Using Imaging Equipment to Perform Procedures

A subspecialty of radiology, interventional radiology uses imaging equipment to perform minimally invasive procedures for both diagnostic and treatment purposes.

Interventional radiology can:

  • Treat blockages inside arteries and veins
  • Block off blood vessels that nourish tumors
  • Destroy malignant tumors using focused heat and freezing
  • Drain blocked organ systems such as the liver, gallbladder and kidney
  • Perform biopsies that would otherwise require surgical exploration

Some of the conditions treated, and procedures used for diagnostic and treatment purposes, include:

Arterial Venous Shunt

Before kidney dialysis treatments can begin, doctors need to create a site where blood can flow both in an out of the patient’s body. By inserting a small tube (shunt) into a blood vessel, called an arterial venous shunt, they create an artificial connection between a vein and an artery.

Sometimes the shunt becomes narrowed or blocked, making it difficult for blood flow. When that happens, interventional radiologists can correct this problem using an ultrasound machine and a small needle. They first inject dye into the shunt and then watch an X-ray image on a screen to see if there is a narrowing in either the shunt or the veins.

If narrowing is found, then venoplasty is performed. This procedure is similar to an angioplasty in which a small balloon is inflated and deflated several times to clear the vein of the obstruction.

Critical Limb Ischemia

Critical limb ischemia is a serious form of peripheral arterial disease (PAD) characterized by severe blockage in the arteries of the lower extremities that can significantly reduce blood-flow. Such poor blood flow can cause severe pain in the legs and feet when a person is not moving or lead to non-healing sores on the feet or legs. Left untreated, critical limb ischemia could make it necessary to amputate the affected limb.

The most common signs of critical limb ischemia include:

  • Pain or numbness in the feet
  • Shiny, smooth, dry skin of the legs or feet
  • Thickening of the toenails
  • Absent or diminished pulse in the legs or feet
  • Open sores, skin infections or ulcers that will not heal
  • Dry gangrene (dry, black skin) of the legs or feet

Most patients have multiple arterial blockages, including blockages of the arteries below the knee. To access the arteries, physicians at the Texoma Medical Center use minimally invasive procedures to help restore oxygenated blood flow to the affected areas of skin. This involved inserting a catheter, under local anesthesia, into the groin to access the diseased portion of the artery.

Various tools and techniques can be used to clear the artery or bypass the artery:

  • Angioplasty: An interventional radiology technique in which a tiny balloon is inserted through the catheter. When the balloon reaches the site of the blockage, it is inflated and deflated to open the artery.
  • Cutting balloon: A balloon with micro-blades is used to cut the surface of the plaque, improving blood flow.
  • Cold balloon (CryoPlasty): A balloon is inflated using nitrous oxide to freeze the plaque.
  • Stents: Different types of metal stents may be inserted into the artery through the catheter and left in place to provide support to vessel walls.
  • Laser atherectomy: The tip of a laser probe is used to vaporize small bits of plaque.
  • Directional rotational atherectomy: A catheter with a rotating cutting blade is used to remove plaque from the artery.

Recovery from these procedures usually takes one or two days, and most of these procedures are done on an outpatient basis.

In some cases, a bypass graft may be performed. This surgical procedure uses either an artificial tube or a vein from the patient’s body as a new artery to bring improved blood flow to the needed area, bypassing the spot where blood flow is constricted. In some cases, surgeons may open the artery and scrape the plaque out to restore the artery to usable condition. Hospitalization after a bypass operation varies from a few days to more than a week. Recovery from surgery may take several weeks.

Fallopian Tube Recanalization

Blocked fallopian tubes can be a cause of infertility for many females. Fallopian tube recanalization can help remove mucus or debris that is blocking one or both fallopian tubes. If the procedure is successful, the estimated rates of conception is approximately 33 percent.

During the 30-minute procedure, interventional radiologists pass a catheter into the cervix to the fallopian tube and the blockage is cleared. Contrast dye is then injected to ensure that there is no leak from the fallopian tube.

Women who have active uterine bleeding, active pelvic infections, have had recent surgery or are currently pregnant are not candidates for this procedure. Because the fallopian tubes are used during ovulation, physicians recommend that this procedure be performed between days six and 11 of the menstrual cycle, which is after a women’s period, but prior to ovulation.

For a small number of patients, the fallopian tubes become re-blocked (occluded) and they require an additional procedure six to 12 months later.

