Procedures
Angioplasty and Stent Placement
Angioplasty and stenting are minimally invasive treatment options for PAD.
Using imaging for guidance, a catheter is placed through a small incision
in the groin into the femoral artery and then maneuvered into the narrowed
or blocked artery. A balloon is then inflated to stretch open the blood
vessel where it is narrowed or blocked. In some cases the blood vessel
is then held open with a stent, a tiny metal cylinder that is like scaffolding
for the blood vessel. This is a minimally invasive treatment that does
not require surgery, just a nick in the skin the size of a pencil tip.
Central Venous Access
A Central Venous Access Catheter (CVAC) is a tube that is inserted beneath
your skin, giving doctors and nurses a simple, pain-free way to draw your
blood or give you medication or nutrients. When you have a CVAC, you are
spared the irritation and discomfort of repeated needle sticks. Several
types of CVACs have been developed, including tunneled catheters, peripherally
Inserted Central Catheters (also called PICC lines), dialysis catheters
and implantable ports are examples of central venous access catheters
that can be inserted by an interventional radiologist without surgery.
Doctors often recommend CVACs for patients who regularly are given:
- chemotherapy treatments
- infusions of antibiotics or other medications
- tube-fed nutritional supplements
- hemodialysis
What To Expect
You can receive medication to help you relax and the area where the insertion
will be performed will be numbed. An interventional radiologist will insert
a needle into the skin, creating a slender tunnel. The Central Venous
Access Catheter is then inserted through the opening, with the tip coming
to rest in a large vein. You may feel some pressure and slight discomfort
during the procedure.
Chemoembolization
Chemoembolization is an interventional radiology procedure used to target
treatment of cancer. It is most often used for the treatment of tumors
in the liver. Both primary liver tumors, or metastatic cancer to the liver
can be treated with chemoembolization.
An interventional radiologist will first access the artery feeding the
tumor. This is achieved by advancing a catheter from the artery in the
groin. Once the artery feeding the tumor is localized, chemotherapy medicine
is injected directly into the tumor. After delivery of the chemotherapy
agent, the feeding artery is then occluded (embolized) to prevent blood
flow from reaching the tumor. The goal of this type of treatment is to
specifically target treatment to the liver, and therefore decrease the
side-effects to the rest of the body, and to decrease or eliminate the
tumors source of oxygen and nutrients.
Chest Tube Placement
Chest tubes are placed for a variety of indications. The most common reason
to insert a chest tube is to drain fluid (pleural effusion) from from
around the lung, or to re-expand the lung if it has collapsed. Lung collapse
can happen spontaneously, as a result of trauma, or following certain
types of surgery or procedures. Fluid can accumulate around the lung due
to inflammation, infection, cancer or other causes.
Insertion of chest tubes can often be done at the bedside. In many instances,
an ultrasound probe is used to locate the pocket of fluid adjacent the
lung. The skin can then be marked. Once the skin is sterilized and numbed,
a small needle is passed between the ribs into the space around the lung
containing fluid. A wire is then inserted and over the wire a small tube
can be passed into the fluid. This requires only a small nick in the skin,
and in most instances, no sutures are required once the tube is removed.
Depending on the reason for the chest tube, in may need to stay in for
several days.
If a chest tube is placed for treatment of a collapsed lung, the tube is
used to evacuate the air around the lung, thereby helping the lung to
re-expand.
Cryoblation
Cryoablation is a minimally invasive technique used for the treatment of
cancer (tumors) that may not be amenable to surgical excision, or in patients
who may be too weak to undergo a surgical operation. The technique is
often used for treatment of tumors in the lung, liver or kidneys, but
tumors in other areas may be amenable to this type of treatment as well.
Cryoablation is typically performed with general anesthesia. The procedure
is performed in a specially designed suite and CT images are performed
throughout the procedure to help guide the radiologist. During cryoablation,
a special probe is inserted through a tiny nick in the skin. The probe
tip is positioned in the tumor to be treated. Once in place, the probe
tip becomes extremely cold, freezing the tumor. The frozen tumor will
shrink and scar over time.
Gastrostomy (Feeding Tube) Placement
A gastrostomy tube (feeding tube) is a a special tube that enters through
the upper abdomen and goes in to the stomach. These are placed for patients
who are unable to eat, for example due to cancer of the throat or esophagus,
or in patients whom eating could be dangerous, such as patients with recurrent
aspiration. The procedure is performed in the interventional radiology
suite using fluoroscopy (special X-ray). With the skin sterilized and
numbed, a small needle is used to access the stomach through the skin.
The stomach is held up against the anterior abdomen with special sutures.
A small wire is then placed through the skin, and over the wire, the feeding
tube can be inserted. A special balloon on the end of the tube helps prevent
it from accidentally getting pulled out. With care, the tube can be left
in place for several weeks, or if needed, several years. It may need to
be changed from time to time.
