Vascular Interventional Procedures


Interventional 1
Interventional 2
Interventional 3

Angiography


Angiography is  imaging of the blood vessels (arteries or veins). This common procedure is performed by the specially trained radiologist and its purpose is to look for any vascular abnormality such as aneurysms, arteriosclerotic disease or to evaluate vascular supply to tumors. Sometimes the study is done to evaluate normal anatomy in the setting of pre surgical planning or organ transplant.

Patient Q & A
What will happen?

After the hospital admission, you will be brought to the Interventional Radiology Suite where the radiologist and radiographer will explain the procedure and answer your questions. The study usually takes 60 to 90 minutes. After completion, you will be monitored overnight for possible complications. Some patients may be discharged after 6 hours of observation.

Do I need any test before the procedure?

You will be asked to have following blood tests:

Urea & electrolytes – to assess if your kidneys will tolerate contrast.

PI/PTT/Platelets – to assess the risk of post procedural bleeding.

You should discuss any allergy history (particularly to Iodine) with the radiologist prior to booking an angiogram.

The angiography procedure:

You will have a drip placed in the arm for vascular access. No sedation is usually required. Under ultrasound guidance and local anaesthetic, a small incision will be made in your groin and a small soft tube (catheter) will be introduced into the vessel. In rare occasions the radiologist may decide to puncture the artery in your arm. Once the tube is in desired place, Iodinated contrast (X ray dye) will be injected through it in order to explore and image the necessary vessels. The puncture site in the groin will be compressed for 10-15 minutes to control bleeding.

What will I feel? Does it hurt?

You will feel a bee sting when the doctor numbs the entry site. When contrast is administered, you may have a warm sensation for 2-3 seconds. Except for communicating with the doctor, most patients are unaware that the procedure is taking place.

What are the risks?

Bleeding at the puncture site happens seldom and is usually minimal. Delayed bleeding is very uncommon but is the major reason for post procedural observation.

Cold, numb, painful limb due to   punctured   artery   blockage happens   extremely   rarely require emergency operation to reopen the vessel.

Allergic reaction to X ray contrast is also very rare (moderate to serious reactions occur in 1/50.000 – 150.000 people). You should mention any allergy history to the radiologist in order to organize appropriate anti-allergic regime.

When will I get my results?

The radiologist will be able to talk to you after the procedure, but all the relevant details will only be available at your official appointment with referring doctor.

When will I resume my normal activities?

If no complications occur, you will be able to get back to your normal activity the next day. It is advisable not to lift any heavy object for a few days and to take showers instead of a bath.

Embolization


Embolization is an interventional vascular procedure used to block abnormal artery or vein; it is achieved by placing the thin plastic tube (angiographic catheter) selectively into the vessel and administering appropriate embolization material. Embolization is much less invasive than open surgery with fewer complications and shorter hospital stay.

Patient Q & A
Why do I need embolization?

Most commonly it is used to control or prevent abnormal bleeding. A typical example is in the setting of trauma where there has been a major vascular injury with active bleeding (embolization for trauma).

It can be used to control haemoptysis — severe bleeding from your lungs (bronchial embolization) or from your intestines (embolization for intestinal bleed)

The other indication include tumor embolization or uterine fibroid embolization

whose purpose is to shrink the tumor and allows easier operative treatment or even in the latter case it represents a reasonable alternative to surgery.

Testicular vein embolization is a recognized treatment for male infertility.

What will happen?

Testicular embolization is done on an outpatient basis; for any other indication, you will have to beadmitted. You will be brought to the Interventional Radiology Suite where the interventionalradiologist (a doctor specially trained in that procedure) and radiographer will explain the procedureand answer your questions. The length of the procedure is usually 60 to 90 minutes but may take much longer depending on the vascular anatomy. After completion, you will be either monitored in the radiology department for 2-3 hours or be transferred to your ward.

Do I need any test before the procedure?

You will be asked to have following blood tests:

Urea & electrolytes — to assess if your kidneys will tolerate contrast. Pl/PTT/Platelets — to assess the risk of post procedural bleeding. You should discuss any allergy history (particularly to Iodine) with the radiologist prior to booking the procedure.

