A minimally invasive, advanced treatment alternative to traditional surgery
Extensive expertise
Our interventional radiology departments are recognized regionally and nationally for having in-depth expertise in state-of-the-art imaging and minimally invasive techniques that help our patients recover faster with less pain and fewer risks than traditional surgery.
As one of the largest interventional radiology practices in the country – and the largest in the region – our team of experts treats a high volume of patients every year, allowing us to continue delivering better outcomes for our patients. It also gives patients distinct advantages:
- Treatment for complex medical conditions
- Being a referral source for out-of-town patients who can travel to seek state-of-the-art interventional radiology treatments
- Subspecialty care that allows us to:
- Advance our treatment techniques
- Stay up-to-date on the latest research
- Provide individualized medical advice informed by our own experiences
In addition, patients can access care at nine acute care hospitals across the region, giving them the latest advanced interventional radiology care close to home.
Benefits and risks
Thanks to clinical and technological advances, interventional radiology provides exceptional benefits to patients. First, interventional radiology may be used to determine if a patient needs surgery while eliminating the need for exploratory surgery.
Additionally, interventional radiologists use the least invasive techniques possible, making only small incisions when necessary. This often results in safer and more effective outcomes than traditional surgery. Because it is minimally invasive, patients typically experience:
- Less pain
- Fewer risks
- Faster recovery
While there is always a risk when you undergo any medical procedure, interventional radiology procedures are relatively safe with a low risk of complications. Interventional radiology procedures generally carry significantly lower risks than surgical procedures, while accomplishing similar goals
What are the benefits and risks of an interventional procedure exam?
Interventional procedures are minimally-invasive and usually performed on an outpatient basis. Often an interventional procedure can be performed in lieu of a surgical procedure and does not require general anesthesia or hospitalization. Interventional procedures using imaging guidance are much more accurate and safe than procedures performed without imaging guidance. An interventional procedure can be instrumental in establishing, confirming or excluding a disease process. Interventional procedures can be diagnostic or therapeutic. Most interventional procedures are performed will very little discomfort to the patient and allow for much faster healing compared with surgical procedures. There are inherent risks with interventional procedures, such as pain, bleeding and post-procedural infection. The benefits, risks and complications of a specific procedure to be performed are always discussed with the patient (or patient’s family, caregiver or durable power of attorney). Verification that the patient understands the potential risks and complications of a procedure must confirmed and written and verbal consent to proceed with the procedure must be obtained from the patient to proceed with the procedure. Occasionally complications arise after a procedure requiring follow up medical care or hospitalization
What will I experience during an interventional procedure exam?
Depending upon the interventional procedure to be performed, patient experiences will vary. After arrival, radiology staff will prepare the patient for the procedure which may include a discussion of physical exam and surgical histories, review of daily medications, a discussion of the procedure with its benefits and risks, checking vital signs and starting an IV. While laying on the imaging table, pre-procedural imaging will probably be performed. After verifying the patient information and procedure to be performed the interventional radiologist performs the procedure. IV sedation may be administered to alleviate pain and anxiety. Some but not all procedures can be associated with pain and discomfort which usually subsides quickly after the procedure. Some of the interventional procedures require a brief recovery period prior to discharge from the imaging facility. If symptoms do not abate or there is an unexpected complication after the procedure a longer recovery period, or hospitalization, may be required. Most interventional procedures are tolerated well by patients.
How do I prepare for an interventional procedure exam?
Prior to a scheduled appointment some preparation may be required. Patients may be asked to avoid eating/drinking or taking certain daily medications for a length of time prior to the exam, however taking daily medication(s) is usually recommended. Patients should be prepared to provide a list of current medications, physical exam details and surgical history. Loose fitting clothing is recommended. Patients may be asked to change into a gown provided by the imaging facility, remove jewelry or empty pockets prior to the exam. Some exams require a radiology nurse to insert an IV for hydration purposes, intravenous injection of contrast material or injection of sedative medication. Some patients may require a blood draw to assess certain blood markers or kidney function prior to the exam to reduce the risks associated with certain procedures. If IV sedation is to be administered during the procedure, outpatient procedure patients should arrange transportation from the facility to home.
