Interventional Radiology

Interventional radiology is a branch of medicine that uses minimally invasive procedures to diagnose and treat a variety of conditions.

The experienced interventional radiologists at the Hospital of Central Connecticut use the most advanced technology and minimally invasive procedures to treat atherosclerosis (hardening of the arteries), blood clots, fractured vertebrae, uterine fibroid tumors, small kidney tumors, and numerous other conditions. Many treatments can be performed on an outpatient basis or with a short hospital stay.

Diagnostic Arteriography

An arteriogram allows doctors to view arteries in nearly any area of the body. It's often one of the first steps the interventional radiologist takes to help diagnose problems and pinpoint treatment areas.

The Procedure

The doctor will insert an intravenous (IV) line into a blood vessel in your arm, groin, neck or chest. A thin, hollow tube (catheter) is then inserted into the IV line and guided to the area of concern. A contrasting agent, usually water, saline, iodine or another substance, is injected into the blood vessel to make it show up on X-ray.

Advantages

The most effective way to view arteries.
Minimally invasive.
Results are often available within hours.

Embolization

Embolization involves blocking a blood vessel or vessels to stop blood flow. It can be used to treat a variety of conditions, including:

Traumatic injuries with uncontrolled bleeding.
Post-partum and gastrointestinal hemorrhaging.
Aortic and cerebral aneurysms.
Tumors (which require blood to survive). Embolization may be combined with chemotherapy for cancerous tumors.
Uterine fibroid tumors.

The Procedure

You will be given a sedative to relax you, along with local anesthesia. The interventional radiologist will then perform an angiography into the artery or vein to pinpoint the source of bleeding. The doctor then inserts a catheter into the body and uses fluoroscopy (a moving X-ray image projected onto a monitor) to guide the catheter to the treatment area. A blocking agent, a balloon, metal coil or chemical particles, is delivered through the catheter to block the problem blood vessel.

Procedures can take 30 minutes to about three hours, depending on the condition being treated.

Advantages

Can often be performed with a sedative and local anesthesia.
Less invasive than traditional surgery, with no large incision scar.
Less bleeding and post-procedure pain, faster healing.
In most cases, only a one-night hospital stay is required.

Uterine Fibroid Embolization (UFE)

Uterine fibroid embolization (UFE): Fibroids, benign tumors that grow in or on the uterus, can cause heavy bleeding, pain, pelvic pressure and other symptoms. UFE blocks the blood vessels that feed fibroids, causing the tumors to shrink and eventually disappear.

UFE usually is most appropriate for patients who have finished childbearing but have not started menopause.

The UFE Procedure:

You will receive a sedative to relax you and local anesthesia in the pelvic area. A catheter is placed in each of the two uterine arteries to deliver the blocking agent.

UFE Advantages:

Multiple fibroids can be treated in one session.
Procedure can be effective for even large tumors.
Smaller incisions, less scarring.
Many patients notice less bleeding during the first menstrual cycle after the procedure.

Vertebroplasty

Compression Fractures

Vertebroplasty is a minimally invasive treatment for compression fractures in the spine. Vertebrae weakened by trauma, osteoporosis or bone cancer can fracture more easily, causing mild to severe pain and in some cases loss of movement.

The Vertebroplasty Procedure

You will be given local anesthesia. The interventional radiologist will insert a needle into your back and, guided by X-ray, inject a special bone cement into the fracture.

Old fractures can be treated, but the procedure is most effective on new fractures. The procedure is not used to treat herniated disks or chronic back pain.

Vertebroplasty Advantages

The minimally invasive procedure takes about an hour and can be done on an outpatient basis.
Several vertebrae can be treated at once.
Most patients feel pain relief within 48 hours after the procedure and can resume normal activities immediately.
Proven to provide lasting relief from the pain associated with compression fractures in most cases.

