Interventional radiologists at Ingalls offer several breakthrough procedures that offer numerous benefits to cancer patients, including minimally invasive techniques to prolong survival, provide pain relief, shrink tumors and improve overall quality of life.

Chemoembolization
Chemoembolization is a method that uses small catheters and highly detailed imaging guidance to deliver chemotherapy directly into tumors. It is used to treat tumors that originate in the liver (primary liver cancer) or tumors that spread (metastasized) to the liver from other primary sites such as the colon or breast. During the procedure, anti-cancer drugs are injected directly into the blood vessel that feeds a cancerous tumor. In addition, a synthetic material called an embolic agent is placed inside the blood vessels that supply blood to the tumor, in effect trapping the chemotherapy in the tumor. This allows for a higher dose of chemotherapy since less of the drug is able to circulate to the healthy cells in the body. Chemoembolization is often performed in patients who cannot undergo surgery to remove the tumor. Even in cases where the cancer can not be cured, this approach may relieve a patient’s symptoms and extend survival.

Radiofrequency Ablation
Radiofrequency ablation is a minimally invasive, image-guided technique that heats and destroys cancer cells. It is most frequently used to treat relatively small tumors of the kidney, liver and lung. During radiofrequency ablation, imaging techniques such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) are used to help guide a needle electrode into a cancerous tumor. High-frequency electrical currents are then passed through the electrode, creating heat that destroys the abnormal cells.

Cryoablation
Cryoablation, also called cryotherapy, cryosurgery or targeted cryoablation therapy, is a minimally invasive treatment that uses extreme cold to freeze and destroy diseased tissue, including cancer cells. Although cryotherapy and cryoablation can be used interchangeably, the term "cryosurgery" is reserved best for cryotherapy performed using an open, surgical approach. During cryoablation, liquid nitrogen or argon gas is applied to cancerous cells. Physicians use image-guidance techniques such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) to help guide these freezing substances to treatment sites located inside the body. Cryoablation is commonly used to treat cancers of the prostate, liver and cervix.

Selective Internal Radiation Therapy (SIRT) or Radioembolization
Ingalls is one of the few cancer programs in Illinois to offer SIRT, a non-surgical outpatient therapy that uses radioactive (Yttrium-90) microspheres to deliver radiation directly to the site of liver tumors. This unique, targeted therapy spares healthy tissue while delivering up to 40 times more radiation to liver tumors than would be possible using conventional radiotherapy. The technique uses the patient’s blood supply to send the tiny spheres, smaller in diameter than a human hair, into the microscopic vessels that feed a cancerous tumor. The spheres eventually become lodged at the tumor sites where they deliver a high dose of radiation. This radiation treatment has been shown to extend life expectancy in patients with malignant liver tumors for several months on average.

Interventional radiologists at Ingalls, working closely with their colleagues in vascular surgery, now offer a minimally invasive alternative to open surgical repair of abdominal aortic aneurysm (AAA) and thoracic aortic aneurysm (TAA) called endovascular stent graft repair.

Unlike traditional surgery, which involves a large incision and lengthy recovery period, endovascular repair involves small incisions in the groin and image-guided catheter placement of a stent graft to reinforce the weakened section of the aorta and prevent rupture. While not all patients are candidates for these procedures, they are highly effective alternatives to open surgery – particularly for high-risk patients with multiple medical conditions.

How Endovascular AAA Repair Works:
Traditional surgery for treating AAA requires an incision over the abdomen to expose the aorta. The aneurysm is clamped off below the renal arteries and above the iliac arteries. A synthetic graft is then placed within the blood vessel containing the aneurysm, essentially removing the risk of future rupture. Since this is major surgery, it requires a hospital stay of seven to ten days, with full recovery estimated at six or more weeks.

For many individuals, particularly high-risk patients with many medical problems, major surgery is not an option, and until recently, there was no alternative.

During endovascular aneurysm repair, a small incision is made in the groin and a catheter is guided through the femoral (leg) artery to the aneurysm. Both X-ray guidance and intravascular ultrasound are used to measure the aneurysm and place an appropriately sized stent graft.