Deep Vein Thrombosis / Pulmonary Embolism
Deep vein thrombosis (DVT) is formation of a blood clot in the deep leg vein, and can lead to permanent damage to the leg (post-thrombotic syndrome) and life-threatening pulmonary embolism. Contractions of the muscles surrounding the deep leg veins and arterial-venous pumps help return blood to the heart against gravity. One-way valves prevent the back-flow of blood between contractions. Slowing of blood circulation due to illness, injury, or inactivity promotes clot formation. Interventional radiologists can treat DVT with catheter-directed thrombolysis, balloon angioplasty, or stenting. Catheter-directed thrombolysis involves inserting a catheter into a vein in the leg to deliver tPA to dissolve the blood clot. Patients who are not ideal candidates for catheter-directed thrombolysis can be treated with the insertion of an IVC filter, a small umbrella-like device inserted in the inferior vena cava to capture blood clots and prevent occlusion of vital vessels.
INFERIOR VENA CAVA FILTERS
Inferior vena cava filters are used in up to 13% of patients with venous thromboembolism.Filters can be placed and retrieved via endovascular approaches. Most guidelines recommend inferior vena cava filters when anticoagulation is contraindicated or PE recurs despite anticoagulation. A recent systematic review involving more than 4,000 patients showed that the use of inferior vena cava filters has an NNT of 20 to prevent PE and an NNH of 50 for recurrent DVT. There was no difference in absolute or PE-related mortality between patients with and without filters. Because complications from inferior vena cava filters increase over time the U.S. Food and Drug Administration issued warnings about increases in adverse effects from inferior vena cava filters, recommending prompt removal when indications allow.Inferior vena cava filter placement was reduced after these warnings, yet only 30% of placed filters are removed during the patient’s lifetime.
Inferior Vena Cava (IVC) Filters
In patients with DVT (clot in the legs) it’s sometimes necessary to put a filter in the main vein going back to the heart to prevent clot travelling to the lungs, which can be life-threatening. We insert these filters through the vein in the groin or the neck and remove them once the clot in the leg has dissolved. Removing the filter is like playing a game of “hook a duck” where we have to put a loop around a tiny 2mm hook inside the centre of the body, all performed from the neck whilst looking inside you with an x-ray camera. Patients for this procedure are referred to us by our medical and surgical colleagues. This procedure is performed under local anaesthetic and can be done as a day case procedure which allows for a quick recovery.
Thrombolysis
Some patients can develop a clot in an artery or a vein. We insert tubes to the affect vessel and slowly drip clot busting drug directly into the affected vessel to dissolve the clot and re-establish blood flow to the affected area. Patients for thrombolysis are usually referred to us by our vascular surgery colleagues and may prevent an open surgical declotting operation. Patients are admitted to the specialist vascular Enhanced Care Unit or General Critical Care for this procedure for close monitoring.
Thrombectomy
Sometimes when clot forms in an artery or a vein we can insert a tube and either suck out the clot using a vacuum or macerate the clot to break it up to help re-establish flow to the affected area. We often perform this procedure on fistulas which have clotted off but it can be performed in other vessels
IVC Filter Removal
Interventional radiologists remove inferior vena cava (IVC) filters when they are no longer needed to filter dangerous blood clots. The FDA recommends that all IVC filters be removed when they are no longer needed. Additionally, an IVC filter may need to be removed if it is causing discomfort. In these cases, our interventional radiologists used a special retrieval procedure pioneered at Penn Medicine.
Peripheral Arterial Disease
Peripheral arterial disease (PAD) commonly results from atherosclerosis as cholesterol and scar tissue build up along vessel walls. Occlusion of the vessel lumen results in decreased blood flow to the legs, which can lead to intermittent claudication, and eventually gangrene and amputation. Symptoms include painful cramping in the leg or hip that occurs when walking or exercising and typically disappears when the person stops the activity, numbness or tingling in the legs/feet, and pain in legs/feet at night. Interventional radiologists can treat PAD using angioplasty and stenting, which involves inserting and inflating a balloon to open the narrowed artery and keeping the vessel open with a cylindrical mesh. Atherectomy can be performed which involves inserting a small catheter at the site of blockage that is able to "shave" the plaque from inside of the artery to re-establish normal blood circulation.