Angioplasty & Stenting

As we age, fatty deposits, cholesterol, calcium, and other substances build up in our arteries as plaque. Plaque can narrows and stiffen the arteries – called atherosclerosis, or hardening of the arteries. The plaque limits blood flow, which can cause heart disease or other serious problems. Peripheral vascular disease occurs when plaque builds up in the arteries to the legs, cutting off blood supply and causing pain and difficulty walking. If left untreated, PFD can lead to gangrene and eventually leg amputation. If medication fails to reduce plaque and improve blood flow, you may have an angioplasty and stenting procedure.

The Procedure

You will be given local anesthesia. The doctor will insert a catheter into your groin area and guide it to the blockage using fluoroscopy (a moving X-ray image projected onto a monitor). During the angioplasty, a tiny balloon is inserted through the catheter into the artery and expanded one or more times to break up the plaque and open the artery.

To keep the artery open, the doctor will then insert a narrow, wire mesh tube called a stent through the catheter. Once in place at the former blockage site, the stent can be expanded to hold the artery open.

Advantages

Less invasive than traditional "open" surgery; performed under local vs. general anesthesia.
Less bleeding and pain and in most cases shorter recovery time.

Endovascular Stent Grafting

Weakness in artery walls can cause bulges called aneurysms. Aneurysms can occur anywhere, but are most common in the abdominal aorta, which supplies blood to the abdomen, pelvis and legs.

Aneurysms pose two major risks: they can rupture, causing massive bleeding; and blood clots can form inside them and be carried into other areas of the body. Some aneurysm patients may be candidates for endovascular stent grafting, a minimally invasive procedure to reinforce artery walls.

The Procedure

You will be given general anesthesia. The doctor will insert a catheter into your groin and guide it to the aneurysm using fluoroscopy (a moving X-ray image projected onto a monitor). The doctor will then insert the stent graft, a narrow mesh tube with a fabric covering, through the catheter, and sew it to the artery wall at the aneurysm site. Blood flows through the stent instead of the bulging portion of the artery.

Advantages

Less invasive than the traditional, "open" surgery to place stent grafts.
Shorter hospital stay.
Smaller incisions/scars.
Many patients return to regular activities in a month.

Radiofrequency Ablation

Radiofrequency ablation (RFA) can be used to treat a variety of conditions. Interventional radiologists use it to treat tumors in a variety of organ systems, including the liver, kidneys, lung and adrenal glands, and in bones.

The Procedure

You will be given a sedative or general anesthesia. The doctor will insert a probe or catheter fitted with an electrode into the affected area. The probe delivers radiofrequency energy, causing heat that destroys diseased tissue while sparing healthy surrounding tissue.

RFA Advantages

Minimally invasive treatments that can usually be done on an outpatient basis.
The heat generated by radiofrequency treatment also closes blood vessels, reducing bleeding.
Can be used to treat inoperable tumors, especially involving the liver and kidney.

Cryoablation for Kidney Tumors

Interventional radiologists use cryoablation, which freezes and destroys kidney tumors up to 3 centimeters in size.

The Procedure

You will be given a sedative and local anesthesia. The doctor will insert a probe into the tumor. The probe is cooled to an extremely low temperature, which freezes and destroys cancerous cells, while sparing healthy, surrounding tissues.

Cryoablation Advantages

Minimally invasive treatment that is usually done on an outpatient basis.
Compared to surgery, cryoablation offers quicker recovery, less pain and decreased risk of complications.
It is becoming the preferred treatment over surgery for kidney tumors up to 3 centimeters.

Thrombolysis

Thrombolysis is used to eliminate blood clots that can restrict blood flow in arteries and veins. Clots can remain stationary or break loose and travel to various organs, causing heart attack, stroke or serious damage to other organs.

The Hospital of Central Connecticut offers thrombolytic therapy, which uses medications to dissolve clots, and mechanical thrombolysis, which uses various devices to break up clots.

The Procedure

You will be given a sedative or general anesthesia. The interventional radiologist will then insert a thin catheter into a blood vessel in the groin, arm or neck and thread it through the body. A dye or other contrast material will be injected through the catheter and an X-ray taken to help the doctor locate the clot(s).

For thrombolytic therapy, the catheter is connected to a machine that delivers medication in specific doses over several hours or days, and you will remain in the hospital during treatment.

