Interventional Radiology

Aneurysms are abnormally enlarged arteries that carry a risk of rupture. Aneurysms can occur in any artery, though they are most common in the brain, aorta, spleen and kidney. Once they develop, aneurysms will continue to grow. The rate of growth and risk of rupture depends on the individual and the location of the aneurysm. When most aneurysms are small, they can generally be monitored with an imaging study such as ultrasound or CAT scan. However, when aneurysms are very large or grow rapidly, they should be treated.

Fortunately, aneurysms can be treated with minimally invasive surgical procedures. Small aneurysms in the brain or spleen can be treated with a technique called “embolization”. These procedures are performed with pinhole incisions, specialized vascular devices and X-ray guidance instead of open surgery. Many of these aneurysms can be treated on an outpatient basis; patients spend a few hours recovering in hospital after the procedure and return home the same day. Even aneurysms in the largest artery in the body, the aorta, can be treated with a minimally invasive surgery called “endovascular aneurysm repair”.

Ascites is an abnormal fluid that accumulates in the abdominal cavity. Ascites occurs in diseases like liver cirrhosis, heart failure and cancer. Mild or small-volume ascites can be treated with medications, though medications may be insufficient to treat large volume ascites. Recurrent ascites or large volume ascites can be treated with a minor procedure called paracentesis. This involves placing a small needle into the abdominal cavity to drain the excess fluid. Sometimes, the volume of fluid drained can be several gallons.

For ascites that reaccumulates rapidly or near the end-of-life, frequent procedures to drain the fluid may be undesirable. Patients with ascites caused by cancer may benefit from a semi-permanent drainage catheter placed into the abdominal cavity. These catheters, sometimes called PleurX or Aspira catheters, allow patients to drain ascites on their own, either at home or with the assistance of a family member or visiting nurse.

Patients with ascites due to liver cirrhosis may benefit from a “TIPS” procedure, though they should discuss this first with a liver specialist called a Hepatologist.

Bile ducts drain digestive products from the liver to the intestines. Bile ducts can be narrowed or blocked by abnormalities in and around the liver such as infection, prior surgery, cancer and autoimmune diseases.  Typically, blockages in the bile ducts can be treated with endoscopy. When endoscopy fails, blockages in the bile ducts can be treated with a minimally invasive surgery performed through the skin. Specialized wires and catheters are used to open the bile duct blockage. Drains or stents may be left in place to allow bile to flow freely. This procedure can also be used to remove stones that may develop in the bile ducts.

We work closely with surgeons and gastroenterologists to ensure the best management of bile duct abnormalities.

Certain medications must be administered directly into central veins located near the heart. Some of these intravenous (IV) medications like antibiotics and chemotherapy must be administered intermittently over the course of several weeks or months. Fortunately, central vein catheters allow for safe and easy administration of IV medications while at home or at a walk-in medical clinic.

Tunneled vein catheters are accessible on the outside of the body but course underneath the skin for a short distance before entering a vein. These catheters are usually placed in the neck and chest, most frequently used for administration of outpatient IV antibiotics. These catheters are small and have a low risk of infection. They may stay in for a few weeks or months and can be easily removed in a matter of minutes.

Chest ports, or chemotherapy ports, are longer-term central vein catheters that help patients with cancer. Chest ports are about the size of the tip of your thumb. The port is surgically placed just under the skin of the chest so that it may be accessed using a small needle. The port is connected to a small catheter, which ends in a vein near the heart. Ports can be used for a number of months or even years if necessary. Chest ports are placed on an outpatient basis, and patients typically spend half of day in the hospital or ambulatory care center. Chest ports can be easily removed in a 10 to 15-minute-long procedure.

Deep vein thrombosis, or DVT, are blood clots that develop in larger veins that help return blood to the heart. DVT can occur after surgery, in cases of prolonged immobilization and as a complication of cancer. DVT most frequently occurs in the legs, where it can cause swelling, impaired mobility, pain and even skin breakdown. DVT is typically treated with blood thinning medications that help the body break down clots.

When there is a large amount of deep vein clot or if symptoms are very severe, certain patients may benefit from a minimally invasive procedure that removes the clot. Using tiny incisions and specialized vascular devices, clots can be removed from the vein or destroyed with clot busting medications. In cases of vein narrowing, such as May-Thurner Syndrome, stents may be placed inside of the veins to keep them open.

