Interventional Radiology (Special Procedures)

Interventional Radiology (IR) is a subspecialty of radiology encompassing procedures performed using imaging guidance such as fluoroscopy, CT, ultrasound and MRI to diagnose and treat a wide variety of conditions. Because diagnostic imaging and interventional techniques can eliminate the need for more invasive and costly exploratory surgery, these special procedures help reduce patient recovery time, with results that are equal or superior to those experienced through more invasive procedures. Interventional radiologists use their expertise in reading x-rays, ultrasounds and other medical images to guide small instruments such as catheters (tubes that measure just a few millimeters in diameter) through the blood vessels or other pathways to treat disease percutaneously (through the skin).

Who performs interventional procedures?

Interventional radiologists are physicians who are specially trained to diagnose and treat conditions using miniaturized tools, while guiding their progress on x-ray or other imaging equipment. Interventional radiology treatments are generally easier for the patient than surgery because they involve no surgical incisions, less risk, less pain and shorter hospital stays. Your interventional radiologist will work closely with your primary care physician or gynecologist to be sure you receive the best possible care. Midland Memorial Radiology has several radiologists trained in interventional radiology. All our physicians are board certified by the American Board of Radiology and recognized with a Certificate of Added Qualifications in Interventional Radiology. All interventional procedures are performed at Midland Memorial Hospital's main campus, home of our state-of-the-art vascular lab.

What types of procedures are considered interventional?

Angiography
Angiography is a diagnostic study used to obtain images of blood vessels in various parts of the body including the heart, brain, and kidneys to determine whether the vessels are diseased, narrowed, enlarged or occluded.

Angioplasty
Angioplasty is a procedure used to open blocked or narrowed blood vessels by inserting a very small balloon into the vessel and inflating it. This technique is used to unblock clogged arteries in the legs or arms (called peripheral vascular disease or PVD), kidneys (called portal hypertension), brain or elsewhere in the body.

Endovenous Laser Treatment (EVLT)
This minimally invasive treatment is an outpatient procedure performed using imaging guidance. After applying local anesthetic to the vein, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the vein and guides it up the great saphenous vein of the thigh. Then the laser energy is applied to the inside of the vein, which heats and seals the vein closed.

Varicose veins are a common condition, affecting one in two people age 50 or older, and about 15 percent of men and 25 percent of women overall. Risk factors include age, family history, female gender and pregnancy. Although many people think of varicose veins as a cosmetic condition, they are a common medical condition that can cause aching pain, night cramps, easy leg fatigue and leg heaviness, all of which worsen as a typical day progresses.

Benefits of vein ablation treatment

  • The treatment takes less than an hour and provides immediate relief of symptoms
  • Immediate return to normal activity with little or no pain. There may be minor soreness or bruising, which can be treated with over-the-counter pain relievers.
  • No scaring, because the procedure does not require a surgical incision, just a nick in the skin, about the size of a pencil tip.
  • High success rate and low recurrence rate compared to surgery.
  • The success rate for vein ablation ranges from 93 to 95 percent.

Stent
A stent is a small flexible tube made of plastic or wire mesh, used to treat a variety of medical conditions (e.g., to hold open clogged blood vessels or other pathways that have been narrowed or blocked by tumors or obstructions).

Aortic endograft and stent-grafts
An aortic endograft or stent-graft is a relatively new, non-surgical alternative to surgery that reinforces a ruptured or ballooning section of an artery, (an aneurysm) with a flexible fabric-wrapped mesh tube used to patch the blood vessel. An aortic aneurysm is a weak area in the aorta, the main blood vessel that carries blood from the heart to the rest of the body. As blood flows through the aorta, the weak area bulges like a balloon and can burst if the balloon gets too big.

Aortic aneurysm endograft stent
Abdominal aortic aneurysm (AAA) occurs in five to seven percent of the people in the United States. Males are at least four times more likely to have AAA than females and this condition accounts for nearly 15,000 deaths each year, making it the thirteenth leading cause of death in the U.S.

Chemoembolization
Chemoembolization is defined as the delivery of cancer-fighting agents directly to the site of the cancer tumor. Chemoembolization is used mostly to treat cancers of the endocrine system, including melanoma and liver cancers.

Embolization
Embolization is the delivery of clotting agents (coils, plastic particles, gel-foam, etc.) directly to an area that is bleeding or to block blood flow to a problem area, such as an aneurysm or a fibroid tumor in the uterus.

