Establishing Interventional Radiology in the Developing World: Intra-Arterial Procedures in Tanzania

Objectives: In the developing country of Tanzania, there are currently no fellowship-trained interventional radiologists to serve the rapidly growing population of almost 60 million people. The inaugural interventional radiology (IR) fellowship in the region was established in 2018 under the auspices of Muhimbili National Hospital (MNH) and Muhimbili University of Health and Allied Sciences. Due to lack of in-country expertise, teaching has been conducted by visiting teams from the United States, training the first generation of Tanzanian IR fellows, nurses, and technologists. While the majority of cases have consisted of nonvascular procedures, this report outlines the first intra-arterial procedures at MNH performed over the past year. Methods: All consultations received by the IR service at MNH were logged via Research Electronic Data Capture, a Health Insurance Portability and Accountability Act compliant workflow application. Patient information including sociodemographics, referral source, medical diagnosis, comorbidities, and indications for IR interventions has been collected since October 2018. In addition, procedure type, technical success, complications, and pathology results for relevant interventions were recorded. Results: A total of 308 consultations and 231 procedures were performed by the newly established IR service from October 2018 to November 2019. Of these, 28 (12.12%) were intravascular procedures. Of these, seven (25%) were intra-arterial procedures, including one pancreatic pseudoaneurysm embolization, one splenic embolization for thrombocytopenia, and five uterine fibroid embolizations (UFEs). No intra- or peri-procedural complications occurred. The pancreatic pseudoaneurysm demonstrated no flow of contrast in the aneurysm on follow-up imaging. The splenic embolization demonstrated an improvement of thrombocytopenia from 30,000 to 42,000 platelets per microliter at 1 month. Follow-up visits demonstrated improvement in bulk symptoms, pain, and bleeding in UFE patients at 1 month, and at 3 months, a patient who previously needed a monthly transfusion had hemoglobin of 11 g/dl with no further transfusions required. Conclusion: Overall, our early experience demonstrates the safety, feasibility, and excellent outcomes of the first intra-arterial procedures performed in Tanzania. Recommendations: The establishment and expansion of IR training improve access to critical IR services in developing countries such as Tanzania.

Publication History

Article published online:
26 April 2021