Introduction

Article Outline

• Copyright

Every interventional radiologist is well aware that contemporary interventional radiology practice is very different than it was a decade ago. Although there are certainly many reasons to fight this change and to work hard to keep things “as they were,” there are just as many reasons to embrace this change and to enthusiastically support its continuing evolution and growth. One of the major reasons I have for being pleased with the current status of my practice, and what I see as the future of our specialty, is the opportunities we now have to be active participants in many different aspects of women’s health.

The present issue of Techniques in Vascular and Interventional Radiology focuses on the role of interventional radiology in treating a variety of health issues unique to women. To many of us, this focus on women’s interventions started with the introduction of uterine artery embolization (UAE) to treat patients with symptomatic uterine fibroids. Therefore, the treatment of fibroids is a prominent part of this issue. First, we present a review of the most recent studies performed to evaluate UAE and to compare it with surgical therapy. In light of the success of UAE, as shown in this review, issues have come up regarding patient selection for this procedure. In particular, patients desiring future fertility have expressed growing interest in undergoing this less invasive treatment to address their fibroids. Therefore, a review of the literature regarding fibroid therapy and fertility has been prepared with the intent of offering a literature-based algorithm to make treatment decisions for patients with demonstrated infertility and patients with a desire to preserve fertility. With the field of fibroid therapy growing rapidly, we end the section on uterine fibroids with a review of the new techniques being evaluated as additional alternatives to open surgical excision of symptomatic fibroids. All of these articles can certainly add to the enthusiasm surrounding this area by insuring us that UAE works, that the potential to expand the indications for UAE is there, and that many of the newer treatment options being explored for fibroids take advantage of the skill set that we already utilize in day-to-day practice.

Despite the fact that many of us equate our involvement in women’s health with UAE, many opportunities exist to expand this involvement beyond fibroid therapy. Pelvic congestion syndrome is an entity known to many of us as a potential cause of pelvic pain and ovarian vein or internal iliac vein embolization is one approach to the treatment of this problem. Fallopian tube recanalization has been utilized for many years as a treatment for infertility caused by proximal fallopian tube occlusion. With this in mind, opportunities now exist for interventional radiologists to offer an alternative to surgical tubal ligation with the use of fallopian tube occlusion techniques that closely mimic embolization procedures. Breast interventions, an area within many of our practices that are often pushed toward mammographers, also represent an opportunity for interventional radiologists, especially as local tumor therapy options such as radiofrequency ablation and cryoablation begin to be explored as options for patients with limited breast disease. Finally, botox is one topic that literally brings a smile to our faces and interventional radiologists seem to be enthusiastic about adding this procedure to the list of things we can offer our patients. Utilizing this for cosmetic purposes is what we all think about when we discuss botox, but we conclude this issue with an article highlighting both the musculoskeletal applications of botox as well as its cosmetic applications.

When we talk about women’s health issues and interventional radiology, it is tempting to limit our focus to the problems described above because these issues (for the most part) are limited to female patients. However, creating a practice that can meet the needs of female patients means that issues frequently affecting but not limited to women also need to be addressed. Even though they are beyond the scope of this issue, procedures such as saphenous vein ablation, vertebroplasty, and kyphoplasty often represent significant components of practices dedicated to women’s health. Therefore, one only needs to look at this large list of procedures to know that the field of women’s interventions is technically challenging and technically varied with real potential to definitively treat a wide variety of health issues in a patient population not shy about expressing their gratitude when their problems are addressed. These all sound to me like great reasons to be excited about today’s practice of interventional radiology.