Institut Gustave Roussy , sometimes called Gustave Roussy , is a cancer research hospital in Europe. It is located near Paris. It is named after Gustave Roussy , a Swiss-French neuropathologist.
61-722: In April 2019, three new interventional radiology rooms were inaugurated, making it the largest facility of this type in Europe dedicated to oncology. Gustave Roussy carries out more than 4,000 interventional radiology procedures each year. Together with the Faculty of Medicine of the University of Paris-Saclay, the Institut Gustave Roussy runs the School of Cancer Sciences, a university division specializing in oncology. The lessons take place at
122-418: A body orifice or tiny incision using small needles and wires . This decreases risks, pain, and recovery compared to open procedures . Real-time visualization also allows precision guidance to the abnormality, making the procedure or diagnosis more accurate. These benefits are weighed against the additional risks of lack of immediate access to internal structures (should bleeding or a perforation occur), and
183-406: A few hours of rest. A transjugular intrahepatic portosystemic shunt (TIPS) is a procedure an interventional radiologist performs to create a shunt (essentially, a new conduit allowing for blood flow) between the hepatic inferior vena cava and the portal vein, a vessel that returns blood from the intestines to the liver. The portal vein is the site where hypertension (high blood pressure) can produce
244-412: A few standard techniques apply to most: The goal of endovascular therapy is to revascularize an affected or diseased vessel. Arteries are the component of the circulatory system that carry oxygenated blood away from the heart to the vital organs and extremities . Arteries have relatively thick, muscular walls, composed of multiple layers, because they transport freshly oxygenated blood through
305-706: A hemorrhagic stroke (bleeding in the brain), elapsed time of greater than six hours since onset of symptoms, or greater than 24 hours in special cases. Hospitals with comprehensive stroke centers are equipped to treat patients with endovascular care. Long-term care after an ischemic stroke is focused on rehabilitation and preventing future blood clots using anticoagulant therapy. Patients work with specialists from fields such as physical therapy , occupational therapy , and speech therapy to complete recovery. Although there are no clearly defined recommendations on treatment of asymptomatic aneurysms, all symptomatic unruptured brain aneurysms should be treated. Endovascular therapy
366-421: A more rapid recovery time compared to a traditional open vascular surgery. Many endovascular procedures have since been developed and refined. Numerous tools are at the disposal of modern vascular and interventional radiologists to perform these procedures, and developing new tools is a burgeoning focus of international research. While some interventional radiology endovascular procedures are highly specialized,
427-438: A myriad of deleterious effects throughout the liver and small or large intestine. Primarily, a TIPS functions to alleviate two different conditions: an emergent/life-threatening GI bleed or ascites (excessive abdominal fluid) caused by too high of blood pressure in the portal vein that is otherwise uncontrolled by diet and medications. The workup for the procedure is straightforward and the interventional radiologist performing
488-402: A needle to puncture a target vessel, then using a series of small medical guidewires and catheters to pass various tools inside for treatment. When these minimally-invasive techniques can be used, patients avoid the need for larger surgical exposure to treat diseased vessels. Though numerous factors can affect patient's post-operative course, in general an endovascular approach is associated with
549-414: A patient's first sign of vascular disease. Therefore, controlling risk factors is crucial in those with known atherosclerosis to prevent progression of disease, and screening is recommended by some vascular disease specialists for those at increased risk, such as those with diabetes, smoking or a strong family history of cardiovascular disease. Screening tests typically use the non-invasive evaluation called
610-482: A percutaneous peripheral vascular revascularization procedure for the first time on January 16, 1964, on Laura Shaw, vascular and interventional radiology (commonly interventional radiology or IR) distinguished itself from earlier approaches to vascular disease by the use of medical imaging to guide endovascular therapies (fixing this from inside the vessel). The Seldinger technique is the basic principle that underlies endovascular procedures. Briefly, this involves using
