Interventional radiology is perhaps the fastest developing field of medicine at the moment. One of its main principles is the minimal invasion of the patient’s body. Such procedures that respect the health of patients are increasingly being applied not only in the diagnosis, but also in the treatment of various diseases, including oncological ones. More about the possibilities of these innovative procedures and their benefits for patients is told by the doctors of the Center for Radiology and Nuclear Medicine of VUL Santaros Clinics, interventional radiologists dr. Donatas Jocius and the head of the Interventional Radiology Department dr. Marius Kurminas.
Interventional radiology is becoming increasingly important in the treatment of many clinical conditions
Dr. Marius Kurmin says that interventional radiology can be figuratively called modern procedural jazz. This area includes hundreds of different procedures performed through needle hole-sized (up to 2mm) punctures or incisions, and the range of these procedures is constantly expanding. In a methodical sense, these are diagnostic and therapeutic procedures performed under the control of visual examination (e.g. ultrasound, X-ray, computed or magnetic resonance imaging). Without an open incision, reaching the deepest structures and controlling everything precisely in real time ensures extremely accurate treatment, patients experience less pain, their hospitalization and rehabilitation time is shortened, and at the same time the risk of complications is reduced. The tools and medical equipment used for procedures are constantly improving, artificial intelligence solutions are being applied, so minimally invasive procedures inevitably become the first choice method in the treatment of many clinical conditions.
“During diagnostic procedures, changes in blood vessels (angiography), bile ducts (cholangiography) are detected, or a piece of tissue is taken with suspicion of a malignant process (biopsy). For therapeutic purposes, with the help of various catheters, access is made to the necessary blood vessel or duct and the expansion of the narrowings with special dispensers (angioplasty) or the reinforcement of its wall with tubes of various metal (stenting) is performed. Blood vessels can be urgently unclogmed (thrombectomy is applied), for example, in case of occlusion of the arteries of the brain, intestines or limbs, or clogged, for example, during bleeding. Blood vessels that feed on tumors or other structures (uterine myomas, varicocele, arteriovenous malformations, or even small arteries such as arteries that cause inflammation and pain in the joint) can also be blocked. Tumors are destroyed by cold (cryoablation), heat (microwave or radiofrequency ablation) or with the help of electro-pulses by introducing special electrodes,” dr. M. Kurmin says about the possibilities of interventional radiology.
According to the Head of the Interventional Radiology Department, highly innovative tools are used to treat brain aneurysms. After the introduction of very thin catheters into the affected area of the brain through the artery of the groin or arm, work is carried out for several hours on the platform of special 3D “maps” and in the presence of a standard, uncomplicated course, the very next day after the procedure, the patient can return to normal daily activities.
According to Dr. Kurmin, in recent years, special attention has been paid to the field of endovascular treatment of extremely complex aortic aneurysms. “Now we can be glad that we are currently the leaders in this field in the Baltic States. With individually applied coated stents (stentgrafts), we can restore the entire largest artery of the human body by introducing additional tubes into each of its branches that feed the internal organs and thus avoiding its rupture. Half a year ago, we used an individual stentgraft in a special place – in the aortic arc with branches that supply blood to the brain. The main advantage of this procedure, which lasts about three hours, is that during it there is no need for artificial blood circulation or opening of the thorax – it is enough to have arterial access points up to 8 mm in diameter in the legs and arm,” the specialist in interventional radiology is pleased with the achievements.
Interventional radiology is an integral part of modern cancer treatment
According to dr. Donatas Jocius, an interventional radiologist, the extremely rapidly developing field of interventional radiology is interventional oncology. The direction of modern medicine is minimally invasive, less traumatic methods, the main goal of which is to achieve the same or better therapeutic effect, reducing the risk of complications and returning the patient to the usual rhythm of life faster. Therefore, both interventional radiology and interventional oncology, when all procedures and operations are performed through small incisions or just punctures, are increasingly delving into the treatment of patients. BCLC Barcelona Clinic Liver Cancer) 2022 guidelines for primary early-stage tumors of the liver (hepatocellular carcinoma) up to 2 cm thermal ablation is recommended as a method of choice equivalent to surgical treatment. Ongoing international research, such as the comparison of thermal ablation and the treatment of liver metastases of an operative colorectal tumor, also promises that ablative therapy will be analogous to operative.
“Interventional radiology has many advantages in the treatment of tumors. These are minimally traumatic procedures with few complications compared to surgical operations. When performing minimally invasive procedures, a relatively large part of the treated organ is preserved, as a result of which its function suffers much less. After the interventional radiology procedure, patients often feel good the very next day, there are no residual phenomena, they can move without problems, so they can often go home. Short hospitalization times, quick recovery after the procedure are important advantages – patients feel good, can quickly return to daily activities and work, which is an important, although rarely measured, economic factor,” emphasizes Dr. D. Jocius.
Dr. Kurmin says that interventional oncology has in its arsenal a large number of anti-cancer weapons, which, by stopping and seeking to control an oncological disease, can be combined with other methods of treatment. Local and highly precise interventional oncology procedures are especially important for patients who cannot undergo surgery due to the spread of the disease, comorbidities or other reasons.
One of the most innovative minimally invasive methods currently used is embolization. “With this method, we can travel with special microcataters to the blood vessels that feed the tumor and clog them with various microspheres, glue, etc. The procedure, when we impregnate special particles in chemopreparations, thereby obtaining a double pathological effect that destroys the pathological formation (it does not include the blood and oxygen necessary for growth, and drugs enter the cells) is called transarteric chemoembolization (TACE). Another method of treatment that has been increasingly used in our clinics in recent years is radioembolization (TARE). This method of treatment is applied in cases of liver tumors and metastases to the liver that are not suitable for operative treatment. For the procedure, an isotope of radioactive holmes is used, which is injected in the form of plastic microspheres (microgranules). Microspheres are spread in the tumor tissue, and the beta radiation emitted by the isotope affects the biology of the tumor and promotes cell death,” says Dr. Kurmin.
