1. Angiograms/Angioplasty/ Vascular Stents
- Aortoiliac
- Upper/lower extremities
- Renal
- Mesenteric
- Carotid
- Endograft Placement for Aortic Aneurysms
- TIPS
- Pulmonary angiography
3. Central Venous Access
4. Embolization therapy
- Uterine artery for fibroids
- Gastrointestinal bleeding
- Tumors/vascular malformations (including chemo-embolization)
- Bleeding from trauma
- Varicocele
Aortoiliac/Upper & Lower Extremities/ Renal/ Mesenteric Angiography
General Information:
The procedure for studying these arteries is basically the same except that the catheter positions are different depending on the vessel(s) of interest.
Since the aorta is the blood vessel from which these arteries originate,
most of these exams begin with an aortogram. This allows localization
of the various branch vessels and facilitates catheter placement for further
study.
What happens during the procedure?
Conscious sedation is provided just prior to starting the procedure.
Patients lie flat on the x-ray table. The technologist will prepare the
skin over the groin by cleaning it with an antiseptic solution and place
sterile drapes and towels over you to create a sterile work space. If
the vessels in the groin are blocked, it is sometimes necessary to enter
the artery through the arm.
Lidocaine local anesthesia is injected into the skin overlying the common
femoral artery in the groin. A needle is used to introduce a wire over
which a catheter is placed into the artery. Contrast dye is injected to
allow visualization of the arteries that supply the area of interest.
If a narrowing is identified, a balloon may be used to perform an angioplasty.
Sometimes angioplasty is not sufficient to return the vessel to normal
size and it becomes necessary to place a stent to help hold the vessel
open.
The catheter is removed and pressure is applied over the artery until
there is no bleeding (approximately 15min.)
This procedure typically requires 1 - 3 hours.
What happens after the procedure?
Since conscious sedation medicine is administered and the femoral artery has been punctured, you will be required to stay to recover for 4-6 hours after the end of the procedure. While in recovery, patients are monitored closely for signs of bleeding from the artery in the groin and ensure that the effects of the sedation have worn off. Patients must have a responsible adult available to drive/escort you home from the hospital.
Since the artery is a high pressure system, patients should refrain from
lifting more than 10 lbs, refrain from strenuous activity or anything
which causes abdominal distension for the following 48-72 hours. Any straining
such as vomiting, coughing, forced bowel movements, could dislodge the
clot that forms to seal the artery and cause bleeding.
Special Note: Patients who have renal artery hypertension
may experience partial or complete resolution of high blood pressure following
angioplasty/stent treatment. Often patients require fewer or a lower dose
of their blood pressure medication. The effect can be so dramatic that
if the usual dose of blood pressure medication is taken, blood pressure
can become too low. It is advisable to check your blood pressure at least
once per day for several days following the procedure prior to taking
regular morning blood pressure medication. If the pressure is much lower
than usual, patients should seek the advice of the prescribing physician
regarding medication dosage adjustment. This effect is particularly dramatic
in young adults with renal artery hypertension. Signs of low blood pressure
include: dizziness, nausea, sweating and unsteadiness when changing from
a sitting to standing position.
General Information:
Carotid artery narrowing, (stenosis,) can cause reduced blood flow to the brain. If a part of a diseased blood vessel becomes dislodged, the fragment can obstruct vessels in the brain which could result in stroke. When the narrowing is greater than 70%, carotid endarterectomy is often the treatment.
Carotid ultrasound with Doppler imaging is the typical screening test
for this disease. If the detected abnormality is borderline or unclear,
an angiogram, is performed to determine if surgery is indicated or even
possible.
What happens during the procedure?
Conscious sedation is provided just prior to starting the procedure.
Patients lie flat on the x-ray table. The technologist will prepare the
skin over the groin by cleaning it with an antiseptic solution and place
sterile drapes and towels over you to create a sterile work space.
Lidocaine local anesthesia is injected into the skin overlying the common
femoral artery in the groin. A needle is used to introduce a wire over
which a catheter is placed into aortic arch and each of the carotid arteries.
