Interventional radiology, or image-guided surgery, is a sub-specialty of radiology where minimally invasive procedures are performed using image guidance.
Some of these procedures are done for purely diagnostic purposes (such as an angiogram), while others are done for treatment purposes (such as angioplasty). Images are used to direct these procedures, which are usually done with needles or other tiny instruments like small tubes called catheters. The images provide road maps that allow an interventional radiologist to guide these instruments through the body to the diseased area.
Many conditions that once required surgery can now be treated non-surgically by interventional radiologists. Interventional radiology treatments offer less pain, risk and recovery time compared to open surgery.
Other procedures performed by interventional radiology include:
- needle biopsies
- venous access procedures (IV catheters for antibiotics, chemo-therapy, dialysis)
- drainage procedures to relieve pressure in the kidney or liver
- removal of infected fluid from an abscess
- placement of feeding tubes through the abdominal wall directly into the stomach
- injections of spinal nerves to relieve pain
- injection of bone cement into vertebral fractures to relieve pain caused by compression
- fractures (vertebroplasty or kyphoplasty)
- tumor therapy for cancers of the liver or kidney, using directly injected chemotherapy in the liver, freezing (cryoablation) of the kidney, or radio-frequency ablation (heat) in the liver
Most interventional radiology procedures are performed using an IV sedative to help you relax. After the procedure, you may have some discomfort in the area of the body where the procedure was performed.
How to prepare
Procedure preparation varies depending on the complexity and if you have are sedated or not. For steroid injections for back pain, catheter removal, thyroid biopsies, joint injections, and drainage tube checks, no preparation is necessary. Simply wear clothing that allows access to the area of concern. No special transportation arrangements are necessary.
For procedures requiring conscious sedation, it is important to have nothing to eat or drink for four hours prior to your procedure. You'll need to arrive at the hospital and go to Admitting one-and-a-half to two hours before your procedure start time for paperwork and any necessary laboratory tests.
If you are on a blood-thinning medication (such as Warfarin, coumadin, aspirin, etc.), you may be asked to stop taking it three days prior to the procedure to reduce the chance of bleeding complications. You may take your regular medications (unless specifically requested not to) with small sips of water prior to your arrival at the hospital.
After your procedure, you'll return to Admitting for 1-6 hours, depending on your procedure. You'll need a ride home as you won't be able to drive after the procedure.
How the procedure is performed
For non-sedation procedures, check in at the radiology admitting desk to complete your paperwork. A staff person will escort you to the interventional radiology department for the procedure. A local anesthetic will be injected and the procedure performed.
For an angiogram, you'll be taken to the interventional radiology department for the procedure where a nurse will attach monitoring equipment. The doctor will inject a local anesthetic, place a needle into your artery, and thread a flexible wire through the needle into your artery. The needle is then removed and a plastic tube called a catheter is threaded over the wire. The wire is removed and contrast is injected as pictures are taken, recording the flow of contrast through your vessels. If a balloon or stent procedure is necessary, a slightly larger tube will be placed through the same site and the procedure will be performed. After the procedure, you will need to lie down for 2-6 hours. You should not drive for 24 hours or do any vigorus exercise or lift heavy objects for one week.
For a biopsy, you'll be transported to the CT department where a nurse will attach monitoring equipment. You will get sedation medicine and local anesthetic will be injected. The needle will be placed, pictures taken to guide the placement of the needle, and the biopsy performed.
Abscess drainage patients
For abscess drainage, you'll be transported to the CT department where a nurse will attach monitoring equipment. You'll receive sedation medicine and a local anesthetic. A needle will be placed into the abscess, a small sample withdrawn and sent to the lab, and the tube placed. The tube will be attached to a drainage bag, which will collect any fluid that builds up. This tube will stay in until the abscess stops draining (usually 1-3 weeks). At that time, another CT scan will be performed, along with a tube injection. If there is no communication with other organs, the tube can be removed at that time. Care of your tube and dressing changes are performed on Tuesday at the Pacific Campus Interventional Clinic. Call 425-258-7985 between 8 am and 4 pm for an appointment.
For drainage procedures of the kidney, gall bladder or bile duct system, you'll be taken to the interventional radiology department for the procedure where a nurse will attach monitoring equipment and a local anesthetic will be injected by the doctor. A small needle will be placed into the area, fluid withdrawn to be sent to the lab, and a wire placed through the needle. The needle is removed, and the drain tube is advanced over the wire. The tube will be attached to a drainage bag. Care of the tube and dressing changes are performed on Tuesday at the Pacific Campus Interventional Clinic. Call 425-258-7985 between 8 am and 4 pm for an appointment.
For venous access procedures for dialysis, chemotherapy or antibiotic therapy, most procedures are more comfortable with sedation. First, a local anesthesia is injected and the needle is placed in the vein using ultrasound guidance and a wire placed through the needle. The needle is removed and the catheter or port is placed over the wire. If the access is on the chest area, you'll have a small incision at the base of your neck. If you have a catheter, you'll be given care instructions by the nursing staff.
For tumor therapy patients, the day usually starts in Admitting. Liver chemoembolization patients will be admitted after the procedure for 1-2 days. These patients have an angiogram with placement of the catheter into the hepatic artery which supplies blood to the liver. Chemotherapy and material to plug the artery are injected to starve the tumor and apply direct chemotherapy. Because the tumor lacks blood supply, pain is common for a few days, which can be controlled with medication in the hospital.
Other procedures include freezing of kidney tumors (cryoablation) or heating of tumors (radio frequency or microwave ablation) of the liver or potentially other organs. These procedures are usually done on an outpatient basis. For these procedures, you'll go to the CT department where a nurse attach monitoring equipment. You'll receive sedation medicine and a local anesthetic will be injected. The needle will be placed, pictures taken to guide the placement of the needle, and the ablation performed. After the procedure, a recovery period of a few hours is necessary before you can go home.
For biopsy patients, results will be sent to the ordering physician by the pathology department, usually in 2-3 days. For all other patients, the Interventional Radiologist will review your procedure with you after the procedure, but you may not remember everything due to the sedation medicine. Your referring physician will also have access to the report the day following the procedure. For post-procedure questions or problems, you can call the Colby Campus Interventional Radiology department at 425-261-4145 or call the answering service at 425-258-7273.