Within a few hours after the procedure, patients are encouraged to walk, and most are discharged within 24 to 48 hours. While some patients may not be candidates for the procedure, it is an excellent alternative to open surgery. Additional benefits include less blood loss, a faster recovery and fewer complications.

How Endovascular TAA Repair Works:
The standard treatment for TAA is open-chest aneurysm repair, but interventional radiologists at Ingalls are able to treat many thoracic and thoraco-abdominal aneurysms with endovascular stent grafting. Using a delivery catheter and X-ray guidance, the interventional radiologist places a thoracic stent graft inside the thoracic aortic aneurysm, without the need for surgery. Once placed in the correct location, the stent graft expands to fit within the diameter of the thoracic aorta and provides a new path for the blood flow.

Patients may be candidates for endovascular stent grafting if their thoracic aneurysm is five centimeters or more in size and has not ruptured. Physical characteristics of the aorta and the aortic aneurysm itself also are important factors when determining if endovascular repair is the best treatment.

As with AAA repair, interventional repair of TAA is an effective treatment that can be performed safely, resulting in lower mortality rates, faster recovery and fewer complications than those reported for open surgical repair.

Ingalls offers several treatments for venous insufficiency and varicose veins.

Laser Vein Ablation
This minimally invasive treatment is an outpatient procedure performed using imaging guidance. After applying local anesthetic to the vein, an Ingalls interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the vein, and guides it up the greater saphenous vein into the thigh. Laser or radiofrequency energy is then applied to the inside of the vein, heating and then sealing the vein closed. By closing the greater saphenous vein, the twisted and varicosed branch veins, which are close to the skin, shrink and improve in appearance. Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing normal flow.

Laser vein ablation is a quick, effective procedure that involves minimal discomfort and represents a vast improvement over the traditional option of vein stripping and ligation surgery that was often painful and required up to six weeks of recovery. After the procedure, a patient can literally walk out of the office and resume normal activities within 24 hours. Laser vein ablation boasts a 95-percent success rate.

Vein mapping helps determine if you are a candidate for laser vein ablation.

Ambulatory phlebectomy
Ambulatory phlebectomy is a minimally invasive surgical technique used to treat varicose veins that are not caused by saphenous vein reflux. The abnormal vein is removed through a tiny incision or incisions using a special set of tools. The procedure is done under local anesthesia and typically takes less than an hour to perform. Recovery is rapid, and most patients do not need to interrupt regular activity after ambulatory phlebectomy.

Injection sclerotherapy
Sclerotherapy treatment is a non-surgical procedure to remove varicose veins. The procedure involves injecting a solution directly into the vein, resulting in a reaction that progressively shrinks the varicose vein. If the vein is labeled as “diseased,” it will typically necessitate several treatments to fully fade away. Of the various treatments available, many patients are finding sclerotherapy spider vein treatment to be an effective option. The sclerotherapy procedure typically takes between fifteen minutes to one hour, based on the number and overall length of the spider veins.

A minimally invasive treatment for fibroid tumors of the uterus, uterine fibroid embolization (UFE) relieves symptoms while allowing a patient to avoid surgery. During a UFE procedure, interventional radiologists use an X-ray camera called a fluoroscope to guide the delivery of tiny particles to the uterus and fibroids. The small particles are injected through a thin, flexible catheter. These particles then block the arteries that provide blood flow to the tumors, causing the fibroids to shrink. Nearly 90 percent of women with fibroids experience dramatic relief of their symptoms.

Because the effect of uterine fibroid embolization on fertility is not fully understood, UFE is typically offered to women who no longer wish to become pregnant or who want or need to avoid having a hysterectomy, which is the surgical removal of the uterus. Benefits of UFE include no surgical incision, little or no blood loss, significantly less pain, a faster recovery and a quicker return to work and normal activities.

Vertebroplasty is a minimally invasive treatment for vertebral compression fractures that fail to respond to conventional medical therapy. Vertebroplasty stabilizes the collapsed vertebra through injection of medical-grade bone cement into the spine, decreasing pain and preventing further collapse of the spine. The procedure is performed on an outpatient basis under local anesthesia and mild sedation. A needle is guided into the fractured vertebra through a small skin nick. Acrylic bone cement is injected into the vertebra, filling the spaces within the bone. The procedure takes from one to two hours. Following a brief observational period, patients go home within a few hours and can often resume normal activities the next day. Vertebroplasty dramatically reduces back pain within hours of the procedure; provides long-term pain relief; and has a low complication rate.

Interventional radiologists use imaging to diagnose, understand and visualize the full scope of a medical condition and then map out a procedure tailored to the individual patient. Angiography is an X-ray exam of the arteries and veins to diagnose blockages and other blood vessel problems. Angiograms are also used to diagnose aneurysms (an area of a blood vessel that bulges out); stroke or bleeding in the brain; and blood vessel malformations.

During an angiogram, a thin tube or catheter is inserted into an artery through a small nick in the skin about the size of a pencil tip. A substance called a contrast agent (X-ray dye) is injected to make the blood vessels visible on the X-ray. In many cases, the interventional radiologist can treat a blocked blood vessel with angioplasty, stent placement or the administration of clot-busting drugs during the actual angiogram itself.

In many cases, interventional radiologists can use balloon angioplasty or stent placement to open blocked or narrowed blood vessels in the legs, neck and kidney. In fact, angioplasty and stenting have generally replaced open surgery as the first-line treatment for blocked arteries throughout the body since numerous clinical studies have shown them to be as effective as surgery.

During balloon angioplasty, the interventional radiologist inserts a very small balloon attached to a thin catheter into a blood vessel through a small nick in the skin. The catheter is threaded under X-ray guidance to the site of the blocked artery. The balloon is inflated to open the artery. If necessary, a small metal scaffold, called a stent, is inserted to keep the blood vessel open.

Interventional radiologists at Ingalls perform a wide range of procedures to diagnose and treat gastrointestinal conditions, including the insertion of feeding tubes (G-tubes and J-tubes) ; Biliary catheter placement to treat a leaking or obstructed bile duct; ultrasound- and CT-guided biopsy; minimally invasive embolization procedures to treat male infertility caused by varicocoeles; coil techniques to control upper and lower gastrointestinal bleeding; embolization of kidney tumors before surgery; and more. Because the procedures are minimally invasive, patients are spared the large, painful incision and lengthy recovery typically associated with surgery.

Interventional radiologists at Ingalls play an important role in the management of patients undergoing dialysis care. Procedures include the insertion of temporary or permanent dialysis catheters; assistance with complex dialysis access, including trans-hepatic and trans-caval access routes; and the removal of blood clots and treatment of strictures that may have formed in a graft or fistula. The Interventional radiology team has access to the most sophisticated state-of-the-art tools, devices and equipment which allow treatment of the most complex dialysis access issues.

Interventional radiologists at Ingalls are also experts at performing vascular access procedures. Through the insertion of a thin, flexible catheter into a blood vessel, vascular access provides a painless way of drawing blood or delivering drugs and nutrients into a patient’s bloodstream over a period of weeks, months or even years.

When an IV line is necessary for a longer period of time and/or a more secure venous access is necessary, a special catheter, called a central access catheter, or a similar device is placed inside a major blood vessel either temporarily (for days) or long-term (for weeks to years) so that it can be easily and repeatedly accessed over a desired period of time.

In a vascular access procedure, a special catheter is inserted inside a major vein (generally in one of the large veins in the neck or in the arm) extending into the large central vein near the heart.

Vascular access procedures are performed when patients need:

• Intravenous antibiotic treatment.
• Chemotherapy or anti-cancer drugs.
• Long-term intravenous (IV) feeding for nutritional support.
• Repeated drawing of blood samples.
• Hemodialysis.

Access catheters may also be used for:

• Blood transfusions.
• Patients who have difficulty receiving a simple IV line