Interventional Radiology

Interventional radiology is a subspecialty of radiology in which minimally invasive procedures are performed using image guidance. Some of these procedures are done for diagnostic purposes, while others are done for treatment. Interventional radiology procedures often replace the need for open surgical procedures. They are generally easier for the patient because they involve no large incisions, less risk, less pain and shorter recovery times.

What Is an Interventional Radiologist?

Interventional radiologists are board-certified physicians with additional advanced training in minimally invasive, targeted treatments performed using imaging to guide them. They offer the most in-depth knowledge of the least invasive treatments available, coupled with diagnostic and clinical experience. The interventionalist can utilize CT, US, MRI or fluoroscopy to guide them during procedures to treat or diagnose disease. With fluoroscopy they can advance catheters in the body, usually in an artery, to treat at the source of the disease.

Interventional radiobiologists perform a wide range of interventional procedures like drain placements, biopsies, embolizations, vertebroplasties, kyphoplasties, ablations, vena cava filter placements, pain management and many more procedures. Here at Providence, we also have a neurointerventional radiologist, which is an interventional radiologist who specializes in things such as stroke, cerebral aneurysms and carotid angioplasty.

Arteriogram

An arteriogram is a study of the arteries using contrast to make the vessels visible. It is performed to evaluate various vascular conditions. Some conditions an arteriogram would be ordered for are aneurysm (weakened area in the blood vessel), stenosis (narrowing of the artery), internal bleeding (to locate the source of the bleeding) or thrombus (clot in the vessel).

What to Expect If an Arteriogram Is Scheduled

If a patient has a scheduled arteriogram, they will be instructed to eat nothing after midnight the day before the scheduled procedure. The procedure is usually done as an outpatient procedure. The patient should arrive at Providence 2 hours before their scheduled procedure. After checking in with admitting, the patient will be directed to outpatient surgery located on the second floor.

The nurses in outpatient surgery will get the patient’s medical history and start an IV. The radiologist will usually order lab work to determine how well the patient’s kidneys are working. The interventional radiologist will also come by to introduce himself. The radiologist will explain the procedure in detail and answer any questions.

The procedure is done with the patient under moderate sedation. This means that the patient is asleep during the procedure but can be easily awakened. The procedure is done in an interventional lab were the radiologist uses a bi-plane fluoroscopy unit. This allows the radiologist to see the front and side of the arteries at the same time during the procedure. After the patient has been given moderate sedation, he will be prepped and draped in a sterile environment.

The radiologist will access the artery under local anesthetic by making a small puncture in the groin area. The puncture is as small as a pencil tip. The radiologist will guide a catheter to the artery by viewing it on the fluoroscopy screen. The catheter cannot be felt moving inside your arteries. When the catheter is in position, contrast will be injected through the catheter and into the vessel. Some patients will feel a warm sensation during the injection. During the injection the radiologist will take pictures of the contrast moving through the arteries. The radiologist will select all vessels needed to diagnose the symptoms the patient is having.

The radiologist may have to make more than one injection. Once the radiologist is done with the imaging the arteries, the catheter is removed and pressure is held to the entry site until the bleeding stops.

What to Expect After the Procedure

The procedure takes about an hour. The patient will be brought back to their assigned room in outpatient surgery. The patient will rest in their room for about 3 hours without lifting their head or moving the leg that the radiologist used to access the artery. During the time the patient is resting, the radiologist will come by to see how the patient is doing and to inform the patient of the findings of the procedure. The nurse will give the patient post-procedure instructions before being discharged from the hospital.

Arthrogram

An arthrogram is used to check a joint to find out what is causing your symptoms or problem with your joint. An arthrogram usually is more useful than a regular X-ray because it shows the surface of soft tissues lining the joint as well as the joint bones; a regular X-ray only shows the bones of the joint. Arthrograms done in the IR department are followed by a CT or MRI.