Angioplasty/Stenting
Arteries can become narrowed or clogged often due to smoking or a fatty diet, but also due to diabetes and other conditions. Angioplasty involves inserting tiny balloons into narrowed or blocked arteries to re-establish flow, most commonly in the leg arteries. The balloons can be inflated, then deflated, widening the vessel and allowing more blood flow. Metal stents can also be placed in certain types of disease, which reduce the chance of a rebuild up of material. Patients for angioplasty are usually referred to us by our vascular surgery colleagues and may prevent a surgical bypass operation. The procedure is usually performed under local anaesthetic and can often be done as a day case procedure.
Vascular Malformations
Vascular anomalies are a heterogenous group of conditions that can broadly be divided into vascular tumors and vascular malformations. The conditions that IRs are often asked to treat include lymphatic malformations, venous malformations, and arteriovenous malformations (AVMs). These lesions can cause patients pain and disfigurement as well as high-output heart failure and steal syndromes in the setting of AVMs. The main treatment options are surgical excision or sclerotherapy where an IR carefully infuses a sclerosant that destroys the abnormal vessels. Since surgery can be dangerous and not feasible for many of these lesions, many patients choose to undergo sclerotherapy
Dialysis Catheters, Venography, and Declots
The kidneys are the master chemists of the body, filtering blood to remove toxins and balance electrolytes and fluid status. When the kidneys fail, they can be replaced via a variety of therapies, the most common being hemodialysis. This requires access to significant blood flow ~3xs per week to filter the blood externally and deliver it back to the body. Initially, IRs are often involved in placing a temporary catheter in the neck to facilitate this. However, if long-term replacement is required, patients often have a conduit surgically created between an artery and vein in the arm (an arteriovenous fistula). To guide this surgery, IRs inject contrast and map-out the venous anatomy of both arms (venography). Unfortunately, these fistulae are associated with clot formation that can cause them to malfunction. IRs can often salvage the fistula be breaking up the clots, called a "declot."
Long Term Venous Access
Some patients need regular intravenous therapy such as chemotherapy or antibiotics or may require a line for dialysis. We insert a needle into a vein and guide a tube over a wire. We then bury the tube under the skin to prevent infection. They are often inserted into the veins in the neck and chest, but can be inserted into the veins in the groin. They are sometimes referred to as Hickman lines, Bard lines, dialysis lines or tunneled central lines. This procedure is usually performed under local anaesthetic and sometimes with sedation. Most are performed as a day case procedure which allows for a quick recovery.
Arterio-Venous Fistuloplasty
Some patients have a surgically formed connection between an artery and vein in the arm to have dialysis if their kidneys have failed. Sometimes these fistulas develop a narrowing. We insert tiny balloons to open up the narrowings to keep the fistula working. The images below show a balloon being inflated in a narrowed segment in the upper arm, then the narrowing is gone. This procedure is performed under local anaesthetic as a day case procedure which allows a very quick recovery.
Image-Guided Biopsies
Image-guided biopsies are done to learn more about a lesion or mass and can be performed almost anywhere in the body, but are most often used for the lymph nodes, lungs, kidney and liver. These procedures usually require only light sedation and can often be performed within 30 minutes to an hour.
Obstructive Nephropathy
Kidney stones (nephrolithiasis) is a common problem that can be extremely painful. Smaller stones can pass on their own, and larger stones can be removed by urological procedures such as lithotripsy. However, some large stones (or tumors) can obstruct the out flow of urine, creating back pressure that can damage the kidneys. This is particularly problematic if there is a co-existing urinary tract infection, pressing bacteria back into the kidneys and bloodstream. Some of these patients are too sick to undergo a urological procedure to remove the stone or obstructing mass, so IRs can place a tube into the kidney to drain urine from behind the obstruction. This is called a percutaneous nephrostomy tube or "perc neph tube."
