Angiography & Interventional Procedures
Interventional radiology is a sub-specialty of radiology that is both diagnostic and therapeutic. Procedures are performed to diagnose and treat medical conditions. Areas of the body are accessed through minimally invasive techniques using imaging guidance. X-ray, ultrasound and CT scans are used to guide the movement of instruments within the body during the procedures.
These radiology procedures often provide alternatives to surgery and have many advantages. They have significantly shorter recovery periods, less severe side effects, less scarring, are often faster and usually don't require general anesthesia. Many times they can provide options for people who have inoperable conditions or otherwise aren't candidates for surgery.
In many cases, interventional radiologists can open blocked or narrowed blood vessels caused by peripheral arterial disease or other conditions. Interventional radiologists can often treat blocked blood vessels without surgery. In most cases, hospitalization and general anesthesia are not required. Often, patients may return to normal activity shortly after the procedure.
What does the equipment look like?
Reasons for having an interventional procedure
An angiogram is a way for physicians to see the health of blood vessels (veins and arteries) inside your body. With this procedure physicians can determine whether there is any abnormal narrowing or enlargement of blood vessels, or if there is any blockage. The procedure utilizes an X-ray scanner and a special dye to create detailed images of your blood vessels.
Angioplasty and Stenting
During angioplasty, the interventional radiologist inserts a very small balloon attached to a thin tube (catheter) into a narrowed or blocked blood vessel through a small incision. The catheter is threaded under X-ray guidance to the site of the blockage. The balloon is inflated to open the artery. A stent is a small, flexible tube made of metal to support the damaged artery walls. Stents are typically placed over a balloon-tipped catheter, which is expanded, pushing the stent in place against the artery wall. When the balloon is deflated and removed, the stent remains permanently in place, acting like a scaffold for the artery.
Thrombolytic therapy 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 the blood flow.
A nephrostomy is an artificial opening created between the kidney and the skin by use of a catheter which allows for the drainage of urine directly from the upper part of the urinary system. A nephrostomy is performed whenever a blockage keeps urine from passing from the kidneys to the urinary bladder via the ureters. Without another way for urine to drain, pressure would rise within the urinary system and the kidneys would be damaged. Urine is collected in an external bag that can be emptied as often as necessary. The most common cause of blockage necessitating a nephrostomy is cancer or kidney stones.
How do I prepare for an interventional procedure?
A recent History & Physical must be available from your doctor. Several days before the procedure, you will receive special instructions from a nurse or technologist who will help perform the procedure. You will need to have blood drawn at the hospital or at a local clinic to learn how well your kidneys are functioning and whether your blood clots normally. Staff also will advise you if there is to be a change in your medication schedule, especially for medications that thin the blood (anticoagulants). You may not eat or drink after midnight the evening before your procedure. You will be admitted to the hospital morning of the procedure and will be examined by the radiologist before the procedure begins. Please leave your jewelry and valuables at home. Female patients must notify their physician if they are or think they might be pregnant, for further instructions.
What will I experience during and after the procedure?
The entire procedure might take less than an hour or as long as several hours. You will be asked to change into a hospital gown and to lie on a scanning table. An area around your groin will be shaved and cleaned in preparation for the insertion of a catheter. You will be given a mild sedative that will make you feel relaxed or sleepy and you may nod off for brief periods, but generally will remain awake throughout the procedure. A local anesthetic will be injected into the catheter site in your groin, and the catheter will be inserted. The imaging physician will direct this catheter through your arteries until it reaches the part of your body that is to be studied. To avoid disrupting the catheter's precise placement, your movement will be restricted during the exam. You may feel slight pressure when the catheter is inserted but no serious discomfort. Once the catheter is in place a special dye will be injected through it giving you a warm sensation, however, this soon passes. Several sets of X-rays will be taken to give the doctors a set of images to study. Depending on the exam the angioplasty balloon, stent, or thrombolytic agents will be guided through the catheter. Additional images may be captured. The catheter will then be removed You will be required to lie quietly for some time afterward, usually with pressure applied to the entry site to prevent bleeding. Many patients experience some side effects after thrombolysis. Pain is the most common and can readily be controlled by oral or intravenous medication. Most patients can resume their normal activities within a day or two. You may or may not remember some things about the procedure.