Pueblo Radiology Interventional Practice

Common Interventional Procedures Offered

Angiography
Angiography involves placement of a small tube into an artery or vein, under local anesthetic, with the injection of X-ray dye in order to obtain detailed pictures of the arteries and veins. It is used for the diagnosis of certain diseases and to help guide other procedures such as angioplasty (stretching open blocked arteries), stenting (inserting a wire mesh tube to hold a narroed vessel open), or embolization (purposely blocking blood flow in an artery).

Balloon angioplasty and stenting
By inflating a balloon inside a narrowed artery, we are able to increase the size of a narrowed blood vessel. This is called Percutaneous Balloon Angioplasty (PTA for short). Sometimes a small metal scaffolding (stent) is also placed in the artery to prop open a narrowed artery. This is called "stenting".

Biliary drainage and stenting
The bile ducts in the liver can become blocked by a variety of diseases, including "stones", benign strictures, or cancer. In a "biliary drainage procedure", we place a tube into the liver to let the trapped bile drain out. A "biliary stent" is an implanted piece of tubing or metal mesh that allows the passage of bile through a previously blocked bile duct.

Biopsy (a)
Using radiologic or ultrasonic guidance, we are able to remove small tissue samples from virtually anywhere in the body through a small needle to allow for evaluation of tissue under a microscope by a pathologist to evaluate the disease processes.

Central venous access (a)
This procedure involves placing a catheter into the venous system with its tip in a large central vein (i.e. superior vena cava). This is done so that medications, like chemotherapy and some antibiotics which would irritate the lining of peripheral veins, can be delivered to the patient. Dialysis, prolonged IV therapy, and difficult IV access are all reasons why central venous access might be necessary. Pueblo Radiology physicians are able to accommodate referring clinician needs for PICC lines, tunneled and non-tunneled catheters, and subcutaneous port installation in our offices and hospitals.

Chemo-embolization
Certain tumors, particularly in the liver, can be treated by injection of chemotherapy directly into the blood vessels going right to the tumor. This allows the delivery of the chemotherapy agent to the tumor in a higher concentration than would be possible by injecting the medication through a standard intravenous route.

Dialysis access (a)
For a patient on hemodialysis, a functioning vascular access is the lifeline that allows them to use the artificial kidney machine. We are able to evaluate vascular access’ that are not functioning properly and perform various procedures to improve their function. Access’ that are completely non-functional (such as clotted dialysis grafts) can often be opened up allowing the patient to continue with dialysis treatments.

DVT treatment and IVC filters
Blood clots in the large veins in the legs (deep venous thrombosis) can break off and go to the lungs causing pulmonary emboli, or may obstruct and damage the veins in the legs. We are able to place devices in the abdominal veins that block the flow of blood clots from the legs and prevent these clots from getting to the lungs. These devices are called IVC filters. We are also able to dissolve clots in the legs veins and open up blocked veins (see angioplasty and stenting) to restore proper drainage of blood from the legs.

Embolization
Embolization involves the injection of substances into blood vessels to block them off. This is commonly done to stop bleeding. It is also useful for treating uterine fibroids and varicoceles. Injection of chemotherapy along with embolic agents, called "chemo-embolization", is used for the treatment of tumors, especially tumors of the liver.

Fallopian tube recanalization (a)
This procedure is performed through a vaginal speculum and can be used to treat infertility caused by fallopian tube blockage. A small cathether and guidewire are passed through the blocked duct and contrast material is injected to assure that the duct is open.

Gastrostomy
This procedure involves placing a small catheter (tube) into the stomach. It is done in cases when the patient is at risk for aspirating food into their lungs as a result of stroke; also done in cases of esophageal cancers and conditions which do not allow food to pass from the mouth to the stomach. This procedure is commonly done in the hospital setting.

Nephrostomy
This procedure is done in response to obstructions in the urinary tract which, if left untreated, could result in the loss of kidney function. Under imaging guidance, a small catheter (tube) is placed into the patient's kidney which allows it to continue to function normally and allows urine to flow from the kidney into a bag attached to the side of the patient. This procedure is done in the hospital setting.

