Definitions of Services and Procedures Performed by IR
Ambulatory Phlebectomy: Ambulatory phlebotomy is a procedure that is used to treat varicose veins that are just under the surface of the skin. This procedure uses micro-incisions to remove the vein which not only improves cosmetic appearance but also improves symptoms.
Angioplasty: An angioplasty is a procedure that uses x-ray guidance and a balloon catheter to open a blocked or narrowed blood vessel. By opening a blocked or narrowed blood vessel, blood flow will improve. A catheter will be inserted that will have a balloon over it which is inflated to open the blockage. Occasionally, these balloons will be coated with a chemotherapy agent, or drug-eluding balloons. Sometimes a stent may need to be placed if there is recoil of the blood vessel after the angioplasty.
Atherectomy: An atherectomy is done by inserting a catheter with a small blade on the end into an artery through a small incision. The small blade is used to scrape away the plaque within the artery. The plaque is collected within a small chamber at the end of the catheter where it can be easily removed from the artery. There are a couple of types of atherectomies including directional and rotational. Typically, we perform rotational atherectomies. We perform a directional atherectomy when we are able to identify exactly where the plaque is sitting using an inter-vascular ultrasound.
Arterial Stent Placement: An arterial stent placement, is a self-expanding, mesh metal tube that is placed in a coronary artery. These are sometimes placed after an angioplasty to prevent the artery from closing back up. We will occasionally use balloon-expanding covered stents because they can be stronger than their metal counterparts.
Central Venous Catheter Placement: Central venous catheter placement is a procedure where a catheter is placed into the vein using both ultrasound and realtime X-rays (fluroscopy). There are many different types of catheters that have different purposes. Central venous catheters can be used to deliver medications such as antibiotics or chemotherapy or be used for dialysis.
Cryoablation: Cryoablation is a process that destroys masses or tumors through a process of freezing these areas. The mass or tumor is located with a CT or ultrasound imaging. A thin needle is then inserted through the skin into the mass. This needle is pumped with an incredibly cold gas which freezes and kills cells in the mass or tumor.
Dialysis Catheter Placement: Dialysis is a medical treatment of exchanging and filtering blood for an individual when kidneys fail to function properly. A dialysis catheter is inserted by a radiologist into a major vein for the purpose of removing blood out of one side of the catheter, filtering it through a dialysis machine and pumping clean blood in through the other side. This can be either a temporary or a more permanent catheter.
Embolization: Embolization refers to the procedure in which medical materials or devices are placed into a blood vessel to temporarily or permanently stop bleeding. This can be used to treat fibroids, pelvic veins, enlarged prostate, varicoceles, and other conditions.
Endovenous Thermal Ablation: Endovenous thermal ablation is a procedure that is used to treat varicose vein disease. An ultrasound is used to place a specialized laser inside of a diseased vein. The energy from the laser causes the vein to close. Overtime, the vein will shrink and be absorbed.
Fistulogram:A fistulogram uses fluoroscopy, a real-time x-ray using x-ray dye, that checks for any abnormalities within the blood flow that may interfere with other medical treatments. It produces images of any abnormal passage within the body called a fistula. Fistulas routinely have narrowings that reduce flow rates during dialysis. Fistulograms are necessary to detect any blockages that may interfere with dialysis treatments. These may lead the doctor to perform an angioplasty sometimes with a stent at the end. Many times, routine surveillance is needed for patients with recurring problems, which can be managed by Interventional Radiologists and Nephrologists.
Gastro-Jejunsotomy Tube Placement: A gastro-jejunostomy (G-J) tube is similar to the gastronomy tube as it extends through the stomach, but the distal tip is in the small bowel. These catheters are placed in patients who have difficulty emptying their stomach or demonstrate gastroesophageal reflux disease (GERD). These have both a stomach port and a small bowel port for feeding or draining the stomach as needed. The process of placing a G-J tube is the same as placing a gastronomy tube except for the distal tip location. The tube may need to be exchanged for proper function as needed.
Gastrostomy Tube Placement: A gastrostomy tube is placed through the anterior abdominal wall into the stomach, allowing an individual to be fed and given medications. The procedure is done by placing a small, thin catheter through the mouth or nose into the stomach. The stomach is then inflated with air which can be viewed through x-ray. An ultrasound is used to confirm that there are no solid organs blocking access into the stomach. When this is confirmed, 2 sutures are placed in the stomach to secure the stomach to the anterior abdominal wall. Then, a small incision is made, access is gained into the stomach and the tube is inserted. A balloon on the tube inflates it to secure it to the abdominal with a disc device. The tube need to be exchanged for proper function as needed.
Image Guided Biopsy: An image guided biopsy involves the use of technology as guidance, either an ultrasound or CT scan, to help the collection of samples of tissue. The imaging allows the doctor to more accurately determine the exact location of the tissue that needs to be sampled and whether it is benign, malignant, or infectious. The imaging also allows the doctor to safely insert needles. Through image guided biopsies, doctors are able to sample major organs such as the liver, kidneys, and thyroid.
