Interventional Radiology uses imaging to perform minimally invasive surgical procedures that diagnose and treat complex conditions, such as cardiovascular diseases and cancer, with precision accuracy. This minimally invasive approach may eliminate the need for traditional open surgeries, which may results in less pain, a shorter recovery time and reduced risk of complications.
Uterine Artery Embolization (UAE)
Uterine fibroids or adenomyosis (non-cancerous abnormal thickening of uterus lining) has been estimated to affect approximately 10% of the female population of the United States. Both can cause life-altering symptoms, including heavy or frequent vaginal bleeding, constipation, frequent urination, and chronic pelvic pain/cramping.
Patients may choose a minimally invasive treatment option, known as UAE. This treatment involves injecting small particles (beads) into the blood supply to the uterus, causing the fibroids or uterus lining to shrink, which reduces symptoms. Typically, an outpatient elective procedure using small needles and catheter in the wrist or groin with IV sedation medication (not requiring a breathing tube). The procedure doesn’t remove the uterus and preserves fertility, if desired.
Ovarian Vein Embolization (OVE)
Pelvic congestion syndrome is a complex medical condition affecting women, typically women undergoing multiple childbirth. This is attributed to (caused) by enlargement of the venous drainage of the uterus. Symptoms included chronic pelvic pain with standing or sitting, painful intercourse, not attributable to other causes.
Patients may choose a minimally invasive treatment option, known as OVE. The treatment involves placement of medication and occlusion devices (i.e. coils) to obliterate (close down) the enlarged veins. Typically, an outpatient elective procedure using small needles and catheter in the wrist or groin with IV sedation medication (not requiring a breathing tube).
Prostate Artery Embolization (PAE)
Benign prostatic hypertrophy (BPH) has been estimated to affect 70% of men greater than 60 years old. Both can cause life-altering symptoms, including incomplete/frequent urination, recurrent urinary infections, and chronic changes of the bladder and kidneys.
Patients may choose a minimally invasive treatment option, known as PAE. The treatment involves injecting small particles (beads) into the blood supply to the prostate, causing shrinkage of the prostate gland. An outpatient elective procedure using small needles and catheter in the wrist or groin with IV sedation medication (not requiring a breathing tube). PAE is generally well tolerated by men, with low risk of developing incontinence (difficult passing urine) or sexual dysfunction.
Varicocele Embolization (VE)
Varicoceles are enlargement of the venous drainage of the scrotum. Enlargement of these veins can cause chronic pain and decrease fertility for men. Patients may choose a minimally invasive treatment option, known as VE.
This treatment involves using medication and devices (i.e. coils) to obliterate (close down) the enlarged vein(s) draining the scrotum. The decrease in the enlarged veins will decrease pain and improve sperm quality and count. An outpatient elective procedure using small needles and catheter in the wrist or groin with IV sedation medication (not requiring a breathing tube). Most men return to work quickly after the procedure and reduction in pain with improvement in sperm count after the recovery period.
Image-Guided Biopsies
When a mass or lesion arises, interventional radiologists perform image-guided biopsy to obtain diagnostic and guide treatment options for patients. Typically, an inpatient or outpatient elective procedure using small biopsy needles with IV sedation medication (not requiring a breathing tube). The treatment uses computerized tomography (CT), ultrasound (US), or magnetic resonance (MR) to obtain a small sample of tissue.
Venous Access
Long-term venous access for various reasons require placement of temporary or permanent devices for sampling of blood and administration of medication/infusions.
Interventional radiologists routinely place all types of venous access device, to include, but not limited too: Subcutaneous ports, tunneled (“tunneled PICC”) and non-tunneled (“PICC”) venous access lines, and tunneled hemodialysis lines (“Perm-cath”). An inpatient or outpatient elective procedure with IV sedation medication (not requiring a breathing tube).
