Minimally Invasive Procedures

By Meghal R. Antani, MD

For many years, surgery was the only treatment available for many conditions. Today, minimally invasive procedures using x-rays, ultrasound, and other imaging guidance are often first-line care for a wide variety of conditions. A physician known as an interventional radiologist often performs these procedures.
Interventional radiologists are board-certified physicians who specialize in minimally invasive, targeted treatments. Interventional radiology treatments offer less risk, less pain and less recovery time compared to open surgery.
Examples of minimally invasive treatments that are performed under x-ray guidance include treatment for varicose veins, placement of central venous catheters for patients needing long term access for medications, pain management (for back pain and pain due to compression fractures of the spine), and treatment of poorly functioning dialysis grafts or catheters in patients who are undergoing dialysis for kidney failure.
Varicose veins are an example of a medical condition that can be treated with excellent results by an experienced interventional radiologist. An interventional radiologist, a doctor specially trained in performing minimally invasive treatments using imaging guidance, will use duplex ultrasound to assess the venous anatomy, vein valve function, and venous blood flow changes, which can assist in diagnosing venous insufficiency. The doctor will map the great saphenous vein and examine the deep and superficial venous systems to determine if the veins are open and to pinpoint any reflux. This will help determine if the patient is a candidate for a minimally invasive treatment, such as the VNUS Closure procedure. A recent study in the Journal of Vascular Surgery compared surgery to remove varicose veins to the VNUS Closure procedure by evaluating procedure-related complications, overall patient recuperation and quality-of-life issues. In every measurable category, patients who underwent the VNUS Closure procedure had better outcomes.
For a patient who is a candidate for the VNUS Closure procedure, this minimally invasive treatment is an outpatient procedure performed using imaging guidance. After applying local anesthetic to the vein, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the vein using ultrasound guidance and guides it up the great saphenous vein in the thigh. Then radiofrequency energy is applied to the inside of the vein. This heats the vein and seals the vein closed. Reflux within the great saphenous vein leads to pooling in the visible varicose veins below. By closing the great 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.
There are a number of other medical conditions that can be successfully treated in the outpatient setting using minimally invasive techniques with x-ray guidance. It is important to get a second opinion and know all of your treatment options before consenting to any procedure or surgery.