Interventional Radiology uses images (X-ray, fluoroscopy, ultrasound or CT) to target treatments. Treatments are minimally invasive, reducing the need for open surgery, thus reducing the time you need to stay in hospital. Your scan is carried out by an Interventional Radiologist or specially trained Radiographer. He or she uses catheters and small instruments which are often fed through blood vessels to treat areas in other places of the body.
There are lots of different types of Interventional Radiology. An angioplasty is a treatment that is designed to widen a narrowed artery, with the aim of relieving your symptoms. It is performed using a special X-ray machine for guidance, which shows pictures of your arteries as you lie on the X-ray table. An angiogram is a minimally invasive medical test that helps diagnose and treat medical conditions of the vessels. Doctors use this procedure to identify abnormalities, such as aneurysms, detect atherosclerotic disease that has narrowed the arteries to the legs and to evaluate obstructions of vessels. Angiography may eliminate the need for surgery. It presents a very detailed, clear and accurate picture of your blood vessels.
Unlike CT or MR Angiography, the use of a catheter makes it possible to combine diagnosis and treatment in a single procedure. For example, if an area of severe arterial narrowing is identified, an angioplasty or placement of a stent may be performed right away. Nephrostomy Tube Insertion/exchange is where urine drains from your kidneys through a narrow tube called the ureter into your bladder. If this is obstructed and the passage is hindered, a nephrostomy tube might help you. It helps to relieve a build-up of urine in the kidney and prevents the kidney from being damaged. This procedure is done in the Radiology department, where a catheter is put directly into your kidney through the skin of your back, the urine will be drained into a bag. This is usually not a permanent solution and the removal of the tube is also performed in the Radiology department. You receive a local anaesthetic, so that the location of the catheter insertion is pain free.
Arterial Stenting can sometimes be completed during angioplasty. A small wire mesh tube called a stent may be permanently placed in the newly opened artery or vein to help it remain open. There are two types of stents: bare stents (wire mesh) and covered stents (also commonly called stent grafts). Vascular stenting is commonly used to treat conditions that involve a narrowing or blockage of arteries or veins throughout the body.
As Vascular Interventional procedures need access to your vessels, bleeding or bruising can occur under the skin. This is very common, but takes one to two weeks to disappear. Occasionally, the artery can be damaged during the procedure. As with all skin-piercing procedures, wound infections are possible.
Although the risks of developing complications from having a nephrostomy is low, there are a few possible complications that you must be aware about, including infection, bleeding or leaking of urine within the abdomen. You will, however, be monitored very closely, so that if any problems may arise, it will be picked up and treated straight away.
It might be that for ureteric stenting the stent cannot be placed properly in the ureter. If this happens, a Surgeon will arrange another method of overcoming the blockage. Occasionally there may be infection in the kidney or the space around it. This generally can be satisfactorily treated with antibiotics.
What to Expect
Angioplasty – During the examination the skin around your groin will be cleaned and then numbed with a local anaesthetic. A small tube is then inserted into the artery in your groin. This allows X-ray dye (contrast agent) to be injected while a series of X-ray pictures are taken. This colourless dye may cause a warm sensation throughout your lower body – this is quite normal. We also use the tube as a passageway for a smaller tube and a balloon which are used to widen the artery. The tube is removed and pressure is applied to your groin for several minutes to prevent bruising. The procedure takes about half an hour in total.
You will need to be on bed rest for three to four hours after the procedure.
Nephrostomy - You will, however, be awake during the procedure. If you need more sedative, you will have a cannula in your arm in case. In the procedure room, you will lie on your side on the X-ray table. Monitoring equipment will be connected to you and may be given some sedation at this point in time. The Radiologist and Nurse will wear sterile gowns and gloves, and your back will be then covered with sterile towels. A small area of skin on your back will be left bare, but will be cleaned with antiseptic, which may be a bit cold.
