Interventional Vascular Medicine

Telephone: 020-89168135 Address: Building 3, 2nd Floor Department Introduction Our hospital's Department of Interventional Radiology was established in 87 and is one of the earlier interventional treatment departments established in Guangdong Province. It has an interventional specialty ward and is a key discipline of Guangdong Second People's Hospital, undertaking important medical, teaching and scientific research functions. It has two of the world's advanced Philips flat-panel digital DSA systems and multiple monitoring devices, and performs interventional treatment of peripheral vessels, neurovascular vessels, the heart and great vessels; interventional vascular treatment and minimally invasive treatment of tumors; and minimally invasive treatment of cervical and lumbar intervertebral disc herniation. At the same time, the hospital has high-end 16-slice and 128-slice spiral CT and open MRI, which can perform image analysis, measurement and evaluation of tissues of various organs, providing reliable support for tissue puncture biopsy and minimally invasive treatment of related diseases. The department has 4 doctors and 6 nurses, including 1 chief physician, 1 associate chief physician and 2 attending physicians, including 3 master's postgraduate students and 1 doctoral student. The nursing group has 1 chief nurse and 2 associate chief nurses. At present, more than 2,000 cases receive interventional and minimally invasive treatment in our department every year, and multiple projects have reached an advanced level domestically. The academic leader, Director Xiao Chengjiang, chief physician, graduated with a master's degree from the First Military Medical University in 1993. He has been engaged in interventional radiology for 20 years and has a solid professional foundation and extensive clinical experience. He specializes in interventional treatment of tumors and vascular diseases and interventional treatment of cervical and lumbar disc protrusion. He has published more than 30 papers, co-edited 4 monographs, received 4 Military Science and Technology Progress Awards and 1 Guangdong Province Science and Technology Progress Award, completed 3 provincial and municipal scientific research projects, and has 1 project under study. He currently serves as a standing committee member of the Interventional Medicine Group of the Guangdong Medical Association, a standing committee member of the Guangdong Interventional Physicians Working Committee, a standing committee member of the Interventional Radiology Branch of the Guangzhou Medical Association, and a member of the Minimally Invasive Group of the Chinese Society of Oncology. Director Xiao Chengjiang performing an interventional procedure under CT guidance Currently, the interventional treatment projects carried out include: 1. Vascular diseases: vascular stenosis and occlusion caused by various reasons, thrombosis, ischemic diseases, massive hemorrhage, vascular malformations, arteriovenous fistulas, hemangiomas, varicose veins, aneurysms, pseudoaneurysms and arterial dissections. 2. Tumor diseases: various benign and malignant tumors, such as liver cancer, lung cancer, gastrointestinal tumors, renal cancer, pelvic malignant tumors, maxillofacial malignant tumors, malignant bone tumors in various sites, nasopharyngeal angiofibroma, vertebral hemangioma, symptomatic uterine fibroids, cavernous hemangioma of the liver, etc., and meningiomas. 3. Bone and joint diseases: benign and malignant bone tumors in various sites, disc herniation, osteolytic tumors of the vertebral bodies, vertebral compression fractures, ischemic necrosis of the femoral head, etc. 4. Luminal stenosis caused by various reasons: such as tracheobronchial stenosis; stenosis of the esophagus, stomach, duodenum, rectum and colon; biliary stenosis; urinary tract stenosis; and fallopian tube stenosis or obstruction. 5. Elimination of organ function using vascular embolization (medical organ resection): such as hypersplenism, hyperthyroidism and termination of ectopic pregnancy. 6. Puncture drainage: treatment of abscesses, cysts, hematomas, effusions, obstructive jaundice and hydronephrosis. 7. Percutaneous puncture biopsy: collection of tissue and pathological specimens to establish a pathological diagnosis (gold standard). 