What is IVR?

An abbreviation for interventional radiology, it refers to a procedure that uses images such as X-ray fluoroscopy, ultrasound, and CT to advance catheters and needles to treat the target organ. In Japanese, it is called “imaging treatment”, but the term is not widespread and IVR is the term widely known to medical professionals.

Because thin instruments such as catheters and needles are used, the burden on the body is generally less than surgical operations (minimally invasive), such as small wounds and many procedures can be performed with local anesthesia. is characterized by Taking advantage of this advantage, treatment of cerebral blood vessels such as cerebral aneurysm and carotid artery stenosis, treatment of coronary artery disease such as myocardial infarction and angina pectoris, treatment of heart disease such as arrhythmia, treatment of malignant tumors such as hepatocellular carcinoma, treatment of trauma and endogenous Hemostasis for bleeding, treatment of aortic aneurysm, treatment of vascular stenosis and occlusion in the lower extremities, etc. have been applied to various diseases throughout the body, making it an indispensable therapeutic method in clinical practice. In the future, it is expected that the range of applicable diseases will continue to expand with the development of therapeutic devices such as various catheters, stents, and embolization materials, as well as equipment such as angiography equipment and diagnostic support software. Furthermore, relatively invasive procedures combined with surgery, such as aortic stent grafting, have been developed and increased, and at our hospital, we have introduced two hybrid operating rooms that can perform IVR and surgery at the same time. increase. In the future, it is expected that IVR that combines such surgical treatment and IVR or that is performed simultaneously with surgical treatment will increase.

About our IVR Center

On the 1st floor of our center, there are 6 X-ray machines dedicated to IVR (5 biplane angiography machines (3 for cardiovascular, 2 for cerebrovascular) + 1 IVR-CT), and various treatments are available. (expansion of blood vessels, clogging, administration of drugs, etc.). In addition to endovascular treatment, IVR-CT is used to perform biopsy and drainage of abscesses using CT images. In addition, in the hybrid operating room on the 4th floor, IVR such as aortic stent graft, TAVI (transcatheter aortic valve implantation), MitraClip (percutaneous mitral valve maljunction repair), intraoperative angiography and IVR for Neurosurgery are performed. From next fiscal year, a biplane angiography system will be installed and operated in the operating room dedicated to Neurosurgery.

Our hospital is focused on emergency medical care, and all clinical departments are available 24 hours a day, 365 days a year to treat a variety of emergencies. Radiology, cardiovascular, cranial nerves are all available for high-level IVR at all times.

Major clinical departments performing procedures at the IVR Center

cranial nerve Neurosurgery, Neurology
Cardiology Cardiology, Cardiovascular Surgery
Digestive organ Gastroenterology
radiation Diagnostic Radiology

Representative diseases for which IVR may be indicated

cranial nerve Cerebral aneurysm, acute cerebral infarction (major artery occlusion), carotid artery stenosis
head and neck Tumor (arterial injection chemotherapy for maxillary cancer and preoperative embolization for juvenile angiofibroma)
chest (excluding heart) Hemoptysis, pulmonary sinus venous malformation
heart, great blood vessels Coronary artery disease, aortic stenosis, mitral regurgitation, arrhythmia, aortic aneurysm, atrial septal defect/patent foramen ovale
abdomen Hepatocellular carcinoma, renal angiomyolipoma, portal hypertension, abdominal visceral aneurysm
peripheral blood vessels Arteriosclerosis obliterans, dialysis shunt trouble
trauma, bleeding Pelvic fracture, abdominal solid organ injury, obstetric bleeding, gastrointestinal bleeding
non-vascular Retroperitoneal tumor (biopsy), abscess

Trends of the last 3 years

  • Introduced the latest ultrasonic inspection machine. This has enabled safer and more accurate procedures than ever before (Diagnostic Radiology)
  • Efforts to shorten the time of acute recanalization therapy, which has been established as evidence that it is effective, have been achieved by hospital-wide efforts (Department of Neurosurgery, Department of Neurology)

Past performance [Number of IVRs (including overtime)]

head and neck vessels
  2012 2013 2014 2015 2016 2017 2018 2019 2020
brain aneurysm 138 136 91 114 114 156 123 78 126
cerebral angioplasty 48 40 12 15 23 26 19 17 9
carotid artery stent     33 40 34 41 36 39 50
thrombus retrieval     29 43 68 84 71 77 64
others 23 25 33 24 37 17 14 34 27
emergency within time     22 28 36 51 50 65 116
Off hours 54 46 58 72 97 109 82 77 75
total
(number of people)		 within time 155 155 140 164 172 219 179 173 215
grand total 209 201 198 236 269 328 261 250 290
cardiovascular
  2012 2013 2014 2015 2016 2017 2018 2019 2020
cardiovascular angiogenesis 10 22 24 27 23 37 27 18 19
stent 393 345 288 340 389 392 331 353 262
others 1 12 9 18 32 11 22 21 20
total 404 379 321 385 444 440 380 392 301
Ablation 363 416 439 434 463 489 562 600 523
IABP, PCPS, in vitro PM     74 84 104 126 100 84 95
Pacemaker placement       59 66 78 81 73 65
others 106 107 49 36 59 58 92 93 20
emergency within time     76 110 111 121 125 129 90
Off hours 70 68 77 84 125 146 105 95 99
total
(number of people)		 within time 697 727 767 897 972 1014 1046 1125 930
grand total 767 795 844 981 1097 1160 1151 1220 1029
Abdominal extremity vessels
  2012 2013 2014 2015 2016 2017 2018 2019 2020
Vascular embolization Hemostasis 75 84 62 75 102 118 109 95 47
TACE 249 233 199 202 152 150 133 121 103
others     69 74 53 72 38 45 35
total 324 317 330 351 307 340 280 261 185
Vasodilation, thrombectomy 28 28 70 88 88 88 93 71 81
reservoir 67 36 41 20 13 9 6 4 3
abscess drainage     39 36 39 60 103 69 53
others 24 13 25 14 21 13 14 23 13
emergency within time     78 61 85 97 123 87 80
Off hours 31 37 34 35 50 60 68 58 32
total
(number of people)		 within time 402 400 463 434 406 442 425 368 287
grand total 433 437 497 469 456 502 493 426 319
hybrid operating room
  2012 2013 2014 2015 2016 2017 2018 2019 2020
brain surgery     8 4 2 4 26 36 30
stent graft     26 36 34 44 43 63 36
TAVI     20 29 30 46 53 58 57
Mitra Clip             1 8 13
CRTD     90 49 48 84 44 43 4
others     5 3 8 13 11 24 26
emergency Off hours 4 6 9 0 1 10 11 13 31
total
(number of people)		 within time 92 134 140 121 121 182 161 211 200
grand total 96 140 149 121 122 192 172 224 231