At each location, contrast dye is injected to allow visualization of the
arteries in the neck and brain. From these images the percentage and location
of narrowing can be measured.
The catheter is removed and pressure is applied over the artery until
there is no bleeding (approximately 15min.).
This procedure typically requires 1-2 hours.
What happens after the procedure?
Since conscious sedation medicine is administered and the femoral artery has been punctured, you will be required to stay to recover for 5-6 hours after the end of the procedure. While in recovery, patients are monitored closely for signs of bleeding from the artery in the groin and ensure that the effects of the sedation have worn off. Patients must have a responsible adult available to drive/escort you home from the hospital.
Since the artery is a high pressure system, patients should refrain from
lifting more than 10 lbs, refrain from strenuous activity or anything
which causes abdominal distension for the following 48-72 hours. Any straining
such as vomiting, coughing, forced bowel movements, could dislodge the
clot that forms to seal the artery and cause bleeding.
Endograft Placement for Aortic Aneurysms
General Information:
Abdominal Aortic Aneurysm (AAA, “triple-A”) is an abnormal
dilatation of the aorta due to weakness of the blood vessel wall. The
most common cause is hypertension and atherosclerosis however infections
and certain genetic diseases may predispose patients to developing AAA.
These aneurysms almost always develop and expand slowly over several years.
When the aneurysm reaches 5 cm in diameter, repair is usually indicated.
Major surgery is often necessary for repair of AAA however a select subset
of patients are eligible for a less invasive treatment: aortic endograft.
The size and location of the aneurysm as determined by angiography will
guide the decision regarding the feasibility of endograft placement.
What happens during the procedure?
The procedure is performed in the operating room in conjunction with a vascular surgeon. The surgeon performs a “cut-down” in each groin to expose the common femoral arteries.
Catheters are inserted into the artery and aortic angiogram is performed
to guide precise placement of a custom made endograft. The endograft is
inserted through sheaths placed in each common femoral artery.
An angiogram is repeated and any necessary modifications can be made before
the vascular surgeon closes the groin incisions
This procedure varies in length from 3-5 hours.
What happens after the procedure?
Follow up CAT scans to assess for “leaks” are performed routinely within 24 hours and at regularly specified intervals thereafter.
General Information:
T.I.P.S. = Transjugular Intrahepatic Portasystemic Shunt
This procedure is reserved for patients who have severe liver (hepatic)
disease called cirrhosis. The most common causes of liver cirrhosis are
alcoholism and viral hepatitis.
In these diseases, chronic inflammation in the liver results in deposition
of stiff fibrous scar tissue which can limit blood flow through the liver
from the portal vein. This causes back up of blood and thus increased
pressure in the portal venous system. As the condition worsens and pressure
increases, the veins begin to distend and form varices (dilated veins.)
The problem with varices is that they have a tendency to bleed-- a problem
which is compounded by the fact that patients with liver disease often
have deficiencies in blood clotting.
Varices develop in the regions which drain blood into the portal vein:
esophagus/ stomach, around the spleen, and rectum (hemorrhoids.) Patients
thus may present with rectal bleeding, vomiting of blood or black tarry
stools.
What happens during the procedure?
Conscious sedation or general anesthesia is administered during the procedure.
Patients lie flat on the x-ray table. The technologist will prepare the
skin over the neck by cleaning it with an antiseptic solution and place
sterile drapes and towels over you to create a sterile work space.
Lidocaine local anesthesia is injected into the skin overlying the right
internal jugular vein. A needle is used to introduce a wire, followed
by a long sheath, into the hepatic vein. A venogram is performed and used
to guide passes of a long needle from the hepatic vein into the portal
vein. Once the portal vein is entered, a wire is placed into it and an
angioplasty balloon is inflated along the track connecting the hepatic
vein with the portal vein. Next a stent is placed within this track to
maintain the connection. A final portal venogram is performed to confirm
adequacy of the shunt.
The jugular vein sheath may remain in place overnight or be removed immediately
following the procedure.
This length of this procedure varies from 1.5 to 4 hours.
What happens after the procedure?
