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.

Patient preparation

When you schedule your appointment, we will inform you about any specific preparations depending upon the specific procedure your doctor has ordered. Please contact the Scheduling Department at 949.764-5573 if you have any questions.

Beginning several days before the procedure, you will need to discontinue certain medications.

  • If you are taking Plavix, Coumadin, Warfarin or Pradaxa, must stop 5-7 days prior to your procedure but you MUST check with prescribing physician first before stopping to see if you doctor has an alternative medication or instructions for you.
  • If you are taking Aspirin, Naprosyn, Ecotrin, Ibuprofen, Advil, Motrin, Aleve, Naproxen or Celebrex on a regular basis, we ask you to stop 5-7 days before your exam procedure but you MUST check with prescribing physician first before stopping to see if you doctor has an alternative medication or instructions for you.
  • If you take Lovenox, you must stop 12 hours before your procedure.
  • Stop taking fish oil, flax seed oil, vitamin E, 5 days prior to your procedure.
  • Tylenol or acetaminophen are not an issue if you are currently taking them.

If you have prior studies outside of Hoag for a comparison, please bring them to your appointment.

This procedure requires radiographic contrast:

  • You should inform your physician if you have any allergies. If you have been told you are allergic to contrast or have ever had a reaction to Iodine or any form of contrast media, your doctor may prescribe medications to reduce the risk of an allergic reaction. A Radiology nurse should contact you. If you have not been contacted by a Radiology nurse at least 24 hours prior to your appointment, please contact the Imaging Scheduler immediately.
  • If you have diabetes, kidney problems, lupus, surgery on your kidneys or multiple myeloma, you must have lab work that includes a BUN and Creatinine performed within 30 days of your exam. If you are over the age of 65 you must have lab work within 90 days of your exam. This provides us with information regarding your current kidney function. Please call your physician if you have not had this blood work.
  • If you have been diagnosed with diabetes and/or you are currently taking any of the following medications: Metformin, Gluicophage, Glucophage XR, Fortamet, Riomet, Metaglip, Glucovance, Actoplus Met, Avandament or Junamet, stop taking your medication for a total of 48 hours after your exam. You must contact your physician for alternative medications and instructions prior to your exam
  • If you are currently receiving Dialysis; please schedule your dialysis to follow your procedure with Contrast or the following day. It is imperative you have dialysis no later than the following day after you have received contrast for your procedure.
  • We encourage you to hydrate with oral fluids at least 24 hours prior to your study. You may have only clear liquids as well as your necessary medications 2 hours before your exam.

You may receive additional specific instructions when you schedule your appointment depending upon the type of procedure that will be performed.

If you have prior studies outside of Hoag for a comparison, please bring them to your appointment.

Please complete, print out and bring with you the following forms to your appointment:

  • Outpatient Medication Reconciliation form (for Breast Center and Interventional Procedures) - Download PDF

Side Effects and Complications

Needle biopsies generally are considered very safe and effective. Any procedure that involves piercing the skin introduces risk of infection or bleeding. We perform all of these procedures with sterile techniques to reduce the chance of an infection.

The radiologist will discuss any possible complications with you and will answer your questions before you sign the consent form.

Follow-up Care

Restricting your activity is necessary to make sure that bleeding or other problems do not occur as a result of getting up too soon. If you have been sedated, someone must drive you home.

Specific instructions will be given to you after your 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.

Side effects and complications

Any procedure that involves piercing the skin introduces a small risk of infection or bleeding. We perform all of these procedures with sterile techniques to reduce the chance of an infection.

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 injections and facet-sacroiliac joint injections.

An epidural steroid injection is done to relieve pain caused by spinal degeneration, spinal stenosis (narrowing that exerts pressure on nerves), or disc herniation or protrusion. The steroid helps to relieve pain by reducing the inflammation. While some patients attain pain relief with a single injection, others may require multiple injections over a period of time.

Facet-sacroiliac joint injections also are prescribed to alleviate pain. The facet joints connect and stabilize the vertebrae, guiding and restricting movement of the spine. The sacroiliac joint, also known as the SI joint, connects the sacrum (the triangular bone at the bottom of the spine) to the pelvis. The steroid relieves pain by reducing the inflammation.

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.

Side effects and complications

Possible complications include a small chance of infection or bleeding.

If the fluid space around the nerve in the spine is inadvertently entered during an epidural steroid injection, you may have a small chance of a post-procedure headache.

Occasionally, patients may describe pain in the area where the needle was placed, transient headaches or leg weakness.

Any of those symptoms should disappear within a few hours. If symptoms persist, please contact our office for further assistance.

Follow-up care

You will be advised to avoid strenuous activities for a certain time following the procedure. Do not drive until at least the next day.