Inferior Vena Cava Filter Placement and Removal:
Placement - An inferior vena cava filter is a small filtration device inserted by an Interventional Radiologist that prevents blood clots from reaching the lungs, which causes a pulmonary embolism. The inferior vena cava (IVC) is the vein that is largely responsible for returning oxygen-deficient blood from the lower body to the heart. The filter is placed by running a catheter up the IVC directed by image guidance technology. When the catheter releases the filter, it expands and attaches itself to the walls of the IVC.
Removal-lWhen the risk of a pulmonary embolism has passed, an IVC filter may be removed. This is done by running a catheter through the IVC to reach the filter. Once the catheter reaches the filter, the catheter grabs the IVC filter and both the filter and catheter are removed from the body.
Joint Injections: Joint injections are performed to treat pain and obtain a diagnosis in joints such as the hips, knees, or shoulders. Joint injections are guided using x-ray imaging, and the medications are administered directly into the joint. A contrast dye is used to improve the precision of the injection.
Jejunostomy Tube Placement: A jejunostomy tube is a thin, plastic tube inserted directly into small intestine through a small incision in the abdomen. This is used to deliver food and medicine directly into the small intestine. This tube is placed in the same manor as the gastrostomy tube. Jejunostomy tubes are placed when patients had a prior significant stomach surgery or have blockages that don't allow for access into the stomach including hiatal hernias. The tube may need to be exchanged for proper function as needed.
Kyphoplasty: A kyphoplasty involves injecting a special cement into the vertebrae. This is used to treat fractures in the spine. A needle is inserted then a balloon-like device inside the needle is inflated to create space in the vertebrae that the cement will fill.
Lumbar Puncture: A lumbar puncture, also known as a spinal tap, is when a needle is inserted between two lumbar vertebrae to remove a small amount of cerebrospinal fluid. Cerebrospinal fluid is the fluid that surrounds your spinal cord and brain to protect them from injuries. Lumbar punctures are done to help diagnose several serious infections, cancers of the spinal cord or brain, and other disorders of the central nervous system. Occasionally lumbar punctures into the cerebrospinal fluid are used to inject chemotherapy medications.
Mediport Placement: A mediport is a small, round device that is placed beneath the skin in the upper chest. The port device attaches to a catheter that connects to a blood vessel. Providers will be able to deliver medicine, blood products, nutrients, or fluids into the bloodstream through the mediport.
Microwave Ablation: Microwave Ablation (MWA) uses a CT scan to guide a small needle or probe to the mass or tumor in question. When the needle is inserted into the mass, it sends out microwaves that heat and eliminate areas of the tumor.
Nasal-Jejuno Tube Placement: Nasal-jejuno tubes are placed into the stomach or small bowel either through the nose, mouth, or directly through the abdomen.
Nephrostomy Tube Placement: Nephrostomy tube placement is done to drain urine from one or both of the kidneys. This procedure is normally done to establish a collecting system during cancers, infections or kidney stones.
Placement: The radiologist will use an ultrasound or fluoroscopy to locate the area of the kidney that the tube will be placed. A needle is used to gain access to the collecting system and a tube is placed over a wire after access is obtained. The tube is secured with a disc with one end of the tube in the kidney and the other end attached to a bag to collect the urine.
Removal: A nephrostomy tube can be removed at any time. If it it must remain attached, catheters are cleaned on unique-to-patient intervals. To remove a nephrostomy tube, the doctor injects the site with an anesthetic to numb the area. The doctor will then remove the tube and appropriately place a bandage over the access point.
Ovarian Vein Embolization: During this procedure, Interventional Radiologists use an image-guided catheter to close the faulty veins that are causing pain and swelling.
Paracentesis: Paracentesis is a procedure to remove access fluid from one's abdomen. A needle is used to collect a small sample of fluid to test for disease, cancer or infection. While the drained fluid can be tested, it is more commonly used to evacuate fluid due to pain or discomfort. The fluid will be drained by attaching a tube to the needle and draining the fluid into a container. During this procedure, the patient is awake but a local anesthetic is applied to the area where the needle will be inserted.
Prostatic Artery Embolization: During this procedure, Interventional Radiologists use an image-guided catheter to deliver small beads into the arteries surrounding the prostate,. These small beads help reduce blood flow which shrinks the prostate and relieves painful symptoms.
Radiofrequency Ablation: Radiofrequency ablation (RFA) uses a CT scan to guide a small needle or probe to the mass, bone or tumor in question. When the probe is inserted into the mass, a radiofrequency current passes through the probe, heating the mass, which destroys the cells. This type of ablation minimizes the potential for bleeding as radiofrequency waves close up blood vessels. Radiofrequency ablation also helps reduce pain.
Sclerotherapy: Sclerotherapy is a tool used to help treat varicose vein disease. An ultrasound is used to locate the diseased vein and a specialized medication is injected into the vein. This causes the vein to close and shrink over time.