Since conscious sedation medicine is administered and the femoral artery has been punctured, you will be required to stay to recover for 2-4 hours after the end of the procedure. While in recovery, patients are monitored closely for signs of bleeding from the vein in the neck, and ensure that the effects of the sedation have worn off. Patients must have a responsible adult available to drive/escort you home from the hospital.
An ultrasound evaluation of the shunt will be performed within 24 hours
after being placed. Ultrasound surveillance is continued every 3 months
for a year and every six months thereafter. In this way early signs of
shunt failure can be treated relatively easily.
Patients are monitored closely for signs of further bleeding, encephalopathy or heart failure.
General Information:
The pulmonary arteries are carry blood to the lungs for oxygenation. Blood clots in the large veins of the legs or arms may travel to and obstruct the pulmonary arteries, (“pulmonary emboli” or “P.E.”,)and cause shortness of breath.
Patients who are suspected of having a P.E. may be evaluated by nuclear
medicine “V/Q scan,” or a CAT scan. Occasionally these tests
do not provide a definitive answer and pulmonary angiography may be necessary.
What happens during the procedure?
Conscious sedation is provided just prior to starting the procedure.
Patients lie flat on the x-ray table. The technologist will prepare the
skin over the groin by cleaning it with an antiseptic solution and place
sterile drapes and towels over you to create a sterile work space.
Lidocaine local anesthesia is injected into the skin overlying the common
femoral vein in the groin. A needle is used to introduce a wire over which
a catheter is placed and guided through the heart into each of the pulmonary
arteries. Contrast dye is injected to allow visualization of the arteries
which deliver blood to the lungs. These images will allow detection of
pulmonary emboli and initiation of appropriate therapy.
The catheter is removed and pressure is applied over the vein until there
is no bleeding (approximately 5min.)
This procedure typically requires 1 hour.
What happens after the procedure?
Following the procedure patients are required to remain at bed rest and be monitored for signs of bleeding at the vein puncture site and ensure that the sedation has worn off.
If no pulmonary emboli are discovered, the search for the cause of symptoms
continues.
If there is evidence of P.E., the typical treatment consists of anticoagulation
therapy (blood thinners) and/ or consideration of a venous filter.
General Information:
Thrombolysis means breaking up or dissolving blood clots. This can be accomplished using powerful blood clot dissolving drugs such as TPA (tissue plasminogen activator,) and/or mechanical devices to remove or break up the clot.
Clots may form in arteries or veins. In general clotted arteries will
cause severe pain without swelling whereas clotted veins cause dull aching
pain with swelling.
Certain patients are more prone to forming blood clots. For example, prolonged
bed rest, many cancers, extensive surgery or trauma, and defects in the
clotting mechanism predispose patients to developing blood clots, most
often in the form of deep vein thrombosis (DVT.)
Clots most commonly form in blood vessels which are injured, or have reduced
rate of blood flow. They may also be associated with foreign bodies such
as catheters, pacemaker wires, stents, or grafts.
What happens during the procedure?
Conscious sedation is provided.
The skin overlying the artery or vein which leads to the area in question
is anesthetized and needle is used to enter the blood vessel. A wire is
inserted and used to guide placement of a catheter through which contrast
dye is injected. This allows visualization of the clot using an x-ray
camera.
An infusion catheter can then be placed within the clot and the clot-dissolving
drug (TPA,) is infused for approximately 12 to 24 hours.
Patients are monitored in the ICU for signs of bleeding and improvement.
The angiogram is subsequently repeated to assess for residual clot and
narrowing in the blood vessel. If a narrowing is identified, angioplasty/stent
placement or surgery may be necessary.
What happens after the procedure?
Since the medications used cannot discriminate between clots which are helpful (e.g. in a wound) and the clots in the blood vessels, patients are required to remain at bed rest for several hours after the catheter is removed and be monitored for signs of bleeding.
Blood thinning medications may be prescribed for several months.
Depending on the cause and location of the clot, surgery and/or activity
modifications may be necessary
General Information:
A port is a metal or plastic disc that is implanted under the skin. The disc is connected to a tube (catheter) which is placed under the skin and into a vein. Ports are mostly used to administer chemotherapy, nutrition, and blood products- but they can also be used to draw blood. They are particularly convenient for patients requiring many IV infusions of medications, frequent monitoring of blood tests and those patients with difficult to access arm veins.
