Patient Care

Arterial intervention is a procedure that uses a catheter to diagnose and treat blockages or narrowing in the arteries, with the goal of improving blood flow and preventing tissue damage.

Fistulography, Thrombectomy, Angioplasty, Stent Placement

Dialysis is a critical medical procedure that filters blood in patients with kidney failure. This filtration process is primarily accomplished through an arteriovenous fistula (AVF) or graft, surgically created in the patient’s arm and connected to a dialysis machine that draws blood from the access site.

An arteriovenous fistula is a surgically created connection between an artery and vein, typically located in the arm. Alternatively, a graft consists of a synthetic fabric tube surgically connected between an artery and vein. Both AVFs and grafts require robust blood flow to facilitate effective dialysis.

These vascular access sites may develop complications over time. Common issues include stenosis (a focal narrowing within the adjacent blood vessels) or thrombosis (blood clot formation) that can obstruct blood flow and compromise dialysis treatment. When dysfunction occurs, diagnostic ultrasound imaging may be performed to identify the underlying cause.

An Interventional Radiologist can treat stenosis or thrombosis through a minimally invasive procedure called fistulography. During this procedure, the physician:

1. Administers local anesthetic (lidocaine) at the access site
2. Inserts a specialized catheter into the fistula or graft
3. Injects contrast material through the catheter to visualize and diagnose the specific problem
4. Implements appropriate treatment:
   • For thrombosis: administers thrombolytic medications or employs mechanical thrombectomy devices
   • For stenosis: performs balloon angioplasty to dilate the narrowed vessel

Upon completion, the catheter is removed, and the insertion site is closed with a single suture. Following successful intervention, patients can typically resume dialysis treatment immediately.

Enteral feeding interventions are medical procedures that deliver nutrition directly into a patient’s gastrointestinal tract through a feeding tube, bypassing the mouth. This is used when a person cannot eat normally due to conditions like stroke, head injury, or severe illness; this commonly includes placing a nasogastric (NG) tube through the nose into the stomach, or a gastrostomy (G-tube) surgically inserted directly into the stomach wall for long-term feeding access.

Fluid aspiration and drainage is an image-guided procedure that uses a needle to remove excess fluid collecting within the body, with the option to leave a small tube (catheter) in place to allow for continuous drainage, if needed.

Percutaneous Nephrostomy, Percutaneous Nephroureteral Stent Placement

A percutaneous nephrostomy (PCN) is a medical procedure in which a specialized catheter is inserted through the skin directly into the kidney to facilitate urinary drainage when the normal pathway is obstructed. The diverted urine is collected in an external collection system.

Urinary obstruction can occur at various points within the urinary system and may result from several underlying conditions, including:

1. Urolithiasis (kidney or ureteral stones)
2. Fibrotic scarring secondary to infection or previous surgical intervention
3. Malignant processes

If left untreated, urinary obstruction can lead to significant complications, including renal dysfunction and severe infection. Therefore, prompt intervention is essential.

The PCN procedure is performed with the patient in prone position. Under sterile conditions, the interventional radiologist uses a combination of ultrasound imaging and fluoroscopic guidance to precisely identify the optimal access route to the kidney. Following administration of local anesthetic, a specialized needle is advanced through the patient’s posterior approach into the renal collecting system. Subsequently, a nephrostomy catheter is positioned to establish external urinary drainage.

The duration of nephrostomy tube placement may be temporary or permanent, depending on the underlying pathology and the patient’s overall clinical condition. Regular monitoring and maintenance of the nephrostomy tube are essential components of ongoing patient care.

A nephroureteral stent placement is an advanced medical device consisting of a specialized catheter that traverses from an external point of entry through the kidney, extending down the ureter and terminating in the bladder. This therapeutic intervention facilitates proper urinary drainage, either into the bladder or externally via a collection system, thereby preventing pathological urine accumulation within the renal collecting system.

This interventional procedure is indicated in patients with ureteral obstruction, which impedes the natural flow of urine from the kidney to the bladder. Common etiologies of ureteral obstruction include:

• Urolithiasis
• Post-surgical or post-inflammatory strictures
• Malignant processes

Without intervention, urinary obstruction can result in significant complications, including renal impairment and severe infectious processes.

The procedure is performed under moderate sedation with the patient in prone position. Using a combination of ultrasound imaging and real-time fluoroscopic guidance, the interventional radiologist:

1. Identifies the optimal renal access route
2. Administers local anesthetic
3. Advances a specialized needle through a posterior approach into the renal collecting system
4. Guides a wire through the obstructed ureter into the bladder
5. Places the nephroureteral stent over the wire to establish patency

The long-term management of these patients may involve several options:

• Complete removal of the nephroureteral stent
• Exchange for an internal ureteral stent
• Permanent placement with periodic exchanges

Management decisions are based on the underlying pathology, response to treatment, and overall clinical context of the individual patient.

Hepatobiliary interventions are minimally invasive procedures that treat diseases of the liver, gallbladder, and bile ducts. They are used to diagnose and treat conditions such as blockages, inflammation, and tumors.

An inferior vena cava (IVC) filter is a small, metal device that prevents blood clots from traveling to the lungs. It’s inserted into the inferior vena cava, a large vein in the abdomen, carrying blood from the lower body up to the heart.

Interventional endoscopy is a minimally invasive procedure that combines imaging and technology to diagnose and treat conditions in the gastrointestinal (GI) tract. It’s performed by guiding a flexible tube through the mouth or anus to access the GI tract.

Lymphatic interventions are procedures that treat lymphatic system abnormalities, such as leaks and fluid accumulation. These procedures involve imaging the lymphatic system and injecting embolization agents to seal abnormal vessels.

Men’s health interventions are non-surgical procedures that use imaging to diagnose and treat urological and reproductive issues in men.

Oncologic interventions are image-guided procedures that deliver treatment to the site of the cancer. These rely primarily on embolization or ablation to destroy tumors in targeted areas.

Pain and palliative interventions refer to the various medical approaches used within palliative care to manage and alleviate pain experienced by patients with serious or life-limiting illnesses.

Pediatric radiology interventions (PIR) are minimally invasive procedures that use imaging to treat children with a variety of illnesses.

Portal hypertension and mesenteric interventions are procedures used to treat portal hypertension, a condition where high blood pressure exists in the portal vein, by performing interventions on the mesenteric veins, often involving techniques like angioplasty, stenting, or thrombolysis to relieve pressure and manage complications, like bleeding varices associated with liver cirrhosis

Pulmonary interventions are procedures that diagnose and treat lung and chest conditions. They are minimally invasive and performed by bronchoscope, a long, thin tube inserted into the airways.

Spinal and vertebral interventions are procedures that diagnose and treat conditions affecting the spine and vertebrae, including receiving injections.

Vascular malformations are rare conditions that occur when blood vessels develop abnormally. They can affect veins, arteries, capillaries, and lymphatic vessels.

Venous access is an intervention that allows access to a patient’s bloodstream through their veins. It’s used to administer fluids, medications, and blood products, and to collect blood samples.

Venous interventions are minimally invasive procedures that treat blocked or narrowed veins. They’re used to treat a variety of conditions, including varicose veins, deep vein thrombosis (DVT), and chronic venous insufficiency (CVI).

Venous sampling is an interventional procedure that involves taking blood samples from a vein to analyze for certain substances. It can help identify diseases in organs and tissues and can provide information about how well organs are functioning.

Women’s health interventions are minimally invasive procedures used to diagnose and treat conditions that affect women. Interventional radiology has become increasingly important in women’s health, especially in the treatment of uterine fibroids, pelvic venous disease, and adenomyosis.