Interventional

Interventional radiology uses images (x-ray, fluoroscopy, ultrasound or CT) to target treatments. Treatments are minimally invasive, reducing the need for open surgery, thus reducing the time you need to stay in hospital. Your scan is carried out by an interventional radiologist. He or she uses catheters and small instruments which are often fed through blood vessels to treat areas in other places of the body.

Types of Interventional Radiology

Angioplasty

An angioplasty is a treatment that is designed to widen a narrowed artery, with the aim of relieving your symptoms. It is performed using a special X-ray machine for guidance, which shows pictures of your arteries as you lie on the X-ray table.

Angiography

An angiography is a minimally invasive medical test that helps diagnose and treat medical conditions of the vessels. Physicians use this procedure to identify abnormalities, such as aneurysms, detect atherosclerotic disease that has narrowed the arteries to the legs and to evaluate obstructions of vessels.

Angiography may eliminate the need for surgery. It presents a very detailed, clear and accurate picture of your blood vessels. This is especially helpful when a surgical procedure.

Unlike CT or MR Angiography, the use of a catheter makes it possible to combine diagnosis and treatment in a single procedure. For example, if an area of severe arterial narrowing is identified, an angioplasty or placement of a stent may be performed right away.

EVAR

EVAR (Endovascular aneurysm repair) is a minimally invasive “keyhole” surgery to repair an aneurysm, typically located in the aorta of your belly. It is performed through a small hole in your groin, which is much different than that of traditional surgical techniques. It is performed in the radiology (x-ray) department by an interventional radiologist and a vascular surgeon. With EVAR, the aneurysm is repaired using a special stent graft (endograft). It is a small, fabric-wrapped, flexible mesh tube that is used to “patch” the enlarged section of the vessel. It does so by being placed inside the artery, which strengthens it and prevents it from bursting.

Nephrostomy Tube Placement / Removal

Normally, urine drains from your kidneys through a narrow tube called the ureter into your bladder. If this is obstructed and the passage is hindered, a nephrostomy tube might help you. It helps to relieve a build-up of urine in the kidney and prevents the kidney from being damaged.

This procedure is done in the radiology department, where a catheter is put directly into your kidney through the skin of your back. The urine will be drained into a bag. This is usually not a permanent solution and the removal of the tube is also performed in the radiology department. You receive a local anaesthetic, so that the location of the catheter insertion is pain free.

Arterial Stenting

During angioplasty, a small wire mesh tube called a stent may be permanently placed in the newly opened artery or vein to help it remain open. There are two types of stents: bare stents (wire mesh) and covered stents (also commonly called stent grafts).

Vascular stenting is commonly used to treat conditions that involve a narrowing or blockage of arteries or veins throughout the body

Ureteric Stenting

Ureteric stents are placed when there is an obstruction in the urinary drainage tract, and the urine cannot be transported to the bladder. An obstruction may cause pressure behind the kidney, which, in turn, causes the kidney’s function to suffer.

A ureteric stent is a specially designed hollow tube made of flexible plastic that is placed in the ureter. There are different lengths, and the one most appropriate for you will be chosen by the radiologist.

Ureteric stents make a channel for the urine to pass and allows the kidneys to drain.

Risks

The following investigations involve exposure to x-rays. X-rays consist of a type of radiation known as ionising radiation. The doses that are used in medical x-rays are very low and the associated risks are minimal. We keep the doses as low as possible and make sure that the benefits of having the x-ray outweigh any risk.

Furthermore, the contrast dye that is used contains iodine, which some people are allergic to. If you have had an allergic reaction to x-ray contrast in the past of if you have a known allergy to iodine, please let us know. The contrast dye can affect kidney function, but a pre-procedure blood test will be performed to assess your kidneys’ function.

As vascular interventional procedures need access to your vessels, bleeding or bruising can occur under the skin. This is very common, but takes one to two weeks to disappear. Occasionally, the artery can be damaged during the procedure. As with all skin-piercing procedures, wound infections are possible.

