David E. Lee, M.D.

Interventional radiologist at Thompson Health discusses his field of medicine and his work promoting the hospital’s VTE (venous thromboembolism) program for people who get blood clots in their legs

By Chris Motola

Q: What is interventional radiology?

A: That’s an interesting question, because when you tell most people you’re an interventional radiologist, you see this look come over their face. They have no idea what an interventional radiologist is. Most people will then say, “Oh, OK, you give radiation to people as treatment for cancer or you read X-rays.” Basically, it’s a subspecialty of radiology where we do minimally invasive surgery-like procedures using various X-ray modalties whether it’s CT-scanning, ultrasound, regular X-rays, etc. We do procedures that, at a previous time, would require actual surgery. So it doesn’t require big incisions. Usually patients can go home the same day. If they need to stay in the hospital, they can recover much more quickly than with some of these other surgical procedures.

Q: What conditions can you treat this way?

A: We do a wide breadth of different types of procedures. At Thompson Hospital right now we are promoting our VTE (venous thromboembolism) program for people who get blood clots in their legs, extending up into their abdominal vessels. We now have ways to treat those patients and take the clot out, basically through little needle sticks, and send those patients home most of the time the same day. They don’t require long-term blood thinners, so that’s one thing. I take care of people who have fibroid disease, people with varicose veins. We do treat people with tumors, but unlike a radiation oncology that may use external beam radiation, we’ll take a little tiny catheter and send it through the blood vessels to the area of the tumor and we’ll inject radioactive beads to try to kill the tumor. We do angiograms, put stents and balloons in various vessels. We do biopsies to diagnose cancers in various locations. As you can see, there’s a pretty wide breadth of things we do.

Q: How do you treat varicose veins with interventional radiation?

A: We can handle them different than we could 20 years ago, which would have required incisions, taking veins out. It had a prolonged recovery time. Today, we can do minimally invasive procedures basically through a needle stick. We can do laser ablation to close off veins. You can use something called cyanocrylate, which is pretty much medical-grade super glue that can close off vessels. We also do something called sclerotherapy, which is a procedure where you take small needles and, using machine guidance, inject a foam or liquid into the vein to close it off.

Q: How long have procedures been done this way?

A: For the deep venous clot? It’s relatively new. Within the past three years, I’d say. For the varicose veins, it’s on a spectrum. Some of it is older. I’ve been using the laser for about 15 years, but there are some newer techniques. For instance, the super glue has been available for about three to five years.

Q: Based on what you’re able to do now, do you see your field becoming able to treat more conditions over time?

A: Yes. I think there are all sorts of opportunities for growth with all of these procedures. I think we can change the way deep vein thrombosis (DBT) is treated. Typically you give anticoagulation, which has been a tried-and-true technique for a long time. In appropriate patients you can directly remove that clot and spare the patient some of the long-term consequences associated with DBT. The other thing I’d mention is something called prostate artery embolization. It’s newer, within the past five years. It’s basically used for men who have enlarged prostates. We use angiography to send little beads to areas in the prostate and try to decrease the prostate’s size, so we can alleviate symptoms that are caused when your prostate gets big as you get older. I think that’s going to be emergent procedure as time goes on.

Q: How are the outcomes?

A: The outcomes are very good over the three- to five-year period. For males, it’s about what kind of urine stream can you get going, how much gets stuck in the bladder and patient quality of life. Many studies have shown quality of life is significantly improved.

Q: You’ve mentioned beads a few times. What are these beads and how do they work?

A: We use different kinds of—we would call them particles—for different applications. At the top of our discussion, we talked about radioactive beads that would go to tumors. Those are a special kind of particle. For other types of embolization, these little particles can be little plastic or gelatinous particles. They’re all precisely sized to the vessel you’re going to use them in. For instance, if I was doing an embolization for a woman with fibroids, I’d typically use particles on the order of 500-700 microns in size. For a prostate artery embolization you’re dealing with smaller vessels, so they’d be between 100-300 microns in size.

Q: Is interventional radiology usually available in rural hospitals these days, or is Thompson unusual?

A: I would say Thompson is unusual. My doctors, all of us with the University of Rochester faculty, offer a higher level of care than you would normally expect to see in a community or rural hospital the size of Thompson.