Image Guided Biopsy (CT and Ultrasound)
A biopsy is a medical test involving the removal of cells or tissues for
examination. It is the removal of tissue from a living subject to determine
the presence or extent of a disease. The tissue is generally examined
under a microscope by a pathologist, and can also be analyzed chemically.
When an entire lump or suspicious area is removed, the procedure is called
an excisional biopsy. When only a sample of tissue is removed with preservation
of the histological architecture of the tissue’s cells, the procedure
is called an incisional biopsy or core biopsy. When a sample of tissue
or fluid is removed with a needle in such a way that cells are removed
without preserving the histological architecture of the tissue cells,
the procedure is called a needle aspiration biospy.
A Radiologist can perform minimally invasive core biopsies or needle aspiration
biopsies using imaging guidance with CT or ultrasound. The Radiologist
uses the imaging guidance to direct the biopsy needle through the skin
into the abnormal area in your body. The biopsy needle is then used to
remove strips of tissue in the case of a core biopsy or cells from the
area in the case of a needle aspiration biopsy.
The doctor performing the biopsy will be able to discuss the type of biopsy
needed with you before your biopsy. Because the risks involved with biopsy
are different depending upon where the abnormality is in your body the
doctor performing your biopsy will discuss your individual risks with
you prior to performing the biopsy.
What To Expect
After locating the suspicious area with ultrasound or under then guidance
of a CT scan, the radiologist will clean the skin and will inject a local
anesthetic (pain killer) into the area. After the anesthetic has taken
effect, the doctor will use a needle to remove a small sample of tissue.
This part of the procedure is done quickly. You may experience a feeling
of pressure when the doctor inserts the biopsy needle.
If after this procedure your physician determines that additional tissue
is needed for a thorough analysis, you may still have to undergo a surgical biopsy.
Nephrostomy
A nephrostomy tube is a special drainage tube that inserted through the
back into the kidney. It is most often used to drain the kidney when there
is an obstruction of urine drainage. The most common cause of obstruction
of the kidney is the presence of a stone which can get lodged in the ureter.
(The ureter is the the small tube that directs urine for the kidneys into
the bladder.) Other causes of obstruction include scarring and cancer.)
Nephrostomy tubes are most often placed using ultrasound and fluroscopy
to allow the interventional radiologist to pass a needle through the skin
into the kidney. Through the needle, a small wire is placed. Over the
wire, a small tube can be advanced into the kidney. This will allow urine
to drain out of the kidney untill the cause of the ureter obstruction
can be addressed
Paracentesis
Paracentesis is a procedure performed to drain excess fluid from the abdominal
cavity. Buildup of abnormal amounts of fluid usually is due to a disease
process. Excess fluid can cause discomfort or shortness of breath, which
often can be relieved by drainage. In addition, evaluation of the removed
fluid can help your physician diagnose and treat your condition.
Performing paracentesis with radiological imaging guidance helps ensure
accurate placement of the extraction needle, so that fluid can be removed
without endangering vital organs and blood vessels.
What To Expect
You probably will lie on your back. After using an ultrasound machine to
locate the fluid, your radiologist will cleanse and numb your skin, then
will insert a thin, hollow needle to draw out the fluid. After the needle
is removed, a small bandage will be placed over the site.
Radiofrequency Ablation
Radiofrequency ablation, often called RFA, is a minimally invasive treatment
for certain types of cancer. It can be used to treat, among other things,
cancer of the lung, liver and kidneys. The technique can also be utilized
for other body parts, such as certain types of bone lesions.
The procedure is most often performed with general anesthesia. The interventional
radiologist will use CT images to help guide the tip of the probe into
the cancer. Only a small nick in the skin is required to allow the probe
to be inserted. Once in place, powerful radiofrequecy is applied, heating
the tip of the probe. This local intense heat kills the cancer cells.
Over time the cancer will scar and shrink.
Spinal Injections
Spinal injections are performed either to confirm a suspected diagnosis
or to reduce pain and inflammation resulting from spinal problems. These
injections are performed under fluoroscopy by an interventional radiologist.
Several types of spinal injections are performed, including:
- Epidural Steroid Injection
- Facet-Sacroiliac Joint Injection
- Discogram/ Facet Cyst Aspiration
- Spinal Epidural Steroid Injection
- Nerve Root Blocks
- Facet Blocks
What To Expect
You will lie on your stomach on a X-ray table. First, the region of your
back requiring injection will be cleaned and prepped. The radiologist
will then insert a small needle in the area and, guided by X-ray imaging,
will inject a small amount of contrast material to confirm proper needle
placement. Once confirmation is made, the radiologist will inject the
medicine and remove the needle.
Thoracentesis
Thoracentesis is a procedure performed to drain excess fluid from the chest.
Buildup of abnormal amounts of fluid usually is due to a disease process.
Excess fluid can cause discomfort or shortness of breath, which often
can be relieved by drainage. In addition, evaluation of the removed fluid
can help your physician diagnose and treat your condition.