Radiofrequency Ablation
A small gauge probe is placed into the liver or other tumor site (similar procedures can be used for bone, lung, kidney, etc.). CT scanning is usually used for guidance. The probe is then activated so that the tumor cells can be destroyed with radiofrequency energy. This procedure is performed in the hospital after consultation with an oncology physician.

Spine Pain Control (Epidurals, Facet, Nerve roots): (a) 

• Epidural Injection
  Whether delivered in the midline or transforaminally, this procedure is done to relieve pain and inflammation in the neck, arm, low back, or leg (sciatica) by injecting a steroid and anesthetic into the epidural space. Pueblo physicians perform the injection under imaging control so as to assure injection in the appropriate location for maximal benefit.
  
  
• Facet Injection
  This is done to relieve pain and inflammation in the back by injecting a steroid and anesthetic agent into the facet joint capsule or adjacent to it. Pueblo physicians perform the injection under imaging control so as to assure injection in the appropriate location for maximal benefit.
  
  
• Nerve Root Injection
  This procedure relieves pain and inflammation in the neck, arm, low back, or leg (sciatica) by injecting a steroid and anesthetic around the nerve root as it emerges from the bony spine. Pueblo physicians perform the injection under imaging control so as to assure injection in the appropriate location for maximal benefit.
  

TIPS: Transjugular Interhepatic Portosystemic Shunt
This procedure is typically done on patients with advanced liver disease that results in hypertension (high blood pressure) in the venous system that drains the GI (gastrointestinal) tract. A passageway is created between the portal vein and the hepatic vein which shunts blood flow more efficiently through the liver and reduces the hypertensive condition. This procedure is done in the hospital setting.

Uterine Fibroid Embolization & Uterine Artery Embolization
This hospital-based procedure is done to resolve a woman's fibroid problem while preserving fertility and hormonal balance, and is an alternative to surgical hysterectomy. Indications for this procedure include pain, infertility, and abnormal uterine bleeding which can be caused by a large uterine fibroid(s). The embolization, which occurs in conjunction with pelvic angiography, will cut the blood supply to the fibroid, resulting in its shrinkage, while resolving the initial problem. The presence of fibroids is identified by pelvic ultrasound examination.

Varicose Veins (a)
Varicose veins of the leg can be painful and unsightly. Percutaneous endovascular laser ablation therapy is a minimally invasive procedure performed in the outpatient setting. It requires local anesthesia only, and has a quick recovery time. We believe that endovascular ablation of the saphenous vein represents the best, least invasive and most cost-effective method of managing this problem, and will eventually replace traditional vein stripping. A peer reviewed journal article states efficacy of treatment outcomes to be similar between endovascular treatment of the greater saphenous vein and surgical stripping of the greater saphenous vein*. The laser ablation treatment has fewer complications and offers a faster recovery, while being performed in an outpatient setting not requiring operating room facilities or general anesthesia.

* Min, R.J, Khilnani, N., Zimmet, S.E.; Endovenous Laser Treatment of Saphenous Vein Reflux: Long Term Results; Journal of Vascular-Interventional Radiology, 2003, Aug. 14(8):991-6

Vena Caval filters
This procedure places a wire device in the Inferior Vena Cava. Its goal is to prevent clots, which form in the lower extremity venous system, from getting to the lungs, causing a pulmonary embolus. This examination is usually performed on hospital-based patients who are sedentary due to extensive trauma or illness.

Vertebroplasty and Kyphoplasty
Osteoporosis affects 28 million people in the United States, 80% of which are women. One of two women and one of eight men over 50 will have an osteoporosis-related fracture in their lifetime. Annually, osteoporosis accounts for 1.5 million fractures, 700,000 of these in the back. (National Institute of Health)

• Vertebroplasty (a)
  Developed in France in 1984 and first performed in the US in 1995, Vertebroplasty is a procedure that involves the injection of bone cement into a vertebral body that has fractured as a result  of osteoporosis or destructive neoplasm. The objective is to stabilize the spinal fracture and provide   pain relief.
  
  
• Kyphoplasty
  Kyphoplasty is a technique refined from vertebroplasty which, with the use of special equipment,    involves the injection of bone cement into the vertebral body after the inflation of a special balloon (tamp). The balloon inflation is done in an attempt to restore the height of the collapsed vertebral body and is followed by the bone cement injection which is intended to stabilize the fracture and provide pain relief.