671-401: A procedure called a percutaneous transhepatic cholangiography (PTC). A PTC is an outpatient procedure lasting anywhere from 15 minutes to an hour where an interventional radiologist accesses the patient's bile duct system with a needle through the skin and liver under imaging guidance. Using fluoroscopy (essentially an X-ray camera) to guide a wire (followed by a catheter over the wire) through
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#1732869427897732-482: A structure. Hence the term "digital subtraction angiography. Subtraction angiography was first described in 1935 and in English sources in 1962 as a manual technique. Digital technology made DSA practical starting in the 1970s. In traditional angiography , images are acquired by exposing an area of interest with time-controlled x-rays while injecting a contrast medium into the blood vessels. The image obtained includes
793-409: A tumor or injection of an imaging contrast agent into a hollow structure, such as a blood vessel or a duct . By contrast, therapeutic IR procedures provide direct treatment—they include catheter-based medicine delivery, medical device placement (e.g., stents), and angioplasty of narrowed structures. The main benefits of IR techniques are that they can reach the deep structures of the body through
854-402: A vein in the groin and embolizes the varicocele. Patients often tolerate this procedure well and are able to return home the same day. About 87% of all strokes are ischemic strokes , in which blood flow to the brain is blocked. A clot-busting medication such as tissue plasminogen activator (t-PA) can be used in a controlled hospital setting to dissolve the clot and help restore blood flow to
915-456: A vein via an abnormal channel. This creates a high flow system that puts the vessel at risk of rupture. Ruptured AVMs require emergency management of the patient; unruptured AVMs require expert consultation to discuss the risks and benefits of treatment. Current treatment options include conservative management, surgical resection, stereotactic radiosurgery , endovascular embolization, or combinations of these treatments. Endovascular embolization
976-522: Is a large operation, where blood flow is temporarily stopped using clamps, the vessel is cut open, the plaque removed and then the vessel resealed. If an occlusion is too dense or complex, a bypass could also be performed, where two segments of vessel are bridged by an additional vein or synthetic graft. Modern endovascular approaches to treating atherosclerosis can include combinations of angioplasty, stenting, and atherectomy (removal of plaque). There are several systems for staging PAD, but an often used scale
1037-455: Is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy , computed tomography , magnetic resonance imaging , or ultrasound . IR performs both diagnostic and therapeutic procedures through very small incisions or body orifices . Diagnostic IR procedures are those intended to help make a diagnosis or guide further medical treatment, and include image-guided biopsy of
1098-415: Is a noncancerous condition that commonly affects men over the age of 50. The prostate gland enlarges and compresses the adjacent urethra, making it difficult for men to control frequency and/or urgency of urination. First-line therapy involves medication, though long-term treatment for symptoms that are persistent despite medical optimization typically involves transurethral resection of the prostate (TURP) as
1159-416: Is a process in which the interventional radiologist accesses the culprit bleeding vessel via a small catheter and interrupts blood flow to the site of bleeding via various mechanisms. Side effects of this procedure are minimal but there is a risk of bleeding and infection—though much less than the equivalent surgical procedure. When successful, the procedure often eliminates the bleed and patients can walk after
1220-935: Is a technique used by neurointerventionalists in which particles, glue, or coils are lodged inside the AVM to prevent blood flow through the abnormal channel. During this treatment, an interventional radiologist guides a catheter through a blood vessel accessed from the patient's leg to the site of the AVM. The particles, glue, or coils induce clotting within the malformation, which reduces the risk of rupture. Utilizing image guidance, local anesthetics and/or long-acting steroid medications can be directly delivered to localized sites of pain. The use of image guidance helps to confirm appropriate needle placement. This includes common imaging modalities used in joint injections: ultrasound , fluoroscopy and computerized tomography (CT). Vertebral augmentation , which includes vertebroplasty and kyphoplasty, are similar spinal procedures in which bone cement