Transcatheter Arterial Radioembolization (Y-90, TARE)/Transcatheter Arterial Chemoembolization (TACE)/Portal Vein Embolization (PVE)
Primary liver cancer, hepatocellular carcinoma (HCC), is a common malignancy in the United States. Also, the liver is a common site to develop metastatic lesions (cancerous disease) from other sites of cancer (i.e colon cancer).
Interventional radiologists are essential in management of HCC and liver metastasis, with gastroenterology and hepatobiliary surgeons. TACE/Y-90,TARE are treatment options for patients who are unable to undergo surgery or liver transplant. TACE/Y-90,TARE involves placement of small particles into the arterial supplying the tumor which have radiation or chemotherapy agents attached to kill the tumor cells. In special cases, portal vein embolization is performed to help patients obtain enough liver to tolerate surgery. An outpatient elective procedure using small needles and catheters in the wrist or groin with IV sedation medication (not requiring a breathing tube).
Percutaneous Ablation
When masses arise in different parts of the body, interventional radiologists can provide a minimally invasive treatment option, particularly for patients who cannot undergo surgery. Percutaneous ablation involves placement of small probes through the skin into tumors which kills the tumor by freezing or burning them. An outpatient elective procedure using small microwave or freezing probes/needles placed through the skin into the tumor to kill tumor cells by burning or freezing the tumor. This can be performed on lesions in the kidney, liver, lung, bones, and soft tissues. This can be performed with IV sedation medication (not requiring a breathing tube) or with general anesthesia with anesthesiology. This treatment doesn’t require removal of tissue or organs and typically patients return to work/lifestyle quickly.
Transjugular Intrahepatic Portosystemic Shunt (TIPS)/Transvenous Obliteration of Portosystemic Shunts/Transjugular Liver Biopsy/Splenic Embolization
Cirrhosis (a.k.a. chronic liver disease) is a common condition in the United States arising from various reasons. In advanced cases, cirrhosis can lead to development of high pressures in an important vein in the abdomen called the portal vein (portal hypertension). Portal hypertension can cause numerous symptoms, to include, but not limited to: recurrent accumulation of fluid in the abdomen or chest (“ascites” or “hydrothorax”) and development of bleeding abnormal veins of the esophagus, stomach or rectum.
For patients unable to undergo liver transplant or other treatment options, a stent can be placed through the liver decreasing symptoms of portal hypertension. In addition, particular dilated veins in the stomach require interventional radiologists to inject medications and devices to stop bleeding called transvenous obliteration of portosystemic shunts.
In special cases in portal hypertension and malignancy, the spleen becomes enlarged and decreases platelets (a component of blood needed for normal clotting). Splenic embolization can be performed to help increase platelet count.
Biliary Disease/Transhepatic Biliary Catheters/Cholecystostomy Tube/Biliary Dilation and Stenting
For various reasons, patients can develop narrowing or disease of the biliary system (production and transporting of bile to the intestines). This can range from stricture from cancer or non-cancerous reasons, infections, and/or obstructions. When this occurs, patients can develop skin color changes, itchiness, infections, or damage to liver.
Interventional radiologists provide a pivotal role in the care of biliary disease with general surgeons and GI/gastroenterologist. This includes placement of transhepatic (through the liver) biliary drains, cholecystostomy tubes (drain of the gallbladder), choleangioplasty (balloon dilation of the bile ducts) and stent placement. Typically, an inpatient or outpatient elective procedure with IV sedation medication (not requiring a breathing tube).
Peripheral Vascular Angiography and Interventions
Lower extremity peripheral arterial disease (PAD) affects approximately 10 % of Americans. PAD is life-changing, with symptoms of claudication (movement related cramping) of the affected leg, limited mobility, and chronic wounds/infections. Unfortunately, in severe cases of PAD, this can lead to amputation (cutting off) of the extremity, if blood flow and symptoms cannot be improved. The roots of interventional radiology began with Dr. Charles Dotter performing the first peripheral vascular intervention, using a balloon in 1950.
