Interventional Radiology: Indications and Best Practices

Interventional radiology employs image-guided techniques to perform minimally invasive procedures for diagnosis and treatment. Interventional radiology is often used to place central venous catheters and subcutaneous ports, with some evidence of benefit over surgical placement. Arterial embolization procedures are used to manage many types of hemorrhage and are highly effective for severe postpartum hemorrhage. Vascular interventions, such as endovascular treatment of varicosities, acute limb ischemia, and pulmonary embolism, are superior to surgical interventions. For chronic limb ischemia and deep venous thrombosis, the choice of therapy is not as clear. Inferior vena cava filters can be placed and removed endovascularly, but there is a significant risk of complications that increases over time. Vascular interventions can be effective for scrotal varicocele and uterine fibroids, although fibroid treatment is limited by high recurrence rates. Image-guided percutaneous drainage and biopsy have become standard of care. Interventional approaches are being used in oncology for local diagnosis and treatment. Percutaneous ablation and targeted delivery of chemotherapy and radiation therapy are being developed as alternatives when surgery is not practical. Vertebroplasty and kyphoplasty provide significant pain and functional improvement in patients with spinal metastases.