The embolization procedure

The procedure starts as general angiography.Under the X-ray guidance the doctor will pass a guide-wire into the vessel of interest and over it, advance a

catheter. After injection of contrast (X-ray dye), a series of X-rays will be taken to determine the best position for the delivery of embolization material. The doctor will decide whether to use temporary agent like gelatin sponge, or the permanent one (Polyvinyl alcoholarticles, embospheres, liquid glue or various coils made of stainless steel or platinum). Injection ofcontrast (X-ray dye) will confirm that the bleeding or the blood flow into tumor has stopped.

What are the risks?

Similar to diagnostic angiography.

Additional risks are specific to the type of the procedure.

What will I feel? Does it hurt?

During the catheter placement similar to angiography.

You may experience some pain during first 24 hours after the procedure; it is easily controlled by peroral or IV painkillers.

Post-embolization syndrome sometimes occurs after tumor embolization; it consists of high fever, general body weakness, nausea and vomiting. It usually does not last more than 48-72 hours.

When will I get my results?

In most cases the radiologist will be able to discuss the results with you and your family immediately after the procedure and advice if the procedure was a technical success.

When will I resume my normal activities?

This will depend on several factors — particularly how you tolerated the procedure and if any otherintervention or operation is needed. The radiologist and attending physician/surgeon will discuss theoptions with you.

Angioplasty/Vascular stent


Angioplasty is insertion of balloon catheter into a narrowed blood vessel. The balloon is inflated for a few seconds dilating the vessel and restoring the blood flow.

a vascular stent is sometimes after dilatation, the blood flow is still inadequate and metallic prosthesis needs to be inserted into the vessel in order to keep it open. These procedures are performed by the specially trained radiologist or vascular surgeon who will discuss the options with you.

Patient Q & A
What will happen?

After the hospital admission, you will be brought to the Interventional Radiology Suite where the radiologist and radiographer will explain the procedure and answer your questions. The study usually takes 60 to 90 minutes but may take much longer depending on the severity of vascular disease. After completion, you will be monitored overnight for possible complications.

Do I need any test before the procedure?

You will be asked to have following blood tests:

Urea & electrolytes — to assess if your kidneys will tolerate contrast. PI/FIT/Platelets — to assess the risk of post procedural bleeding. You should discuss any allergy history (particularly to Iodine) with the radiologist prior to booking an angiogram.

The angioplasty procedure

The procedure starts as general angiography.

Under the X-ray guidance the doctor will pass a guide-wire through the narrowed vessel and over itadvance a balloon catheter. Using a special device the balloon will be inflated for a few seconds in order to open the vessel. To prevent clot formation, Heparin (blood thinner) will be administered directly through the catheter. If the vessel does not open enough, the doctor will insert a stent (metallic prosthesis) to get satisfactory blood flow.

What will I feel? Does it hurt?

You may feel slight pressure while the balloon is inflated; otherwise same as for generalangiographyWhat are the additional risks?

Bleeding at the puncture site may happen because we use big catheter and Heparin in your blooddelays clotting process. Despite this it is uncommon and most often minor. Close post-interventional observation is extremely important. Post procedural instruction chart will be presented to the nursing staff in the ward and you will also be instructed how to monitor the site of puncture.

Immediate post angioplasty blockage of the dilated vessel happens extremely rare but maynecessitate emergency operation.

The other complications are the same as for general angiography

When will I get my results?

In most cases the radiologist will be able to discuss the results with you and your family immediately after the procedure

When will I resume my normal activities?

If no complications occur, you will be able to get back to your normal activity the next day. You may even be encouraged to increase the level of your activities in order to maintain good blood flow and facilitate healing process. It is still advisable not to lift any heavy object for a few days and to take showers instead of a bath. The doctor will be in position to give you the advice appropriate for yourhealth condition.

Dialysis Shunt Interventions


Arterio-venous shunt is a surgically created connection between the artery and vein – most often in your forearm or upper arm. It provides easy access for procedure called hemodyalysis in people whose kidneys have failed.

Patient Q & A
Why do I need a dialysis arterial venous shunt study?

Occasionally the shunt becomes narrowed or blocked, making dialysis more difficult or impossible. The narrowing may also occur anywhere in the veins between the arm and the heart. The study is performed in order to assess the connection and to intervene by means of angioplastyor stenting if necessary.

What will happen?

Hospital admission is not a prerogative for the procedure but this may depend on your general health condition. You will be brought to the Interventional Radiology Suite where the interventional radiologist (a doctor specially trained in these procedures) and radiographer will explain the procedure and answer your questions. The study usually takes about 60-90 minutes but may take longer if there are multiple narrowings. After completion, you will be monitored for 1 hour for possible complications.

