Interventional Radiology: Indications and Best Practices

 

Am Fam Physician. 2019 May 1;99(9):547-556.

  See related AFP Community Blog post: Introducing Dr. Mike Arnold, the first Jay Siwek Medical Editing Fellow

Author disclosure: No relevant financial affiliations.

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.

Interventional radiology employs image-guided techniques to perform minimally invasive procedures, providing lower-risk alternatives to many traditional medical and surgical therapies. Since the advent of interventional radiology in the 1960s, its role has expanded to encompass the diagnosis and treatment of diseases across multiple body systems.1  The treatments discussed in this article represent a sample of what interventional radiology can offer to family physicians. Guidelines regarding procedural bleeding risks and recommended anticoagulation management are shown in Table 1.2,3

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Overall complications and costs are reduced when ports are placed with interventional radiography rather than surgically.

B

57

Endovascular treatments of abdominal aortic aneurysms have improved 30-day mortality and equivalent total mortality compared with surgery.

A

14

Endovascular treatments for varicose veins have similar success rates and lower complication rates than surgery.

A

17, 18

Transarterial embolization for postpartum hemorrhage has a high success rate and can preserve fertility.

B

24, 29

Catheter-directed thrombolysis for massive and submassive pulmonary embolism has mortality benefits over anticoagulation alone.

B

4951

Interventional percutaneous drainage and biopsy procedures have success rates that are at least equivalent to open surgical approaches.

B

5860, 64, 65, 67, 68

Vertebroplasty and kyphoplasty provide significant pain and functional benefits to patients with painful spinal metastases.

B

78


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Overall complications and costs are reduced when ports are placed with interventional radiography rather than surgically.

B

57

Endovascular treatments of abdominal aortic aneurysms have improved 30-day mortality and equivalent total mortality compared with surgery.

A

14

Endovascular treatments for varicose veins have similar success rates and lower complication rates than surgery.

A

17, 18

Transarterial embolization for postpartum hemorrhage has a high success rate and can preserve fertility.

B

24, 29

Catheter-directed thrombolysis for massive and submassive pulmonary embolism has mortality benefits over anticoagulation alone.

B

4951

Interventional percutaneous drainage and biopsy procedures have success rates that are at least equivalent to open surgical approaches.

B

5860, 64, 65, 67, 68

Vertebroplasty and kyphoplasty provide significant pain and functional benefits to patients with painful spinal metastases.

B

78


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

 Enlarge     Print

TABLE 1.

Guidelines for Percutaneous Interventions

CategoryBleeding risk of procedure
LowMediumHigh

Procedures

Catheter exchange/removal Dialysis access Inferior vena cava filter placement Joint aspira

The Authors

show all author info

MICHAEL J. ARNOLD, MD, is a faculty member in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md. At the time this article was written, he was a faculty member in the Department of Family Medicine at Naval Hospital Jacksonville (Fla)....

JONATHAN J. KEUNG, MD, is an interventional radiologist at the Walter Reed National Military Medical Center, Bethesda.

BRENT MCCARRAGHER, MD, is a radiology resident at the Walter Reed National Military Medical Center.

Address correspondence to Michael J. Arnold, MD, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814 (e-mail: michael.arnold@usuhs.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

Editor's Note: Dr. Arnold is a medical editing fellow for AFP.

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