Interventional Radiology Treatments for Blocked Blood Vessels

INTERVENTIONAL RADIOLOGY PROCEDURES-
MEDICAL CONDITIONS TREATED

Angiography -- an x-ray exam of the arteries that uses a catheter to enter the artery and a contrast agent (x-ray dye) injection that makes the artery visible on the x-ray.

Balloon Angioplasty -- opens blocked or narrowed blood vessels.

Chemoembolization -- delivery of cancer-fighting agents directly to the tumor site.

Dialysis graft thrombectomy--opening clotted dialysis extremity grafts.

Needle Biopsy -- diagnostic test for breast or other cancers that is an alternative to surgical biopsy
.
Pain Management--treatment of back pain, etc with spinal injections and nerve blocks

Kyphoplasty and Vertebroplasty--treatment of painful spinal compression fractures

Ovarian Vein Embolization -- a treatment for "varicose veins" in the ovary - a cause of pelvic pain.

TIPS -- (transjugular intrahepatic portosystemic shunt) - improves blood flow for patients with severe liver dysfunction.

Vena Cava Filters -- prevents blood clots (pulmonary emboli) from reaching the lungs.

Varicocele Embolization -- a treatment for "varicose veins" in the testicles - a common cause of male infertility.

Vascular Embolization -- a technique to treat bleeding from injured blood vessels.

Fallopian Tube Catheterization -- opens blocked fallopian tubes - a common cause of female infertility.

Thrombolysis -- dissolves blood clots by the administration of medications into the clot.

Uterine--Fibroid Embolization a minimally invasive alternative to hysterectomy for uterine fibroids

Angiography
(X-ray exam of the blood vessels)

		Angiography is an X-ray exam of the arteries and veins to diagnose blockages and other blood vessel problems.
	An interventional radiologist performs this X-ray procedure, which is also called an angiogram. During the angiogram, the doctor inserts a thin tube (catheter) into the artery through a small nick in the skin about the size of the tip of a pencil. A substance called a contrast agent (X-ray dye) is injected to make the blood vessels visible on the X-ray.

One of the most common reasons for angiograms is to see if there is a blockage or narrowing in a blood vessel that may interfere with the normal flow of blood through the body. In many cases, the interventional radiologist can treat a blocked blood vessel without surgery at the same time the angiogram is performed. Interventional radiologists treat blockages with techniques called angioplasty and thrombolysis.

Some other reasons for performing an angiogram

aneurysms -- an area of a blood vessel that bulges or balloons out

cerebral vascular disease, such as stroke or bleeding in the brain

blood vessel malformations

to diagnose problems not resolved by other tests. Angiograms are sometimes used by surgeons to plan an operation or choose the best surgical procedure.

Interventional Radiology Treatments for Blocked Blood Vessels

In many cases, interventional radiologists can open blocked or narrowed blood vessels caused by peripheral arterial disease or other conditions. For example, in some patients, high blood pressure is caused by blockage to the artery to the kidney, a condition known as renal vascular hypertension. Interventional radiologists can often treat blocked blood vessals without surgery. In most cases, hospitalization and general anesthesia are not required. There is no surgical incision --just a small nick in the skin -- and no stitches are needed. Often, patients may return to normal activity shortly after the procedure.

Angioplasty In this technique, the interventional radiologist inserts a very small balloon attached to a thin tube (catheter) into a blood vessel through a small nick in the skin. The catheter is threaded under X-ray guidance to the site of the blocked artery. The balloon is inflated to open the artery.

Balloon

Sometimes, a small metal scaffold / tube, called a stent,
is inserted to hold the blood vessel open.

Stent

Thrombolytic Therapy This treatment is used if the blockage in an artery is caused by a blood clot. Thrombolytic drugs that dissolve clots are injected through a catheter to eliminate the clot and restore blood flow.

Central Venous Access Catheters (CVAC) and Gastrostomy (Feeding) Tubes

People with certain diseases or medical conditions sometimes require that tubes be placed into the body so that they can receive medications or nutrients directly into the blood stream or gastrointestinal system, or so blood can be drawn. Once, surgery was required to insert these tubes, but today these procedures can be done without surgery by an interventional radiologist.