What happens during the procedure?
Conscious sedation is provided.
You will be lying flat on the x-ray table. Pillows can be placed under your knees to help take the pressure off your back. A towel is wrapped around your head to protect your hair from the antiseptic solutions used to clean your skin. Sterile drapes are placed over your head and body with your neck/upper chest exposed. Your face will not be covered and the nurse can communicate with you during the procedure.
Lidocaine local anesthesia will be injected under the skin overlying the site of entry into the vein (right or left neck). A small needle is used to enter the vein and used to place a wire into the vein. The needle is then removed and a tapered plastic tubing called a dilator is placed over the wire.
Next, more lidocaine is injected into skin below the collar bone (clavicle). A horizontal incision is made, approximately 2-3 inches long below the clavicle about 4 -5 inches. The physician will create a small pocket for the port to be placed just under your skin. You may have sensations of pulling. A narrow, tapered instrument is used to create a small tunnel under your skin connecting the vein puncture site and the port incision site.
Finally, the port incision is sutured using absorbable sutures
This procedure takes 1 -2 hours.
What happens after the procedure?
If conscious sedation medicine was administered, you will be required to stay to recover for 2 hours following the end of the procedure.
You will have two dressings- one on your neck and one where the port is
on your chest. The neck incision is a small nick in your vein. steri-strips
may be covered by a small gauze and tegaderm. This may be removed 2 days
after your procedure- apply a band-aid if needed. Your chest incision
where your port is may or may not be accessed, meaning a special huber
needle is pierced into the port and secured in place with a sterile dressing.
We will often leave a port "accessed" if you have treatments
that day or the next. Your chest incision dressing will need to be changed
2 days after it was placed.
Remove old dressing. If steri-strips are in place, leave them for 5 days.
Cleanse with warm clean water. Dry thoroughly. Apply bacitracin ointment
along the incision. Cover with 4 in x 4 in gauze folded in half, and hold
in place with tape or tegaderm. You then will change the dressing each
day until the 6th day after the port was placed, then you can remove the
dressing. You will be given a card and booklet with instructions for when
you go home.
General Information:
Dialysis/ pheresis catheters are used to “clean” the blood in patients with kidney failure requiring hemodialysis or patients with immune diseases requiring plasma pheresis. These treatments require rapid flow of blood in & out of the body and thus the catheters tend to be relatively large in diameter (approximately 4mm.)
Specific catheters:
AshSplit® catheter -- tunneled catheter
Tessio® catheter -- tunneled catheter
Hickman® catheter -- tunneled catheter
Quinton® catheter (for short-term use)
Groshong® catheter -- tunneled catheter
The catheter chosen for you depends on the intended use and the expected
length of time it will be needed.
These catheters are usually place into a vein in your neck (internal jugular)
or sometimes under the collar bone (clavicle.) They are referred to as
“tunneled catheters” because part of the catheter travels
under the skin. This actually reduces the risk of infection and is more
convenient to manage.
What happens during the procedure?
Conscious sedation is provided just prior to starting the procedure.
You will be lying flat on the x-ray table. Pillows can be placed under
your knees to help take the pressure off your back. A towel is wrapped
around your head to protect your hair from the antiseptic solutions used
to clean your skin. Sterile drapes are placed over your head and body
with your neck/ upper chest exposed. Your face will not be covered and
the nurse can communicate with you during the procedure.
Lidocaine local anesthesia will be injected under the skin overlying the
site of entry into the vein. A small needle is used to enter the vein
and used to place a wire into the vein. The needle is then removed and
a tapered plastic tubing called a “dilator” is placed over
the wire. Sequentially larger dilators are passed in and out to make the
hole in the skin and vein large enough to accommodate the catheter. You
will have sensations of pushing or pulling but you should not feel sharp
pain.
Next, more lidocaine is injected into the skin below the collar bone (clavicle.)
A small, (~5mm,) incision is made approximately 4-5 inches below the clavicle.