8. Tumor ablation technology: directly puncturing the tumor under imaging equipment and injecting chemotherapeutic drugs or absolute alcohol to kill cancer cells, and using radiofrequency and microwaves to generate a thermal effect inside the tumor to kill it. 9,125I seed implantation internal radiotherapy technology: radioactive 125I seeds are implanted into the tumor according to the TPS plan, providing highly conformal continuous radiotherapy to the tumor for 24 hours. 10. Neurointerventional treatment: thrombolytic treatment for hyperacute cerebral infarction, stent angioplasty for insufficient cerebral blood supply caused by cerebral artery and carotid artery stenosis, and embolization treatment of cerebral aneurysms and cerebral AVM. 11. Other: interventional treatment of portal hypertension due to cirrhosis, TIPPS, and Budd-Chiari syndrome. Typical Case Presentations I. Interventional treatment of liver and lung tumors This technique treats tumors by using a catheter to directly inject antitumor drugs into the local tumor or simultaneously block the tumor's nutritional blood supply. Although this method does not directly remove the tumor, it can cause obvious tumor necrosis and shrinkage and may even completely cure the tumor. Among them, the longest survival after interventional treatment of primary liver cancer has reached more than 10 years. Case presentation: 1. Interventional treatment of liver cancer Figure 3 Figure 1 Figure 2 Figure 1: A patient with primary liver cancer; hepatic arteriography showed a huge mass-type liver cancer in the right liver, approximately 10X300px in size. Figure 2: After 1 interventional treatment, the mass was significantly reduced; iodized-oil chemotherapeutic drugs were injected through the artery, together with PVA embolization of the tumor artery. Figure 3: After 2 treatments, DSA re-examination showed that the mass was significantly reduced, the tumor vessels were occluded, and the staining had disappeared. Figure 4: Liver cancer in the medial segment of the left liver; percutaneous multipolar radiofrequency ablation under CT localization. ‍ Figure 5: Portal-vein tumor thrombus from liver cancer; 125I seeds implanted into the portal-vein tumor thrombus under CT localization after interventional treatment. 2. Interventional treatment of hepatic hemangioma Figure 6 Figure 7 Figure 6: CT showed a hemangioma in the left lobe of the liver, approximately 5X150px in size. Figure 7: Three months after interventional treatment, follow-up CT showed that the hemangioma had almost disappeared. 3. Interventional treatment of lung cancer Figure 8: Peripheral lung cancer (adenocarcinoma) in the left lower lung; intraoperative superselective left bronchial artery chemoembolization. Figure 9: CT image before interventional treatment. Figure 7: CT re-examination 3 days after interventional treatment showed good deposition of iodized oil within the tumor, with tumor necrosis and cavity formation visible. Figure 10 Figure 11 Figure 10: TPS planning image before 125I seed implantation for left lung cancer. Figure 11: The mass had shrunk 1 month after 125I seed implantation. II. Interventional treatment of vascular diseases This treatment refers to treatment of various vascular stenoses or aneurysms, arteriovenous fistulas and similar conditions through multiple advanced vascular interventional techniques. For vascular stenosis, balloon-catheter dilation and intravascular stent placement can be performed; for arteriovenous fistulas or arteriovenous malformations, embolization of the malformed vessels and other procedures can be performed. Case presentation: 1. Interventional treatment of renal artery stenosis Figure 8: Renal arteriography showed 90% stenosis of the left renal artery. Figure 9: After intravascular stent implantation, normal flow was restored. 2. Interventional treatment of inferior vena cava obstruction Figure 12: Inferior vena cava angiography showed complete obstruction of its upper segment, and blood flow could not pass. Figure 11: After balloon dilation, blood flow could be seen passing smoothly directly into the right atrium. Figures 13, 14, 15, 16: Deep venous thrombosis of the left lower limb with complete femoral-vein occlusion; a thrombus filter was first placed in the vena cava below the renal V, fresh thrombus was aspirated through a catheter, and the femoral vein was completely recanalized after combined thrombolytic treatment. 3. Interventional treatment of hemorrhage Figure 17: Comminuted fracture of the right pelvis; angiography showed bleeding from the right iliolumbar artery, superior gluteal artery and internal pudendal artery. Figure 18: After vascular embolization, the bleeding vessels had been blocked and the bleeding stopped. 