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Advances in Interventional Medicine
Exciting Advances in Interventional Medicine for Veterinary Patients
The Ohio State Veterinary Medical Center, always on the forefront of patient care, offers the latest interventional procedures for cardiac patients, and also for those with pulmonary problems, vascular disease, urologic issues and cancer. Until recently, if a dog was diagnosed with a patent ductus arteriosus (PDA), the only viable treatment option was surgical ligation. For other cardiac defects, such as ventricular septal defects (VSD) or atrial septal defects (ASD), no good surgical options existed. However, as in human medicine, the quality of veterinary care has improved thanks to advanced technology and the use of minimally-invasive therapies, otherwise known as interventional medicine.
Brian Scansen, DVM, MS, Diplomate ACVIM, has a great interest in interventional medicine and has forged the way with providing these therapies for our patients. The procedures that Dr. Scansen uses are minimally invasive with reduced risk, pain, and recovery time as compared with standard invasive surgery. In addition to these benefits, interventional medicine offers therapies for conditions that previously had no good treatment options, or conditions in which the surgery to correct the problem would be life-threatening in itself.
"The techniques are imaging-guided, such as with X-rays, fluoroscopy, and ultrasound, and by using wires, stents, coils, and balloons, we can compliment or even replace classic open-surgery procedures," said Dr. Scansen.
Specific examples of interventional medicine techniques in veterinary patients include placement of tracheal stents for correction of tracheal collapse, urinary tract stents (both urethral and ureteral) to maintain patency for a variety of obstructive conditions, occlusion of vascular/cardiac defects, cardiac pacing for rhythm disturbances, occlusion of the blood supply to tumors and/or delivery of chemotherapeutic agents directly to the tumor site, retrieval of intravascular or pulmonary foreign bodies, among others. Indeed, the scope of interventional medicine is limited only by the imagination of the interventionalist - even percutaneous mitral valve repair for degenerative valve disease is on the horizon.
Dr. Scansen recently treated a nine-month old cat that had inhaled a small rock. The rock had lodged in the trachea where it splits into each lung. Since cats have small airways, the obstruction was difficult to see with the bronchoscope. Traditionally, the next step would have been surgery. However, under fluoroscopy, Dr. Scansen fed in a wire behind the stone, inserted a balloon, and inflated the balloon behind the stone in order to grab and bring it out through the trachea. In addition to avoiding the discomfort and recovery time of an invasive surgery, this technique solved the problem and cost the owner significantly less money than a standard surgery.
Interventional techniques are expected to have an equal or even greater success rate than traditional therapies. One example of this is surgery for patients with abnormal vascular connections in the liver-called intrahepatic portosystemic shunts, or IHPSS. Patients with this condition often show signs of neurological disease because the liver is not able to detoxify substances from the bloodstream. Surgery for IHPSS is a high-risk procedure with a 10 to 30 percent mortality rate during the operation due to the risk of bleeding. With the new technique, we simply make a small incision in the neck, reach the problem area by inserting catheters via the jugular vein, and close the vascular connection using a stent and coil. The benefits to this non-invasive procedure are threefold. Dr. Scansen explained, "With this procedure, the operative risk and surgical pain are reduced, patients can go home the next day, and the results appear comparable to surgery."
Dr. Scansen received his B.S. from the University of Washington in 2000 and his M.S. and DVM from Michigan State University in 2004. He continued on to The Ohio State University College of Veterinary Medicine and completed an internship in Small Animal Medicine and Surgery which led immediately to a three-year cardiology residency. He is currently a Clinical Assistant Professor of Cardiology and Interventional Medicine. Dr. Scansen's interest in interventional medicine originated during his residency in cardiology and his desire to transfer the advanced, novel techniques used in human medicine to all aspects of veterinary medicine. Thus, he has performed interventional procedures for cardiology, pulmonology, urology, vascular and oncology cases. Obviously he has a unique expertise, but credits his clinical flexibility with what he learned during his residency at Ohio State. "My experience with using these interventional techniques in cardiology allows for the transfer to all specialties," Dr. Scansen said.
For more detailed information please refer to an article written by Dr. Scansen.
If you would like to consult or refer a patient that may benefit from an interventional technique, please contact Dr. Brian Scansen at 614-292-3551 or scansen [dot] 2 [at] osu [dot] edu.
By: Kristine McComis