Needle biopsy
An alternative to surgical biopsy, a needle biopsy is used to identify the cause of a lump, mass or other abnormal condition in the body. Using one of several imaging techniques, a needle is inserted into the abnormal area and a tissue sample is removed to be studied by a pathologist for evaluation.

Thrombolysis
Thrombolysis is a technique used to dissolve blood clots by injecting a drug directly at the site of the clots. Thrombolytic drugs - sometimes called clot busters dissolve the clot and restore blood flow. Usually, the drugs are administered through a catheter directly into the clot. These drugs are frequently combined with another treatment such as angioplasty. Thrombolysis is frequently used to treat Peripheral Vascular Disease (PVD).

UFE (Uterine Fibroid Embolization)
Uterine fibroid embolization is a new therapy for the treatment of symptomatic uterine fibroids. This procedure is an alternative to hysterectomy and has a very high success rate. It is a minimally invasive procedure, requiring only a tiny nick in the skin. It is performed while the patient is conscious but sedated - drowsy and feeling no pain. The interventional radiologist makes a small nick in the skin (less than ¼ of an inch) in the groin and inserts a catheter into an artery. The catheter is guided through the artery to the uterus while the radiologist guides the progress of the procedure using a moving x-ray (fluoroscopy). The interventional radiologist injects tiny plastic particles the size of grains of sand into the artery that is supplying blood to the fibroid tumor. This cuts off the blood flow and causes the tumor, or tumors, to shrink.

The catheter is inserted through a tiny nick in the skin into an artery and advanced to the uterus. Tiny particles pass through the catheter and wedge in the small vessels, blocking the blood flow to the fibroid.

What are uterine fibroids?
Uterine fibroids are non-cancerous (benign) growths that develop in the muscular wall of the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding.

Fibroids can be located in various parts of the uterus, causing different symptoms.

There are three primary types of uterine fibroids:

  • Subserosal fibroids develop in the outer portion of the uterus and expand outward. They typically do not affect a woman's menstrual flow, but can become uncomfortable because of their size and the pressure they cause.
  • Intramural fibroids develop within the uterine wall and expand, making the uterus feel larger than normal. These are the most common uterine fibroids and they can cause heavier menstrual flows, pelvic pain and pressure.
  • Submucosal fibroids develop deep within the uterus, just under the lining of the uterine cavity. These are the least common fibroids, but they often cause symptoms, including very heavy and prolonged menstrual cycles.

What are the benefits of UFE?

  • Shorter hospital stay
  • UFE: < one day
  • Hysterectomy: 2-3 days
  • Return to work faster
  • UFE: 5-7 days
  • Hysterectomy: 30-40 days
  • Fewer complications (after 30 days)
  • UFE: 12.7%
  • Hysterectomy: 32%

Kyphoplasty
Kyphoplasty is a minimally invasive procedure used in the treatment of painful vertebral compression fractures commonly associated with osteoporosis. To stabilize broken bones of the spine, a needle is inserted into the vertebrae and a balloon is inflated attempting to raise the collapsed vertebra and return it to its normal position. Once the vertebra is in the correct position, the balloon is deflated and removed. This process creates a space within the vertebral body. The space functions as a container for the bone cement. The space is then filled with bone cement to stabilize the fracture. The cement forms an internal cast that holds the vertebra in place.

Balloon kyphoplasty provides significant improvement in the quality of life to patients suffering from spinal fractures due to osteoporosis.

How do I prepare for the procedure and what can I expect?

Most interventional procedures will require some preparation though instructions will vary depending on the type of procedure to be performed. When your healthcare provider schedules your appointment, you will be given specific instructions to follow. In most cases, you will need to be accompanied and arrange for transportation following the procedure. In some cases, an overnight stay in the hospital may be required.

How will I know the results of the procedure?

Following your exam, the interventional radiologist will analyze and interpret the images from your exam and prepare a full report. This report will be sent directly to your physician who will share the results with you. To request a copy of the report, you may contact your physician's office or Midland Memorial Hospital's Medical Records Department (432) 221-1600.

How do I schedule an appointment?

When your physician orders an interventional radiology procedure on you, the physician's office will contact the Interventional Radiology Department and make the arrangements.

What do I need to bring with me the day of the exam?

You will need to bring the order your physician gave you, a form of personal identification and any insurance or Medicare information. If you are taking any medications, please print and complete the second page of the Pocket Medication Card and bring the list with you. Please do not bring the medications. This will help expedite your visit and reduce the possibility of losing any of your medications.

To learn more, please call (432) 221-1580.