Do I need any blood results?

You will be asked to have Pl/PTT/platelets in order to assess the risk of bleeding

We need to give you contrast (X-ray dye), so you should discuss any allergy history (particularly to Iodine) with the radiologist prior to booking a procedure.

Procedure

No sedation is usually required. The shunt area will be cleaned with sterile soap and ultrasoundmachine will be used to locate the shunt. Under local anesthetic, a tiny incision will be made in your arm and a small soft tube (catheter) will be introduced into the shunt. Contrast injection will show ifthere is any significant narrowing or blockage.

The radiologist will decide if it is necessary to performangioplasty or stenting to correct the narrowing and the intervention will follow in the same setting. Upon completion, the tube will be removed and special stitches will be applied to prevent the bleeding. If the shunt is completely clotted, the radiologist may decide to mechanically evacuate thrombus or to perform thrombolysis. In the latter case you will need to stay in Intensive Care Unit for the close monitoring.

Does it hurt?

You will feel a bee sting when the doctor numbs the entry site. Most patients feel mild discomfort during the inflation of angioplasty balloon.

What are the risks?

The risk of infection is very low but we may need to give you antibiotics if the procedure lasts longer than anticipated.

The risk of bleeding during the procedure is minimal and is simply treated by elevation of your arm. The other complications are similar as for general angiography.

When will I get my results?

The radiologist will be able to talk to you immediately after the procedure.

When will I resume my normal activities?

In most cases, you will be able to get back to your normal activity the next day. You should avoid any extensive physical activities and particularly it is advisable not to lift any heavy object.

PICC Line


A Peripherally Inserted Central Catheter is a thin soft plastic tube, placed through the vein in your arm and guided into a large vein above your heart (Superior Vena Cava) where blood flows quickly. 
Patient Q & A
Why do I need a PICC line?

Through it you can get fluids to hydrate you and give you nutrition, blood transfusion and medicines, like chemotherapy or antibiotics. A PICC line can be used to get blood test without another needle stick. It can be cared for at home and can stay in place for many weeks or months, if needed.

What will happen?

You will be brought the Interventional Radiology Suite where the radiologist and radiographer will explain the procedure and answer your questions. The study usually takes about 60-90 minutes. After completion, you will be monitored for 1hour for possible complications..

Do I need any blood results?

In some cases we may need to give you contrast (X-ray dye), so you should discuss any allergy history (particularly to Iodine) with the radiologist prior to booking a procedure.

The PICC line placement

No sedation is usually required. Under ultrasound guidance and local anesthetic, a tiny incision will be made in your arm and a small soft tube (catheter) will be introduced into the vein. Using X-rays, it will be positioned in the desired place above your heart. The line will be secured by stitches and the insertion site will be covered by sterile bandage.

Does it hurt?

You will feel a bee sting when the doctor numbs the entry site. Most patients feel little or no discomfort during the procedure.

What are the risks?

The possibility of bleeding or damage of your vein is minimized by the used of ultrasound guidance. Irregular heartbeat, meaning that the tube was put too far into the heart, is avoided by the X-ray guidance. However the catheter can move out of the best position if you cough, move a lot or have severe vomiting. In this case it may need to be removed or repositioned.

Very rarely, a piece of catheter may break off and travel into the bloodstream. The line can get clotted, but this can usually be cleared.

The risk of infection is very low.

When will I get my results?

The radiologist will be able to talk to you after the procedure.

When will I resume my normal activities?

In most cases, you will be able to get back to your normal activity the next day. You should avoid any extensive physical activities and particularly it is advisable not to lift

Catheter Directed Thrombolysis


Thombolysis is a treatment aimed at dissolving blood clots and restoring the blood flow through the blocked vessel; it is achieved by placing the thin plastic tube (angiographic catheter) into or close to the clot.
Patient Q & A
What will happen?

After the hospital admission (often directly to ICU), you will be brought to the Interventional Radiology Suite where the interventional radiologist (a doctor specially trained in that procedure) and radiographer will explain the procedure and answer your questions. The study usually takes 60 to 90 minutes but may take much longer depending on the severity of vascular disease. After completion, you will be transferred to ICU for the treatment and brought back to Radiology Suite forfollow-up — usually after 18-24 hours.

Do I need any test before the procedure?

