The Role of the Interventional Radiologist in Obstetrics and Gynaecology

The Role of the Interventional Radiologist in Obstetrics and Gynaecology

The Role of the Interventional Radiologist in Obstetrics and Gynaecology (1462)

John Vrazas ¹

St Vincents Private, Fitzroy, VIC, Australia

Image guided procedures have played an important and helpful adjunct in the diagnostic evaluation and treatment of the gynaecological patient. Since the 1970’s, a number of vascular and non-vascular procedures have been developed and refined to provide solutions to some of the most difficult problems facing the gynaecological patient and their doctor.

Some of the most important areas where interventional radiology can play a crucial role will be discussed.

One of the most distressing problems for both patient and surgeon is bleeding.The interventionalist can assist in the control of bleeding, such as menorrhagia due to fibroids and adenomyosis, post partum haemorrhage and placenta accreta and post operative haemorrhage. Controversies surrounding uterine fibroid embolisation and surgery will be reviewed.

Uterine fibroid embolisation (UFE) has shown considerable success in the control of bulk and pressure symptoms in patients with fibroids. Reversal of symptoms such as urinary frequency, constipation and abdomino-pelvic bloating have given UFE a very high rating in Quality of Life improvement Surveys. Patients have demonstrated a high degree of satisfaction with the outcome of UFE in management of menorrhagia and bulk symptoms.

Chronic pelvic pain presents one of the most difficult problems in medical practice. Its’ diagnosis is complex and convoluted, requiring multiple tests and invasive procedures. One entity which has eluded us for many years is Pelvic Congestion Syndrome, and management by ovarian and pelvic variceal embolisation and sclerotherapy can provide a most welcome solution. Given the chronicity of this condition and its elusive diagnosis, most of the patient also have a chronic pain syndrome that needs attention in parallel to pelvic congestion. This condition is often accompanied by varicose veins of the perineum, vulva and the lower limb. Some rarer causes of pelvic pain, such as the entrapped ovary will be presented.

Hysterosalpingography and fallopian tube recanalization have historically been a first line entity in the management of the infertile patient. The unique benefits of the “endoluminal” approach of these procedures provides an evaluation and treatment option not achievable by other modalities.

Authors contributing to this abstract.

Vrazas, J

Dr Vrazas graduated in medicine in 1987 from the University of Melbourne and completed his specialist training in radiology at the Royal Melbourne Hospital in 1995. He went onto cardiovascular and interventional radiology fellowships in the USA at Alexandria Hospital, Virginia, George Washington University Medical Centre, Washington DC and Miami Cardiac and Vascular Institute, Miami. Upon returning to Australia, he was consultant interventional radiologist at Royal Melbourne and Western Hospitals and Cabrini Hospital. He became head of the Department of Radiology and Director of Cardiovascular and Interventional Radiology at Western Hospital in 1999. In 2000 he moved to St Vincents Hospital and is now in private practice as an interventional radiologist. Dr Vrazas has played a leading role in the pioneering development of many minimally invasive surgical image guided procedures, across a range of medical and surgical specialties in adults and children. He performs the following interventional procedures • Peripheral vascular disease management – non- invasive diagnosis, angiography, venography, angioplasty, stenting including renal and visceral stenting, thrombolysis • Carotid stenting and neurovascular procedures • Embolization • Uterine fibroid embolization and ovarian vein embolization • Central venous access including PICC lines, ports, Permacaths, Hickman or Broviac catheters • Interventional oncology including TACE • Venous interventions including thrombolysis, stenting, IVC filters • Hepatobiliary interventions including percutaneous biliary drainage, stenting, cholecystectomy, TIPS, veno-occlusive disease • Genitourinary interventions including nephrostomy, ureteric stenting varicocele embolization • Biopsies and drainages • Pediatric interventions Dr Vrazas’s consulting rooms are located at St Vincents Private Hospital and an appointment can be made via a direct referral. Dr Vrazas’s qualifications and Training MB, BS University of Melbourne Fellow of the Royal Australian and New Zealand college of Radiologists Member of the Society of Interventional Radiology, USA Member of the Interventional Radiology Society of Australasia Fellow and Clinical Instructor in Cardiovascular and Interventional Radiology Alexandria Hospital, Virginia USA and George Washington University, Washington DC, USA Fellow and clinical Instructor in Cardiovascular and Interventional Radiology, Miami Cardiac and vascular Institute, Miami USA Member Cardiovascular and Interventional Society of Europe Fellow and Examiner European Board of Interventional radiology

The Role of the Interventional Radiologist in Obstetrics and Gynaecology (1462)

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