Interventional radiology in the elderly

Abstract

Interventional radiological percutaneous procedures are becoming all the more important in the curative or palliative management of elderly frail patients with multiple underlying comorbidities. They may serve either as alternative primary minimally invasive therapies or adjuncts to traditional surgical treatments. The present report provides a concise review of the most important interventional radiological procedures with a special focus on the treatment of the primary debilitating pathologies of the elderly population. The authors elaborate on the scientific evidence and latest developments of thermoablation of solid organ malignancies, palliative stent placement for gastrointestinal tract cancer, airway stenting for tracheobronchial strictures, endovascular management of aortic and peripheral arterial vascular disease, and cement stabilization of osteoporotic vertebral fractures. The added benefits of high technical and clinical success coupled with lower procedural mortality and morbidity are highlighted.

Double-layered covered stent for the treatment of malignant oesophageal obstructions: Systematic review and meta-analysis

“…The present meta-analysis has demonstrated a high pooled success of stent insertion (> 97%) with acceptable rates of procedure-related complications. The latter were encountered in a quarter of the cases (27.6%) and seem to be in line with the usually encountered complications during oesophageal stent insertion for palliation of cancer-related dysphagia[ 2 , 4 , 12 ]. Most importantly, significant relief of dysphagia was found that was 2 points on average out of the 0-4 dysphagia scale.…”

“…In addition, esophageal cancer usually affects elderly patients who suffer from multiple co-morbidities. Both these factors render affected patients poor surgical candidates[ 1 , 2 , 4 ]. The most important complaint of these patients is the tumour related dysphagia resulting in poor oral intake and malnutrition.…”

Tracheobronchial Stenting for Malignant Airway Disease

“…Therefore, most of the stent-related complications reported come from trials investigating benign airway disease. 17,2 However, in this study SEMS deployment demonstrated very low complication rates after almost 6 months of mean time follow-up and after up to 2 years of follow-up. The high survival rate (40% at 6 months and 21% at 24 months) should be attributed to the successful holistic treatment of these patients, which included surgical procedures, various minimally invasive interventions, chemotherapy, and radiotherapy.…”

“…1 Palliative airway stenting has been widely used for the management of inoperable neoplastic obstructions of the tracheobronchial tree. [2][3][4] Although other techniques, such as laser ablation, cryotherapy, and photodynamic therapy, may be applied for the management of endoluminal lesions, stenting is the only available method resulting in immediate symptomatic relief for treating extrinsic compressions. 5 Stenting may also be utilized in order to alleviate an acute respiratory insufficiency and therefore serve as a bridge to further adjunctive chemotherapy and/or radiotherapy.…”

Floroscopy guided airway stenting at malign airway stenosis

“…İnoperabl neoplastik obstrüksiyonlara bağlı trakeobronşiyal darlıklarda stentleme sıklıkla kullanılan palyatif bir yöntemdir [2][3][4].…”