By Raj Pyne, MD Spring 2018
In this new IRQ column, we ask IRs questions, thought-provoking and otherwise, and collect some of our favorite answers. Watch for more questions to be posted to SIR Connect!
What is your favorite or most gratifying procedure to perform and why?
My most gratifying procedure is embolization of postpartum hemorrhage. These are women who should be enjoying one of the happiest days of their lives but who, instead, are facing the loss of future fertility though hysterectomy—or worse. Angiography often identifies a single bleeding vessel that, once treated, immediately stops the bleeding. Even when we have to do a less-selective embolization, the response is usually dramatic.
My favorite procedure is TIPS. It offers a great mix of technical challenge and clinical reward and, even all these years after its introduction, still feels to me like a radical, fantastical new-world procedure.
—R. Torrance Andrews, MD, FSIR
UFE because it’s a procedure that provides a significant clinical benefit to a patient who typically has a full lifestyle with career and family. As a result, they are usually very grateful for the improvement.
—Meghal Antani, MD, MBA, FSIR
—John Crocker, MD
While my interests are in interventional oncology, peripheral arterial disease and venous disease/pulmonary embolism, the most gratifying procedures that I perform are ones that have the potential to save a patient’s life such as endovascular management of submassive or massive pulmonary embolism, trauma, postpartum hemorrhage, aortic dissection and aneurysm rupture. The ability to save an acutely threatened ischemic limb is also gratifying.
—Ripal Gandhi, MD, FSIR
Intra-arterial thrombectomy for stroke because it doesn’t get better than watching a patient with a large vessel occlusion and flaccid paralysis walk out of the hospital and play golf the next day.
—Saba Gilani, MD
Kyphoplasty—near-immediate satisfaction—the patients are often overjoyed with their results nearly instantaneously.
—Warren Krackov, MD
My favorite procedures are those in which the patient has no other good treatment options and interventional radiology is able to come in and “save the day.” One such case involved a refractory chylothorax following trauma with thoracotomy. It was a challenging case in which the cisterna chyli never opacified but the lopiodol was able to sclerose the ducts. With the help of TPN, the patient was discharged in a few weeks.
—Barbara Nickel Hamilton, MD
Electively, I would say a technically challenging embolization, like a visceral aneurysm, AVM or complex type 2 endoleak. Especially when nobody else thinks it can be done. Emergently, postpartum hemorrhage embolization. Nothing more gratifying than having a woman go from the best day of her life all the way to the brink of death, and then to be able to save her and allow her to see the baby again.
—Raj Pyne, MD
There is something very gratifying about draining pus. I can physically see and even quantify how I am helping the patient. Many patients often feel immediate relief as well. I also like more complicated cases like portal vein recanalizations/complex TIPS. Like most of us, I enjoy a good challenge.
—Susan Shamimi-Noori, MD
Venous recanalization for ulcer healing in young patients. This disease doesn’t kill the patient but leads to a lifetime of suffering and disability. We used to have nothing to offer. Now we can change these lives forever. It doesn’t get much better than that.
—E. Brooke Spencer, MD, FSIR