Suprapubic Catheter Placement: A suprapubic catheter is a hollow flexible tube that is used to drain urine into a bag. The tube is placed directly into the bladder, slightly below the belly button. This procedure provides more comfort than a regular catheter because of the placement not being through the urethra. To place this catheter, an ultrasound is used for guidance and an X-ray with contrast dye is used to better visualize the urinary bladder when inserting the needle for confirmation. Once the catheter is in place in the bladder, a small balloon on the catheter secures it from falling out.
Tenotomy: A tenotomy is a procedure for a chronically damaged or scarred tendon, known as chronic tendonitis. Conditions that result from chronic tendonitis include plantar fasciitis and tennis elbow. An ultrasound is used to find the tendon that is causing pain. A specialized tool is then placed into the tendon which stimulates healing and reduces pain. Most patients only need a single treatment to drastically reduce or eliminate pain and can return to normal activity in as little as 6 weeks.
Thoracentesis: Thoracentesis is a procedure that takes place for the purpose of removing fluid from the pleural space that surrounds the lungs. It is performed by inserting a needle in between the thin, double-layered membrane that protects the lung and the inner chest wall to drain the excess fluid in that area. There is usually a small amount of fluid within the double-layer membrane, but when there is excess fluid, the individual will begin to experience chest pain, shortness of breath or discomfort. This can be used to diagnose many conditions including heart and liver disease, cancers, and various fungal, viral or bacterial infections.
Thrombectomy: A thrombectomy is a procedure to remove a blood clot from a vein or artery. During this procedure, the doctor will insert a thin catheter into the leg or groin through a small puncture site. The catheter is guided to the blood clot utilizing a contrast dye to locate the blood clot location. A device at the end of the catheter breaks up the blood clot. A thrombectomy in an outpatient setting will take between 2 and 3 hours to complete.
Thrombolysis: Thrombolysis is a catheter-directed procedure that treats blood clots within the arteries or veins and improves blood flow by dissolving abnormal blood clots. X-Ray imaging is used for guidance. A blood clot, also known as a thrombus, can block off blood supply to certain parts of the body, which may cause serious damage. Using the x-ray and a catheter, the doctor is able to direct a special medication or medical device to dissolve the blockage, remove it, or prevent the artery or vein from becoming permanently blocked. Due to the medications used, this procedure may require a longer, overnight stay in the hospital. An overnight stay will also allow doctors to determine the initial cause of the blood clot.
Tunneled Catheters: Tunneled catheters offer patients who experience recurring fluid build-up the ability to drain fluid on a regular schedule from home to avoid repeated hospital visits.
Tunneled Pleural Catheter: A tunneled pleural catheter is used to drain fluid from around the patient's lungs.
Tunneled Peritoneal Catheter: A tunneled peritoneal catheter is used to drain fluid from the patient's abdomen.
Ureteral Stent Placement/Removal: Ureters are the tubes that connect the bladder and the kidneys. A ureteral stent is a tiny plastic tube that is inserted into the ureters to open them up when there is a blockage or constriction in the ureters.
Placement: Placement of a ureteral stent is guided by an imaging tube that is inserted through the urethra into the ureters. A second tube is passed through the imaging tube to release a dye that helps the radiologists identify the the problem areas in the kidney and ureters. Once the radiologist knows where to place the stent, a wire with the stent on the end is passed through the imaging tube and secured in the ureters with on end of the stent secured in the kidneys and the other end secured in the bladder.
Removal: Occasionally, ureteral stents are placed with a string on the end to allow for removal. If this is not the case, the radiologist will insert an imaging tube through the urethra to locate the stent, and use small clasps to secure and remove the stent.
Uterine Fibroid Embolization: Uterine fibroid embolization is performed using a real time x-ray, a fluoroscopy, as guidance and a catheter. This allows the doctor to deliver agents to the uterus and fibroids to treat tumors of the uterus. The agents will block arteries that provide blood to the fibroids, causing them to shrink.
Varicocele Embolization: Varicocele embolization is a procedure that uses imaging guidance and a catheter. Tiny coils and/or a liquid substance will be placed in a blood vessel to divert blood flow away from the varicocele. This allows for treatment of an enlarged vein in a male patient’s scrotum.
Venous Stent Placement: A venous stent is a small, metal, mesh-like tube that is utilized when there is a blockage due to blood clots or damage to a vessel wall. Prior to a venous stent, an angioplasty is typically attempted. If there is failure of the angioplasty, the venous stent is placed. There are two types of venous stents; balloon-expandable or self-expanding. Some of these stents are bare-metal while others are covered.The appropriate type of stent will be chosen depending on the type of lesion. To insert the venous stent, the balloon placed during the angioplasty is removed and a catheter is inserted with a stent attached to the end. When the stent is placed in the appropriate location, it applies pressure to the walls of the vein to keep it open and allow for better blood flow.