  • Pre-Procedure Instructions: Arthrograms are done before the MRI and are done has an outpatient. You may eat at any time before your arthrogram. Check in 30 minutes before your appointment in admitting. Once the admitting process is complete you will be directed to the MRI department. MRI will have a questionaire for you to fill out, clearing you to have a MRI. Once the form is filled out and reviewed by the MRI staff, you will be escorted to the IR department for the arthrogram. In the IR department, the interventional radiologist will explain the procedure in detail.
  • Procedure: The interventional radiologist preps and drapes the joint. Then the entry site is numbed with an anesthetic. A small needle is inserted into the joint where contrast is injected to fill the joint. The radiologist uses a fluoroscopy unit to guide the needle. The needle is removed and the IR staff will escorts you back to the MRI department for your MRI.
  • Post-Procedure: You will be asked to wait 20 minutes in the waiting room after your procedure is complete. If you have any questions, you can call Interventional Radiology at 254-715-4264 7:30 a.m. through 4:30 p.m. Monday through Friday.

Carotid Angioplasty & Stenting

Plaque in the carotid artery can cause an occlusion or blockage, preventing the flow of blood to the brain. The blockage can causes insufficient blood flow, which can cause an ischemic stroke if the blood flow is blocked long enough. Carotid stenting is a procedure in which a slender metal mesh tube is placed in the carotid artery to increase the flow of blood blocked by plaque. The stent is inserted following a procedure called angioplasty, in which the physician guides a balloon catheter into the blocked artery. The balloon is inflated to reopen the artery. The stent helps to prevent the artery from collapsing.

Provenience Health Center has two vascular rooms that are approved for performing carotid angioplasty and stenting. Dr.Borowski is a specialist in neurointerventional radiology and is certified to perform carotid angioplasty and stenting.

Who are candidates for carotid angioplasty & stenting?

At the present time, carotid stenting has been approved for the treatment only on patients who have carotid stenosis greater than 70 percent blockage and considered to be too high risk for carotid endarterectomy.

Cerebral Aneurysm Embolization

A cerebral aneurysm is caused when an artery in the brain weakens and part of the vessel wall bulging out. They can range in size from a few millimeters to as large as 25 millimeters. The larger the aneurysm, the greater the chance the aneurysm could rupture.

Treatments for a Cerebral Aneurysm

There are three options for treating aneurysms which depend on the size of the aneurysm and the locations of the aneurysm in the brain.

  1. Do nothing and have a yearly follow-up MRA to monitor the growth of the aneurysm. This is done on the smaller aneurysms where the risk of treating the aneurysm would outweigh the risk of the aneurysm rupturing.
  2. Surgical clipping the cerebral aneurysm
  3. Embolize the aneurysm. This is the most common practice to treat aneurysms today because it is a less invasive procedure than surgery. Cerebral aneurysm embolizations are treated at Providence Health Center by a highly trained neurointerventional radiologist, Dr.Adam Borowski. Dr.Borowski consults all patients before any procedures are done.

Liver Chemotherapy Embolization

This procedure is for patients who have been diagnosed with liver cancer. The radiologist performs a liver arteriogram on the patient to identify liver tumors. The interventional radiologist will select the artery feeding the tumor with a small catheter call a micro catheter. The radiologist will combine the chemotherapy with an embolic agent. The embolic agent and chemotherapy drug are injected directly into the tumor and the artery to the tumor is shut down. The patient will be admitted to the hospital overnight for this procedure. The patient will need to talk to their oncologist to see if they are a candidate for this procedure.

Discogram

A discogram is an examination of the intervertebral discs. Contrast media is injected into the center of the disc. The contrast media makes the disc clearly visible on a fluoroscope.

 

Why Is It Done?

Discograms are used to determine which disc has structural damage and whether it is causing pain. A discogram can show if a disc is damaged. By injecting contrast into the disc under fluoroscopy, the radiologist increases pressure in an attempt to mimic the pain the patient experiences daily. This test is usually done prior to surgery to help the doctor determine the location of the problem.

How Is It Done?

The discogram is an outpatient surgery procedure. The patient comes to Providence 2 hours before their scheduled procedure. After checking in through admitting, the patient will be directed to outpatient surgery located on the second floor. The nurses there will get the patient’s medical history and start an IV. The interventional radiologist will come by to introduce himself. The radiologist will explain the discogram in detail and answer any questions.

The patient will be given medication to relax them but they will still be conscious. The purpose of the procedure is to communicate with the patient during the procedure about their pain. The procedure is done in an interventional lab were the radiologist uses a bi-plane fluoroscopy unit that allows them to see the front and side of the back at the same time during the procedure. After the patient has been given relaxing medication the entry site is prepped and draped.