A narrow, tapered instrument is used to create a small tunnel under the
skin connecting the vein puncture site with the small incision (exit site.)
The catheter is threaded through this tunnel and placed into the vein.
Under x-ray (fluoroscopic) guidance, the tip of the catheter is positioned
within or near the right atrium of the heart.
Finally the catheter is sutured to the skin. Over the ensuing weeks your
body will form a tight seal around a specially designed part of the catheter
and the sutures will no longer be necessary. This seal also is important
in guarding against infection.
This procedure takes approx 1hr- 1.5hrs
What happens after the procedure?
If conscious sedation medicine was administered, you will be required to stay to recover for 2 hours following the end of the procedure.
After the initial dressing the dialysis nurse will take care of changing
the dressings. Often the radiologist will place two sutures to secure
the catheter in place that should stay in place for at least 10 days following
the placement of the catheter. You should be very careful not to inadvertently
pull on the catheters when dressing or undressing. You will be given a
card and booklet with instructions for when you go home.
You must have a responsible adult available to drive/escort you home from
the hospital.
PICC lines
General Information:
PICC = Peripherally Inserted Central venous Catheter
This line does not need to be changed every three days like most IV’s.
They can be used for up to six weeks or sometimes longer. It can be used
for long term antibiotics, blood products, nutrition, and special medications
such as chemotherapy drugs.
Often these lines can be place at the bedside by a specially trained IV
nurse, however in circumstances where this is not possible it is placed
by the Interventional Radiologist.
What happens during the procedure?
You will have an IV placed in your hand and you will be lying flat on the x-ray table. The technologist will prepare your skin by cleaning it with an antiseptic solution and place sterile drapes and towels over you to create a sterile work space.
The Radiologist injects IV contrast dye through the IV in your hand flows
into your upper arm and allows visualization of the veins using x-rays.
A vein suitable for the PICC is chosen and lidocaine is used to numb the
skin and insert the IV catheter. Usually, two sutures are placed to keep
the IV securely in place. The radiology staff will place a sterile dressing
over the IV site as well as a gauze wrap (kerlex) dressing to place gentle
pressure over the site for 24hours.
This procedure takes approx. 1hr.
What happens after the procedure?
The dressing will need to be changed by your VNA nurse, usually a minimum of three times each week. You must be careful not to inadvertently pull on the catheters when dressing, undressing etc. You will be given a card and instruction booklet to take home with you. With diligent care these lines can be used for several weeks.
Uterine Artery Fibroid Embolization
General Information
Uterine fibroids are benign tumors which can cause excessive menstrual bleeding and pain. These tumors grow slowly but may become large enough to compress the bladder and rectum causing constipation and/or urinary frequency.
Traditional treatment has been hysterectomy however patients have the
option of a less invasive procedure called: “embolization.”
Embolization is a procedure in which particles are injected into an artery
that feeds a particular area of interest, (in this case the uterus.) This
deprives the uterus and fibroids of its blood supply which causes it to
atrophy or shrink over time. Because the uterus has a rich blood supply
it will ultimately endure the insult.
Since fibroids are slow-growing tumors which essentially stop growing
after menopause, this procedure is best suited for perimenopausal women.
What happens during the procedure?
Conscious sedation is provided just prior to starting the procedure.
You will be lying on the x-ray table. The technologist will prepare the
skin over the groin by cleaning it with an antiseptic solution and place
sterile drapes and towels over you to create a sterile work space.
Lidocaine® local anesthesia is injected into the skin overlying your
groin. A catheter is placed into the artery and contrast dye is injected
to allow visualization of the arteries that supply the uterus. A guidewire
is used to direct the catheter into each of the uterine arteries, (right
and left.) Small inert particles are injected into these arteries until
the blood flow to the uterus has stopped. These particles are mixed with
x-ray dye so that the radiologist can be assured that they are going only
to the uterus and not elsewhere.
The catheter is removed and pressure is applied to the groin until there
is no bleeding (approximately 15min.)
This procedure takes approximately 1.5 - 2 hours.
What happens after the procedure?
