Interventional Radiology, Frankford Hospitals
Arteries, ducts, and other vessels of the body may become blocked from within or compressed from without and require opening
of their interior. This step can help to treat a variety of conditions. Using catheters, interventional radiologists open vessels (including with angioplasty) and then place small tube-like devices called stents to maintain the opening of the vessel (or, in other words, to make sure
that vessel’s “lumen” stays “patent”). Specialists perform this additional stenting step in the majority of cases where they use angioplasty, especially in arteries.
Most stents used today are small, flexible and expandable wire- or plastic-mesh tubes (or coils, about the diameter of the
lead in a pencil, but of varying sizes depending on the targeted vessel). The stent remains permanently in place to maintain the vessel’s correct shape and function, and thus to allow normal flow
of bodily fluids. The approach is the same as that used by interventional cardiologists to open, and maintain the opening of, coronary arteries.
Fallopian tube catheterization
Women may experience fertility problems if their fallopian tubes become compressed or if one is closed, and certainly if both
tubes become blocked. Eggs from the ovary are unable to travel to the uterus – the trip that results in fertilization (normally
within the tube) and implantation of an embryo (pregnancy) under proper conditions. Plugged or narrowed fallopian tubes are
the most common cause of female infertility.
Radiologists can use interventional techniques to diagnose and treat this problem. They advance a thin catheter through the
vagina and cervix, and into the uterus. They use the catheter to inject a contrast agent into the uterine cavity and fallopian
tubes, and then x-ray these structures. If the specialists identify a blockage, they can use the catheter access to insert
a tiny drainage tube into the fallopian tube to open it and keep it open. This procedure is called a tuboplasty.
The imaging portion of the procedure may also be done prior to the full procedure for diagnosis and planning. The interventionalist
may perform this imaging and the fallopian tube catheterization with the assistance of the patient’s gynecologist. |
With improving catheter technology and various angiography and other imaging techniques for guidance. Radiologists can treat difficult-to-reach vessels of the body in this way, often allowing patients to avoid surgery for treatment
of their vessel condition. Interventionalists may place a stent in blood vessels that they treat with angioplasty, including the arteries of the extremities
(to treat peripheral vascular disease) and of the kidneys, in which cases the stent is normally placed immediately after the
angioplasty and as part of the same catheterization-lab procedure. Such stenting is also in early use for narrowed blood vessels of the liver. (Neurosurgeons – or, at some centers, interventional
neuroradiologists – can also use the same technique in carotid arteries to treat narrowing that can cause stroke. In addition, vascular surgeons can use catheter access to place a special kind of graft with a fabric component that actually
replaces the vessel wall in the aorta of patients who have aortic aneurysms). Interventionalists can also apply angioplasty
and stenting to other primary vessels of the body, including iliofemoral, subclavian, mesenteric vessels, as well as to vessels
within the arm that are used for hemodialysis access.
In addition, the interventional radiologists may insert stents or drainage tubes, through small incisions in the skin, to
open the ducts of obstructed organs to allow fluids such as urine or bile to flow properly. Conditions such as cancer or stones, for example, may obstruct the urinary tract or the pancreatic or biliary ducts. (Colorectal surgeons also use stents to treat partial obstructions in the intestines, and gastroenterologists use them to
treat esophageal obstructions.) Stenting and tube drainage are important, as well, among interventional radiologic procedures for conditions of the common biliary duct. In this case, and the case of ureteral stents (tubes in the ureters to treat blocked kidneys, or nephrostomy tubes), the drainage
accomplished helps to prevent infection, organ failure, and other consequences of blockage. Ureteral blockages may be caused by kidney stones, infection, kidney-transplant complications, cancer, or other conditions. Biliary or ureteral drainage may be internal or to an external drainage system that uses a bag placed close to the skin.
Most patients who undergo stenting or tube placement will remain for just one night in the hospital, though some can return
home the same day of their procedure. They will resume normal activities shortly thereafter.
These minimally invasive, low-cost, low-risk procedures are helping many patients avoid the risk and recovery involved in
surgery that would otherwise have to be employed to address blocked vessels or fluid collections. Specialists can repeat these procedures if a vessel or area becomes closed again.
