the stomach and/or jejunum.

Dialysis access and related interventions:

Placement of tunneled hemodialysis catheters, peritoneal dialysis catheters, and revision/thrombolysis of poorly functioning surgically placed AV fistulas and grafts.

TIPS:

Placement of a Transjugular Intrahepatic Porto-systemic Shunt (TIPS) for management of select patients with critical end-stage liver disease and portal hypertension.

Biliary intervention:

Placement of catheters in the biliary system to bypass biliary obstructions and decompress the biliary system. Also placement of permanent indwelling biliary stents.

Endovenous laser treatment of varicose veins:

Placement of thin laser fiber in varicose veins for non-surgical treatment of venous insufficiency.

Tools

There are a number of catheters used in interventional radiology that can be loosely divided into five types:

Diagnostic angiographic catheters

Micro catheters

Drainage catheters

Balloon catheters

Central venous catheters

References

^ Society of Interventional Radiology -- Global Statement Defining Interventional radiology. http://www.sirweb.org/news/newsPDF/IR_Global_Statement.pdf
^ http://www.radiology.ucsf.edu/patient-care/sections/ir
^ SIR - Fellow Residents and Students - APDIR
^ http://www.theabr.org/present/ABR%20Update.ppt
^ The Society for Pediatric Radiology
^ "Imaging studies challenge Zamboni theory of MS". Canadian Medical Association. Retrieved 14 April 2011.
^ "FDA Safety Communication: Chronic Cerebrospinal Venous Insufficiency Treatment in Multiple Sclerosis Patients". Food and Drug Administration. May 2012.
^ "Percutaneous venoplasty for chronic cerebrospinal venous insufficiency for multiple sclerosis". National Institute for Health and Clinical Excellence. March 2012.
^ Nonsurgical Treatment for Spinal Fractures From Osteoporosis - SIR
^ Male Infertility and Varicocele Treatment - SIR
^ ^a ^b Central Lines, Ports and Feeding Tubes - SIR
^ Image-Guided Needle Biopsy - SIR
^ Pediatric Interventional Radiology - SIR

Helpful Resources:

• Historic Highlights of Interventional Radiology, by Josef Rösch of Dotter Interventional Radiology.

• Abrams’ Angiography: Vascular and Interventional Radiology. Herbert L. Abrams (Editor), Stanley Baum (Editor) and Michael J. Pentecost (Editor) Little Brown and Co., 2005. ISBN: 0781740894

• Advanced Radiographic and Angiographic Procedures: With an Introduction to Specialized Imaging. Patrick A. Apfel, Marianne Rita Tortorici. F A Davis Co., 2010. ISBN: 0803612559

• Handbook of Interventional Radiologic Procedures Krishna Kandarpa (Editor) and John E. Aruny (Editor). Lippincott Williams and Wilkins Publishers, 2010. ISBN: 0781768160

• The Birth, Early Years, and Future of Interventional Radiology by Josef Rösch, Frederick S. Keller, and John A. Kaufman. (2003) J. Vasc. Interv. Radiol.14: 841-853.

• The Catheter Introducers by Leslie A. Geddes and LaNelle E. Geddes of Cook Group Incorporated, Mobium Press, Chicago. 1993. ISBN: 0916371131

• The Ship in the Balloon: The Story of Boston Scientific and the Development of Less-Invasive Medicine by Jeffrey L. Rodengen. Write Stuff Enterprises, Inc., Fr Lauderdale. 2001. ISBN: 0945903502

External links

Society of Interventional Radiology
Cardiovascular and Interventional Radiological Society of Europe
Society of Pediatric Interventional Radiology
The Endovascular Forum
Interventional radiology procedures

Blindog143 (talk) 03:55, 24 February 2013 (UTC)reeves

UpToDate Contents

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1. 婦人科疾患のマネージメントにおけるインターベンショナルラジオロジー interventional radiology in management of gynecological disorders
2. 画像検査の放射線関連リスク radiation related risks of imaging studies
3. 出血性消化性潰瘍の治療の概要 overview of the treatment of bleeding peptic ulcers
4. 経皮的生検、穿刺吸引生検、および腹腔鏡下肝生検 percutaneous fine needle aspiration and laparoscopic liver biopsy
5. Throwing injuries of the upper extremity: Clinical presentation and diagnostic approach

English Journal

Recovery time of platelet function after aspirin withdrawal.

Lee J1, Kim JK1, Kim JH1, Dunuu T2, Park SH3, Park SJ4, Kang JY5, Choi RK6, Hyon MS7.
Current therapeutic research, clinical and experimental.Curr Ther Res Clin Exp.2014 Mar 25;76:26-31. doi: 10.1016/j.curtheres.2014.02.002. eCollection 2014.
INTRODUCTION: Inappropriate antiplatelet therapy discontinuation increases the risk of thrombotic complications and bleeding after dental procedures. To determine the platelet reactivity recovery time after aspirin withdrawal in vivo, our study was conducted in patients with low-risk cardiovascular
PMID 25031665

Appearance of monoclonal plasma cell diseases in whole-body magnetic resonance imaging and correlation with parameters of disease activity.

Kloth JK1, Hillengass J, Listl K, Kilk K, Hielscher T, Landgren O, Delorme S, Goldschmidt H, Kauczor HU, Weber MA.
International journal of cancer. Journal international du cancer.Int J Cancer.2014 Nov 15;135(10):2380-6. doi: 10.1002/ijc.28877. Epub 2014 Apr 17.
The aim of our study was to assess in which way different infiltration patterns of monoclonal plasma cell diseases in whole-body (wb) magnetic resonance imaging (MRI) are associated with clinical stages, plasma cell content in bone marrow samples and established serum markers of disease activity. In
PMID 24706394

Assessment of T1, T1ρ, and T2 values of the ulnocarpal disc in healthy subjects at 3 tesla.

Rauscher I1, Bender B2, Grözinger G1, Luz O1, Pohmann R3, Erb M4, Schick F5, Martirosian P6.
Magnetic resonance imaging.Magn Reson Imaging.2014 Nov;32(9):1085-90. doi: 10.1016/j.mri.2014.05.010. Epub 2014 Jun 21.
OBJECTIVE: The purpose of this study was to implement clinically feasible imaging techniques for determination of T1, T1ρ, and T2 values of the ulnocarpal disc and to assess those values in a cohort of asymptomatic subjects at 3 tesla. Resulting values were compared between different age groups, si
PMID 24960365

Japanese Journal

IVRの効果と限界 (特集胸部外傷診療)

水沼仁孝,和田慎司,林敏彦 [他]
救急医学 = The Japanese journal of acute medicine 38(4), 398-404, 2014-04
NAID 40020064616

経皮的椎体形成術 : 最近の知見 (特集 Interventional Radiology : 最近の話題)

樋渡昭雄,栂尾理,山下孝二 [他]
臨床放射線 59(4), 533-539, 2014-04
NAID 40020063922

静脈奇形の硬化療法 (特集 Interventional Radiology : 最近の話題)

三村秀文,芝本健太郎,宗田由子 [他]
臨床放射線 59(4), 524-532, 2014-04
NAID 40020063888

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関連記事	「interventional radiology」「interventional」「radiology」

「interventional radiology」

Interventional Radiologist
Occupation
Names	Doctor, Medical Specialist
Activity sectors	Medicine
Description
Education required	Doctor of Medicine, Doctor of Osteopathic Medicine

Interventional radiology
	Intervention
	; Balloon dilatation of the stenosed internal jugular vein (photo from an X-ray angiograph monitor). While pressure in the balloon is relatively low, stenosis prevents the balloon from inflating in the middle. Further increase in pressure will dilate the narrowing and restore the full blood flow.
MeSH	D015642

　　[★] インターベンショナルラジオロジー

(画像診断を応用した非侵襲的な治療や組織診断)ンターベンショナルラジオロジー

関: IVR

同: IVR
同: IVR

「interventional」

　　[★]

adj.

介入性の、介入する

関: intercurrent、intervene、intervention、involvement

「radiology」

　　[★]

放射線学、放射線医学、放射線科

関: radiological

[1] 日本IVR学会HP

[2] 筑波大学放射線科HP

[3] Goetz MP, Callstrom MR, Charboneau JW, Farrell MA, Maus TP, Welch TJ, Wong GY, Sloan JA, Novotny PJ, Petersen IA, Beres RA, Regge D, Capanna R, Saker MB, Grönemeyer DH, Gevargez A, Ahrar K, Choti MA, de Baere TJ, Rubin J.: Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol. 15:300-306.2004

[4] Kobayashi T, Arai Y, Takeuchi Y, Nakajima Y, Shioyama Y, Sone M, Tanigawa N, Matsui O, Kadoya M, Inaba Y; Japan Interventional Radiology in Oncology Study Group (JIVROSG). Phase I/II clinical study of percutaneous vertebroplasty (PVP) as palliation for painful malignant vertebral compression fractures (PMVCF): JIVROSG-0202.:Ann Oncol.20:1943-7. 2009 .

[5] Margulis AR: Interventional diagnostic radiology: a new subspeciality. Am J Roentogenol 99:761-762, 1967.

[6] Wallace S: Interventional radiology. Cancer 37:517-531, 1976.

[7] Luessenhop AJ, Spence WT: Artificial embolization of cerebral arteries. J Am Med Assoc 172:1153-1154, 1960.

[8] Dotter CT, Judkins MP: Transluminal treatment of arteriosclerotic obstruction: description of a new technique and a preliminary report of its application. Circulation 30:654-670, 1964.

[9] Grüntzig A, Hopff H: Perkutane Rekanalisation chronisher arterieller Veschlüsse mit einem neuen Dilatationskatheler. Dtsch Med Wochenschr 99:2502-2511, 1974.

[10] Porstmann W, Weirny L, Wranke H: Der Versehluss des ductus arteriosus persistens ohne thoracotomy. Fortschr Geb Röentogenstr Nuklearmed 109:133-148, 1968.

[11] Parodi JC, Palmaz JC, Barone HD.: Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:491-499, 1991.