Varicose Veins
Varicose veins are enlarged, swollen vessels that develop when weak valves allow blood to flow backwards and pool. Symptoms include aching, throbbing, fatigue, and weakness that worsen as the day goes on. Interventional radiologists can treat varicose veins using endovenous ablation. In this procedure, laser or radiofrequency is applied via a catheter to the inside of the abnormal saphenous vein to seal it closed.
Endovenous Ablation for Varicose Veins
Varicose veins are enlarged superficial veins of the legs, which can cause pain, leg fatigue, skin changes and ulceration. Endovenous ablation is a procedure that closes enlarged veins just below the skin of the leg and redirects the venous blood into the deeper veins of the leg and back towards the heart. The procedure is performed in about an hour and only requires a local anesthetic. Prior to the availability to this procedure, vein stripping surgery was performed and required a hospital stay. Today, patients are encouraged to walk and perform light activity the same or next day.
Portal Hypertension
Portal hypertension is increased blood pressure in the portal vein, which connects the GI and spleen to the liver, and its branches and tributaries. Causes of portal hypertension include liver diseases such as cirrhosis and hepatitis, which decrease the portal vascular radius resulting in increased vascular resistance and portal blood pressure. Interventional radiologists can treat portal hypertension using a transjugular intrahepatic portosystemic shunt (TIPS) procedure. TIPS relieves high blood pressure in the portal system by creating a channel connecting the portal vein (which brings blood from digestive organs to the liver) to a hepatic vein (which carries blood
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Patients with liver disease can develop dilated veins in the abdomen and around the oesophagus due to high pressure within these veins. These can rupture and lead to life-threatening bleeding. To prevent this, we insert a needle into a vein in the neck and guide a wire into the liver. We then form a communication between the liver and the heart to reduce the pressure in the veins and prevent the chance of catastrophic bleeding. The x-ray images below show how this is performed. Patients for this procedure are referred to us by our gastroenterology colleagues. This is a complex and challenging procedure and is one of very few procedures we perform under general anaesthesia. Patients are cared for on the gastroenterology ward after their procedure for close observation and monitoring.
Bile Duct Obstruction
In patients with liver cancer, bile duct cancer, cholecystitis, cholangitis, or other hepatobiliary pathology, the bile duct may become blocked and bile cannot drain from the liver. A stent, a small metal cylinder, or catheter can be placed to help with biliary drainage.
Interventional Oncology
Interventional radiologists play an integral role in the diagnosis and treatment of different cancers including bone, breast, kidney, liver, and lung. Pathological diagnosis remains the gold standard for diagnosis of most cancers. Interventional radiologists perform needle biopsies for definitive diagnoses. Interventional radiologists are also able to treat using methods such as ablations and chemoembolization.
- Radiofrequency ablation employs radiofreqency heat to "cook" and destroy tumor cells. Radiofrequency ablation can be used to treat kidney tumors, liver cancer, lung cancer, and adrenal cancer.
- Cryoablation uses extreme cold to freeze and destroy cancer cells. Cryoabation can be used to treat kidney tumors, liver cancer, and prostate cancer.
- Chemoembolization involves delivery of a cancer-killing drug through a catheter directly to the organ and embolization of arteries to the tumor to deprive the tumor of its blood supply and prevent the cancer-killing drug from flowing to other areas of the body.