Comments from the clinical department about the IVR Center

Cranial nerve area (Neurosurgery, Neurology)

New devices are constantly being developed, and new evidence is being built through clinical trials. Our center conducts clinical trials for almost all of the devices introduced in Japan, and also leads and participates in many multi-center collaborative studies. I will introduce some topics.

1) Acute recanalization therapy

Its efficacy was proven in 2015, and the number of treatments has increased dramatically around the world. In order to improve patient outcomes, it is necessary to minimize the time from onset to recanalization, and the goal is 110 minutes from admission to recanalization. Therefore, we have formed a stroke treatment team involving the emergency department, Nursing Department, and Radiological Technology.

2) Cerebral aneurysm treatment, flow diverter and stent-assisted coil embolization

Pipeline Flex, which was reimbursed in 2015, marked the beginning of domestic introduction of flow diverters. From early on, our hospital has been actively involved in clinical trials, undertaking doctor training, etc. We are the only hospital in Japan with multiple certified practitioners, and together with other devices that have been in charge of clinical trials, we have more than 100 experiences with flow diverters. In addition, regarding stent-assisted coil embolization, which began in 2010, we are in charge of all clinical trials for Enterprise, Neuroform, and LVIS introduced in Japan, and have accumulated 600 cases of experience. We are also actively engaged in research on computer fluid dynamics, an application that measures changes in blood flow in cerebral aneurysms (aneurysm flow) incorporated in Philips devices.

3) Treatment targets and techniques for cranial nerve area
embolization Cerebral aneurysm, cerebrospinal arteriovenous malformation, dural arteriovenous fistula, head and neck tumor, etc.
reopening acute stroke
Dilation Carotid artery stenosis, intracranial artery stenosis, vasospasm after subarachnoid hemorrhage, etc.

Cardiovascular (Cardiology)

Cardiology, many examinations and treatments are performed at the IVR Center.
In 2020, 292 cases of percutaneous coronary angioplasty (including 92 cases of emergency), 62 cases of peripheral angioplasty, and 492 cases of ablation were performed. We have also implanted a pacemaker, which has been performed in 127 cases. Most of it is done at the IVR Center. The number of these examinations and treatments is top class in Japan. At the IVR Center, there are three catheterization rooms used by our department, all of which are equipped with the latest fluoroscopy equipment from two directions. In addition, all rooms are spacious enough to start machines such as aortic balloon pumping and percutaneous cardiopulmonary assist devices in an emergency, and even when using a ventilator, procedures can be performed smoothly. increase.

Department of Gastroenterology and Diagnostic Radiology

Gastroenterology IVR Center mainly treats liver cancer. Most of them are elective chemoembolization, but we also perform emergency embolization for liver cancer rupture. In addition, although it is not a procedure at the IVR Center, treatment such as percutaneous drainage of the liver and biliary tract (including emergency) and radiofrequency treatment for liver cancer are also IVR procedures performed at the Department of Gastroenterology. We discuss treatment strategies for liver cancer at a weekly conference with the Department of Diagnostic Radiology.

With the cooperation of various clinical departments, the Department of Diagnostic Radiology conducts a wide variety of IVR as follows. In particular, our hospital has a high proportion of emergency procedures, reflecting the high number of emergencies (more than 100 cases per year). Another feature of our department is that it does not have its own outpatient clinic or ward, and performs procedures upon request from each clinical department. For this reason, it may be difficult to understand what we are doing, but we support medical care in many departments in various aspects.

Procedures performed in Diagnostic Radiology
Emergency hemostasis, revascularization Bleeding due to pelvic fracture, gastrointestinal bleeding (difficult to stop bleeding with endoscope), bleeding from abdominal parenchymal organs (liver, spleen, kidney), IVR for vascular injury (embolization or stent placement), superior mesenteric artery embolism such as thrombectomy for

Arterial chemotherapy for hepatocellular carcinoma (partial), arterial reservoir placement, embolization for renal angiomyolipoma

  
Embolization for internal iliac aneurysms, abdominal visceral aneurysms, etc. (including before stent graft surgery)  
IVR for dialysis shunt trouble  
IVR for the portal system B-RTO, PTO, PTS, angiogenesis
IVR using CT (or ultrasound) Abscess drainage, biopsy (removal of tissue, such as a tumor, with a needle)