4. Interventional treatment of ischemic necrosis of the femoral head Figure 19: Ischemic necrosis of the right femoral head; angiography of the right medial circumflex femoral artery showed sparse blood-supplying vessels in the femoral-head region. Figure 20: Two weeks after interventional treatment, angiography of the right medial circumflex femoral artery showed a marked increase in vascular branches and opening of collateral circulation. III. Interventional treatment of varicocele Varicocele is one of the main causes of male infertility. Interventional embolization treatment of varicocele avoids the pain caused by anesthesia and surgery and postoperative complications such as scrotal edema and hematoma. Interventional treatment is painless and readily accepted by patients, its effect is reliable and the recurrence rate is low, and patients do not need hospitalization and can be treated as outpatients. Figure 16: Left renal arteriography showed reflux of blood in the left spermatic vein (the cause of varicocele). Figure 17: Selective left renal spermatic venography showed marked dilation and tortuosity of the pampiniform venous plexus in the left scrotum. Figure 18: Post-embolization angiography showed that the left spermatic vein had been blocked, reflux had disappeared, and the normal collateral vessels were well preserved. Figure 19: Preoperative color Doppler ultrasound showed marked dilation and tortuosity of the pampiniform venous plexus in the left scrotum, with persistent red-and-blue alternating color-flow signals visible. Figure 20: Color Doppler ultrasound on postoperative day 4 showed that the originally varicose pampiniform venous plexus had decreased in size and the color-flow signal of reflux had basically disappeared. IV. Interventional treatment of nonvascular luminal obstructive diseases This treatment mainly uses advanced interventional techniques such as percutaneous transhepatic or transoral balloon dilation and/or internal stent and internal drainage-tube placement to treat nonvascular luminal obstruction, including benign and malignant intrahepatic and extrahepatic biliary obstruction, benign and malignant esophageal and tracheal stenosis, esophageal fistula, ureteral stenosis and nasolacrimal duct stenosis. It can thereby achieve luminal patency and eliminate symptoms. Case presentation: 1. Interventional treatment of esophageal stenosis Figure 21: In a patient with malignant esophageal obstruction, contrast medium was seen passing with difficulty through the lower esophagus. Figure 22: A stent was placed at the esophageal stenosis, and the esophagus was seen to have regained patency. 2. Interventional treatment of biliary stenosis Figure 23: Percutaneous transhepatic cholangiography showed obstruction of the lower common bile duct. Figure 24: A biliary stent was placed at the stenotic obstructed site of the common bile duct, and the common bile duct regained patency. 3. Interventional treatment of fallopian-tube obstruction Figure 25: Infertility 5 years after marriage; hysterosalpingography showed bilateral fallopian-tube occlusion. Figure 26: The right fallopian tube was patent after interventional treatment. Figure 27: The left fallopian tube was patent after interventional treatment. Pregnancy occurred two months later. V. Interventional treatment of disc herniation This technique uses special dedicated instruments inserted into the intervertebral disc to grasp and remove disc tissue protruding into the spinal canal, thereby achieving treatment; or injects drugs such as ozone and collagenase to dissolve and destroy the nucleus pulposus tissue protruding into the spinal canal. Case presentation Figure 28-29: A puncture needle was inserted into the intervertebral disc by combining anteroposterior and lateral views with percutaneous puncture through the body surface. Figure 30: Preoperative CT showed L5-S1 intervertebral-disc herniation. Figure 31: Three months after interventional treatment, symptoms had completely resolved, and follow-up CT showed retraction of the intervertebral disc. Upper image: Compression fracture of the first lumbar vertebra (L1); vertebroplasty was performed by percutaneous transpedicular puncture and injection of bone cement into the vertebral body; postoperative pain was immediately relieved, and the patient could get out of bed and walk after 6 hours. VI. Interventional treatment of uterine fibroids This technique involves superselective insertion of a catheter into both uterine arteries followed by injection