Areas of Expertise

Dr Alex Barnacle BM MRCP FRCRThe challenge of interventional radiology (IR) is to be able to find minimally invasive ways of diagnosing and treating disease so that procedures are safer and children have a shorter hospital stay and find their treatment easier to cope with.

In a busy department like ours, we could be asked to treat any number of different conditions in one day, so we need to keep on top of all the developments in paediatric medicine as well as understand what our colleagues in adult IR are developing, so we can modify those techniques for children.

As well has having to be ‘expert generalists’, most of us have specialist interests in certain areas of paediatric medicine. My passion is centred on the diagnosis and treatment of vascular anomalies but I also work with a specialist team treating renal (kidney) stone disease in children and I have a strong interest in musculoskeletal imaging and interventions such as joint and tendon sheath injections and bone disease. Recently, we have been working on promoting the early treatment of extensive thrombosis (blood clots) in children. This treatment, called thrombolysis, is well developed in adult medicine. Clots are treated by a combination of drugs and mechanical intra-vascular IR devices to break down and remove clot from the cardiovascular system. Extensive clots (thrombosis) are far less common in children than adults but can have significant effects when they occur. I’m keen to promote early treatment of thrombosis to give children better long term outcomes.

The term ‘vascular anomalies’ embraces a very broad collection of conditions including port wine stains, haemangiomas and more complex vascular malformations. Vascular malformations include venous malformations, lymphatic malformations (sometimes called cystic hygromas or lymphangiomas) and high flow arteriovenous malformations (AVMs). IR is at the forefront of treating these conditions, using a combination of sclerotherapy, embolisation and occasionally more innovative techniques such as endovenous laser ablation, although we work closely with a specialist team of experts from many different medical fields.

Vascular malformations are not uncommon in children but are often poorly understood and part of the challenge is to offer a diagnosis early, so that children and families don’t have to go via several doctors and hospitals before they reach a specialist centre which is familiar with managing their condition. I like being able to reassure families that their child’s condition is clearly understood and that there are things we can do to help. In many cases, there is no easy cure for a vascular malformation and treatment is often aimed at minimising a child’s symptoms or improving how their malformation looks. So it’s important that we develop a trusting and friendly long term relationship with families to support them in every way they need.

The treatment of vascular malformations requires a multi-disciplinary team approach and we work closely with experts in dermatology, plastic surgery, ENT, orthopaedics, ophthalmology, urology and psychology. We’re also well supported by specialist physiotherapists and occupational therapists.

There is much research happening in this field and it’s important to collaborate with teams in other centres to share experience and expertise. We have solid relationships with centres in North America and Europe. Most malformations affect the musculoskeletal system but I’m also interested in finding ways to treat malformations that affect less common areas of the body such as the urinary tract, the airway and the orbit. Historically, these malformations have been treated with surgery, with varying results, and the challenge is to find new, effective, minimally invasive ways of managing them so that children suffer less. Recently, I have worked closely with the ophthalmology team at Great Ormond Street Hospital to make significant improvements in the treatment of orbital lymphatic malformations (lymphangiomas).