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PICC Line Placement
A PICC line is a specialized form of intravenous line. It
is placed in a peripheral vein in the arm and threaded into
the central circulation. The catheter tip may be left in
the superior vena cava (a PICC line) or in the axillary
vein (a "mid" line). A PICC line is indicated for any patient
who needs a catheter for short to intermediate term IV access
and in whom repeated IV punctures are difficult or contraindicated.
A PICC line can be left in place for up to 3 months.
Venography
Venography is an X-ray test used to examine the veins in
the body. Although veins do not normally show up on X-rays,
in venography a special dye is injected into the veins so
that they can be seen on X-ray picture. Venography is used
to evaluate the condition of the veins and the valves within
the veins. Venography is a test that can be used to study
the veins in the legs (lower-extremity venography), the
arm (upper-extremity venography), and the veins leaving
the kidneys (renal venography).
Angioplasty
Coronary balloon angioplasty is an invasive method of opening
blocked arteries that might impede flow to the heart, and
possibly result in heart attack or death. It is more formally
known as percutaneous transluminal coronary angioplasty
(PTCA): percutaneous means "through the skin," transluminal
means "inside the blood vessel," coronary means "relating
to the heart," and angioplasty means "blood vessel repair."
The procedure involves creating space in the blocked artery
by inserting and inflating a tiny balloon, which compresses
some of the blocking plaque against the arterial wall. When
the balloon is deflated and removed, the plaque still remains
compressed, clearing space in the artery and improving blood
flow.
Stent Placement
Stenting is a catheter based procedure in which a stent
(a small, expandable wire mesh tube) is inserted into a
diseased artery to hold it open. It is often used in conjunction
with a balloon angioplasty to treat coronary artery disease.
After the angioplasty reduces the narrowing of the coronary
artery, the stent is immediately inserted, typically leaving
less than 10 percent of the original blockage in the artery.
In fact, stenting is done about 75 percent of the time after
a balloon angioplasty and/or atherectomy (in which plaque
is removed from an artery).
Stereotactic Breast Biopsy
When a radiologist has discovered an area of question change
or concern on a mammogram, stereotactic breast biopsy provides
a means to obtain tissue without open surgical biopsy. During
a stereotactic biopsy, small samples of tissue are removed
from the breast using a hollow needle, which is precisely
guided to the suspicious location via mammography and computer
coordinates. A woman undergoing the procedure lies face
down on a specifically designed table; the breast will be
slightly compressed and held in position during the procedure.
The examination can take from thirty to forty-five minutes
and only local anesthesia is used. Most women report only
mild discomfort after the procedure.
Biliary Drainage
A biliary drainage is a procedure performed by an interventional
radiologist to drain bile from your liver. The most common
reason for biliary drainage is blockage of the bile ducts.
These ducts carry bile from the liver to the bowel. Biliary
drainage may also be performed to help heal a hole in the
duct, or in preparation for surgery such as removal of a
bile duct stone. The doctor will first inject anesthetic
into the area where the catheter will be placed. You will
only feel pressure as the doctor guides a needle into your
bile duct, followed by a guide wire and the drainage catheter.
The catheter will be connected to a drainage bag. The procedure
usually lasts about two hours, however, it is not possible
to know exactly how much time the procedure will require.
Diagnostic Angiography
Diagnostic angiograms are useful, among other things, for
making diagnoses, identifying the location of active gastrointestinal/pancreatic
bleeding sources, identifying and assessing the extension
of tumors in the gastrointestinal tract, and identifying
and evaluating the location and spread of liver tumors.
Diagnostic angiograms also provide an invaluable road map
of the vasculature of the abdominal organs, which may be
useful for prospective surgery and other more invasive procedures,
such as liver transplant. A catheter placed in the blood
vessel feeding a diseased organ, as in the case for diagnostic
angiography, provides an excellent opportunity for treatment
of that organ. The selectively placed catheter can be used
as the vehicle for injection of drugs, devices and other
therapeutic systems. A recent advance in that area is the
transcatheter liver cell transplant, which is still experimental
but a promising technique.
Artificial Embolizations
The catheter used for diagnostic angiography may be used
for vessel occlusion, utilizing the selective introduction
of so called Aembolic particles or devices. These devices
will cause clotting of the target vessels of certain organs
or territories. A typical indication for this type of procedure
is to control active bleeding into the lumen of the bowel
(also called GI bleeding). Other abnormalities may be treated
as well with embolization, such as a vascular malformation
or tumor. Bleeding is the most common indication for an
embolization procedure. An ulcer in the digestive tract,
stomach, or bowel, can bleed in certain circumstances. Embolization
(vessel occlusion) may control permanently the bleeding
with minimal risks and sparing a major surgical procedure
to the patient. Sparing the patient a major surgical procedure
is the greatest advantage of embolization. In other cases,
surgery can be delayed until the patient is stable, making
it much safer. Risks and complications of embolization are
few but serious and may be related to occlusion of non-target
vessels and organs, potentially causing damage to healthy
adjacent organs. These complications may require surgical
treatment or some form of endovascular procedure to control
damage.
Abscess Drainage
Abscess drainage is usually performed under CT scan guidance,
using a needle stick, followed by exchange of the needle
for a catheter (drain) over a wire. Abscess drainage is
very effective in treating infected or symptomatic pseudocysts
of the pancreas, but prolonged drainage is required (weeks
to months). Other abscesses are also easily drained under
CT scan guidance. The insertion of a drain in an abdominal
abscess is followed by a dramatic improvement in the symptoms
and infection. Abscesses that are not connected by a fistula
to a hollow organ like the gut, are easily treated by drainage
in a few days to a week's time. When a fistula is connected
to the abscess cavity more prolonged drainages may be necessary.
Abscess drainage spares the patient major surgery, but a
few uncommon complications may develop. Bleeding is a possible
complication, as well as infection spread (sepsis).
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