of an embolic agent or sclerosing agent. The procedure is simple, causes little trauma, provides rapid recovery and has marked effects. It is especially suitable for patients with excessive menstrual bleeding or severe dysmenorrhea and rectal or bladder compression symptoms. Young female patients can retain the uterus and become pregnant successfully after interventional treatment. Case presentation Figure 32: Pre-interventional-treatment CT showed a giant uterine fibroid, approximately 10X200px in size. Figure 33: CT two months after interventional treatment showed that the fibroid had shrunk markedly; the patient had a full-term vaginal delivery one year later. VII. Interventional treatment of portal hypertension due to cirrhosis Cirrhosis can cause portal hypertension, resulting in gastrointestinal bleeding, ascites, gastrointestinal disease, splenomegaly and hypersplenism. The main interventional treatment methods include transjugular intrahepatic portosystemic shunt (TIPS), embolization of esophagogastric varices, splenic embolization and percutaneous peritoneal fluid-to-venous shunting, which can effectively control the above complications. Case presentation: Male, 51 years old. Admitted for primary liver cancer. Hepatic arteriography showed multiple mass-type liver cancers in the right lobe of the liver, and chemoembolization was performed. Follow-up angiography one year after surgery showed that the masses had shrunk markedly, there were no tumor vessels, and the liver volume had decreased (Figure 34). One month later, esophageal-variceal bleeding occurred. Conservative medical treatment failed to stop the bleeding, and emergency TIPS was successfully performed (Figure 35); the bleeding stopped. VIII. Percutaneous left subclavian artery catheter drug-port-system placement This can establish a long-term intra-arterial drug-delivery route. It is widely used for palliative treatment of malignant tumors of the chest, abdomen and pelvis, and can also be used for diseases requiring long-term intra-arterial drug treatment, such as ischemic necrosis of the femoral head and osteomyelitis. Compared with surgical placement of a drug-port system, it has the advantages of less trauma, simple operation and accurate catheter placement. Figure 36: The drug port was placed subcutaneously in the left anterior chest, and the connected catheter entered the body through the left subclavian artery. Figure 37: The catheter drug-port system was used for long-term chemotherapy of pancreatic-head cancer; the catheter was placed in the common hepatic artery, and the positions of the catheter end hole and side hole are shown. Figures 38, 39, 40: Cerebral vascular malformation (AVM) in the left parietal lobe; under DSA guidance, a microcatheter was superselectively advanced into the AVM-feeding artery, and a special tissue glue was injected to embolize the AVM; follow-up DSA after embolization showed that the AVN was completely occluded. Figures 41, 42: Rupture of a cerebral artery aneurysm at the left top of the brain caused subarachnoid hemorrhage; under DSA guidance, a microcatheter was superselectively advanced into the arterial aneurysm sac, and a special microcoil was delivered through the microcatheter to embolize the aneurysm. Figures 43, 44: The horizontal segment of the right middle cerebral artery; acute, motor and sensory functions immediately returned to normal. Figures 45, 46: Stenosis of the horizontal segment of the right middle cerebral A reached 90%, with insufficient blood supply; after stent placement, the stenosis completely recovered and blood flow improved. Figures 47, 48: Stenosis of the left carotid A reached 95%; after stent placement, the left carotid A stenosis improved markedly, decreasing to 20%. Figures 49, 50, 51: Diabetes with atherosclerosis of both lower-limb arteries; the left lower-limb peroneal A and posterior tibial A were occluded; after DEEP balloon angioplasty, the occluded posterior tibial A opened and blood circulation was restored. Figures 52, 53: Sigmoid-colon CA caused colonic obstruction; a colonic stent was placed under DSA guidance and the obstruction was relieved. Figures 54, 55: Obstruction of the descending segment of the duodenum; an intestinal stent was placed under DSA guidance to relieve the obstruction. Fig.: 56, 57 Late-stage prostate cancer caused complete atrophy and loss of function of the left kidney, with right ureteral obstruction and anuria for 6 days; percutaneous right nephrostomy was performed under B-ultrasound localization.