The actual procedure itself is not particularly painful however the crampy pain that follows can be quite uncomfortable. For this reason patients are admitted to the hospital overnight for pain control and IV fluid hydration. You will have a PCA (Patient Controlled Anesthesia) pump connected to an IV line. This will allow you to self administer morphine by clicking a button.
Some patients have nausea which can be treated with medication and IV
fluids.
Most patients are able to go home the next morning with a prescription
for pain medication. The crampy pain should gradually subside over the
next several days.
Patients can expect to see gradual improvement in fibroid-related symptoms
with more than 95% of patients having complete resolution or marked improvement
by 6 months.
While low grade fever (101.1°F) is common following fibroid embolization,
you should contact your physician if you experience progressively increasing
pain, spiking fevers and/or shaking chills.
Patients can expect a follow-up pelvic ultrasound at 3 and 6 months to
assess response to therapy.
Gastrointestinal Bleeding Embolization
General Information
Bleeding from the GI tract often manifest as passing blood per rectum but can also be vomited blood. There are various causes for GI bleeding including peptic ulcers, diverticulosis, hemorrhoids and abnormal blood vessels within the wall of the intestine. A particularly frustrating problem with GI bleeding is that the bleeding is intermittent. Furthermore, by the time the blood reaches the rectum and is passed, the bleeding site is no longer actively bleeding. In order to treat this bleeding with embolization therapy patients must be bleeding while the study is being performed, otherwise physicians will not know which part of the GI tract to treat.
Prior to angiography, other tests/procedures may be performed such as
endoscopy or a bleeding scan.
If active bleeding is shown at angiography, small inert particles such
as Gelfoam or gelatin-like particles called Embospheres® can be injected
into arteries at the bleeding site.
This procedure is usually performed in a emergent circumstances to control
life-threatening bleeding. It is typically not the definitive treatment
but serves to “buy time” until the source of the problem can
addressed either by surgery or endoscopy in a controlled setting.
What happens during the procedure?
Conscious sedation is provided
just prior to starting the procedure.
You will be lying on the x-ray table. The technologist will prepare the
skin over the groin by cleaning it with an antiseptic solution and place
sterile drapes and towels over you to create a sterile work space.
Lidocaine® local anesthesia is injected into the skin overlying your
groin. A catheter is placed into the artery and contrast dye is injected
to allow visualization of the arteries that supply the intestine/stomach.
If active bleeding is shown on the angiogram, a guidewire is used to direct
the catheter into small branches of the artery and small inert particles
are injected until the bleeding in that area has stopped. These particles
are mixed with x-ray dye so that the radiologist can be assured that they
are going only to the area of interest and not elsewhere.
The catheter is removed and pressure is applied to the groin until there
is no bleeding (approximately 15min.)
This procedure typically requires approximately 1.5 - 3 hours.
What happens after the procedure?
Patients who undergo this procedure are admitted to the Intensive Care Unit and closely monitored for signs of further bleeding.
If no bleeding is identified, which is often the case, patients may return
for repeated angiograms until a source is identified.
Once stabilized your physicians will form a suitable treatment plan to
prevent a recurrence.
Tumors/ Vascular Malformations (including chemo-embolization)
General Information
Some tumors, often in the liver or kidney, have a very rich blood supply. Some surgeons prefer that these tumors be embolized prior to resection to reduce the blood loss during operation. In the case of the kidney, absolute ethanol is injected directly into the artery to the kidney. The alcohol is toxic to the blood vessels and causes thrombosis. Alternatively, particles can be used to embolize the tumor.
Other tumors, particularly in the liver, may benefit from direct injection
of chemotherapeutic medications. In this instance, a predetermined dose
of chemotherapy is injected into the artery that supplies the tumor. The
rationale for this method of treatment is that a high concentration of
drug can be delivered to the tumor, (the intended target,) and minimize
the toxic side effects to the rest of the body.
Vascular malformations are abnormal tangles of blood vessels which can
occur anywhere in the body. Many are of no consequence while others may
cause recurrent bleeding. One of the treatments for these malformations
is vascular embolization.
What happens during the procedure?
