Dr Nestor Kisilevzky from the Israeli Albert Einstein Memorial hospital, Sao Paulo, Brazil spoke on how a team of two interventional radiologists, one nurse, one assistant, and one driver took a mobile unit performing uterine fibroid embolizations (UFE) in female patients to Sao Paulo with low incomes.
Promising at the outset of his talk at the 2009 annual scientific meeting of the Society of Interventional Radiology, San Diego, to tell “a very different story”, Kisilevzky from the Israeli Albert Einstein Memorial hospital, explained how the “vast majority of interventional radiology facilities are located in the private hospitals.”
What really drew his attention in the last year was the vast number of patients who came seeking uterine fibroid embolizations within the public health system, only to be disappointed. These patients had neither insurance coverage nor the financial resources to afford the procedure privately.
Kisilevzky says, “This is what prompted us to think about how we can change this landscape. We realised that in our metropolitan areas, which are almost 300 square km in area, there are no UFE programmes available on a routine basis. This affects almost 1.6 million women with low incomes who need treatment for their fibroids.”
Since the team encountered difficulties in taking the low-income group patients to the private hospitals, they decided to take this technology to them. “That is how the concept of having a mobile interventional radiology unit was born,” says Kisilevzky.
The programme, sponsored by the Albert Einstein Social Responsibility Institute, aims to test the safety and efficacy of using a mobile unit on a hundred patients, who are selected by gynaecologists at local hospitals.
The team first obtained a small truck (called Angiomovel). Their slogan is “Providing medical technology with social responsibility” and the truck is loaded with all the equipment needed to perform uterine fibroid embolizations.
“We basically visit four selected public hospitals, with whom we have an agreement, once a week , carrying everything we need right from a modern mobile “C” arm, a radiological table, contrast medium, sheaths, catheters, microcatheters, embolic agent and protection aprons. We then ask for an empty room at the surgery which serves as our temporary angiosuite and perform several procedures in one day. When we finish the last procedure, we put all supplies back in the truck and leave,” says Kisilevzky.
He clarifies that supplies are partially donated by related companies like Philips, Bayer and Biosphere Med and that the interventional radiologists work on a completely philanthropic basis.
Quick facts on the procedures
59 UFE procedures in 12 weeks
Technical success: 100%
Mean procedure time: 41.5 minutes
Mean fluoroscopy time: 20.56 minutes
Mean amount of embolic used: 2.45 syringes, 2cc
Contrast used: 3.1 vials, 50 cc
Initial outcomes from the study
Patients discharged in 24 hrs – 58/59 -98.3%
Patients discharged at 48 hrs 2/59 – 3.4%
Readmissions at one week for pain management 3/59, 5.2%
Follow up @ 3 month (24 patients were seen at the office):
Improved: 21 (87,5%)
Unchanged: 2 (8,3%)
Worse: 1 (4,16%)