Interventional Radiology Tests & Procedures

Aspiration is a medical procedure that removes a substance from an area of the body by sucking it out. These substances can be air, body fluids, or bone fragments. Aspiration as a medical procedure may also be used to remove tissue samples, such as a breast lesion, for a biopsy. This is sometimes called a needle biopsy or aspirate.

A fistula is a passage from your kidney that allows kidney dialysis. A fistulagram is an X-ray procedure used to check for blood clots or other blockages in your fistula. If a blockage or narrowing is found, your radiologist may perform a balloon angioplasty. A balloon angioplasty involves putting a balloon-tipped, small plastic tube into the narrowed blood vessel and then inflating it, which forces open the narrowing so more blood can flow.

Having a fistulagram can help prevent problems with your dialysis and contribute to improved treatment. It can extend the life of a fistula.

There is a muscular tube inside the body called the ureter that drains urine from the kidney into the bladder. If the tube is blocked because of a blood clot or a stone, you may need a nephrostomy. This procedure involves inserting a catheter through the skin into the kidney. The catheter will drain the urine into a bag outside the body. Nephrostomy procedures can also be done to give your provider access to the urinary tract so stones can be dissolved or chemotherapy can be delivered. 

A radiologist conducts the procedure because X-ray and scanning tools must be used to insert the catheter correctly and because the procedure requires expertise in reading and understanding these scanned images.

Stents are little steel-mesh tubes your doctor may put in place after surgery to keep your blood vessels open. You may have a radioactive stent or a drug-coated stent implanted to reduce the chance of the vessel closing again. Although stents are often used in cardiac procedures, they have a wide range of other uses:

• To keep open arteries in the kidneys, legs, brain, lower abdomen or pancreas
• To open the renal arteries that provide blood to the kidneys and legs
• To treat patients with liver disease
• To treat blockages in the esophagus to make it easier to swallow

Inserting a stent into an artery is not a temporary procedure. The device becomes part of your vascular system. The stent itself can re-stenose, in which case you may receive radiation directly to the stent to help open it again or have an additional stent placed. Stents reduce the likelihood of the need for further procedures to open narrowing vessels.

Known medically as uterine artery embolization, this is a fundamentally new approach to the treatment of fibroids that blocks the arteries that supply blood to the fibroids. It is a minimally invasive procedure, which means it requires only a tiny nick in the skin, and it is performed while the patient is conscious but sedated—drowsy and feeling no pain.

While embolization to treat uterine fibroids has been performed for more than six years, embolization of arteries in the uterus is not new. The procedure has been used successfully by interventional radiologists in uterine arteries for decades to treat heavy bleeding after childbirth. Today, fibroid embolization is being performed at hospitals and medical centers across the country, in Canada and around the world.

Fibroid embolization is usually done in a hospital by an interventional radiologist.

The interventional radiologist makes a small nick in the skin (less than one-quarter of an inch) at the crease at the top of the leg to access the femoral artery and inserts a tiny tube (catheter) into the artery. Local anesthesia is used so the needle puncture is not painful. The interventional radiologist steers the catheter through the artery to the uterus using X-ray imaging (fluoroscopy) to guide the catheter's progress. The catheter is moved into the uterine artery at a point where it divides into the multiple vessels supplying blood to the fibroids.

An arteriogram (a series of images taken while radiographic dye is injected) is performed to provide a road map of the blood supply to the uterus and fibroids.

The interventional radiologist slowly injects tiny plastic (polyvinyl alcohol or PVA) or gelatin sponge particles the size of grains of sand into the vessels. The particles flow to the fibroids first, wedge in the vessels, and cannot travel to other parts of the body. Over several minutes, the arteries are slowly blocked. The embolization is continued until there is nearly complete blockage of the blood flow in the vessel.

The procedure is then repeated on the other side, so the blood supply is blocked in both the right and left uterine arteries. Some physicians block both uterine arteries from a single puncture site, while others puncture the femoral artery at the top of both legs. After the embolization, another arteriogram is performed to confirm the results. The skin puncture where the catheter was inserted is cleaned and covered with a bandage.

As a result of the restricted blood flow, the tumor (or tumors) begins to shrink.