Although the risks of developing complications from having a nephrostomy is low, there are a few possible complications that you must be aware about, including infection, bleeding or leaking of urine within the abdomen. You will, however, be monitored very closely, so that if any problems may arise, it will be picked up and treated straight away.

It might be that for ureteric stenting the stent cannot be placed properly in the ureter. If this happens, a surgeon will arrange another method of overcoming the blockage. Occasionally there may be infection in the kidney or the space around it. This generally can be satisfactorily treated with antibiotics.

What to Expect

Angioplasty – During the examination the skin around your groin will be cleaned and then numbed with a local anaesthetic. A small tube is then inserted into the artery in your groin. This allows X-ray dye (contrast agent) to be injected while a series of X-ray pictures are taken. This colourless dye may cause a warm sensation throughout your lower body – this is quite normal.

We also use the tube as a passageway for a smaller tube and a balloon which are used to widen the artery. The tube is removed and pressure is applied to your groin for several minutes to prevent bruising.

The procedure takes about half an hour in total.

You will need to be on bed rest for 3-4 hours after the procedure.

Angiography – During the examination the skin around your groin will be cleaned and then numbed with a local anaesthetic. A small tube is then inserted into the artery in your groin. This allows X-ray dye (contrast agent) to be injected while a series of X-ray pictures are taken. This colourless dye may cause a warm sensation throughout your lower body – this is quite normal.

We also use the tube as a passageway for a smaller tube and a balloon which are used to widen the artery. The tube is removed and pressure is applied to your groin for several minutes to prevent bruising.

The procedure takes about half an hour in total.

EVAR – You will be given an epidural and a sedative, which is medication to help you relax. You will, however, be awake during the procedure. If you need more sedative, you will have a cannula in your arm and the medication will be injected through that.

In the procedure room, you will lie on your back on the x-ray table. The groin area will be cleaned with antiseptic fluid, and there will be a sterile drape over most of your body. You will be given a local anaesthetic in your groin area, which might sting at first, but will settle almost immediately.

Once numbed, an incision is made, a tube (sheath) will be placed in the artery to keep it open, and a catheter will be inserted into the artery located there. This catheter will be pushed through your arterial system until it gets to the aneurysm. Contrast dye is used to visualise your arteries and will be administered using the catheter. The stent will be placed on the end of the catheter and directed to the location of the aneurysm, using the catheter as a guide-wire for correct placement. The stent is opened, and the aneurysm is sealed. Following that, the catheter is removed, the incision in the groin is closed and the procedure is finished.

Nephrostomy – You will be given an epidural and a sedative, which is medication to help you relax. You will, however, be awake during the procedure. If you need more sedative, you will have a cannula in your arm in case. In the procedure room, you will lie on your stomach on the x-ray table.

Monitoring equipment will be hooked up and you may be given some sedation at this point in time.

The radiologist and nurse will wear sterile gowns and gloves, and your back will be then covered with sterile towels. A small area of skin on your back will be left bare, but will be cleaned with antiseptic, which may be a bit cold.

The radiologist will use x-rays to identify the kidney and to determine where the best place is to put in the tube. You will receive some local anaesthetic (which may sting a bit, but lessens quickly), and a fine needle will access the kidney.

A small guide wire and a small plastic tube will be inserted, and once the tube is in place, the guide wire is removed. The tube will be secured to the skin and a drainage bag will be attached to the catheter.

Typically, this procedure does not hurt, but if you do experience some pain, there will be a nurse of another member of staff who monitors you.

Arterial Stenting –You will be positioned on the examining table and will be connected to monitors that track your heart rate, blood pressure and pulse during the procedure.

A radiographer will place a cannula into a vein in your hand or arm so that sedative medication can be given intravenously. Moderate sedation may be used.

The area of your body where the catheter is to be inserted will be shaved, sterilized and covered with a surgical drape. The area will be numbed with a local anaesthetic. Once numbed, a very small skin incision is made at the site.

A sheath is first inserted into the artery. Guided by x-rays, the catheter is then inserted through the skin and manoeuvred through the artery until it reaches the site of the blockage. Once the catheter is in place, contrast dye will be injected and images will be taken of the blocked artery to help identify the site of the blockage.