Hemodialysis is a common treatment for patients with chronic kidney dysfunction or end-stage renal disease. When the kidneys are unable to function, dialysis may be necessary to remove excess fluid and toxins that accumulate in the blood. During hemodialysis, blood is filtered and cleaned by a specialized machine. To collect and return this blood, hemodialysis requires a specialized catheter or a surgically created connection between an artery and vein called a hemodialysis fistula.

Fistulas are the best way to receive long-term hemodialysis. Fistulas are created surgically. They encounter occasional problems such as narrowing or clots that may interfere with hemodialysis. Fortunately, these problems are generally treatable with a minimally invasive procedure called a fistulagram. During a fistulagram, an interventional radiologist uses specialized catheters and devices to restore flow and function via pinhole incisions. Fistulagrams are performed under twilight sedation and are most often performed on an outpatient basis. Patients may return home after a fistulagram and even receive same-day hemodialysis.

Hemorrhoids are swollen veins in the rectum that result from long-term straining or constipation. Hemorrhoids can cause a variety of symptoms including anal itching, bleeding and pain. Most hemorrhoids resolve over time with conservative treatments like hydration and a healthy, fiber-rich diet. For persistent hemorrhoids or hemorrhoids with severe symptoms, there are a number of treatment options.

The most common treatment is hemorrhoid banding, in which surgeons or gastroenterologists place a small rubber band around the hemorrhoid via an anal scope. Surgery may also be performed to remove the hemorrhoid tissue altogether. A new, minimally invasive procedure called hemorrhoid artery embolization has been proven effective for patients suffering from prolonged hemorrhoidal bleeding. This procedure seeks to close tiny hemorrhoid vessels from the inside using pinhole incisions in the wrist or leg arteries. Under X-ray guidance, tiny wires are navigated into the hemorrhoid artery and used to stop the bleeding. There are no rectal incisions or inserted scopes for this procedure. Ask your gastroenterologist or surgeon if hemorrhoid artery embolization is right for you.

Inferior vena cava filters, or IVC filters, are small metallic cage-like devices that are placed into the largest abdominal vein, the IVC. IVC filters may be beneficial for patients with deep vein thrombosis, or DVT. Generally, DVT is treated with blood thinning medications. Unfortunately, some patients are unable to safely receive blood thinning medications. In these instances, patients may instead receive an IVC filter, which prevents dangerous clots in the legs and pelvis from traveling to the heart and lungs.

IVC filters are placed via minimally invasive techniques. Using a pinhole incision overlying the neck or leg veins, the filters are deployed using specialized devices under X-ray guidance. IVC filter technology has steadily advanced over the past 40 years. The newest generation of IVC filters are retrievable, which means we can place the filters temporarily and safely remove them when they become unnecessary. Even older filters can be removed via minimally invasive techniques and with small risks. If you have an IVC filter, check with your primary care provider to see if your IVC filter can be removed.

Kidney cancer is common in the United States. Cancer in the kidney may be discovered “accidentally” or it may present with blood in the urine or flank pain. Once diagnosed, doctors meet to discuss the best treatment for patients with kidney cancer. Common treatments may include chemotherapy, surgical removal of the cancerous kidney or a minimally invasive treatment called ablation.

Thanks to advances in modern medicine, we can treat and even cure kidney cancer via pinhole incisions. Tumor ablation uses specialized probes inserted through the skin to destroy the cancer whilst preserving the rest of the normal kidney. Ablation is performed under general anesthesia and takes 1-2 hours. Patients spend 2-4 hours in recovery and typically return home on the same day. Symptoms of the treatment are typically mild and may include flank discomfort and temporary blood in the urine. Recovery is minimal and patients typically return to their daily activities in 1-2 days.

Liver cancer is the 6th most common cancer in the world and a leading cause of cancer-related death. Chronic inflammation of the liver increases the risk of developing liver cancer. Viral hepatitis, fatty liver disease and alcoholic liver disease are common causes of liver inflammation. Individuals with these diseases should be monitored for liver cancer with laboratory tests and surveillance imaging.

At the Queen’s Medical Center, doctors meet frequently to discuss the best treatment for patients with liver cancer. These meetings include transplant surgeons, specialized liver doctors called hepatologists, oncologists and interventional radiologists. In interventional radiology (IR), we focus on the minimally invasive treatment of liver cancer. Thanks to advances in modern medicine, we can diagnose, treat and even cure liver cancer via pinhole incisions and minimally invasive surgery.

One of these treatments called percutaneous ablation uses specialized probes inserted through the skin to destroy the liver cancer whilst preserving the rest of the liver tissue. Other procedures called tumor embolization use tiny devices inside the liver arteries to deliver potent chemotherapy or deadly radiation therapy to the cancer. These procedures also allow us to treat the cancer whilst preserving the rest of the liver.

