Interventional Radiology

Interventional Radiology (IR) is a subspecialty of radiology in which minimally invasive procedures are performed using image guidance. Some of these procedures are done for purely diagnostic purposes (e.g., angiogram), while others are done for treatment purposes (e.g., angioplasty). Pictures (images) are used to direct these procedures, which are usually done with needles or other tiny instruments like small tubes called catheters. The images provide road maps that allow the Interventional Radiologist to guide these instruments through the body to the areas of interest.

All interventional radiology procedures involve precise placement of a needle into the body under imaging guidance. After needle placement into a solid organ, biopsies can be performed or drugs can be injected or other devices can be placed through the needle to burn or freeze tumors. If the needle is placed into a hollow structure such as a blood vessel, a bile duct, the stomach or an abscess, a wire can be advanced through the needle into the structure. A catheter (small tube) can then be advanced over the wire. The tube can then be used to drain fluid out of the structure or can be used for placement of a balloon catheter to dilate narrowing’s in ducts or blood vessels (angioplasty). This is all performed while watching the needles, wires and tubes under imaging guidance (x-rays, c.t. scan or ultrasound) on a video monitor.

Common IR procedures:

  • Angiography: imaging the blood vessels to look for abnormalities with the use of various contrast media, including iodinated contrast, gadolinium based agents, and CO2 gas.
  • Chemoembolization: delivering cancer treatment directly to a tumor through its blood supply, then using clot-inducing substances to block the artery, ensuring that the delivered chemotherapy is not "washed out" by continued blood flow.
  • Cholecystostomy: placement of a tube into the gallbladder to remove infected bile in patients with cholecystitis, an inflammation of the gallbladder, who are too frail or too sick to undergo surgery
  • Drain insertions: placement of tubes into different parts of the body to drain fluids (e.g., abscess drains to remove pus, pleural drains)
  • Embolization: blocking abnormal blood (artery) vessels (e.g., for the purpose of stopping bleeding) or organs (to stop the extra function e.g. embolization of the spleen for hypersplenism) including uterine artery embolization for percutaneous treatment of uterine fibroids. Various embolic agents are used, including alcohol, glue, metallic coils, poly-viny alcohol particles, Embospheres, encapsulated chemo-microsphere, and gelfoam.
  • Thrombolysis: treatment aimed at dissolving blood clots (e.g., pulmonary emboli, leg vein thrombi, thrombosed hemodialysis accesses) with both pharmaceutical (TPA) and mechanical means
  • Biopsy: taking of a tissue sample from the area of interest for pathological examination from a percutaneous or transjugular approach
  • Radiofrequency ablation (RF/RFA): localized destruction of tissue (e.g., tumors) by heating
  • Cryoablation: localized destruction of tissue by freezing
  • Line insertion: Vascular access and management of specialized kinds of intravenous devices (IVs) (e.g. PICC lines, Hickman lines, subcutaneous ports including translumbar and transhepatic venous lines)

    “The efficiency of everyone from scheduling, registration and the nursing staff makes it so easy for patients to have surgery at Edgewood. Flexibility, which allows my patients to have surgery when it is best for them, is so important. You couldn’t ask for more.”

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    Podiatrist

  • IVC filters: metallic filters placed in the inferior vena cavae to prevent propagation of deep venous thrombus, both temporary and permanent.
  • Vertebroplasty: percutaneous injection of biocompatible bone cement inside fractured vertebrae
  • Nephrostomy placement: Placing a catheter directly into the kidney to drain urine in situations where normal flow of urine is obstructed. NUS catheters are nephroureteral stents which are placed through the ureter and into the bladder.
  • Radiologically Inserted Gastrostomy or RIG: Placement of a feeding tube percutaneously into the stomach and/or jejunum.
  • Dialysis access and related intervention: Placement of tunneled hemodialysis catheters, peritoneal dialysis catheters, and revision/thrombolysis of poorly functioning surgically placed AV fistulas and grafts.
  • Biliary intervention: Placement of catheters in the biliary system to bypass biliary obstructions and decompress the biliary system. Also placement of permanent indwelling biliary stents.
  • Endovenous laser ablation of varicose veins: Placement of thin laser fiber in varicose veins for non-surgical treatment of venous insufficiency

Using imaging technology we are able to perform a wide range of procedures to diagnose and treat many common as well as rare disorders. Often with interventional procedures surgery can be avoided. In fact, we are able to treat some disorders for which there is no surgical alternative.