1281-410: Is an effective treatment for select cases. During this treatment, an interventional radiologist inserts a catheter into the patient's leg and uses it to guide a coil through blood vessels to the site of the aneurysm. The coil induces clotting within the aneurysm, which reduces the risk of rupture. Multiple coils may be used depending on the size. Imaging studies ( DSA , CTA , or MRA ) help characterize
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#17328694278971342-409: Is another broad term for an enlarged vessel, but is not necessarily pathological. Rupture is a dreaded complication of aneurysms that can lead to extensive, difficult to control bleeding. Aneurysms can also clot, or thrombose , and rapidly occlude the involved vessel, leading to acute distal ischemia. A variety of endovascular grafts are available, and each has advantages and disadvantages depending on
1403-416: Is defined as an enlargement of the veins within the scrotum, most commonly occurring on the left side due to anatomical reasons. When this happens, blood can stagnate within these dilated veins and cause temperature fluctuations within the testicle itself. The exact cause to this condition remains unknown and an ill-favored sequela can be male infertility . The mainstay of treatment for this condition within
1464-427: Is injected through a small hole in the skin into a fractured vertebra to try to relieve back pain caused by a vertebral compression fractures . It was found ineffective in treating osteoporosis -related compression fractures of the spine. The people in both the experimental and placebo groups reported improvement in their pain, suggesting that the benefit is related to the placebo effect . As of 2019 , routine use
1525-770: Is the revised Rutherford classification. Plaque and blood flow can be evaluated using ultrasound , CT angiography , MR angiography, and catheter-based angiography to establish anatomic segments of disease. The severity of ischemia can be evaluated by correlating symptoms and non-invasive physiologic vascular studies including toe pressures, TCPO2, and skin perfusion studies. Certain monitored exercises, such as walking regimens, have been shown to significantly improve walking distance especially when used consistently for at least six months. When medical management fails, vascular interventional radiologists can attempt to restore blood flow to extremities using angioplasty and stenting. Sometimes repeat interventions are required. The goal of therapy
1586-400: Is thus not recommended. Interventional oncology (IO) procedures are commonly applied to treat primary or metastatic cancer. IO treatments may be also offered in combination with surgery, systemic chemotherapy/immunotherapy, and radiation therapy to augment the therapeutic outcome. A variety of interventional oncological treatments for tumors arise: Vascular disease refers to disorders of
1647-558: Is to maintain perfusion, avoid amputation and preserve the limb structure and function. Aneurysm refers to pathologic dilation of an artery to greater than 1.5 times its normal size. True vascular aneurysms are due to degenerative processes in the wall of the artery. Aneurysms can be solitary or multiple and are sometimes found in association with various clinical syndromes, including forms of vasculitis or connective tissue diseases. Aneurysms are typically classified by major shapes, either fusiform (tubular) or saccular (eccentric). Ectasia
1708-717: Is to re-establish or optimize perfusion and stop ischemia. Atherosclerosis refers to a progressive narrowing of the arteries due to atheroma , derived from the Greek word for 'gruel, porridge'. Atheromatous plaque is a mixture of fat and inflammatory debris that sticks to the inner walls of an artery. Plaque can be soft or become firm as it accrues layers of calcium, a byproduct of chronic inflammation. Atherosclerosis has no single cause but many recognized risk factors. Some risk factors are modifiable, and others are not. Age and genetic predispositions are examples of non-modifiable risk factors. Medical management of atherosclerosis aims to address
1769-413: Is useful in the diagnosis and treatment of arterial and venous occlusions, including carotid artery stenosis , pulmonary embolisms , and acute limb ischaemia ; arterial stenosis, which is particularly useful for potential kidney donors in detecting renal artery stenosis (DSA is the gold standard investigation for renal artery stenosis ); cerebral aneurysms and arteriovenous malformations (AVM). DSA
1830-400: Is usually an X-ray image intensifier , which then keeps producing images of the same area at a set rate (1 to 7.5 frames per second). Each subsequent image gets the original "mask" image subtracted out. (Mathematically, the incoming image is divided by the mask image) The radiologist controls how much contrast media is injected and for how long. Smaller structures require less contrast to fill
