Interventional Radiology

Our interventional team comprises a group of skilled radiologists, trained in their areas of expertise. They include the only fellowship-trained Interventional Radiologist in the area. Our radiology technologists are well trained and include the only Registered Vascular Interventional Radiographer in the area. Trained and qualified interventional nurses are also present in each procedure in order to administer sedation and monitor patients. Interventional Radiologists offer the most in-depth knowledge of the least invasive treatments available, coupled with diagnostic and clinical experience across all specialties.They have the ability to use x-ray imaging in order to treat the source of problems non-surgically.

Interventional Radiology has the advantage of using X-ray and fluoroscopy equipment during each procedure. This allows any interventional procedure to be performed through only a tiny nick in the skin, allowing less possibility for infection and bleeding, and promoting a rapid recovery for the patient. This department offers a wide variety of services, including, but not limited to, the following:

• Diagnostic arteriograms of the head, neck, abdomen, and extremities
• Epidural injections
• Biliary drainage catheter/stent placements
• Renal drainage catheter/ureteral stent placements
• Kyphoplasties
• Embolizations for arterial bleeds within the body
• Embolizations for chemotherapy
• Dialysis access placement/manipulation/intervention
• Bone/liver biopsies
• Vena caval filters
• Gastrostomy tube placements
• Hysterosalpingograms
• Sialograms
• Transjugular Intrahepatic Portosystemic Shunt (TIPS)
• Uterine Fibroid Embolizations
• Peripheral vascular intervention

Procedures

Our department performs a multitude of procedures by using extensive knowledge and experience to provide exceptional quality and results.These procedures include peripheral intervention, kyphoplasty, vascular embolization and TIPS.

Peripheral Intervention

A vast majority of patients who are seen for peripheral intervention have diabetes, signs and symptoms of atherosclerosis (a build-up of plaque in the arteries), claudication, gangrene on extremities, and poor circulation. Some have cases so severe that the need for amputation is near. Hendrick's Interventional Radiology Department provides a different solution. Blood flow can be returned by three actions:

PTA (Percutaneous Transluminal Angioplasty)

Using a small balloon inside the artery, the area sclerosed by plaque is expanded from the center of the artery, then the balloon is deflated. Arterial flow is less restricted as a result.

Stent Placement

In the same type of location in a vessel, a stent is measured by length and diameter and placed inside the artery. These stents are designed to push toward the outer wall of the vessel and, once expanded, are unable to reduce to a smaller diameter.

Atherectomy

In using PTA and stent placement, plaque is not removed but is pushed outward, increasing the inner diameter of the artery. An atherectomy is actually the removal of such plaque. Using a small catheter, able to cut in any direction along the vessel desired, the plaque is shaved away 1/3 of a millimeter with each pass of the cutting device and stored within the catheter. This has the advantage of removing the plaque without leaving a foreign body inside the vessel.

• Pre-Atherectomy
• Post-Atherectomy
  All of these actions are performed using a small, flexible wire as a guide through the length of the artery. If an area is completely occluded by plaque, the radiologist must cross through the plaque and recannalize the vessel, allowing blood flow to follow its original path and not be forced to use collateral arteries. Occluded anterior tibial artery Crosser™ Catheter across proximal cap Central lumen vessel recanalization by Crosser™ Catheter Fully recanalized anterior tibial artery
• Pre-Op
• Post-Op

Kyphoplasty

With age comes a decrease in bone density and an increase in the likelihood of bone fractures. The vertebrae in the spine can be easily fractured with a fall, a sudden impact, or even a violent sneeze in some cases. Kyphoplasties are performed to relieve pain and increase the strength of the fractured vertebral bodies. Once again, through a tiny nick in the skin, a radiologist gains access into the vertebral body and inflates a balloon. This creates a cavity within the body, making room for a bone cement mixture that is to be placed inside that vertebral body within a matter of minutes. That cement hardens only minutes after being administered inside the body and immediate results are seen. The vertebral body being worked on now has the density it needs, and often patients are pain-free when they are taken off the procedure table.

Vascular Embolizations

Arteries and veins are embolized, meaning the blood flow to a certain area is blocked. The most common reasons for a blockage are: A vessel is bleeding within the body, resulting in a dangerous amount of blood loss. A vessel supplies the blood flow to a tumor Blood flow can be blocked using a variety of methods. Most commonly, coils and embolization particles are used. Coils are small, tightly-wound wires that are soft and have tiny “hairs” covering them. These “hairs”, along with the coil, are designed to cause the blood to clot at the location of the coil. Particles are small liquid-type beads that work to do the same. Using a very small catheter, the radiologist navigates via large arteries to the smaller ones that are requiring attention. After performing a contrast injection to verify the desired location to be embolized, the radiologist will then eject the coils or inject the particles, based on the anatomical needs, and embolize the artery or arteries necessary. Particles are sometimes loaded with a type of chemotherapy medication, designed to release the substance gradually over a period of a few months. These particles are used in some biliary cases involving a lobe of the liver that supplies a tumor via its arteries. As these particles occlude the artery or arteries, the embolic is held in that occluded portion, releasing chemotherapy medication into the tumor and preventing it from traveling to the rest of the body, thereby decreasing systemic toxicity.

TIPS

A Transjugular Intrahepatic Portosystemic Shunt is performed under general anesthesia and is done in order to relieve pressure in the portal vein due to cirrhosis of the liver. This is not an operation, but another procedure done through a tiny nick in the skin located just above the clavicle. This built-up pressure is relieved by providing a shunt that connects the portal vein to one of the hepatic veins, allowing blood flow from the portal vein to bypass the scarred tissue of the liver and drain into the hepatic vein, inferior vena cava, and ultimately the heart.