Cysts are fluid-filled collections that can form anywhere in the body. Generally, cysts are very small and go unnoticed. Large cysts can grow in organs like the liver and kidney where they can cause abdominal pain or organ dysfunction. Fortunately, these cysts can be treated without open surgery.

Cyst sclerotherapy seeks to remove the cyst fluid and shrink the lining of the cavity so that fluid does not reaccumulate. This treatment involves placing a small drainage catheter through the skin and into the cyst. Catheters are generally the size of a charging cable. The fluid is removed using the drain and a cleansing agent is instilled into the cyst cavity. Patients return home with their drain and the cleansing process is repeated every day for several weeks. This process causes the cyst cavity to shrink and eventually close permanently. When treatment is completed, we simply remove the catheter.

Osteoarthritis (OA) of the knee is a leading cause of disability and pain. OA is a degenerative process that reflects chronic, wear-and-tear damage of the joint. Inflammation accompanies this joint degeneration and contributes to pain. Treatment options for joint degeneration include pain medications, steroid injections and surgical joint replacement. Several new, minimally invasive procedures can help reduce joint pain without open orthopedic surgery.

Genicular artery embolization, or GAE, treats several tiny arteries in the knee joint to reduce inflammation and associated pain. This minimally invasive procedure is performed on an outpatient basis allowing patients to return home the same day. Most patients experience substantial pain relief within 1-2 weeks. GAE is an excellent option for patients with severe degenerative knee pain who are unable to receive a surgical knee replacement, or who are not interested in surgery.

Watch a video about new treatments for knee arthritis, from UCLA. 

Pelvic congestion syndrome, or pelvic venous insufficiency, is a common cause of pelvic pain in post-partum women. Over time and especially after pregnancy, veins in the pelvis may become “insufficient” or lose their ability to return blood to the heart. This is also how varicose veins develop in the legs. Insufficient pelvic veins can cause pelvic pain, protuberant groin veins and painful intercourse. Pelvic congestion syndrome is often diagnosed with a CAT scan or ultrasound.

Pelvic venous insufficiency can be treated with a minimally invasive procedure called gonadal vein embolization, or GVE. GVE is performed on an outpatient basis and patients return home the same day. The procedure is performed under conscious sedation. Using X-ray guidance, tiny devices are inserted into the neck or leg veins and used to close the abnormal vessels in the pelvis and groin. There are no incisions in the vaginal region.

Prostate enlargement, or benign prostatic hyperplasia (BPH), is a common cause of urinary obstruction in men. Symptoms including frequent urination, nighttime urination, poor urinary flow and incomplete bladder emptying are often related to prostate gland enlargement. Symptoms are highly disruptive and can lead to urinary tract infection and even irreversible kidney damage.

Traditional surgical treatments of BPH include open prostate removal (prostatectomy) and transurethral resection of the prostate (TURP). While surgical treatments effectively improve urinary symptoms, they have known side effects including permanent sexual dysfunction.
Prostate artery embolization, or PAE, is a minimally invasive procedure that treats tiny arteries in the prostate to limit blood flow and cause shrinkage of the prostate gland. PAE is performed on an outpatient basis, allowing patients to return home the same day. Patients do not require a urinary catheter for this procedure. PAE has a lower complication rate compared to the most common surgical alternative. The procedure is performed via tiny pinhole incisions overlying arteries in the wrist or leg. There are no incisions made in the prostate or genital region.

If you believe you have symptoms of BPH, check your prostate symptom score here, which will be rated as mild, moderate or severe. If you would like more information about this treatment, please schedule a consultation with us or ask your PCP or urologist.

Calculate Your International Prostatism Symptom Score (IPSS) >>

Arteriovenous malformations, or AVMs, are abnormal connections between arteries and veins. Pulmonary AVMs occur in the lungs and are frequently seen in a genetic syndrome called HHT, or Hereditary Hemorrhagic Telangiectasia. Pulmonary AVMs may be discovered incidentally on chest imaging, or may bring about substantial symptoms such as shortness of breath, low oxygen levels and even stroke. Pulmonary AVMs can be treated without surgical resection of the lung. In fact, they can be successfully treated with a minimally invasive procedure called embolization. Embolization of a pulmonary AVM is performed under twilight sedation on an outpatient basis. During this procedure, a small catheter is inserted into a vein in the neck or groin and navigated to the AVM under X-ray. The malformation is then permanently closed with tiny metallic coils or plugs. Patients who present with symptoms related to their AVM typically experience resolution within days of treatment!

