Philip Orons, DO, FSIR, FAOCR an Interventional Radiologist at UPMC Magee-Womens Hospital talks about embolization and how tiny coils were used to help baby Oliver.
Interview conducted by Ivanhoe Broadcast News in February 2019.
For viewers who are not familiar with what an interventional radiologist does, how would you describe what it is that you do?
ORONS: Interventional Radiologists were really the first minimally invasive surgeons because everything we do we do through little teeny holes, remotely, using some type of imaging guidance whether that be ultrasound, CT fluoroscopy or even MR. Almost everything we do is done remotely. So generally, when we’re operating on a patient, when we’re doing procedures, we’re not looking at the patient; we’re looking at a screen.
If you could tell me what it is that your role was in surgery. What did you have to do?
ORONS: Dr. Emery and I talked about this case beforehand because we had done this only once before. This is a rare circumstance. And while Dr. Emery has a tremendous skill set, that skill set at the time didn’t include embolization. But that’s something that interventional radiologists do all the time every day – every single day.
What is embolization?
ORONS: Embolization is when you treat a patient therapeutically by blocking an artery or a vein or even a lymphatic duct. It’s sort of counterintuitive to think that you can sometimes treat people by blocking off their arteries because we know arteries are generally are supposed to stay open. But it’s actually amazing how often we treat patients by blocking their arteries. And there are a variety of devices to do this.
You had a couple of options for this patient. How did you come down to the one that you thought would work best?
ORONS: Well, we did discuss the choice of embolic agent because when you treat vascular tumors elsewhere in the body there are other ways they are treated. And frankly, usually they’re not treated like this. When you treat vascular tumors, the idea is you want to treat the entire tumor. And tumors elsewhere, especially vascular tumors, often do what’s called recruitment of blood supply. So if you block off an artery too far away from the tumor, arteries will go around that and still supply the tumor. So sometimes we treat tumors with little particles. They look almost like grains of sand. Sometimes we use a liquid embolic like alcohol, plain old ethyl – absolute alcohol which effectively occludes whatever vessel is injected with it. We even use glue. It’s like super glue inside your arteries. But in this case we didn’t want to do that because, after speaking to the pathologist, we were very worried there was going to be shunting inside the tumor. And if we used agents that moved too easily, we risk them going right through the tumor and going into the baby. So in this case, we wanted to use something larger. In general, one of the tenets of embolotherapy is “the bigger the embolic, the safer the embolic”. The biggest embolics we have are actually coils. However, even these only measure millimeters in size,. But in terms of embolics, that’s very big.
Coils you thought would provide the least risk.
ORONS: Yes.
Can you describe that for me?
ORONS: We used something called a microcoil which is a little platinum device with these little threads on it that promote blood clotting. It looks almost like a teeny, weeny fishing lure and we call it a coil because even though it starts out straight, when you push it through a catheter or through a needle, it coils up. This particular microcoil is called a Tornado because it actually looks like a little vortex, like a little tornado. And that’s just what this particular brand is called.
So Dr. Emery got the needle in and then you took over? Describe for our viewers what you did?
ORONS: It was really extraordinary actually how quickly and easily he got this needle into something which is unbelievably small. The size of the vessel was only six millimeters in diameter – about ¼ of an inch. And we’re going through the woman’s belly, through the uterus, and right next to the placenta. To get into a space that small, you have to be very, very precise. And not just that small in diameter but you have to go to a very specific area of the artery because if you’re too far away from the tumor it won’t be effective. If you’re too close, it won’t be effective. So he was able to put it very precisely into exactly a point where the artery was just about to enter the tumor and at that point, while holding the needle very, very still, I introduced the coil. There’s a little introducer that you place into the needle and just gently push the coil in with a pusher wire. Usually when we do this, we’re doing it under X-ray guidance. We’re looking at an x-ray machine and, when you look up at the screen you see the coils going in. In this case, we weren’t using any x rays; it was purely ultrasound. But the ultrasound is extremely high resolution. And how clearly we saw the coils going into the artery was actually extraordinary. I was surprised – his ultrasound machine is a lot better than what we use in IR generally, I’ve got to tell you.
When did you know that it was a perfect fit.
ORONS: Well, to tell you the truth. We didn’t know exactly until later on. Because we really didn’t know if this was a successful treatment until a few months later when the baby was born. Sometimes I’ll say technically successful. And we knew it was technically successful within moments of putting the coils in the artery because were trying to occlude the blood flow in the artery. And you can measure blood flow and identify blood flow extremely accurately and with great sensitivity using ultrasound. And within moments, seconds, of having the coils in place. We saw the blood flow had stopped. But just because the blood flow stopped – we were very pleased at that – but that doesn’t necessarily mean the procedure was a success. That would become evident later on when we saw what happened to the tumor. Dr. Emery described how they looked at the tumor after delivery, and it was amazing how the tumor was completely necrosed, completely treated, but the placenta was completely healthy.
Did you have the opportunity to talk to the parents or meet Oliver?
ORONS: No, I have not. I was really only a very, very small part of this. I met them at a very brief window in time. They seemed like lovely people but I have not spoken with them since.
Is there anything I didn’t ask you that you would want people to know about what you and Doctor Emery and the team were able to accomplish?
ORONS: Only that very often some of the best things in medicine occur when you collaborate between groups. And the team here at Magee in particular, I found to be a very collaborative group where people aren’t worried about glory or rewards. They try to treat in a team concept to do what’s best for the patient. I think that’s really what was done here. Dr. Emery – this was all his idea. It was his idea to do this, not mine. And when he first approached me, I was a little skeptical, because I’d never done any kind of intrauterine intervention. I’d never done that before. But he made it look easy. And together we got a nice result!
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Madison Brunner, PR
412-432-8390
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here
