Editorial
A Welcome From the Editor
Dear Readers, It gives me great pleasure to present this edition of Intervention IQ, with venous interventions as the leading theme. When we talk of venous disorders, many people might think only of unsightly varicose veins and underestimate them as merely a cosmetic problem. However, visible varicose veins are just one sign of chronic venous insufficiency; a disease state that has serious implications fo...
General Information
Interventional Quarter is published three times a year. To add an address to the mailing list, please contact [email protected] or refer to www.intervention-iq.org. Editorial Office Neutorgasse 9/8 AT-1010 Vienna, Austria Tel: +43 (0)1 904 2003 Fax: +43 (0)1 904 2003 30 E-mail: [email protected] www.intervention-iq.org ISSN: 2075-5813 Cover Image © dreamstime.com/Piotr Marcinski © Al...
Patient Story
Varicose Vein Treatment
The IR Way The Patient Ms. feraye kılıç, a patient of Prof. Levent Oguzkurt, explains how undergoing interventional radiology (IR) treatment for varicose veins made a real difference to her life: “After my second pregnancy, unsightly varicose veins appeared on my left leg and got larger and larger over the last three years. The appearance was only one part of the problem. In my right leg, there was...
Varicose Vein Treatment the IR Way
The IR
Prof. Levent Oguzkurt spoke to IQ about the particular strengths of interventional radiologists, which enable them to provide excellent treatment for symptomatic varicose veins: “Our hospital is one of the biggest centres in Turkey for laser ablation of varicose veins. Since 2007, when we started providing IR treatments for this condition, we have performed more than 1,500 thermal ablation pro - cedur...
New Horizons
Turning the Tide of Venous Insufficiency
Innovation and constant technical development are some of the hallmarks of interventional radiology (IR). One area in which interventional radiologists are applying their ingenuity is in the search for a new solution to chronic venous insufficiency (CVI). Thanks to the great contribution of Prof. Elias Brountzos and Prof. Dusan Pavcˇnik, two interventional radiologists in volv ed in this field of research...
Report
Voting with Their Wallets
Minimally invasive treatments for varicose veins are offering patients more choice than ever, and even where they are not offered by public health insurers, patients are voting with their wallets and seeking out private treatment. Dr. Kieran McBride runs the Scottish Vein Centre, a private clinic in Edinburgh that offers varicose vein sufferers the gentle options they are looking for. He tells us why the...
Worldview
Dr. Sanjoy Kundu,Medical Director of the Vein Institute of Toronto and Active Staff at the Scarborough Hospital, Toronto/Canada “Image-guided treatments for varicose veins, including endothermal ablation and ultrasound-guided sclero the ra py, have revolutionised the treatment of superficial venous insufficiency. These treatments are characterised by markedly improved outcomes, decreased complications and...
Economy Class Syndrome
Deep vein thrombosis (DVT), often referred to as Economy Class syndrome, is a well-known medical complaint much discussed in lifestyle magazines. unsurprisingly – in a world where long-haul flights and sedentary lifestyles are so prevalent, we are more at risk than ever before. What is DVT? DVT is the formation of a blood clot within the veins that lie deep within our muscle tissue. This is most commo...
Ask the Expert
Why is it Important to Treat DVT – What can be the Consequences of Not Doing so? “DVT can have serious consequences: venous thrombo - embolism (VTE) is the third biggest cause of cardiovascular mortality after stroke and heart attack. Additionally, post-thrombotic syndrome affects a large proportion of patients post-DVT and is disastrous in terms of morbidity. Multiple long-term studies have shown huge...
The Colleague’s Perspective
Dr. Maccon Keane is a Medical Oncologist at University Hospital, Galway. He is a keen supporter of IR, and works closely with Gerard O’Sullivan and his colleagues. “Our Oncology Department has been working closely with the IR Department since 2003. Oncology patients, due to a variety of factors, such as altered blood chemistry and increased bed rest, are quite prone to developing blood clots. They’...
Venous Interventions
Introduction
Circulation When everything is running smoothly, most people don’t give their circulation much thought. But silently and out of sight something impressive is happening. The heart pumps the equivalent of approximately 7,000 lit - res of blood around the body each day. Blood is first sent along the arteries, delivering oxygen from the lungs to the other organs and tissues. Then it is the job of the veins...
Radio Frequency Ablation
The Treatment Radiofrequency (RF) ablation is one of the common ways to treat symptomatic varicose veins by applying endovenous heat. With the latest technology a catheter with an RF tip is inserted into the varicose vein and advanced to where the treatment should begin, which is typically at the groin level. The RF tip heats each segment to 120°C for 20 se - conds, as the catheter is carefully pulled...
Laser Ablation
The Treatment Laser ablation (also called endovenous laser treatment or ELT/EVLT) is very similar to radiofrequency (RF) ab lation: by applying heat from within, the malfunctioning vein can be sealed off. In a similar manner to RF ablation, a very thin laser fibre is inserted into the vein under local anaesthetic. Once in place, the laser is switched on and slowly withdrawn down the vein. The heat literall...
Foam Sclerotherapy
A third minimally invasive treatment option is foam sclerotherapy, which acts differently to the thermal ablative techniques. Dr. Kieran McBride, who runs a private vein clinic in Edinburgh, Scotland, talks us through its uses and advantages. “There is certainly a role for foam sclerotherapy in treating varicose veins, as well as other venous malformations. While laser has shown to be the most effective...
Non-IR Treatments
Apart from the minimally invasive treatments provided by interventional radiology (IR), there are a number of other strategies available for the management of symptomatic varicose veins. Conservative Management Graduated compression hosiery is a mainstay of managing venous insufficiency. Specially designed to provide more compression at the bottom of the leg than the top, the poor functioning of the vein...
The Diverse Role of IR
The previous pages have shown a range of interventional radiology (IR) treatments which are available for the effective management of venous disorders. Interventional radiologists combine imaging expertise and technical skill with catheters and guidewires; allowing treatment of the problem at source. However, not all venous interventions are in response to a venous disorder. Sometimes the veins are used...
Venous Interventions Trials and Registries
Trial: a study carried out with the purpose of testing a new medical treatment on a defined group of people. The results are compared with a group that are treated using another method and/or a control group. Registry: a (retrospective) collection of data about a certain treatment or illness. using the compiled data, conclusions can be drawn about effectiveness of a particular treatment method. Early Out...
Health Economics
Venous Disorders
The high cost of venous disorders is guaranteed by the sheer number of people affected. Alongside the expen - ses of acute treatment and long-term care, the wider economy must absorb associated costs, such as the high number of missed work days. A European Example: The Situation in Germany Chronic Venous Disease A German study into the prevalence of venous disorders found every 6th man and every 5th woman...
Weighing up the Benefits of IR
In an ideal world, patients would have unlimited access to all the treatments they might need. In re ality, however, healthcare decision makers face the difficult task of balancing need with availability. With limited resources, cost effectiveness is central to any decision. Lieven annemans, Professor of health Economics at Ghent university and Brussels university (VuB) and author of “health economics...
Daily Practice
Paediatric IR
The smallest patients need special care, and that is precisely what paediatric interventional radiologists provide. although a rare breed, there is great interest in this sub-specialty, with many children's hospitals offering a paediatric interventional radiology (IR) programme, or looking to begin one. IQ talks to Dr. anne-Marie Cahill, director of the Paediatric IR programme in the Children’s hospita...
Trials and Registries
Angioplasty
Cutting Balloon versus Non-cutting Balloon for the Treatment of Venous Stenosis in the Fistulas of Hemodialyzed Patients (PREST) Contact Dr. Eric Picard, Centre Hospitalier Universitaire de Nîmes, FRDate Opened September 2011Status Not yet recruitingDescription The main objective of this study is to evaluate and compare the primary patency rate at 12 months in a group of haemodialysis patients operated on...
Carotid Stenting
Effects of Cerebral Protection with Filters vs. Flow Reversal on Cerebral Embolization after Carotid Artery Stenting Contact Dr. Carlos H. Timaran, Dallas VA Medical Center, USDate Opened October 2011Status RecruitingDescription This study was designed to investigate whether balloonbased protection systems are more effective than filters in reducing the amount of particles that break off and travel to the b...
Embolisation
Balloon Catheters in Cases of Abnormal Placentation (Accreta) Contact Dr. Raed Salim, HaEmek Medical Center, IL Date opened January 2009 Status Recruiting Description The objective of this study is to estimate the efficacy of balloon catheter interventions among women diagnosed with a placenta accreta. ClinicalTrials.gov Identifier: nCT01373255 Efficacy of Radiation Therapy and Transarterial Chemoemboliz...
Renal Denervation
Efficacy and Safety of Radiofrequency Renal Denervation in Drug Resistant Hypertension Contact Dr. Stanislav Pekarskiy, Siberian Branch of the Russian Academy of Medical Sciences, RUDate Opened March 2010Status RecruitingDescription Single-centre, single group study of the efficacy and safety of transcatheter renal denervation for treatment of patients with essential hypertension uncontrolled despite combin...
UAE/UFE
Diffusion and Perfusion Weighted MRI for Response Prediction of Symptomatic Leiomyomas following Uuterine Artery Embolization Contact Prof. Geert Maleux, University Hospital Gasthuisberg, BEDate opened January 2012Status RecruitingDescription It is known that volumetric response of leiomyomas following uterine artery embolisation correlates well with patients’ clinical outcome. The aim of this study is to...
The Early Days of IR
An Interview with Prof. Rolf Günther
Many Inventions Result from Eureka Moments, but Others Unfold Slowly Over Years of Dedicated Focus. The World’s First Optional Filter was One Such Invention. IQ Talks to its Inventor, Prof. Rolf Günther, About his Years of Dedication and Research. “When I started my training, interventional radiology (IR) barely existed. As I completed my training in 1975, the contours of therapeutic interventions w...