Conscious sedation is provided
just prior to starting the procedure.
You will be lying on the x-ray table. The technologist will prepare the
skin over the groin by cleaning it with an antiseptic solution and place
sterile drapes and towels over you to create a sterile work space.
Lidocaine local anesthesia is injected into the skin overlying your groin.
A catheter is placed into the artery and contrast dye is injected to allow
visualization of the arteries that supply the region of the tumor or vascular
malformation. Once the blood supply the region in question has been adequately
defined, a catheter is directed as close to the area as possible. Additional
contrast is injected to ensure against embolization of unintended regions.
Depending on the nature of the embolization, particles, coils or chemotherapeutic drugs, are then injected. Following embolization, contrast dye is reinjected to be certain that the entire area of interest is embolized. The catheter is removed and pressure is applied to the groin until there is no bleeding (approximately 15min.)
This procedure typically requires approximately 1.5 - 3 hours.
What happens after the procedure?
Since conscious sedation medicine is administered and the femoral artery has been punctured, you will be required to stay to recover for 5-6 hours after the end of the procedure. While in recovery, patients are monitored closely for signs of bleeding from the artery in the groin and ensure that the effects of the sedation have worn off. Patients must have a responsible adult available to drive/escort you home from the hospital.
Since the artery is a high pressure system, patients should refrain from
lifting more than 10 lbs, refrain from strenuous activity or anything
which causes abdominal distension for the following 48-72 hours. Any straining
such as vomiting, coughing, forced bowel movements, could dislodge the
clot that forms to seal the artery and cause bleeding.
Embolization of Bleeding from Trauma
General Information:
Trauma, commonly as a result of motor vehicle accidents, gunshot or stab wounds, is a major cause of internal bleeding. In motor vehicle trauma, bleeding is usually caused by crushing of internal organs, (e.g. liver/ spleen, kidney) or broken bones which lacerate blood vessels. This bleeding may stop spontaneously or require some form of intervention (i.e. surgery or intravascular embolization.)
A CT scan is performed as first line evaluation of any major trauma and
can accurately detect most cases of internal bleeding.
What happens during the procedure?
Conscious sedation is provided just prior to starting the procedure, however
many patients who require this procedure are unconscious due to injury
or already sedated.
You will be lying on the x-ray table. The technologist will prepare the
skin over the groin by cleaning it with an antiseptic solution and place
sterile drapes and towels over you to create a sterile work space.
Lidocaine local anesthesia is injected into the skin overlying your groin.
A catheter is placed into the artery and contrast dye is injected to allow
visualization of the arteries that supply the area of interest. If active
bleeding is shown on the angiogram, a guide wire is used to direct the
catheter into small branches of the artery and small inert particles are
injected until the bleeding in that area has stopped. These particles
are mixed with x-ray dye so that the radiologist can be assured that they
are going only to the area of interest and not elsewhere.
The catheter is removed and pressure is applied to the groin until there
is no bleeding (approximately 15min.)
This procedure typically requires approximately 1 - 3 hours.
What happens after the procedure?
Patients who require this procedure are admitted to the Intensive Care Unit and closely monitored for signs of further bleeding.
If additional bleeding is suspected, patients may require additional embolizations
or surgery.
Once patients are stabilized, attention is turned toward any other associated
injuries.
General Information:
A varicocele is a collection of dilated veins surrounding a testicle. It is caused by incompetent valves in the gonadal vein that drains the testicle which results in impaired drainage and venous distension.
This can cause persistent testicular pain and occasionally infertility.
Varicoceles can be treated by embolizing the gonadal vein with coils.
This effectively prevents blood from entering the impaired gonadal vein
and promotes drainage of blood through surrounding veins with normal function.
What happens during the procedure?
Conscious sedation is provided just prior to starting the procedure.
You will be lying on the x-ray table. The technologist will prepare the
skin overlying the groin by cleaning it with an antiseptic solution and
place sterile drapes and towels over you to create a sterile work space.
