Trend to Watch: ASCs Are Adding Interventional Radiology

Interventional radiology (IR) is slowly finding its way into ASCs. IR physicians perform a wide variety of “pinhole surgeries” — minimally invasive procedures that leverage catheters, wires, needles and sheaths — using image guidance provided by fluoroscopy, ultrasound, CT or MRI. They can interpret images in real time and use them to perform therapeutic procedures that traditionally have been open or laparoscopic in nature. In a sense, IR physicians function simultaneously as radiologists and surgeons. Proponents say IR procedures are less risky and less painful with shorter recoveries than traditional surgeries. They are often performed using sedation rather than general anesthesia.

In many cases, IR physicians focus on cardiovascular issues, but they can also perform a wide variety of procedures that touch on other specialties. The British Society of Interventional Radiology offers a breakdown of IR treatments:

• Blood vessel disease. IR physicians treat peripheral vascular disease using techniques such as balloon angioplasty or stents to stretch narrowed arteries or, to avoid limb amputation, infuse clot-busting drugs into the artery via catheter. They can also treat aneurysms and hemorrhages using stent grafts.

• Veins. IR physicians prevent pulmonary embolisms by placing inferior vena cava filters to capture blood clots or using catheter tubes to break them up. They also treat varicose veins through laser or microwave heat treatments, drugs or embolization techniques, and blocked veins via thrombolysis or stents.

• Non-vascular conditions. Sometimes referred to as interventional oncology, IR physicians focus on diseases in the liver, kidney and uterus. This includes treating tumors or cancers through ablation and embolization; removing blockages caused by the effects of cancer; draining fluid or pus in the chest or abdomen; placing feeding tubes; and treating collapsed spinal bones via vertebroplasty.

• Stone diseases. IR physicians attack kidney stones through nephrostomy, which involves placing a tube in the kidney to allow urine to drain while removing the stones through instrumentation. They treat gallstones by placing a catheter tube through the liver to remove the stones or place stents.

IR could make sense as a service line addition at ASCs in states where regulatory conditions allow it. Its close alliance with cardiovascular medicine dovetails with the current trend of bringing cath labs and associated procedures to ASCs.

Last year, Comprehensive Surgical Care (CSC) opened its flagship ASC in Gilbert, Ariz. The 15,000-square-foot multispecialty facility features three ORs — one outfitted as a cath lab with a ceiling-mounted C-arm, the other two with mobile C-arms — and a hot lab for Y-90 procedures. CSC has since opened additional ASCs across the Midwest and has plans to add several more facilities in California, Oregon, Idaho and Arizona.

CSC founder Joel Rainwater, MD, whose areas of specialty include peripheral vascular disease and interventional oncology, says IR has evolved since he completed training. “It used to be considered a subspecialty within the general radiology training track,” he says. “The training has become more specialized and unique as its own separate pathway.”

IR has always been comparable to surgery, according to Dr. Rainwater. “The specialty has grown in scope,” he says. “I now see more interventional radiologists behaving more like their surgical colleagues. They’re seeing patients, developing and implementing treatment plans and following up with patients.”

Dr. Rainwater typically performs transcatheter treatment of primary and metastatic liver cancers. “We place an angiographic catheter into the hepatic artery supply and inject the treatment directly into the liver, a method that accomplishes a much higher concentration into the target volume of the tumors,” he says.