Thrombolysis Advantages

A potentially life-saving treatment, thrombolysis can prevent heart attack, stroke, gangrene of an extremity or other serious conditions if administered at early signs of blockage.
Less invasive than traditional "open" surgery, which means less bleeding and post-operative pain and a shorter hospital stay.
Less post-thrombotic syndrome for patients with deep vein thrombosis, a clot that usually forms in the leg. Post-thrombotic syndrome may include pain, swelling, skin discoloration and other symptoms.

Varicose Vein Treatment

For many people, varicose veins are merely a cosmetic problem. But the bulging, twisted veins close to the surface of the leg can cause pain, itching, leg fatigue or other discomfort and lead to more serious problems. Spider veins are a milder version of varicose veins that do not require medical treatment. If conservative treatments such as elevation and compression hosiery fail, The Hospital of Central Connecticut's interventional radiologists have a variety of options to treat varicose veins, including:

Sclerotherapy

The most common treatment, in which the doctor injects a solution into the varicose or spider veins, causing them swell and seal shut. Without a blood supply, the vein turns to scar tissue and is reabsorbed by the body.

Endovenous Laser and Radiofrequency Ablation

Endovenous laser and radiofrequency ablation are non-surgical treatments in which a catheter equipped with electrodes heats vein walls and destroys the affected vein tissue.

Phlebectomy

Phlebectomy is the surgical removal of varicose veins via small incisions.

Advantages

Though more abnormal veins can develop over the years following treatment, current techniques have much higher success rates than traditional treatments.

Varicocele Treatment

Normally, blood flows from the testicles upward, through a network of veins. Valves in the veins prevent blood from flowing back into the testicles. If the valves fail, blood flows back, stretching the veins around the testicle and creating a tangle of blood vessels called a varicocele.

Embolization is a minimally invasive alternative to traditional "open" surgery to treat varicoceles.

The Procedure

You will be a sedative to relax you. The physician will make a small incision, usually in the groin, and thread a catheter to the varicocele site. A blocking agent – a balloon, metal coil or chemical particles - is delivered through the catheter to block blood flow to the varicocele.

Cancer Treatments

Using catheters or needles, physicians can deliver radiation or chemotherapy drugs directly into tumors, sparing healthy, surrounding tissue.

Interventional Treatments Include:

Chemo-embolization, in which chemotherapy drugs are injected into an artery supplying a tumor with blood.
Tumor ablation, in which cold, heat or radiofrequency waves are used to destroy tumor cells.

Advantages

Treatments are less invasive and typically involve less pain and quicker recovery. Many can be performed on an outpatient basis or with a short hospital stay.

Other Treatments

Dialysis Access

For patients preparing to undergo long-term dialysis, the interventional radiologist performs minor surgery on a vein and artery to create a permanent portal. The portal allows blood to be removed from the body to be filtered during dialysis.

Venous Access

A catheter is inserted into a vein to allow doctors to deliver medication or other treatments. The catheter can be left in place for a long time for repeated treatments.

Organ Biopsies

Using imaging guidance, the interventional radiologist inserts tiny needles into the affected organ to remove tissue for further study. The procedure is a minimally invasive alternative to "open" surgery to remove tissue samples.

Transjugular Liver Biopsy

Traditional liver biopsy involves inserting a needle through the skin to obtain tissue samples. This can cause the liver to bleed – a concern for patients with fluid in the liver or abdomen or those with blood-clotting problems.

With transjugular biopsy, the interventional radiologist inserts a catheter into the jugular vein in the neck and guides the catheter to the liver. A needle is inserted into the catheter to take the tissue samples. Any bleeding from the tissue sample removal occurs inside the blood vessel, rather than in the abdominal cavity.

Vena Cava Filters

An umbrella-shaped filter is inserted into the vena cava - a large vein that carries blood up from the lower extremities - to prevent a blood clot from traveling to the lungs. The interventional radiologist inserts the collapsed filter via a catheter and deploys the filter when it's in place.

The treatment is used for patients who have deep-vein thrombosis (a blood clot in a deep vein, usually in the lower legs), or problems with anticoagulation medication.