With x-ray guidance, a guide wire will then be moved to the site. A stent, which is a small, flexible tube made of plastic or wire mesh to support the damaged artery walls may be placed.

At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.

Uteric Stenting – On the ward, a cannula will be placed in your arm and you will receive some antibiotics. You may also receive some mild sedation at this time.

You will be brought into the suite and will be positioned on the examination table on your stomach. The radiology team will be dressed in sterile gowns and gloves, and will proceed to put sterile towels over your back.

The radiologist will use the x-ray equipment to decide where it is best to insert the stent. Once located, you will receive a local anaesthetic, which may sting, but this will pass quite quickly.

A guide-wire will be inserted into the kidney, and the hollow stent will be threaded onto the wire and put in place. Once the radiologist is satisfied with the positioning of the stent, the guide-wire will be removed.

The urine should then be able to pass down the stent and into the bladder.

The procedure can take anywhere from 20 to 90 minutes, but we typically tell our patients to expect that the procedure will take about 60 minutes.

Afterwards

Interventional radiology uses images (x-ray, fluoroscopy, ultrasound or CT) to target treatments. Treatments are minimally invasive, reducing the need for open surgery, thus reducing the time you need to stay in hospital. Your scan is carried out by an interventional radiologist. He or she uses catheters and small instruments which are often fed through blood vessels to treat areas in other places of the body.

Angioplasty –Some slight bruising of your groin may occur and your groin may ache for a day or two after the angioplasty. If you experience excessive pain or swelling when you return home, please contact your GP.

Patients who have undergone an angioplasty will be reviewed in the Angioplasty Clinic after approximately six weeks. In most cases, once the scan is completed, you will go back to the ward.

You can eat and drink straight away, but a few hours of bed rest (typically 3-4 hours) is necessary. Typically, we prefer that our patients do not shower for at least 24 hours and do not drive or do any form of strenuous exercise for 48 hours after the procedure.

Angiography – Some slight bruising of your groin may occur and your groin may ache for a day or two after the angioplasty. If you experience excessive pain or swelling when you return home, please contact your GP.

Patients who have undergone an angioplasty will be reviewed in the Angioplasty Clinic after approximately six weeks. In most cases, once the scan is completed, you will go back to the ward.

You can eat and drink straight away, but a few hours of bed rest (typically 3-4 hours) is necessary. Typically, we prefer that our patients do not shower for at least 24 hours and do not drive or do any form of strenuous exercise for 48 hours after the procedure.

EVAR –Some slight bruising of your groin may occur and your groin may ache for a day or two after the procedure. If you experience excessive pain or swelling when you return home, please contact your GP.

You can eat and drink straight away, but bed rest will be necessary. Typically, we prefer that our patients do not shower for at least 24 hours and do not drive or do any form of strenuous exercise for 48 hours after the procedure.

Nephrostomy –You will be taken back to the ward on a trolley and the nurses will monitor your vital signs on a regular basis to make sure that you are feeling well. You may need to stay in bed for a short while until your vital signs are stable.

You can eat and drink straight away.

The nurses on the ward will teach you how to care for your tube and how to empty the bag.

Should you go home within 24 hours after the procedure, we highly recommend that you find someone to drive you home or that you take a taxi.

Once home, rest quietly for a day or two. Lie on the settee, prop your feet up and try to relax a little. Drink plenty of fluids.

Arterial Stenting – After the exam, you can eat and drink straight away, but a few hours of bed rest (typically 3-4 hours) is necessary. Typically, we prefer that our patients do not shower for at least 24 hours and do not drive or do any form of strenuous exercise for 48 hours after the procedure.

Uteric Stenting – You might experience some slight burning with urination or pass a small amount of blood following the procedure. There may also be a sense of needing to urinate even after the bladder is emptied, but that is normal. This feeling is likely due to the stent irritating the bladder, and if this is bothersome to you, ask your doctor for assistance.

You can eat and drink straight away. It is important to remember that the ureteric stent is not permanent and must be removed or changed in the future.