Today, interventional radiologists continue to be a cornerstone for diagnoses and treatment of PAD. The treatment involves angiography (taking images of the vessels) and using balloons and stents to restore flow to the affected extremity. An outpatient elective procedure using small needles and catheters in the wrist or groin with IV sedation medication (not requiring a breathing tube).
Venous Disease and Interventions/Venous Thrombolysis and Thrombectomy/Venous Stenting/Inferior Vena Cava Filter Placement and Retrieval
Venous disease (clots and abnormal narrowing, “stenosis” of veins) can affect all parts of the body. Venous clots or narrowing can result in various range of symptoms from facial, arm or leg edema and swelling and/or severe pain. Interventional radiologists utilize cutting-edge technology with imaging to remove clots, restore venous flow, and decrease symptoms associated with venous disease.
Also, when blood clot(s) develop(s) in the leg, blood thinning medication (anticoagulation) is routinely prescribed, but in certain conditions, given blood thinning medication can be high-risk or contraindication (not recommended); therefore, interventional radiologists can place special device, called filter, in the main vein in the abdomen to capture clot before traveling to the lung, which can be harmful or deadly.
Importantly, when either blood thinning medication becomes safe to take or treatment has finished, the filter needs to be removed. The filter can be removed as an outpatient elective procedure with IV sedation medication (not requiring a breathing tube).
Vascular Malformation or Fistulas and Sclerotherapy
Vascular malformation, known as abnormal development of blood vessels, can develop in many different areas of the body. In certain cases, intervention and/or treatment is indicated to reduce or eradicate these atypical vessels.
Patients can choose image-guided procedures to inject medication or devices to treat various types of vascular malformation. Typically, an outpatient elective procedure using small needles and catheters with IV sedation medication (not requiring a breathing tube).
Pulmonary AVM Embolization (pAVM)/Bronchial Artery Embolization
Pulmonary arteriovenous malformation (AVM) are abnormal vessels that develop in the lungs and can increase risk for strokes, heart attack and bleeding. Patient may choose a minimally invasive treatment to occlude the abnormal vessel with coils or plug. An outpatient elective procedure using small needles and catheters in the neck or groin with IV sedation medication (not requiring a breathing tube). In certain cases, interventional radiology will discuss conditions that can predispose patients to pAVM (HHT).
Also, patients with long-term pulmonary disease (i.e cystic fibrosis) or large pulmonary tumors of the chest, can develop abnormal dilated vessels that can cause abnormal bleeding called hemoptysis (coughing up blood). Interventional radiologists can access these vessels with special catheters and inject small particles to solve or reduce the amount of bleeding. An inpatient procedure is performed with general anesthesia by the anesthesiologist.
Pulmonary Thrombolysis/Thrombectomy
Pulmonary embolism (PE) is a medical condition in which clots travel or develop within the arteries supplying the lung. Blood thinning medication may be given for treatment. However, severe cases may require more invasive treatment options.
Patients may choose this specialized invasive procedure to break-up and dissolve clot or remove the clot with special catheters. Typically, an inpatient procedure is performed with IV sedation or general anesthesia by the anesthesiologist.
Injections
Chronic pain is a debilitating condition affecting many Americans. Patient may choose a non-surgical treatment options for chronic pain, to include, but not limited to: cervical/lumbar epidural steroid injection, transforaminal nerve root block/injection, facet block/injections, intercostal nerve blocks, celiac plexus neurolysis. Typically, an outpatient elective procedure using small needles with local anesthesia (numbing) medications.
Nephrostomy and Ureteral Stents
A catheter or stent is placed into the kidney drainage system for treatment of various conditions affecting the kidney.
A catheter is placed to infected collection in the body to aid in eradication of infections.
Tunneled Pleural and Peritoneal Catheters
A catheter is placed for patients with recurrent accumulated fluid in the chest or abdomen for palliative purposes.
Interventional Radiology Physicians
Christopher R. Ahmed, MD
Samuel Q. Armstrong, DO
Darrel A. Ceballos, DO
Robert J. Egbert MD
Stephen L. Fernandez, MD
Eric C. Lund, MD
Brett L. Storm, MD