A multidisciplinary team helps to ensure the most optimal treatment in each case
University hospitals have a special complexity of clinical cases – after all, patients with the most complex health problems fall here. “Conducting research, constantly improving specialists, advanced, scientifically proven treatment methods and state-of-the-art equipment provide our patients with the opportunity to return to a full life in the fastest possible way. The range of procedures performed in our department is extremely wide and is constantly expanding, we can treat all organs. Our patients are also very diverse, from newborns to seniors of respectable age,” says Dr. M. Kurmin.
According to the interlocutors, one of the key factors in ensuring optimal treatment of each patient with an oncological disease is the multidisciplinary team. With the participation of many different medical professionals, after assessing the data, needs and expectations of a particular patient during the discussion, a specific treatment plan for that patient is drawn up, thus making fewer mistakes.
Dr. Donatas Jocius says that currently, at VUL Santaros Clinics, the interventional radiologist, like specialists in other fields, is an integral part of a multidisciplinary team, and minimally invasive methods of tumor treatment often expand the treatment options of patients. “For example, surgical treatment of a small tumor in the central part of the liver can be complex (a large part of the liver needs to be removed), while performing ablation of a small tumor is relatively uncomplicated. We are faced with cases when it is extremely difficult or even technically impossible to remove tumors surgically, while using interventional radiology methods, such tumors can be destroyed,” says Dr. D. Jocius.
Dr. Marius Kurmin points out that still not all specialist doctors or family doctors know that the patient can be sent directly to an interventional radiologist for consultation. Many still imagine the radiologist only as a description of the “photos”, but it is precisely that basic knowledge that is the basis of high-quality and guaranteed patient care in these times of the era of visual medicine. Already, work in the operating room in most cases is no longer planned without a visual examination control device, and the treatment recommendations have been indicated for some time that the puncture of the central vein by performing ultrasound control can also avoid albeit rare, but extremely painful complications. Being able to see what you are doing is extremely important for successful treatment,” emphasizes the interventional radiologist.
Innovative navigation systems allow for more precise destruction of cancer cells
Another innovation used in interventional radiology procedures in Santaros clinics is an innovative navigation system used for renal and liver cancer ablation (destruction of cancer cells). The purpose of this tool is to help perform the procedure quickly and accurately, to reduce the overall time of the procedure. The system reduces the risks caused by the human factor, makes it possible to destroy cancer cells more accurately and evaluate the effect of treatment during the same procedure. “In surgery, we have a radical edge of resection (which means that the tumor is removed within the boundaries of healthy tissues, and in the operating room there is no tumor left), while in interventional radiology procedures the tumor physically remains, but it is destroyed at a critical temperature, and therefore is “dead”. Using the navigation system, we can assess whether there is an unaffected tumor in the doctor’s area by comparing (merging) the images before and after treatment – the navigation system does it automatically, during the procedure. This facilitates decision-making and increases the efficiency of the procedure. Thanks to this tool, we can achieve better results by treating tumors of various localizations (liver, kidneys, pancreas, lungs, bones), reduce the number of repeated biopsies, repeated therapeutic procedures,” says Dr. D. Jocius.
According to scientific publications, the use of navigational systems achieves greater efficiency compared to conventional imaging during the interventional radiology procedure.
Santaros Clinics – the latest achievements in radiology science and technology
Currently, at the Center for Radiology and Nuclear Medicine of VUL Santaros Clinics, applying the latest achievements in radiology science and technology, patients are provided with the highest level of diagnostic and treatment services. The structure of the center consists of three sections. Dr. Marius Kurminas, head of one of them – Interventional Radiology – says that today it seems that it cannot be otherwise, but the formation of such a department required a lot of concentration of colleagues and the far-sighted support of the administration. Previously, specialists performing interventional radiology procedures were scattered in different departments, which made it difficult to optimally organize the work.
“We have been working with quality equipment in new operating rooms for several years now. Highly qualified human and up-to-date technological forces, growing experience of specialists help to ensure versatile, top-level radiological diagnostics and successfully treat increasingly complex cases of diseases. We are an excellent team, each of the specialists working in the department proactively specializes in their favorite field. The team is growing both in quantitative and qualification terms – we cooperate with European and world scientists, adapt the latest global achievements, share experience with specialists from other countries. Although there is still a lot of work to be done before the department that my colleagues and I imagine, I think we are on the right track. By the way, we would be happy to accept nurses who want to work with innovations and help with unique procedures in the department, so those who wish to contact us,” says Dr. Marius Kurminas.
According to Donatas Jocius, interventional radiology, especially when performing vascular interventions, is currently an actively cultivated field of medicine in all three Baltic states. Although, according to him, non-angiological interventional radiology procedures in Lithuania are more advanced in terms of volume – there is not a single medical institution in our country where minimally invasive interventional radiology methods for the treatment of liver, kidneys, lungs, bone tumors are widely applied, Latvians and Estonians are also moving in this direction, and experience is constantly shared with colleagues of neighboring countries.
“I believe that in this area we are keeping up with Western Europe, and our joint work will help to ensure optimal and modern care for oncological patients both in Lithuania and in the Baltic States,” emphasizes Dr. Donatas Jocius.