Patient preparation

Discogram/Facet Cyst Aspirations

When you schedule your appointment, we will inform you about any specific preparations depending upon the specific procedure your doctor has ordered. Please contact the Scheduling Department at 949.764-5573 if you have any questions.

Please arrive 1 1/2 hours prior to procedure time. Preparation includes: Nothing to eat or drink after midnight or 6 hours prior to procedure except necessary medications with just enough water to swallow medication. You will be monitored for 4 to 6 hours after the procedure. You will need to have a driver to drive you home.

Do not take any medications for pain or inflammation or anything that would mask your symptoms the day of your procedure since this exam will help determine which level or levels of the spine are generating the symptoms

Beginning several days before the procedure, you will need to discontinue certain medications.

  • If you are taking Plavix, Coumadin, Warfarin or Pradaxa, must stop 5-7 days prior to your procedure but you MUST check with prescribing physician first before stopping to see if you doctor has an alternative medication or instructions for you.
  • If you are taking Aspirin, Naprosyn, Ecotrin, Ibuprofen, Advil, Motrin, Aleve, Naproxen or Celebrex on a regular basis, we ask you to stop 5-7 days before your exam procedure but you MUST check with prescribing physician first before stopping to see if you doctor has an alternative medication or instructions for you.
  • If you take Lovenox, you must stop 12 hours before your procedure.
  • Stop taking fish oil, flax seed oil, vitamin E, 5 days prior to your procedure.

Spinal Epidural Steroid Injection, Nerve Root Blocks and Facet Blocks

When you schedule your appointment, we will inform you about any specific preparations depending upon the specific procedure your doctor has ordered.Please contact the Scheduling Department at 949.764-5573 if you have any questions.

Please arrive one hour prior to your procedure. Two hours prior to your procedure, drink clear fluids only. You must have a driver to drive you home.

Do not take any medications for pain or inflammation or anything that would mask your symptoms the day of your procedure since this exam will help determine which level or levels of the spine are generating the symptoms

Beginning several days before the procedure, you will need to discontinue certain medications.

  • If you are taking Plavix, Coumadin, Warfarin or Pradaxa, must stop 5-7 days prior to your procedure but you MUST check with prescribing physician first before stopping to see if you doctor has an alternative medication or instructions for you.
  • If you are taking Aspirin, Naprosyn, Ecotrin, Ibuprofen, Advil, Motrin, Aleve, Naproxen or Celebrex on a regular basis, we ask you to stop 5-7 days before your exam procedure but you MUST check with prescribing physician first before stopping to see if you doctor has an alternative medication or instructions for you.
  • If you take Lovenox, you must stop 12 hours before your procedure.
  • Stop taking fish oil, flax seed oil, vitamin E, 5 days prior to your procedure.

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.

How to Prepare

When you schedule your appointment, we will inform you about any specific preparations depending upon the specific procedure your doctor has ordered. Please contact the Scheduling Department at 949.764-5573 if you have any questions.

Side effects and Complications

Any procedure that involves piercing the skin introduces risk of infection or bleeding. All of these procedures are performed under sterile techniques to reduce the chance of an infection. The slight possibility of a lung collapse also exists. The radiologist and nursing staff will closely observe you following the procedure, monitor for possible complications, and administer treatment as necessary.

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.

Side effects and complications

UFE is a very safe method for treating symptomatic fibroids and, like other minimally invasive procedures, has advantages over conventional open surgery. However, there are some associated risks, as there are with any medical procedure. A small number of patients have experienced infection, which usually can be controlled by antibiotics. Injuries to the blood vessels through which the embolization is performed can occur and will rarely need surgical repair or result in an ineffective embolization. There also is chance of injury to the uterus, potentially leading to a hysterectomy. There is a small chance the fibroids can re-grow after UAE and a small number of women undergoing UAE will require more than 1 treatment for maximum effect. Overall complication rates are simliar to hysterectomy and myomectomy but complications tend to be less severe. You should discuss complications of any medical procedure with your doctor prior your procedure or surgery.

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.

How to prepare

When you schedule your appointment, we will inform you about any specific preparations depending upon the specific procedure your doctor has ordered. Please contact the Scheduling Department at 949.764-5573 if you have any questions.

You may not eat or drink anything 8 hours prior to your procedure. Certain blood-thinning medications, including aspirin, may need to be discontinued for a period of days before your procedure. Your physician will give you more specific instructions.

Side effects and complications

Possible complications include infection, bleeding, pain, numbness or tingling. Paralysis is an extremely rare complication. The inventionalist will discuss all of these possibilities with you and will answer any questions before you schedule a vertebroplasty.

Follow-up care

You can expect to feel some soreness at the point of the needle insertion for two to three days. Ice or heat can help alleviate that discomfort. Bed rest is recommended for the 24-hour period following the procedure.