The Radiologist will use X-rays to identify the kidney and to determine where the best place is to put in the tube. You will receive some local anaesthetic (which may sting a bit, but lessens quickly), and a fine needle will access the kidney. A small guide wire and a small plastic tube will be inserted, and once the tube is in place, the guide wire is removed. The tube will be secured to the skin and a drainage bag will be attached to the catheter.
Typically, this procedure does not hurt, but if you do experience some pain, there will be a nurse of another member of staff who monitors you.
Arterial Stenting – You will be positioned on the examining table and will be connected to monitors that track your heart rate, blood pressure and pulse during the procedure.
A Radiographer will place a cannula into a vein in your hand or arm so that sedative medication can be given intravenously. Moderate sedation may be used. The area of your body where the catheter is to be inserted will be shaved, sterilised and covered with a surgical drape. The area will be numbed with a local anaesthetic. Once numbed, a very small skin incision is made at the site. A sheath is first inserted into the artery. Guided by X-rays, the catheter is then inserted through the skin and manoeuvred through the artery until it reaches the site of the blockage. Once the catheter is in place, contrast dye will be injected and images will be taken of the blocked artery to help identify the site of the blockage.
With X-ray guidance, a guide wire will then be moved to the site. A stent, which is a small, flexible tube made of plastic or wire mesh to support the damaged artery walls may be placed.
At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding, or a special device called an AngioSeal will be used. The opening in the skin is then covered with a dressing. No sutures are needed.
Ureteric Stenting – On the ward, a cannula will be placed in your arm and you will receive some antibiotics. You may also receive some mild sedation at this time. You will be brought into the suite and will be positioned on the examination table on your stomach. The Radiology team will be dressed in sterile gowns and gloves, and will proceed to put sterile towels over your back. The Radiologist will use the X-ray equipment to decide where it is best to insert the stent. Once located, you will receive a local anaesthetic, which may sting, but this will pass quite quickly. A guide-wire will be inserted into the kidney, and the hollow stent will be threaded onto the wire and put in place. Once the Radiologist is satisfied with the positioning of the stent, the guide-wire will be removed. The urine should then be able to pass down the stent and into the bladder.
The procedure can take anywhere from 20 to 90 minutes, but we typically tell our patients to expect that the procedure will take about 60 minutes.
Angioplasty – Some slight bruising of your groin may occur and your groin may ache for a day or two after the angioplasty. If you experience excessive pain or swelling when you return home, please contact your GP. Patients who have undergone an angioplasty will be reviewed in the Angioplasty Clinic after approximately six weeks. In most cases, once the scan is completed, you will go back to the ward. You can eat and drink straight away, but a few hours of bed rest (typically three to four hours) is necessary. Typically, we prefer that our patients do not shower for at least 24 hours and do not drive or do any form of strenuous exercise for 48 hours after the procedure.
Nephrostomy – You will be taken back to the ward on a trolley and the nurses will monitor your vital signs on a regular basis to make sure that you are feeling well. You may need to stay in bed for a short while until your vital signs are stable. You can eat and drink straight away. The Nurses on the ward will teach you how to care for your tube and how to empty the bag. Should you go home within 24 hours after the procedure, we highly recommend that you find someone to drive you home or that you take a taxi.
Once home, rest quietly for a day or two. Lie on the settee, prop your feet up and try to relax a little. Drink plenty of fluids.
Arterial Stenting – After the exam, you can eat and drink straight away, but a few hours of bed rest (typically three to four hours) is necessary. Typically, we prefer that our patients do not shower for at least 24 hours and do not drive or do any form of strenuous exercise for 48 hours after the procedure.
Ureteric Stenting – You might experience some slight burning with urination or pass a small amount of blood following the procedure. There may also be a sense of needing to urinate even after the bladder is emptied, but that is normal. This feeling is likely due to the stent irritating the bladder, and if this is bothersome to you, ask your Doctor for assistance.
You can eat and drink straight away. It is important to remember that the ureteric stent is not permanent and must be removed or changed in the future.
GEH 641 21-24 July 2021