Interventional radiology in veterinary care - DVM
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Interventional radiology in veterinary care
Minimally invasive procedures can have maximum benefits, experts say


DVM360 MAGAZINE


Nutrition support and more

The advantages of enteral nutritional support over parenteral nutritional support are widely recognized. In humans requiring nutritional support, enteral feeding is not only more natural but tends to be associated with fewer infective complications and shorter hospitalizations, leading to overall decreased costs of service.

In veterinary medicine, the cost savings of enteral nutritional support over parenteral methods like TPN is obvious. However, when there is poor tolerance of gastric feeds, reduced or poor motility or regurgitation and vomiting, IR offers an option for distal tube placement to support feeding directly into the jejunum.

Using fluoroscopic guidance, a catheter and guidewire are used to move past the pyloris and through the duodenum into the jejunum, where the tube is then passed.

Beal reports that jejunal access is achieved in 84 percent of patients and that nasojejunal tube placement has become the standard of care in his service where jejunal feeding is desirable, including those animals suffering from pancreatitis, septic peritonitis or any conditions associated with protracted vomiting or problems with gastric motility.

The value of IR, Beal tells DVM Newsmagazine, is that the approaches can lend themselves to a wide variety of treatments across many disciplines. In addition to relieving obstructions, aiding in placement of tubes and devices and even tracheobronchial or vascular foreign-body retrieval, IR can be used to deliver treatments more efficiently over a prolonged period.

Thrombolytic drugs and chemotherapy agents can be administered directly to the area in need, and biopsies and other tissue samplings can be accomplished more rapidly and with less trauma to the patient.

Cautions

Although IR procedures are less invasive, they do carry a level of risk. Because most procedures involve imaging technologies, exposure to radiation for the animal and the staff must be carefully monitored. Protective precautions should be taken and every effort made to limit the dose the patient receives.

Second, Dr. Beal notes that IR procedures are technically demanding and should be performed only by properly trained practitioners. In untrained or inexperienced hands, significant harm or even death may result.

The Interventional Radiology Services at Michigan State and the original IR training program at the School of Veterinary Medicine at the University of Pennsylvania in Philadelphia currently are the only two formal clinical programs that exist for this emerging specialty.

The huge commitment in costs of imaging equipment and supplies may be a contributing factor to the limited number of programs at this time.

"But, as students are coming through the professional curriculum, the more they see and the more they know what's available for their patients in the future," Beal says.

Looking ahead

Beal says he sees much enthusiasm for this specialty, not just as an offshoot of the human applications, but as its own distinct entity.

"Dogs and cats are not people," he says. "It's not just a question of adapting human procedures to animals. It's how to optimally develop techniques to meet the needs of dogs, cats and other animals in general.

"In an ideal world, it would be a true cooperative approach," Beal adds. "Maybe what we (veterinarians) discover can have broader applications. Maybe physicians could look at the techniques and results of trials that are being performed on animals and adapt them for human use. Then, everyone wins."

Wetzel is a freelance writer in Cleveland, Ohio

Disclosure: Beal is on the advisory board for Infiniti Medical, a distributor of IR products for veterinary medicine.


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Source: DVM360 MAGAZINE,
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