Interventional Radiology: A Patient-Centered Approach to Minimally Invasive Endovascular Surgery

With Karen Garby, MD and Brooke Spencer, MD

Reprinted from MDNews Magazine, November 2006

At Desert Endovascular Center, the list of new procedures is evolving so fast, it as been said that Interventional Radiology is being hailed as the surgery of the 21st century. For doctors Karen Garby, MD and Brooke Spencer, MD, it is a field of instant gratification. 

As interventional radiologists, Drs. Garby and Spencer perform the latest procedures using imaging guidance with fluoroscopy, ultrasound or computed tomography (CT). These innovative procedures are performed all through micro incisions, using small catheters and various other tiny devices. The objective is to be as minimally invasive as possible, thus preventing long hospital stays, heavy anesthesia, and extended recovery periods. Results are faster, too. Relieving pain and allowing patients to enjoy daily activities is the most rewarding aspect of my work,  says Dr. Karen Garby. To be able to improve the life of patients, many of whom are not candidates for conventional invasive surgery, is an incredible feeling.

Interventions range from treating arteries and veins to procedures that extend life expectancy in cancer patients and that heal spinal fractures. They here frequent complaints from compression fracture patients. Osteoporotic patients are sent to us regularly with tiny compression fractures in their spine, says Garby, who treats spinal fractures with two types of procedures. She explains that something as small as a cough can cause micro fractures in the vertebral body, resulting in immense pain. Many people go undiagnosed, she continues, they think it's just a part of aging. If the pain lasts for an extended period of time, there tends to be a downward spiral effect, impacting the physical, social, and psychological aspects of a patients life. The two procedures are called Vertebroplasty and Kyphoplasty. Both involve inserting liquid bone cement into the spine, thus sealing the breaks. If a patient has height loss due to the fractures, a balloon is inserted, restoring vertebral body height and length to the spine. Talk about instant gratification: the majority of patients that undergo the procedure have at least some instant pain relief and are able to walk out of the hospital within a few hours.

Both Dr. Garby and Dr. Spencer believe that their careers have evolved over the years. Interventional Radiology has moved from a general practice to a more focused, clinical-based practice. We diagnose the problem, select and carry out the course of action, and follow through with the patient on the path to wellness. We see patients in the office before and after treatment, and treatments are scheduled shortly after consultation with little delay. Garby, who completed her residency at The University of Missouri in Kansas City and her Fellowship in Interventional Radiology at Case Western Reserve University, is the Medical Director of Desert Endovascular Center.

Dr. Spencer completed her residency at Duke University Medical Center and her Fellowship at Washington University in St. Louis after starting originally as a general surgery resident. Dr. Spencer has developed a special interest in treating venous disease and partnered with Dr Garby in this effort. Interventional radiology techniques have allowed them to treat all vein diseases, going deeper than traditional cosmetic treatments. For example, one particularly evasive diagnosis in women is an affliction that causes chronic pelvic pain. The often-undetected condition is called pelvic congestion syndrome, characterized by abnormal or diseased veins in the pelvis. Varicose veins occur in places other than the legs,  Spencer says. She performs an embolization procedure to cut off blood supply to the troubled veins, thus relieving pain at the source. Leg veins are usually treated in combination with the embolization, leaving the patient pain free. As women physicians they have really become interested in treating female conditions whose prevalence and importance have been underestimated or required major surgery.

Garby and Spencer are excited about the emerging acceptance of techniques such as embolization with small particles to the uterine artery, performed to cut off blood supply to uterine fibroids. This procedure helps to preserve the uterus in women who might not choose to have a hysterectomy. Fibroids are benign tumors that can cause significant symptoms such as heavy bleeding and pain. It s all about choices, and informing patients and referring physicians that these procedures do exist, Garby says.

Cutting off blood supply to affected areas is a common treatment approach with interventional oncology as well. Several types of cancer are treated this way, with liver, lung or kidney tumors being targeted either by heat (Radiofrequency), or freezing (cryoablation). Chemoembolization is directed to tumors by sending small particles mixed with chemotherapy directly into the tumors, via an artery.

With all of the new technologies available, there are also challenges. Both doctors agree that a test they face is that the field of interventional radiology is in constant evolution. New, less invasive procedures are invented and mastered every year, so maintaining proficiency in old procedures while gaining mastery in new procedures is crucial. Spencer explains that as part of a larger group of radiologists, they are afforded the opportunity for individuals to sub-specialize and master advanced techniques. This is achieved through small hands-on courses and larger international meetings such as the Society of Interventional Radiology annual conference. The practice is therefore covered for nearly all emerging technologies at a high level of proficiency.  As both Dr. Garby and Dr. Spencer and the rest of the group learn and master new techniques, they are then able to mentor each other, maintaining a well-rounded armamentarium for each individual. When a particularly difficult patient problem arises, there is always an expert in the group that is available to handle it. Many of us have enjoyed sharing our expertise through teaching others around the country by speaking at meetings and occasionally hosting visiting physicians for training sessions  said Spencer. With all that knowledge, training and support, the gratification is felt all around.