CT-guided Lung Biopsy -
Transcatheter Arterial Chemoembolization -
Renal Oncology Management -
Thermal Ablation -
Stroke and Carotid Artery Stenosis
Strokes are classified into two type: ischemic (caused by blood clots) and hemorrhagic (caused by blood vessel rupture). CT, MRI, and angiography can be employed to identify type of stroke and localize affected areas of the brain. Within the first three hours from onset of symptoms of an ischemic stroke, tPA (tissue plasminogen activator) can be given to dissolve the clot. Remember that tPA catalyzes the conversion of plasminogen to plasmin, which degrades fibrin clots. If tPA fibrinolysis cannot be performed within the first three hours, interventional radiologists can treat ischemic strokes through intra-arterial thrombolysis treatment. A catheter is inserted through the femoral artery and guided to the blood clot to deliver tPA directly or mechanically breakup the clot. Interventional radiologists can treat hemorrhagic strokes using tiny metal coils to embolize and block the abnormal vessel. The same technique can be used to treat aneurysms and AVMs
Renal Artery Stenosis
Renal artery stenosis is often caused by atherosclerosis or fibromuscular dysplasia. It is a common cause of secondary hypertension. Stenosis decreases blood flow to glomerulus. Juxtaglomerular apparatus responds by secreting renin, which converts angiotensinogen to angiotensin I. Angiotensin I is converted to angiotensin II by angiotensin converting enzyme (ACE). Angiotensin II raises blood pressure by contracting arteriolar smooth muscle (increasing peripheral resistance) and promoting adrenal release of aldosterone (which increases resorption of sodium in the distal convoluted tubule and results in expanded plasma volume).
Interventional radiologists can treat renal artery stenosis using balloon angioplasty or stenting. In angioplasty, a deflated balloon is tunneled to the narrowed artery then inflated to open up the vessel and restore blood flow. The addition of a stent strengthens vessels walls to prevent collapse of the artery.
Uterine Fibroids
Uterine fibroids are noncancerous growths that develop in the muscular wall of the uterus. Found in 20-40% of women age 35 and older, fibroids are the most common tumors of the female genital tract. Most women with uterine fibroids are asymptomatic, but 10-20% may experience symptoms such as heavy menstrual periods, pelvic pain, frequent urination (due to pressure on bladder), and abnormally enlarged abdomen. This latter subset of patients can be treated with uterine fibroid embolization (UFE), also known as uterine artery embolization (UAE). The interventional radiologist guides a catheter to the uterine arteries and releases small particles which occlude the fibroid's blood supply and shrink the tumor.
Uterine Fibroid Embolization (UFE)
Uterine fibroid embolization is a method for treating fibroid tumors of the uterus. Fibroid tumors, also known as myomas, are masses of fibrous and muscle tissue in the uterine wall which are benign but may cause heavy menstrual bleeding, pain in the pelvic region, or pressure on the bladder or bowel. With methods similar to those used in heart catheterization, a tiny catheter is placed in each of the two uterine arteries and small particles are injected to block the arterial branches that supply blood to the fibroids. The fibroid tissue dies, the masses shrink, and in most cases symptoms are relieved. Uterine fibroid embolization is much less invasive than open surgery done to remove uterine fibroids.
Prostate Artery Embolisation - for Benign Prostatic Hypertrophy (BPH)
Many men suffer with difficulty passing urine due to an enlarged prostate. This procedure involves inserting a needle into the groin, then passing a catheter into the prostate arteries under x-ray guidance. Once we’re in the right place, we inject tiny beads into the arteries supplying the prostate which causes it to shrink and improves symptoms. Patients for prostate artery embolisation are referred to us by our urology colleagues and may prevent a surgical operation. Patients are seen in an IR outpatient clinic prior to the procedure to ensure they understand the procedure and give informed consent. The procedure is performed under local anaesthetic and sedation, and can often be performed as a day case procedure without the need for an overnight stay in hospital.