The interventional radiologist will numb the entry sites with an anesthetic. The radiologist will insert a needle into each disc space being tested using fluoroscopy for guidance. Once all of the needles are in place, the radiologist will began to inject contrast through the needles. Contrast is injected into each disc to determine which disc is normal or damaged. If the disc being tested causes pain similar to your back or leg pain it is a good indication that the selected disc is causing your problems. The radiologist will ask the patient to describe the feeling on each injection. The test is over after all selected discs have been tested and documented.

What to Expect After the Procedure

The procedure takes about 30 to 40 minutes depending on how many discs are being tested. Immediately after the procedure, the patient is taken to CT to have the disc scanned. The patient will then be taken back to their assigned room in outpatient surgery, then rest for about 1 hour.

Kyphoplasty

During kyphoplasty, a needle is inserted into a compressed vertebra. A balloon is then inserted through the needle and inflated to raise the collapsed vertebra. The balloon is withdrawn and surgical cement is injected into the bone to stabilize the vertebra.

Who Is a Candidate for Kyphoplasty?

People who have suffered recent back fractures that are causing back pain may be candidates. Backbones or vertebrae can become fractured for several reasons but one of the most common reasons is osteoporosis. If you have a fracture it can be very painful. Typically an X-ray or CT is done of your back to determine if there is a fracture.

If a fractured is identified, the next step is to find out if the fracture is a recent fracture or an old fracture. Kyphoplasty are performed on new fractures. In most cases, an MRI of your back is ordered to determine the age of the fracture. If you have a recent fracture and meet the insurance diagnosis qualifications for a kyphoplasty, this procedure could help you.

How Is the Procedure Done?

Kyphoplasty is a day surgery procedure. The patient comes to Providence 2 hours before their scheduled procedure. After checking in with admitting, the patient will be directed to outpatient surgery, located on the second floor. The nurses there will get medical history and start an IV. The interventional radiologist will come by to introduce himself. The radiologist will explain the procedure in detail and answer any questions.

The procedure is done with the patient under moderate sedation. This means the patient is asleep during the procedure but can be easily awaken. The procedure is done in an interventional lab where the radiologist uses a bi-plane fluoroscopy unit that allows him to see the front and side of the fracture at the same time during the procedure. After the patient has been given moderate sedation, the entry site is prepped and draped.

The interventional radiologist will numb the entry site with an anesthetic. The radiologist will insert a needle into the fractured vertebra using the fluoroscopy for guidance. A balloon is then threaded through the needle and placed inside of the vertebra. The balloon is then inflated. The balloon is deflated and removed. Surgical cement is injected through the needle and into the vertebra. The cement is the consistency of paste when filling the vertebra but quickly hardens to stabilize the vertebra. The radiologist monitors the injection by watching the cement fill the vertebra on the monitors and making sure the vertebra body is completely treated.

When the radiologist is done filling the vertebra body with the surgical cement, the needle is removed and an adhesive bandage is placed over the entry site. The patient is awakened in the vascular lab before they are sent back to the outpatient room.

What to Expect After the Procedure

The procedure takes about an hour depending on how many fractures there are and the severity of the fracture. The patient will be brought back to their assigned room in outpatient surgery. Most patients are awake enough to tell that they feel better than they did before the procedure. The patient will rest in their room for a couple of hours, during which time the radiologist will come by to see how they are doing. The nurse will give the patient post-kyphoplasty instructions before discharging them from the hospital.

Stroke

A stroke is the rapidly developing loss of brain function due to disturbance in the blood to the brain, caused by a blocked or ruptured blood vessel. This can be caused by thrombosis or embolism blocking blood flow or due to a hemorrhage.

Signs & Symptoms of Stroke

  • Facial drooping
  • Arm weakness
  • Sudden loss of arm or leg use
  • Slurred speech
  • Inability to speak

What to Do If You See Someone With Stroke Symptoms

Get the patient to the hospital quickly. The sooner the patient gets to the hospital, the more options there may be for treating stroke. At Providence, our interventional radiology department may be able to treat the stroke at its origin. The key for interventional radiology treatment is to get the patient to the emergency room with early onset of symptoms of stroke.