Performing thoracentesis with radiological imaging guidance helps ensure
accurate placement of the extraction needle, so that fluid can be removed
without endangering vital organs and blood vessels.
What To Expect
You will be in a sitting position. After using an ultrasound machine to
locate the fluid, your radiologist will cleanse and numb your skin, then
will insert a thin, hollow needle to draw out the fluid. After the needle
is removed, a small bandage will be placed over the site.
Transjugular Intrahepatic Portosystemic Shunt – TIPS
TIPS is a special procedure used to treat portal hypertension. The liver
has two blood supplies to it, namely the hepatic artery and the portal
vein. The portal vein directs blood and absorbed nutrients from the intestine
into the liver for processing. In patients with cirrhosis, the pressure
in the portal veins is increased. This high pressure leads to varices
(dilated veins) which can result in life threatening bleeding.
To decrease the pressure in the portal veins, a special tube (shunt) is
used to connect the portal vein to the hepatic vein within the liver.
This allows much of the blood draing into the portal vein to bypass the
liver. The connection of the portal vein to the hepatic vein is made by
placing a stent (small metal tube) into a tract formed between to the
two vein structures.
Uterine Artery Embolization
Uterine fibroid embolization (UFE), also known as uterine artery embolization
(UAE), is performed by an interventional radiologist, a physician who
is trained to perform this and other types of minimally invasive procedures
under image guidance. It is performed while the patient is conscious,
but sedated. It does not require general anesthesia. Most women with symptomatic
fibroids are candidates for UFE and should obtain a consultation with
an interventional radiologist to determine whether UFE is a treatment
option for them.
What To Expect
To perform the embolization, the interventional radiologist makes a tiny
incision in the skin of the groin and inserts a catheter into the femoral
artery. Using real-time image guidance, the physician guides the catheter
into the uterine artery and then releases tiny particles, about the size
of grains of sand, into the arteries that supply blood to the fibroid
tumor. This blocks the blood flow to the fibroid tumor and causes it to
shrink and die.
Fibroid embolization can be performed as an outpatient with discharge home
the evening of the procedure or with hospital stay of one night. Pain-killing
medications and drugs that control inflammation typically are prescribed
following the procedure to treat cramping and pain. Many women resume
light activities in a few days and the majority of women are able to return
to normal activities within seven to 10 days.
On average, 85-95 percent of women who have had the procedure experience
significant or total relief of heavy bleeding, pain and/or bulk-related
symptoms. The procedure is effective for multiple fibroids and large fibroids.
Recurrence of symptoms from treated fibroids is rare. Multiple clinical
studies have shown no difference in symptom relief or patient satisfaction
when UFE is compared with hysterectomy (surgical removal of the uterus).
While some women have been able to become pregnant after UFE, the effects
of UFE on a women's ability to concieve, carry a child to term and
deliver are unknown. As the ability to have children may be compromised
by the UFE procedure, we do not currently recommend UFE in those women
with a desire to have children in the future. Myomectomy (surgical removal
of fibroids) may be an option for some women wishing to preserve fertility
and this should be discussed with your gynecologist. Some women treated
with UFE may experience early menopause, with typical menopausal symptoms,
and the chance of this happening increases with patient age.
Varicocele Treatment
Varicocele is an important cause of male infertility. A varicocele is dilation
of the veins which go to the scrotum. When the valves of the gonadal veins
aren't functioning properly, blood can flow backward toward the scrotum.
This increased blood flow and dilatation of the veins can cause pain and
infertility. By occluding (embolizing) the gonadal vein, the reverse blood
flow to the scrotum is interrupted, and fertility can be restored. Embolization
is accomplished by accessing the gonadal vein by inserting a small wire
and catheter through a large vein in the groin. Once the catheter is positioned
into the gonadal vein, small coils (or sometimes glue) can be inserted
to occlude the vein.
Vertebroplasy or Kyphoplasty
Vertebroplasty is a minimally invasive procedure for treating compression
fractures of the spine. A compression fracture is a collapse of the bone,
usually caused by osteoporosis or cancer. This therapy stabilizes the
weakened or crushed bone, decreasing the pain and helping to prevent further
fractures at that site.
The therapy is performed by inserting a special needle into the affected
bone and injecting a glue-like cement substance, which strengthens the
internal structure of the bone. Vertebroplasty relieves pain and increases
mobility for more than 80 percent of patients.
What To Expect
An interventionalist who specializes in this procedure will see you in
our outpatient clinic and evaluate you and your history to make sure you
can benefit from the procedure. An image of your spine and lab work usually
are ordered in preparation of vertebroplasty.
Your procedure will require mild sedation, and anesthetic. You will be
positioned comfortably on your stomach while the interventionalist uses
real-time X rays to position the needle and insert it into the fractured
bone. You will be monitored throughout the hour-long procedure by our
staff and will be able to return home later that day.
Most patients feel pain relief from their fracture as soon as the procedure
is complete.