SCROTAL VARICOCELES
Varicoceles affect up to 15% of males and are the most common diagnosis in infertile men.Varicoceles are most often treated in cases of orchialgia, infertility, or reduced testicular size in adolescents. Endovascular therapy embolizes the affected spermatic vein using coils or sclerosants. Studies have shown that gonadal vein embolization is effective for relieving orchialgia, with 87% of 154 patients having complete pain relief at 39 months in one review. A Cochrane review of low-quality studies that did not differentiate between surgery and embolization suggests varicocele treatment improves fertility
Varicocoele Embolisation
Some men suffer with distended veins in the scrotum which causes swelling and pain. This procedure involves inserting a needle into the vein in the groin or neck, then guiding a catheter under x-ray guidance to the vein draining the scrotum. We then place metal coils or glue into the vein draining the scrotum which relieves the symptoms. We now also perform this procedure for some men with poor sperm function as there is an association with subfertility. Patients for this procedure are referred to us by our urology colleagues or the subfertility clinic. Patients are seen in an IR outpatient clinic prior to the procedure to ensure they understand the procedure and give informed consent. The below x-ray images show a catheter inside the veins and following deployment of coils in the testicular vein. This procedure is performed under local anaesthetic as a day case procedure which allows a very quick recovery
Percutaneous Drainage and Biopsy
Image-guided percutaneous drainage and biopsy are safe, well-tolerated procedures and can be performed in nearly any part of the body.The benefits of percutaneous drainage are well-established and reflected in current practice guidelines. Indications include further characterization of abnormal fluid collections, definitive drainage, or partial drainage before definitive surgery.Patients with abscesses larger than 3 cm are usually considered candidates for drain placement, whereas patients with smaller abscesses or who need sterile collections can be treated with aspiration or antibiotic therapy alone. Overall, the outcomes of percutaneous drainage are at least equivalent to open surgical approaches, with possible reductions in morbidity, length of hospital stay, and cost.
Image guidance can be used for biopsies in a nontargeted fashion or to sample a specific mass. For superficial head and neck masses, such as in the lymph nodes, salivary glands, or thyroid, ultrasonography is commonly used. Guidelines recommend fine-needle aspiration for concerning thyroid lesions, but nearly 30% of samples are nondiagnostic.
Core needle biopsies improve sample adequacy to 95%, although negative predictive values vary from 69% to 93% depending on site. Biopsy of deeper head and neck masses often requires computed tomography guidance for optimal visualization to avoid high-risk structures. Small studies show that computed tomography–guided biopsies provide adequate samples from 73% to 96% of deep neck lesions.
Liver masses can be biopsied with high accuracy, although rates of needle tract seeding approach 5% in patients with hepatocellular carcinoma. Kidney mass sampling is often unnecessary because of high rates of benign and indolent disease but has high accuracy for characterizing indeterminate lesions. Computed tomography–guided transthoracic sampling of peripheral lung nodules has a much higher sensitivity than ultrasound-guided transbronchial biopsy, although it has a 1% rate of pneumothorax requiring a chest tube.
In children, biopsy of soft tissue masses has an accuracy of more than 95%, with most lesions amenable to ultrasound guidance because of proximity to the skin surface.
Image Guided Biopsies
Using ultrasound or CT guidance we can insert a needle to nearly anywhere in the body and obtain a sample of tissue to assess whether there is infection or tumour or other types of disease present at this location. The image below shows a CT image of a needle being inserted into a lung cancer. Patients for this procedure can be referred to us by any medical or surgical specialty. It is usually performed under local anaesthetic. Some procedures can be performed as day case procedures but often patients are cared for on a ward following the procedure for close observation and monitoring.
Image Guided Drains
Using ultrasound or CT guidance we can insert a needle into fluid collections or abscesses anywhere in the body and insert a drain over a wire to remove the fluid or abscess. The CT images below show a drain being inserted into an abscess in the pelvis. Patients for this procedure can be referred to us by any medical or surgical specialty. It is usually performed under local anaesthetic. Most patients requiring abscess drainage are quite poorly and need post procedure care on a ward for close observation and monitoring.
Cholecystostomy
If the gall bladder becomes blocked with stones or tumour it can make patients very unwell and lead to septicaemia. We use ultrasound or CT to guide a needle through the skin and liver into the gall bladder. We then insert a tube over a wire to allow the gall bladder to drain. This procedure is usually performed under local anaesthetic. Most patients requiring cholecystostomy are quite poorly and need post procedure care on a ward or ITU for close observation and monitoring
Portal Vein Embolisation (PVE)
Here we insert a needle through the skin under ultrasound guidance directly into the main vessel which supplies the liver with blood. We then inject glue, beads or tiny metal coils to block off the blood supply to the side of the liver which contains tumour. This causes this side of the liver to shrink and the opposite side to grow which allows surgeons to remove the cancerous side of the liver without putting the patient into liver failure. Patients for this procedure are referred to us by our hepatobiliary surgical colleagues. The procedure can be performed under local anaesthetic but often we keep patients overnight on a ward for close observation and monitoring.