1891-464: The ankle–brachial index , which compares the blood pressure between the arm and the ankle. This can help detect narrowing in the major vessels of the chest, abdomen, pelvis, and legs. CT scans of the heart with evaluations of coronary artery calcium are also used in some instances to stratify risk of coronary artery disease. Historically, open vascular surgical approaches were required for all critically advanced atherosclerotic disease. An endarterectomy
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1952-561: The "gold standard" of care. However, TURP can lead to urinary incontinence or permanent male infertility and may not be the ideal procedure for a certain subset of patients. For those reasons, a physician may recommend undergoing a treatment known as prostate artery embolization (PAE). Patients typically go home the same day as the procedure and can expect to feel some symptom relief in a matter of days. Though rare, risks of PAE include unintentional embolization of nearby blood vessels, which can result in loss of blood flow to surrounding areas of
2013-742: The Cancer Campus in Villejuif in the Val-de-Marne. In the various courses offered by the faculty of medicine (adult, adolescent and child oncology; surgery; best practices; medical imaging; radiotherapy; other courses), the establishment integrates the Doctoral School of Oncology, Biology, Medicine, Health (and its Master 2 in Biology and Health, Cancerology specialty), created with the École Normale Supérieure Paris-Saclay. Directed in 2015 by Pierre Blanchard,
2074-580: The GI tract can cause a condition called jaundice . While jaundice can be caused by a few viruses that the human body can naturally clear, jaundice in the setting of an obstruction is usually caused by a cancer and can result in intolerable itching and a worsening of liver function that can be life-threatening. Depending on a patient's condition, this type of obstructive jaundice can be alleviated with surgery or chemotherapy but if these measures fail to restore proper flow of bile, an interventional radiologist can perform
2135-559: The aneurysm to decide the best course of treatment, whether endovascular coiling or surgical clipping. Endovascular coiling is associated with a reduction in procedural morbidity and mortality over surgical. For cases of ruptured aneurysms, emergent treatment is based on the type of aneurysm, and may use a combination of techniques. Conservative therapy focuses on minimizing modifiable risk factors with blood pressure control and smoking cessation. Arteriovenous malformations (AVMs) are abnormal blood vessel structures in which an artery connects to
2196-440: The bile duct system and into the GI tract, essentially restoring the normal flow of bile. If the patient's GI tract cannot be accessed due to the obstruction, the catheter can be placed to drain the bile duct system into a bag that the patient can wear during daily activities. Risks of this procedure include bleeding and infection but these are much lower than an equivalent surgical procedure. Benign prostatic hyperplasia , or BPH,
2257-465: The biliary or urinary systems), a sheath (which slides over the guidewire and holds the path open without injuring it), and catheters (that allow fluids to be pushed through them). Also common to all intervention radiology procedures are the medical imaging machines that allow the healthcare provider to see what is occurring within the body. Some use X-rays (such as CT and fluoroscopy ) and some do not (such as ultrasound and MRI ). In each case,
2318-459: The bladder or rectum. Data suggests that TURP may have higher rates of symptom resolution at one and six months, but PAE appears to provide lower risks of complications more commonly associated with surgery, such as infection. Kidney stones can be present along any part of the course of the urinary tract from the kidneys to the urethra. The most common symptoms, whether in men or women, are sudden onset, intense flank pain accompanied by blood in
2379-447: The blood vessels, together with all overlying and underlying structures. The images are useful for determining anatomical position and variations, but unhelpful for visualizing blood vessels accurately. In order to remove the distracting structures to see the vessels better, first a mask image is acquired. The mask image is simply an image of the same area before the contrast is administered. The radiological equipment used to capture this
2440-457: The body at relatively high pressures. Arterial diseases can affect one or multiple layers of the artery wall. The aorta is the largest artery in the body, and the major aortic branches continue to divide multiple times, giving way to smaller arteries, muscular arterioles and thin-walled capillaries . In contrast to arteries, capillaries have thin single-layered walls, so oxygen and nutrients can be exchanged with tissues in capillary beds before