Central Venous Access Catheters (CVAC)

A CVAC is a tube that is inserted beneath your skin so there is a simple, pain-free way for doctors or nurses to draw your blood or give you medication or nutrients. When you have a CVAC, you are spared the irritation and discomfort of repeated needlesticks. More than 3.4 million CVACs are placed each year, and doctors increasingly recommend their use. There are several types of CVACs, including tunneled catheters (Hickman or Broviac), peripherally inserted central catheters (also called PICC lines or long lines), dialysis catheters, and implantable ports.

Doctors often recommend CVACs for patients who regularly have:

Chemotherapy treatments
Infusions of antibiotics or other medications
Nutritional supplements
Hemodialysis

Interventional radiologists also open up blocked hemodialysis grafts, using procedures such as such as angioplasty or thrombolytic therapy.

Gastrostomy [Feeding] Tube

Doctors often recommend placing a gastrostomy tube in the stomach for a variety of conditions in which a patient is unable to take sufficient food by mouth. In the procedure, the feeding tube is inserted through a small nick in the skin and into the stomach under X-ray guidance.

Chronic Pelvic Pain

Many women suffer from chronic pelvic pain (also called pelvic congestion syndrome), a condition caused by varicose veins in the pelvis. Symptoms may include pelvic pain that worsens towards the end of the day or after long periods of standing, pain during or after intercourse, or varicose (swollen) veins of the vulva. The condition is difficult to diagnose, and many women mistakenly conclude that the pain "is all in my head."

Interventional radiologists can diagnose and treat chronic pelvic pain. First, an X-ray called a venogram is performed. A thin tube (catheter) is inserted through a a small nick in the skin and threaded through a vein into the pelvis. An X-ray dye is injected to show the abnormal veins. Next, the veins can be blocked by injecting tiny coils into the vein, cutting blood flow to the affected area, and shrinking the varicose veins.

Interventional Radiology Treatments for Infertility

Some common causes of infertility in both women and men can now be treated without surgery by interventional radiologists. Often these treatments do not require hospitalization or general anesthesia. Patients usually may return to normal activity shortly after the procedure.

Female Infertility: Blockage of the Fallopian Tube

The most common cause of female infertility is a blockage of the fallopian tube through which eggs pass from the ovary to the uterus. Occasionally, these tubes become plugged or narrowed, preventing successful pregnancy.

Interventional radiologists can diagnose and treat a blockage in the fallopian tubes with a nonsurgical procedure known as selective salpingography. In the procedure, which does not require an incision, a thin tube (catheter) is placed into the uterus. A contrast agent, or dye, is injected through the catheter, and an X-ray image of the uterine cavity is obtained. When a blockage of the fallopian tube is identified, another catheter is threaded into the fallopian tube to open the blockage.

Male Infertility: Treatment for Varicoceles

Varicoceles -- tangled blood vessels, or varicose veins, in the testicles is a major cause of male infertility. Interventional radiologists treat varicoceles without surgery with a procedure known as varicocele embolization. A thin tube (catheter) is threaded through a small nick in the skin and into the affected vein in the testicle. An embolization agent -- either a drug, a small balloon or tiny metal coils -- is injected through the catheter to block off the varicocele. The swollen vessel shrinks, often resolving the infertility problem.

Interventional Treatments for Liver Disease

There are a number of problems in the liver that can be treated with nonsurgical, interventional radiology techniques.

Portal Hypertension Seen most frequently in patients with liver disease such as cirrhosis or hepatitis, portal hypertension is a condition in which the normal flow of blood through the liver is slowed or blocked by scarring or other damage. Patients with the condition are at risk of internal bleeding or other life-threatening complications.

Interventional radiologists treat portal hypertension without surgery, using a procedure called TIPS (transjugular intrahepatic portosystemic shunt). The doctor threads a thin tube (catheter) through a small incision in the skin near the neck and guides it to the blocked blood vessels in the liver. Under X-ray guidance, the doctor creates a tunnel in the liver through which the blocked blood can flow. The tunnel is held open by the insertion of a small metal cylinder, called a stent.