You will be asked to have following blood tests:

Urea & electrolytes — to assess if your kidneys will tolerate contrast. PI/FIT/Platelets — to assess the risk of post procedural bleeding.You should discuss any allergy history (particularly to Iodine) with the radiologist prior to booking the procedure.

The catheter placement procedure

The procedure starts as general angiography.

Under the X-ray guidance the doctor will pass a guide-wire into the clotted vessel and over it, advance a catheter into the best position for the infusion of thrombolytic agent. The catheter will be secured and connected to a special machine, which will deliver medication at precise rate (prescribed by the vascular surgeon). You will then be transferred to ICU and specially trained nurse will monitor infusion as well as your vital signs. Duration of treatment will depend on the maturity of clot but is usually not longer than 48 hours. You will have at least one control angiography through the catheter after which the radiologist and vascular surgeon will decide if your vessel will need any additional treatment (angioplasty or stenting).

Does it hurt?

During the catheter placement similar to angiography

Clot dissolving process is sometimes followed by moderate pain, which is easily controlled by per oral or IV painkillers

What are the additional risks?

Whenever thrombolytic agent is used, there is a risk of bleeding somewhere else in your body — often happening at the site of tube insertion. The most serious complication is bleeding in your brain. The other complications are the same as for general angiography.

When will I get my results?

In most cases the radiologist will be able to discuss the results with you and your family immediately after the procedure

When will I resume my normal activities?

This will depend on several factors — particularly how you tolerated the infusion and if any other intervention or operation is needed. The radiologist and attending surgeon will discuss the options with you.

Vena Cava Filter


A Vena Cava filter is a metallic device, which is positioned in the main abdominal vein (inferior vena cava) in order to mechanically prevent passage of blood clots from your legs or pelvis towards your lungs.
Patient Q & A
Why do I need a filter?

Blood clots that develop in the veins of your legs or pelvis may break up and large pieces can travel to the lungs causing so-called pulmonary thrombo-embolism. It may result in severe damage of the lungs, pressure on your heart and even death. The purpose of the filter is to trap large fragments and prevent them from travelling to the lungs. The filter will be retrieved when your doctors decide that there is no more danger of clot propagation.

What will happen?

The procedure can be done on an outpatient basis. However, in most cases, venous thrombosis is a complex health condition, which necessitates hospitalization. You will be brought to the Interventional Radiology Suite where the interventional radiologist (a doctor specially trained in these procedures) and radiographer will explain the procedure and answer your questions. The intervention usually takes about 60 minutes. After completion, you will be monitored for 2-3 hours for possible complications or if admitted, transferred to your ward.

Do I need any blood results?

We will need to give you contrast (X-ray dye), so you should discuss any allergy history (particularly to Iodine) with the radiologist prior to booking a procedure.

You will need to have your U&E checked to assess if your kidneys can handle the contrast.

The vena cava filter placement

The procedure is similar to general angiographv.

No sedation is usually required. Under ultrasound guidance and local anesthetic, a tiny incision will be made in your groin or neck and a small soft tube (catheter) will be introduced into the vein. Contrast (X-ray dye) will be injected and series of X-rays will demonstrate inferior vena cava and identify the best spot for the filter placement. Filter delivery system will be advanced to that level and the filter will be deployed.

The procedure of filter retrieval is practically identical.

What will I feel? Does it hurt?

You will feel a bee sting when the doctor numbs the entry site. You may feel slight pressure when the delivery device is inserted in your vein, but most patients feel little or no discomfort during the procedure.

What are the risks?

The possibility of bleeding or damage of your vein is minimized by the used of ultrasound guidance.

The chance that the filter may break loose and dislodge into the heart or lung is minimal and is avoided by the careful assessment of the size of inferior vena cava and most appropriate lending zone. Follow up abdominal radiograph in 24 hours time will confirm that the filter is stable.

Very seldom, the filter may get clogged with clots resulting in swelling of the legs.

The risk of infection is very low.

When will I get my results?

The radiologist will be able to talk to you after the procedure.

When will I resume my normal activities?

This will depend on your general health condition and the interventional radiologist and your attending physician will give you proper advice.

When will the filter be removed?

It will also depend on your general condition and particularly on the results of the treatment of legs or pelvic clots. Newly manufactured filters can stay in your vein for a couple of months. Sometimes the your doctors may decide that it is unsafe to remove it, in which case it will be converted into a permanent one.