2501-472: The body. Tissues and blood vessels on the first image are digitally subtracted from the second image, leaving a clear picture of the artery which can then be studied independently and in isolation from the rest of the body. Some limited studies have indicated that IV-DSA is not suitable for patients with diabetes or kidney failure because the dye load is significantly higher than that used in arteriography . However, IV-DSA has been used successfully to study
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2562-439: The characteristics of the aneurysm and patient. Digital subtraction angiography Digital subtraction angiography ( DSA ) is a fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment. Images are produced using contrast medium by subtracting a "pre-contrast image" or mask from subsequent images, once the contrast medium has been introduced into
2623-413: The damaged area of the brain. Certain patients with an acute ischemic stroke may be candidates for endovascular therapy. Endovascular therapy is a procedure performed by neurointerventionalists to remove or dissolve the thrombus (clot) and restore blood flow to parts of the brain. Using a catheter that is directed through the blood vessels in the arm or leg up to the brain, the interventionalist can remove
2684-421: The de-oxygenated blood is carried away by the venous system. Perfusion refers to the flow of oxygen and nutrient rich blood into the capillary beds of the muscles and organs, this is critical for their function. The lack of adequate perfusion is referred to as ischemia and is typically the cause of symptoms related to vascular disease. The goal of revascularization therapies, whether endovascular or surgical,
2745-457: The different types of atherosclerosis. In particular, patients with peripheral arterial disease have an increased risk of coronary artery disease, and severe peripheral artery disease symptoms can be a predictor of cardiac-related mortality. The majority of patients begin to develop symptoms from ischemia around middle age, even though vessel narrowing can develop silently and slowly over decades. Unfortunately, sudden cardiac death or stroke can be
2806-408: The field of interventional radiology is varicocele embolization. An embolization, within the context of this procedure, results in the interruption of venous blood flow. The interruption of blood flow abates venous dilation of blood that can lead to impaired testicular temperature regulation and theoretically improve infertility. The physician accesses the dilated scrotal veins with a small catheter via
2867-415: The health of the patient's heart and liver prior to the procedure and the risk-benefits of the procedure must be thoroughly discussed with their interventional radiologist before beginning. If the post-procedural consequences are more troublesome to the patient than their initial symptoms the artificial conduit created by the procedure can be reversed if the post-procedural side effects outweigh those caused by
2928-415: The hemodynamic function of the patient. The role for the interventional radiologist is to offer patients an image-guided, minimally invasive procedure to alleviate a condition that could be otherwise be potentially life-threatening. The avenue for the interventional radiologist to dictate the clinical course of a GI bleed is largely influenced by location of bleed, overall patient health and other conditions
2989-484: The images created may be modified by computer to better visualize the structures as is in the case with digital subtraction angiography , CT and MRI, or the display of the images improved with virtual reality or augmented reality presentation. Vascular Biliary intervention Catheter placement Ablative Genitourinary The treatment of gastrointestinal hemorrhage can range anywhere from monitoring an asymptomatic bleed to supporting and maintaining
3050-447: The mainstay of IR treatment is a percutaneous nephrostomy tube. This is a procedure where a small caliber catheter is placed through the skin and into the urinary collecting system upstream of the stone. This procedure not only drains any infection, often bringing about a precipitous improvement in the patient's symptoms but also diverts urine—thus giving the patient more time to recover before definitive surgical treatment. A varicocele
3111-418: The many other known modifiable risk factors, such as smoking, diet, and exercise, as well as blood sugar levels in patients with diabetes. Using medications to control blood pressure and cholesterol have also been shown beneficial. Atherosclerosis is described, evaluated, and treated differently depending on the affected artery, as described below. However, multiple studies have shown strong correlations between