[12] Baum S, Nusbaum M: The control of gastrointestinal hemorrhage by selective mesenteric arterial infusion of vasopressin. Radiology 98:497-505, 1971

[13] Rösch J, Dotter CT, Brown MJ: Selective arterial embolization. A new method for control of acute gastrointestinal bleeding. Radiology 102: 303-306, 1972.

[14] Rösch J, Hanafee WN, Snow H: Transjugular portal venography and radiologic portacaval shunt: an experimental study. Radiology 92:1112-1114, 1969.

[15] Richter GM, Palmaz JC, Nöldge G, Rössle M, Siegerstetter V, Franke M, Wenz W: Der transjugulae intrahepatische portosystemische stent-shunt (TIPSS). Radiologe 29:406-411, 1989.

[16] Yamada R, Sato M, Kawabata M, Nakatsuka H, Nakamura K, Kobayashi N: Segmental obstruction of the hepatic inferior vena cava treated by transluminal angioplasty. Radiology 149:91-96, 1983.

[17] Lunderquist A, Vang J: Sclerosing injection of esophageal varices through transhepatic selective catheterization of the gastric coronary vein. A preliminary report. Acta Radiol Diagn 15:546-550, 1974.

[18] 金川博史, 美馬聡昭, 香山明一, 他: バルーン下逆行性経静脈的塞栓術（B-RTO）による胃静脈瘤治療. 肝臓 32: 442-444, 1991.

[19] Doyon D, Mouzon A, Jourde AM, Regensberg C, Frileux C: L’embolisation artérielle hépatique dans les tumeurs malignes du foie. Ann Radiol 17:593-603, 1974.

[20] Goldstein HM, Wallace S, Anderson JH, Bree RL, Gianturco C: Transcatheter occlusion of abdominal tumors. Radiology 120:539-545, 1976.

[21] Yamada R, Sato M, Kawabata M, Nakatsuka H, Nakamura K, Takashima S: Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology 148:397-401, 1983.

[22] Sugiura N, Takara K, Ohto M, et al: Percutaneous intratumoral infection of ethanol under ultrasound imaging for treatment of small hepatocellular carcinoma. Acta Hepatol Jpn 24: 920-923, 1983.

[23] Rossi S, Di Stasi M, Buscarini E, Quaretti P, Garbagnati F, Squassante L, Paties CT, Silverman DE, Buscarini L: Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer. Am J Roentogenol 167:759-768, 1996.

[24] Watkins E Jr, Khazei AM, Nahra KS: Surgical basis for arterial infusion chemotherapy of disseminated carcinoma of the liver. Surg Gynecol Obstet 130:581-605, 1970.

[25] 三浦建、他: 肝癌に対する肝動脈内注入化学療法の治療現況. 手術 33:1131-1146, 1979.

[26] Wiechel KL: Percutaneous transhepatic cholangiography. Technique and application. With studies of the hepatic venous and biliary duct pressures, the chemical changes in blood and bile and clinical results in a series of jaundiced patients. Acta Chir Scand Suppl. 11:Suppl 330:1-99, 1964.

[27] Kaude JV, Weidenmier CH, Agee OF: Decompression of bile ducts with the percutaneous transhepatic technique. Radiology 93:69-71, 1969.

[28] Molnar W, Stockum AE: Relief of obstructive jaundice through percutaneous transhepatic catheter: a new therapeutic method. Am J Roentgenol Radium Ther Nucl Med 122:356-367, 1974.

[29] 打田日出夫, 黒田知純, 中村仁信, 他: 経皮的胆管ドレナージとその内瘻化: 特に手技と経時的造影の診断価値. 日本医放会誌 35:53-67, 1975.

[1] Society of Interventional Radiology -- Global Statement Defining Interventional radiology. http://www.sirweb.org/news/newsPDF/IR_Global_Statement.pdf

[2] ttp://www.radiology.ucsf.edu/patient-care/sections/ir

[3] SIR - Fellow Residents and Students - APDIR

[4] ttp://www.theabr.org/present/ABR%20Update.ppt

[5] The Society for Pediatric Radiology

[6] "Imaging studies challenge Zamboni theory of MS". Canadian Medical Association. Retrieved 14 April 2011.

[fda-7] "FDA Safety Communication: Chronic Cerebrospinal Venous Insufficiency Treatment in Multiple Sclerosis Patients". Food and Drug Administration. May 2012.

[nice-8] "Percutaneous venoplasty for chronic cerebrospinal venous insufficiency for multiple sclerosis". National Institute for Health and Clinical Excellence. March 2012.

[9] Nonsurgical Treatment for Spinal Fractures From Osteoporosis - SIR

[10] Male Infertility and Varicocele Treatment - SIR

[autogenerated1-11] Central Lines, Ports and Feeding Tubes - SIR

[12] Image-Guided Needle Biopsy - SIR

[13] Pediatric Interventional Radiology - SIR

Interventional radiology
Intervention
Balloon dilatation of the stenosed internal jugular vein (photo from an X-ray angiograph monitor). While pressure in the balloon is relatively low, stenosis prevents the balloon from inflating in the middle. Further increase in pressure will dilate the narrowing and restore the full blood flow.
MeSH	D015642

匿名

検索

案内

Interventional Radiology