Lidocaine® local anesthesia is injected into the skin overlying your
groin and a catheter is placed into the common femoral vein. The catheter
is placed into the gonadal vein on the symptomatic side and contrast (x-ray
dye) is injected to perform a venogram. This allows visualization of the
vein an guides placement of a nest of coils into the lower portion of
the gonadal vein.
The catheter is removed and pressure is applied to the groin until there
is no bleeding (approximately 5min.)
This procedure typically takes approximately 1 hr.
What happens after the procedure?
Following the procedure patients are required to remain at bed rest and be monitored for signs of bleeding at the vein puncture site and ensure that the sedation has worn off. Patients are usually allowed to go home 2 hours after the procedure.
A follow up ultrasound is often performed within 6-8 weeks.
Inferior Vena Cava (IVC) Filter Placement
General Information:
An IVC filter is a small metallic device which is like an umbrella without the fabric. This is often placed within the IVC, (vein bringing blood back to the heart from the lower half of the body,) of patients who have clots in the veins of the legs or pelvis. In most cases this is a permanent implant, although in some cases a temporary filter may be used.Temporary/ removable IVC filters are starting to be used.
The purpose of the filter is to prevent large and medium sized blood clots from entering the lungs (“Pulmonary Embolism” or “PE”).” Small clots can pass through the filter but these are well tolerated in most patients.
Common Indications for IVC Filter Placement:
Patients with lower body deep vein thrombosis (blood clots), (“DVT”,) who are not candidates for traditional anticoagulation (blood thinning,) therapy. [e.g. patients who are likely to bleed due to recent surgery, known peptic ulcers, recent stroke or brain tumors.]
Patients with major trauma/ surgery in whom a prolonged bed-ridden course
is expected.
Patients with DVT who continue to have pulmonary emboli despite adequate
anticoagulation (blood thinning therapy.)
What happens during the procedure?
This procedure is usually performed on patients who are already in the hospital. Conscious sedation is usually provided.
The filter is usually placed through the common femoral vein (in the groin)
but a variety of circumstances may require other sites of insertion: i.e.
the internal jugular vein (in the neck) or the brachial vein (in the arm.).
The skin overlying the vein to be entered is anesthetized with lidocaine.
The vein is punctured with a needle and wire is inserted to guide placement
of a catheter.
Contrast dye is injected to perform a venogram. This will allow accurate
placement of the filter.
The filter is inserted through the sheath in the vein and is deployed
as it springs open into the IVC.
Length of procedure: approximately 30 minutes.
What happens after the procedure?
Following the procedure patients are required to remain at bed rest for
at least 2 hours an be monitored for signs of bleeding at the venous insertions
site. Anyone placing venous lines into your groin should be aware that
you have a filter and be careful not to dislodge it.
If a temporary filter was used, it will need to be removed or slightly
moved 10-12 days after placement or last adjustment.
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If you have been scheduled for a procedure that may cause you some discomfort or anxiety, the Radiologist may recommend that we administer sedation to you during your procedure.
This conscious sedation/sedation for the procedure will be administered to you by a specially trained radiology nurse. Its purpose is to relax you during your procedure and to reduce any discomfort that you may experience. You may or may not be drowsy. You will remain conscious and able to speak and follow instructions by the Radiologist throughout your procedure. You will not be "put to sleep." The most frequently used medication given for conscious sedation are Fentanyl and Midazolam. If you have allergies to either of these medications, please let your doctor know. The medications will be given to you in an IV line that will be started prior to you procedure.
The following are instructions to all patients whom may receive conscious sedation/sedation for procedures;
DO NOT eat solid foods for six hours before your procedure.
You may have clear water, black coffee or tea, or apple, cranberry, grape
juices, jello and broth, two hours before your procedure.
You may take all of your routine medications with clear liquids up to
two hour before your procedure.
If you have been requested to stop taking certain medications by your
doctor, do not take those.
If you are a diabetic on insulin, you should consult with your doctor
regarding your insulin dosage for the Morning of your procedure.
You must have a responsible adult driver escort you home from the hospital.
A Radiology nurse will be calling you reviewing these instructions and able to answer any questions you may have or you can call 802-847-3946 M-F 8:00-4:30pm. If one of us are not readily available you can leave a message and we will get back to you.