Inferior Vena Cava (IVC) Filter

The Inferior Vena Cava (IVC) is the large vein that carries deoxygenated blood from the lower body to the heart. Doctors may place a filter into the IVC to capture blood clots that move from a patient’s legs to the lungs causing breathing problems. Filters are often placed in a patient’s IVC prior to surgery and are removable.

Interventional radiologists can insert the IVC filter into the patient through a large vein at the top of the leg. A catheter is placed into the IVC and contrast dye injected to identify the proper location for the filter. The filter is then put in place through the catheter and expanded in place.

Placement of an IVC filter is an almost painless procedure. Most patients go home the same day, and can return to their normal activities the next day.

Interventional Oncology

Interventional radiologists often work with oncologists to perform the following minimally invasive procedures using imaging equipment to treat many cancer patients.

Y-90 Therapy

Selective internal radiation therapy (SIRT) or radioembolization, commonly referred to as Y-90 therapy, is an advanced and minimally invasive treatment option for liver cancer. Using precise imaging guidance, radioactive isotope yttrium90 (Y-90) particles deliver radiation directly to tumors through a catheter. This approach allows interventional radiologists to effectively target tumors that are otherwise inaccessible through traditional surgeries or radiation therapies.

Needle Biopsy

Many cancers are now diagnosed by a needle biopsy. During this procedure, interventional radiologists use imaging techniques, such as CT, X-ray, ultrasound or MRI, to remove a small amount of tissue from a tumor to determine if cancer cells are present. An alternative to conventional surgical biopsy procedures, needle biopsies can be less painful and result in a shorter recovery times.

Relief of Obstructions

Interventional radiologists use imaging techniques to determine where cancers have obstructed the normal flow of urine or bile. Such obstructions can cause pain, infection or even liver or kidney failure.

While watching images on a screen, doctors insert a catheter into the obstructed area to drain excess fluids. A stent might also be inserted into the organ to bypass the obstruction and permit fluids to drain normally.

Pelvic Congestion Syndrome

Chronic pelvic pain can be attributed to a variety of causes, but for some women it may be caused by varicose veins in the pelvic region, a condition known as pelvic congestion syndrome.

As with varicose veins in the legs, varicose veins in the pelvis develop when valves in the veins become weak and don't close properly. This allows blood to flow backwards and pool in the vein, causing bulging and pain.

Symptoms

Women with pelvic congestion syndrome typically feel pain while standing but not when they are lying down. This can make diagnosis difficult because women are usually asked to lie down for a pelvic exam, relieving the painful pressure that brought them to the doctor in the first place. Other symptoms include:

  • A dull, aching pain in the lower abdomen and lower back that comes after intercourse, during their menstrual cycles, after standing and during pregnancy
  • Related signs include an irritable bladder, abnormal menstrual bleeding, vaginal discharge or visible varicose veins on the vulva, buttocks or thighs

Doctors can diagnose pelvic congestion syndrome with the following tests:

  • Pelvic venography:  Interventional radiologists perform a venogram by injecting dye into the veins of the pelvic organs to make them more visible during an X-ray. Patients are examined on an incline because the veins being examined often decrease in size when a woman is lying flat.
  • MRI: Images that provide a detailed view of specific pelvic blood vessels can be used to diagnose this condition.
  • Pelvic and/or transvaginal ultrasound: Provides views of the pelvic cavity and veins (not effective unless the woman is standing for the test).

Treatment often consists of closing off varicose veins in the pelvic area during an outpatient procedure. Although pain is reduced, the veins never return to normal, and in some cases, other pelvic veins may also be affected and may require additional treatment.

Spine Treatments: Vertebroplasty

Vertebroplasty may offer hope for patients who have severe back pain caused by a compression fracture due to osteoporosis or metastatic disease of the spine. If left untreated, a compression fracture can lead to an abnormal spine curvature.

Vertebroplasty offers another option for patients who do not respond to conservative treatments (pain medications, bed rest and bracing) and those who are not good candidates for major spine surgery.

In general, vertebroplasty is recommended for those with a fairly recent fracture (six months or less). Performed by interventional radiologists with the assistance of an X-ray image on a monitor, vertebroplasty is typically done as an outpatient procedure with local anesthetic. Acrylic bone cement is placed into the fractured vertebrae through a small incision. The cement stabilizes the vertebra resulting in significant pain reduction as soon as 24 hours.