Bile Duct Obstruction In some patients, such as those with liver cancer or individuals who have had an injury to the liver, the bile ducts become blocked and bile cannot drain from the liver. The interventional radiologist places a thin tube (catheter) through the skin and into the bile ducts to drain the bile. In some cases, a small metal cylinder, called a stent, is placed in the liver to hold the blocked area open. A catheter may also be placed to drain bile in patients who have a hole in the bile ducts or as preparation for surgery on the bile ducts.

Needle Biopsy

Needle biopsy is a medical test performed by interventional radiologists to identify the cause of a lump or mass, or other abnormal condition in the body. During the procedure, the doctor inserts a small needle, guided by X-ray or other imaging techniques, into the abnormal area. A sample of tissue is removed and given to a pathologist who looks at it under a microscope to determine what the abnormality is -- for example, cancer, a noncancerous tumor, infection, or scar.

Needle Breast Biopsy

Many lives can be saved when women have routine mammograms -- an X-ray examination of the breast that can detect breast cancer in its earliest, most curable stages. However, most of the abnormalities seen on mammograms are not cancer. Often, the only way to make a diagnosis is to perform a biopsy in which a sample of tissue is removed from the breast for analysis -- a procedure that in the past required painful and disfiguring biopsy surgery. Today, interventional radiologists often can make a diagnosis without surgery with a technique called needle breast biopsy. In the technique, an X-ray guided needle is used to remove small samples of tissue from the breast. It is less painful, much less disfiguring (there is no scar) and requires a shorter recovery time than surgical biopsy.

Interventional radiologists can treat many conditions without surgery:

Aneurysms Sections of blood vessels that bulge or balloon out abnormally (aneurysms), often may be treated without surgery by interventional radiologists. The doctor threads a thin tube (catheter) into the blood vessel and inserts a device that blocks off the supply of blood to the aneurysm.

Arteriovenous Malformations (AVM) are blood vessel abnormalities in the brain or elsewhere. If untreated, AVMs can rupture, causing life-threatening bleeding. Interventional radiologists can often treat these abnormalities without surgery by guiding thin tubes (catheters) to the site and injecting a substance that blocks the supply of blood to the affected blood vessels.

Bleeding Internally When a patient is bleeding inside the body due to injured blood vessels after an accident or other trauma, the interventional radiologist pinpoints the area of injury with angiographies. The doctor injects a clotting substance, such as a gel, foam, or tiny coils, through a thin tube (catheter) to stop the bleeding.

Blood Clots that form in the deep veins of the lower legs (known as deep vein thrombosis or DVT) can cause chronic swelling and leg pain when walking. There is a risk that the clots will move to the lung (pulmonary embolism) or heart -- a potentially life-threatening complication. Interventional radiologists treat DVT by dissolving the clot with thrombolytic therapy. This treatment opens up blood flow and may prevent permanent damage to the blood vessels, a common side effect of DVT.

Blood Clot Filters Patients with certain chronic illnesses or other conditions that require prolonged periods of inactivity, are at risk of forming blood clots that can travel to the heart or lungs. The interventional radiologist can insert a small filter (called a vena cava filter) into a blood vessel to catch and break up blood clots.

Cancer Treatments Some types of cancers, such as those of the endocrine system that have spread to the liver, can be treated by delivering cancer-fighting agents directly to the site of a tumor in a procedure known as chemoembolization.

High Blood Pressure In some patients with high blood pressure, the condition is caused by a narrowing of the arteries in the kidneys. The problem, called renal hypertension, often can be treated with angioplasty.

Infection and Abscess Drainage Patients with a variety of illnesses may develop an area of persistent infection (abscess) in the body. The infection can be drained by inserting a thin tube (catheter) through a small nick in the skin and to the site of the infection.

Urinary Tract Obstruction The ureter -- the tube that carries urine from the kidneys to the bladder -- sometimes becomes blocked by kidney stones or other obstructions. The interventional radiologist inserts a thin tube (catheter) through a small nick in the skin and into the blocked kidney to drain the urine.

SOURCE: SOCIETY OF CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY