Interventional Radiology is the latest frontier in Medicine, paving new ways and methods of treatment options all done through a 3mm hole in a vessel. Medicine is evolving continuously at a tremendous speed adding years to average life span, unraveling new diseases, and complex presentations. Increased access to technology, restricted physical activities, unhealthy lifestyle is contributing to the constant increase in lifestyle-related disorders such as obesity, varicose veins, high blood pressure and other associated diseases from an earlier age.
Similar to the way all the gadgets have become more sleek and sophisticated, surgical procedures to have become more advanced to a point of day-care solutions being offered to many diseases. In this regard Interventional Radiology has been a torchbearer, imbibing the innovations and uses image guidance in providing minimally invasive and laser-accurate targeted therapies. The spectrum of Interventional Radiology includes pain management, peripheral vascular disease, men’s & woman’s health, cancer, and stoke management. An interventional radiologist provides emergency care like controlling internal bleeder (Embolization) and also electively increasing flow to a non-healing ulcer on foot (Angioplasty). An Interventional Radiologist works in close association with other care providers to provide integrated care and adds significantly to the armamentarium especially when the options are significantly limited.
Almost all the procedures are done under local anesthesia, thereby surgically unfit patients are also taken care of, warding off the risks associated with anesthesia and prolonged stay in the hospital, hence the costs involved are minimized and rapid recovery is ensured. Interventional Radiology uses the imaging modules such as ultrasound, CT and C-arm (X-Rays), and with aid of wires and catheters reaches the target organs via the blood vessels by entering through a small prick of 3mm. The hazards associated with radiation are kept to the lowest possible by constant application of evolving technology and other protective measures.
Varicose Veins-Endovenous Laser Ablation
When does one requires this procedure ?
You require this procedure when dilated veins in your legs are causing symptoms such as ● Pain in legs by evening. ● Swelling of legs and ankle by evening. ● Skin discolouration around ankle ● Itching around veins. ● Cramping of legs in nights
Who are prone to develop varicose veins?
● Family history ● Post pregnancy ● Professions requiring prolonged sitting/ standing ● Obese ● Following trauma to limbs ●Long term Smokers
How is it diagnosed ?
Ultrasound scan , to be done in standing position and may require a CT venogram in special instances.
Who does it?
A radiologist trained in imaging guided procedures does it, Interventional radiologist.
What are the alternates?
● Venaseal- Latest development in treating varicose veins, and is useful in avoiding even the mild complications of laser ● Microwave Ablation: Similar to laser therapy ● RF Ablation: Similar to laser therapy ● Compression bandages -Provide partial symptomatic relief but not permanent cure, has to be worn religiously ● Sclerotherapy- Best suggested for small veins) ● Surgery - Requires admission, general anaesthesia and results in scar
What are the advantages of laser therapy?
● Success rate of 98% ● Day care procedure, discharged within 24 hours ● Done under local anaesthesia. ● Procedure takes 30 to 60 minutes. ● Can resume work next day
What are the consequences of postponing?
Pressure effects may progress, and may bleed/ulcerate and progress to clots which may extend into deeper veins.
What are the advantages of imaging guidance?
You are assured that vital structures in the path are avoided and the catheter is place in the vessel exactly.
How should I prepare for the procedure?
Shave and do not use any lotion or oil on legs for 24 hours prior to the procedure. You would be kept on overnight fasting, as sometimes a mild anaesthetic may be sometimes given
How long does the procedure / procedure takes?
The procedure usually takes 30 minutes for a limb, and 60 minutes for both limbs. Depending on the extent of disease , the radiologist decides if you may require additional sclerotherapy to obliterate smaller vessels .
Is it painful?
The procedure is done under local/spinal anaesthesia most of the times. The needle track till the vein would be made numb and pain is not felt.
How is it done?
A small catheter would be placed in a vein near your ankle, through which laser fiber would be introduced upto upper thigh. Gradually laser fiber would be retracted delivering pulses of energy, causing the vein to collapse. Post procedure the limb would be wrapped in compression stockings and you would be asked to walk for 20 minutes.
How should I take care of the procedure site?
The puncture site would be dressed properly following the procedure. The port site is usually of pinhead size and does not bleed, however, it need to be kept dry. Do not apply any powder/ointment on it. Watch for any swelling/ skin color change/pain and consult your radiologist/ physician immediately.
What are the post-procedure instructions?
Wear stockings continuously for the first 24 hours, following which you can avoid stockings during sleep and shower.
What are the likely complications?
Serious complications are extremely rare with laser therapy. Minor complications include mild swelling ( which comes down in a day or two), bruising ( which comes down in a day or two ), and cramping sensation.
Can I drive after the procedure?
It is always advised to have someone accompany you, who can drive.
What are the dietary restrictions after the procedure?
No specific dietary restrictions when the procedure is done under local anesthesia.
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