Pre-Operative Tumour Embolisation
If a tumour is very large or has an extensive blood supply, we can insert a needle into an artery (usually in the groin) and pass a tiny tube (catheter) up through the aorta and into the artery that supplies the tumour with blood. We can then inject glue or tiny beads, particles or tiny metal coils into the arteries supplying the tumour which blocks the blood supply. Due to a lack of blood the tumour shrinks and has less blood in it, making it easier to remove by traditional open surgery. Patients for this procedure are referred to us by various surgical specialties and can be performed under local anaesthetic. Patients usually stay overnight on a ward after the procedure for close observation and monitoring.
Acute Arterial Catheter Directed Thrombolysis
This involves passing a tube into a blocked blood vessel and slowly injecting clot busting medication to try to unblock the vessel and re-establish blood flow. If blood flow cannot be re-established as quickly as possible, there is a real risk of limb loss. Patients for thrombolysis are usually referred to us by our vascular surgery colleagues and may prevent an open surgical declotting or bypass operation. Patients are admitted to the specialist vascular Enhanced Care Unit or General Critical Care for this procedure for close monitoring.
Embolisation for Post-Partum Bleeding
Following childbirth sometimes the uterus fails to contract enough to stop bleeding. There are many ways the bleeding can be stopped by the obstetric doctors but very rarely the bleeding doesn’t stop. In this scenario we can insert a needle into the artery in the groin and pass a catheter into the arteries supplying the uterus. We then inflate tiny balloons which stop the blood flow to the uterus. If this does not work, we can inject particles or a glue-like substance into the uterus to stop it from bleeding. We sometimes also perform this procedure in women who have complex problems with their placenta which puts them at high risk of bleeding during delivery. In those circumstances we insert balloons into the arteries, then inflate them as the baby is being delivered by c-section. This reduces the blood loss during c-section and helps the obstetric team deliver the placenta
Embolisation for Gastrointestinal Bleeding
Bleeding into the bowel is commonly controlled by putting a camera through the mouth or up the back passage to find the source and either inject it with glue or place metal clips on the bleeding vessel. Sometimes this fails so we are called to insert a needle into the artery in the groin, direct a catheter under x-ray guidance into the artery which supplies the bowel, then guide the catheter to the source of bleeding and stop it from the inside by using tiny metal coils, particles or glue. The black splodge on the below images shows the source of bleeding which is subsequently stopped. Patients for this procedure are usually referred by our gastroenterology colleagues and can be very sick. Although the procedure can be performed just under local anaesthetic, we often ask our anaesthetic colleagues to attend in case we need help when patients are bleeding profusely. Patients normally go back to the gastroenterology ward or ITU following this procedure for close observation and monitoring
Embolisation for Trauma
This involves identifying the source of internal bleeding in patients following trauma and using a variety of materials to stop the bleeding, including glue, beads, metallic coils and covered stents. More often than not, internal bleeding can be stopped without the need for a traditional open operation, thus avoiding the need for open surgery and an associated long recovery. The images below show bleeding into the spleen (black splodge) followed by stopping the bleeding with a single metal coil and disappearance of the black splodge. Although the procedure can be performed just under local anaesthetic, we often ask our anaesthetic colleagues to attend in case we need help when patients are bleeding profusely. Patients always go back to a ward or ITU following this procedure for close observation and monitoring.
Endovascular Aneurysm Repair (EVAR)
This involves inserting large metal stents lined with a synthetic cloth coating into the aorta and vessels in the abdomen to prevent the aorta rupturing in patients with an abdominal aortic aneurysm (AAA) which occurs when the main artery taking blood away from the heart dilates and there is a risk of rupture which often leads to death. This procedure re-lines the aorta and reduces the risk of it rupturing. It is usually performed as a joint procedure with our vascular surgery colleagues under general anaesthesia, where the vascular surgeons open the groins and give us direct access to the arteries so that we can insert these very large stents. However, more recently, we can now perform this procedure under local anaesthetic without the need for opening of the groins which allows for much quicker recovery
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