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Vascular Interventional Radiology
Vascular Interventional radiology is a medical specialty which provides minimally invasive image-guided diagnosis and treatment of disease. Although the range of procedures performed by interventional radiologists is broad, the unifying concept behind these procedures is the application of image guidance and minimally invasive techniques in order to minimize risk to the patient.

Procedures
Interventional radiologists commonly perform both diagnostic and therapeutic procedures, although diagnostic angiography is becoming less common as the quality and reliability of CT and MRI angiography has allowed for alternative forms of non invasive evaluation.

Diagnostic
  • 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.
  • Cholangiography : Imaging the bile ducts within the liver to look for areas of blockage.
  • Biopsy : Taking of a tissue sample from the area of interest for pathological examination from a percutaneous or transvenous approach.
Therapeutic
Vascular
  • Balloon angioplasty/stent : Opening of narrow or blocked blood vessels using a balloon, with or without placement of metallic stents to aid in keeping vessel patent.

  • Cather embolization is the technique of deliberately
    occluding a blood vessel to obtain a therapeutic effect
  • Endovascular aneurysm repair : Placement of endovascular stent-graft across an aneurysm, in order to prevent expansion or progression of the defective vessel.
  • Embolization : Placement of a metallic coil or embolic substance (gel-foam, poly-vinyl alcohol) to block blood flowing through to a blood vessel, either to stop bleeding or decrease blood flow to a target organ or tissue.
    • Uterine artery embolization (UAE) or uterine fibroid embolization (UFE)
  • Thrombolysis : Catheter-directed technique for dissolving blood clots, such as pulmonary embolism, deep venous thrombosis with either pharmaceutical (TPA) or mechanical means.
  • IVC filters : Metallic filters placed in the vena cava to prevent propagation of deep venous thrombus.
  • Dialysis related interventions: Placement of tunneled hemodialysis catheters, peritoneal dialysis catheters, and revision/thrombolysis of poorly functioning surgically placed AV fistulas and grafts.
  • TIPS: Placement of a Trans-jugular Intra-hepatic Porto-systemic Shunt (TIPS) for select indications in patients with critical end-stage liver disease and portal hypertension.
  • Endovenous laser treatment of varicose veins: Placement of thin laser fiber in varicose veins for non-surgical treatment of venous insufficiency.
Biliary Intervention
  • Placement of catheters in the biliary system to bypass biliary obstructions and decompress the biliary system.
  • Placement of permanent in-dwelling biliary stents.
  • Cholecystostomy: Placement of a tube in 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.
Catheter placement
  • Central venous catheter placement: Vascular access and management of intravenous devices (IVs), including both tunneled and non-tunneled catheters (e.g. PIC, Hickman, port catheters, hemodialysis catheters, translumbar and transhepatic venous lines).
  • Drainage catheter placement: Placement of tubes to drain pathologic fluid collections (e.g., abscess, pleural effusion). This may be achieved by percutaneous, trans-rectal, or trans-vaginal approach. Exchange or repositioning of indwelling catheters is achieved over a guidewire under image guidance.
  • Radiologically inserted gastrostomy or jejunostomy : Placement of a feeding tube percutaneously into the stomach and/or jejunum.

  • small tubes called catheters can be navigated to just about any blood
    vessel in the body and specialized agents delivered precisely to obtain results.
Ablative
  • Chemo-embolization: combined injection of chemotherapy and embolic agents into the arterial blood supply of a tumor, with the goal of both local administration of chemotherapy, slowing "washout" of the chemotherapy drug, and also decreasing tumor arterial supply.
  • Radio embolization: combined injection of radioactive glass or plastic beads and embolic agents into the arterial blood supply of a tumor, with the goal of both local administration of radiotherapy, slowing "washout" of the radioactive substance, and also decreasing tumor arterial supply.
  • Radio frequency ablation (RF/RFA): local treatment which uses a special catheter to destroy tissue by using heat generated by medium frequency alternating currents.
  • Cryoablation: local treatment which uses a special catheter to destroy tissue by using cold temperature generated by rapid expansion of compressed argon gas. This technique is mostly used for the treatment of small renal cancers and for the palliation of painful bone lesions.
  • Microwave ablation: local treatment which uses a special catheter to destroy tissue by using heat generated by microwaves.
Genito-urinary
  • Percutaneous nephrostomy or nephroureteral stent placement: Placement of a catheter through the skin, directly into the kidney in order to drain from the collecting system. This is typically done to treat a downstream obstruction of urine.
  • Ureteral stent exchange: indwelling double-J type ureteral stents, typically placed by urologist using cystoscopy, may be exchanged in retrograde fashion through the female urethra. The IR uses a thin wire snare under fluoroscopy to capture the distal portion of the stent. After partially extracting the distalmost stent, exchange for a new stent can be accomplished over a guidewire.
Pain management
  • Vertebroplasty: Percutaneous injection of biocompatible bone cement inside a fractured spinal vertebrae in order to restore vertebral body height and relieve pain.
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