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#17328694278973172-404: The patient may have, most notably heart and liver functions. For most cases, collaboration between the gastroenterologist and interventional radiologist optimizes patient outcome but again, is largely dictated by anatomical location of the GI bleed. If a patient is evaluated and determined to be a candidate for an interventional procedure, then the bleed is often treated by embolization. Embolization
3233-404: The prior conditions. In addition to normal liver tissue, the liver has three main vessels traversing it: arteries, veins and bile ducts. While bile is made in the liver and stored in the gallbladder, the bile eventually passes into the GI tract through the hepatic, cystic and common bile ducts. Any condition that prevents the normal flow of bile from the liver, through these bile vessels and into
3294-571: The procedure often orders several tests to assess how well the patient will tolerate the procedure. These are often simple blood tests, and an ultrasound of the heart and liver. The procedure is often well tolerated and can result in a permanent reduction or elimination of symptoms. The procedure can take anywhere between 15 minutes to an hour and has lower risks of bleeding or infection compared to an equivalent surgical procedure. A TIPS may cause temporary confusion or worsening of liver/heart function. The degree of these two side effects largely depends on
3355-473: The risks of radiation exposure such as cataracts and cancer. Interventional radiology is a set of techniques that allows access to the internal structures of the body through body orifices or very small incisions and guidance with medical imaging . Regardless of the reason for the intervention, the procedure will likely use common elements such as a puncture needle (to pass through the skin), guidewires (to guide through structures such as blood vessels or
3416-564: The school had trained nearly 2,800 students and awarded 26 university degrees. In 2020, the Institut Gustave Roussy was ranked as the first leading cancer hospital in Europe and in the top five best specialized hospitals in the world. In 2017, a virologist from the Institut Gustave Roussy was sentenced to 5 years in prison for poisoning colleagues with sodium azide in 2014. 48°47′41″N 2°20′55″E / 48.79472°N 2.34861°E / 48.79472; 2.34861 Interventional radiology Interventional radiology ( IR )
3477-409: The thrombus or deliver drugs to dissolve the thrombus. These procedures are referred to as mechanical thrombectomy or thrombolysis , and several factors are considered before the procedure is completed. People who may be eligible for endovascular treatment have a large vessel occlusion, which means the thrombus is in an artery that is large enough to reach and there are no contraindications such as
3538-488: The urine. Most kidney stones pass spontaneously, but larger ones (greater than 5 mm) are less likely to, and can cause severe pain or infection. The interventional radiologist plays a large clinical role in the treatment of kidney stones that are unlikely to pass on their own. The gold standard of treatment for these types of stones is surgical removal. However, some patients have an infected stone and are simply too ill for an operative surgical removal. In these instances,
3599-410: The vasculature or circulatory system , most commonly involving the arteries , veins and lymphatics . The symptoms related to vascular disease can range from asymptomatic, bothersome symptoms or limb- and/or life-threatening conditions. Vascular and interventional radiologists are at the forefront of treating a wide variety of vascular diseases. Since its development by Charles Dotter when he did
3660-470: The vessel than others. Images produced appear with a very pale grey background, which produces a high contrast to the blood vessels, which appear a very dark grey. Intravenous digital subtraction angiography (IV-DSA) is a form of angiography which was first developed in the late 1970s. IV-DSA is a computer technique that compares an X-ray image of a region of the body before and after radiopaque iodine based dye has been injected intravenously into
3721-430: The vessels of the brain and heart and has helped detect carotid artery obstruction and to map patterns of cerebral blood flow . It also helps detect and diagnose lesions in the carotid arteries, a potential cause of strokes . IV-DSA has also been useful in assessing patients prior to surgery and after coronary artery bypass surgery and some transplant operations. DSA is primarily used to image blood vessels. It
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