Pulmonary embolism, or PE, occurs when clots travel from veins in the arms, legs or pelvis to the lungs. Large clots in the lungs can be very dangerous and even deadly. Most patients with mild PE can be successfully treated with blood thinners. However, blood thinners may be insufficient for patients with large PE or for patients with underlying heart or lung disease. These patients may benefit from a minimally invasive procedure called thrombectomy.

Thrombectomy removes clots from the lungs without open surgery. Under X-ray guidance, small devices are inserted into neck or leg veins and navigated into the lung. Clots in the lung vessels are removed using suction devices or clot busting medications. This procedure decreases the risk of death and prevents permanent injury to the lungs and heart. The procedure typically takes about an hour and patients are monitored closely in the hospital thereafter.

Treatment of PE is coordinated by a large team of specialized doctors, including emergency physicians, pulmonologists, critical care doctors and interventional radiologists. Minimally invasive treatment of PE is a cutting-edge field that delivers promising results for patients. Many patients return home within several days of thrombectomy treatment.

Uterine fibroids, or leiomyomas, are benign masses in the uterus that can cause pelvic heaviness, pelvic pain, painful intercourse, difficulty urinating and irregular uterine bleeding. Uterine fibroids are diagnosed on CAT scan, MRI or ultrasound. Traditional surgical treatments include myomectomy, which resects the fibroids, and hysterectomy, which removes the uterus entirely.

Fortunately, for patients who wish to treat fibroids and preserve the uterus, a non-surgical alternative exists. Uterine fibroid embolization, or UFE, is a minimally invasive procedure that treats blood vessels in the uterus causing fibroids to slowly shrink and symptoms to improve.

UFE is performed on an outpatient basis. The procedure involves a single pinhole incision overlying the wrist or leg arteries and avoids genital incisions altogether. The procedure lasts about an hour and is performed under conscious sedation, sometimes with epidural anesthesia. Patients can be discharged home on the same day as the procedure or may stay in the hospital for 1-2 days.

If you have symptomatic uterine fibroids, please schedule a consultation or ask your PCP or gynecologist about UFE.

Varicose veins are enlarged superficial veins in the legs that are caused by “venous insufficiency”. Normal veins help return blood to the heart, often against the force of gravity. Weakened or insufficient veins don’t function properly and may become protuberant varicose veins.

Varicose veins may be unsightly or painful. In severe cases, venous insufficiency can cause leg swelling and even skin ulcers. There are many minimally invasive treatments for varicose veins and venous insufficiency. Microphlebectomy removes unsightly or painful varicose veins through pinhole incisions. Venous ablation treats larger insufficient veins and is also performed through pinhole incisions. If you have varicose veins or lower extremity swelling, schedule a consultation and see if interventional radiology is right for you.

Varicoceles are small, dilated veins in the male pelvis and scrotum that can cause scrotal heaviness, testicular pain, sexual dysfunction and even infertility. Varicoceles are generally diagnosed with an ultrasound. Varicoceles can be easily treated with a minimally invasive procedure called gonadal vein embolization, or GVE.

GVE is performed on an outpatient basis and patients return home the same day. The procedure is performed under twilight sedation and takes less than an hour. Under X-ray guidance, tiny devices are inserted into the neck or leg veins and used to close the dilated veins in the pelvis from the inside. There are no incisions in the penis or scrotum. The procedure has an extremely high success rate and minimal side effects.

If you have been diagnosed with varicocele, please schedule a consultation with us or ask your PCP or urologist for a referral.

Vertebral compression fractures, or VCFs, are fractures of the load-bearing elements of the spine. They are common in the elderly and in those with decreased bone mineral density. VCFs can be very painful and debilitating, often causing prolonged immobility and associated problems like bedsores, pneumonia and social isolation. Initial treatment of VCFs is pain management, application of a back brace and physical therapy. For patients with severe or persistent pain despite these therapies, vertebral augmentation (VA) should be considered.

Vertebral augmentation is a minimally invasive procedure performed under conscious sedation. Under X-ray guidance, small needles are inserted through the skin into the fractured, load-bearing portion of the spine. Next, a puddy-like cement material is injected, hardens and stabilizes the spine. The procedure can be performed on an outpatient or inpatient basis and takes about an hour. Most patients experience near-immediate pain relief and can even return home on the same day. There is no need for prolonged immobility after the procedure. In fact, patients are encouraged to walk after a 1-2 hour recovery.