Interventional Radiology
Our Interventional Radiology section consists currently of 5 fellowship-trained radiologists. We provide service to both Deaconess Main Campus and Deaconess Gateway. Some of the services we currently provide are:
- Dialysis access management
- Venous access
- Portacath placement
- Foreign body retrieval
- Vena cava filter placement
- Arterial and venous angioplasty and stenting
- Arterial and venous embolization
- Chemoembolization
And all percutanous non-vascular procedures:
- Image-guided biopsies
- Image-guided drainage procedures
- Compression fracture augmentation/Kyphoplasty
- Percutaneous Nephrostomy
- Ureteral Stenting
- Transhepatic cholangiogram
- Biliary stenting
 Osteoporosis, in which bones become fragile and easily broken, causes over 700,000 spinal fractures annually in the U.S.-more fractures than in the hip and wrist combined. Approximately two-thirds of all spinal fractures go undiagnosed or untreated due to the absence of symptoms or difficulty determining the cause of symptoms, leading some to call osteoporosis a “silent disease.”
Since 50 percent of women and 25 percent of men older than 50 will have an osteoporosis-related fracture in their lifetime and bone loss can begin as early as 30, now is the time to take a closer look at osteoporosis and new options for treating fractures caused by osteoporosis. Through proper diagnosis and treatment, patients with spinal fractures can significantly improve their ability to perform normal activities of daily living and enjoy an overall improvement in their quality of life.
With osteoporosis, bones in our spine, hip and wrist deteriorate and become susceptible to fractures. In the spine, small fractures lead to compression of the vertebral body (called vertebral compression fractures or VCFs). Left untreated, these VCFs create a curvature of the spine, sometimes referred to as “dowager’s hump.” Over time, this curvature can become more pronounced, painful and debilitating.
 What options are there if I have a spinal fracture?
Traditional treatments for spinal fractures include extended bed rest, pain medication and back braces, all of which can relieve pain but do not address the deformity caused by the fracture. Open surgery is also an option, but it is more invasive than non-surgical management and is typically reserved for patients with neurological complications. Balloon Kyphoplasty, a minimally invasive procedure, is designed to treat the fracture and restore the vertebra to the correct position. Balloon Kyphoplasty has been demonstrated to significantly reduce back pain, correct spinal deformity and improve quality of life.
How is Balloon Kyphoplasty performed?
Balloon Kyphoplasty is a minimally invasive procedure performed by a spine specialist. It can be performed using either a local or general anesthesia. It typically takes about one hour to treat each fracture and may require an overnight hospital stay.
Does insurance cover Balloon Kyphoplasty?
In most cases, Medicare provides coverage for Kyphoplasty. Other insurance may also provide coverage. Check with your insurance carrier or doctor to find out about coverage.
What can Balloon Kyphoplasty do for me if I have a spinal fracture?
If you have a spinal fracture, Balloon Kyphoplasty can restore vertebral body height, significantly reduce back pain and increase mobility, often shortly after the procedure. In addition to pain reduction, patients experience an increased ability to return to such simple, everyday activities as walking, reaching, bending and lifting. Patients also report improved mental health, vitality, social function and emotional health.
VASCULAR ACCESS FOR HEMODIALYSIS
For more information please refer to
http://kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess/
If you are starting hemodialysis treatments in the next several months, you need to work with your health care team to learn how the treatments work and how to get the most from them. One important step before starting regular hemodialysis sessions is preparing a vascular access, which is the site on your body where blood is removed and returned during dialysis. To maximize the amount of blood cleansed during hemodialysis treatments, the vascular access should allow continuous high volumes of blood flow.
A vascular access should be prepared weeks or months before you start dialysis. The early preparation of the vascular access will allow easier and more efficient removal and replacement of your blood with fewer complications.
The three basic kinds of vascular access for hemodialysis are an arteriovenous (AV) fistula, an AV graft, and a venous catheter. A fistula is an opening or connection between any two parts of the body that are usually separate-for example, a hole in the tissue that normally separates the bladder from the bowel. While most kinds of fistula are a problem, an AV fistula is useful because it causes the vein to grow larger and stronger for easy access to the blood system. The AV fistula is considered the best long-term vascular access for hemodialysis because it provides adequate blood flow, lasts a long time, and has a lower complication rate than other types of access. If an AV fistula cannot be created, an AV graft or venous catheter may be needed.
An AV fistula requires advance planning because a fistula takes a while after surgery to develop-in rare cases, as long as 24 months. But a properly formed fistula is less likely than other kinds of vascular access to form clots or become infected. Also, properly formed fistulas tend to last many years-longer than any other kind of vascular access.
A surgeon creates an AV fistula by connecting an artery directly to a vein, frequently in the forearm. Connecting the artery to the vein causes more blood to flow into the vein. As a result, the vein grows larger and stronger, making repeated needle insertions for hemodialysis treatments easier. For the surgery, you’ll be given a local anesthetic. In most cases, the procedure can be performed on an outpatient basis.
Forearm arteriovenous fistula.
If you have small veins that won’t develop properly into a fistula, you can get a vascular access that connects an artery to a vein using a synthetic tube, or graft, implanted under the skin in your arm. The graft becomes an artificial vein that can be used repeatedly for needle placement and blood access during hemodialysis. A graft doesn’t need to develop as a fistula does, so it can be used sooner after placement, often within 2 or 3 weeks.
Compared with properly formed fistulas, grafts tend to have more problems with clotting and infection and need replacement sooner. However, a well-cared-for graft can last several years.
One kind of AV graft.
If your kidney disease has progressed quickly, you may not have time to get a permanent vascular access before you start hemodialysis treatments. You may need to use a venous catheter as a temporary access.
A catheter is a tube inserted into a vein in your neck, chest, or leg near the groin. It has two chambers to allow a two-way flow of blood. Once a catheter is placed, needle insertion is not necessary.
Catheters are not ideal for permanent access. They can clog, become infected, and cause narrowing of the veins in which they are placed. But if you need to start hemodialysis immediately, a catheter will work for several weeks or months while your permanent access develops.
Venous catheter for temporary hemodialysis access.
For some people, fistula or graft surgery is unsuccessful, and they need to use a long-term catheter access. Catheters that will be needed for more than about 3 weeks are designed to be tunneled under the skin to increase comfort and reduce complications. Even tunneled catheters, however, are prone to infection.
VENOUS ACCESS
Patients sometimes require frequent injections for medicines, nutrients, and blood tests. In order to make this easier on the patient, a tube may be inserted that eliminates painful, continual needle sticks. One such procedure is a technique called a central venous catheter. An interventional radiologist makes a small incision near the shoulder and inserts a long narrow tube (catheter). It is secured in place and enables hospital staff to administer necessary fluids without the discomfort of a needle insertion. Sometimes this catheter is able to be placed with a more peripheral access via a small incision in the arm. This is termed a peripherally inserted central cather or PICC.
PERCUTANEOUS NEPHROSTOMY TUBE PLACEMENT
The ureter is the fibromuscular tube that carries urine from the kidney to the bladder. When this tube is blocked, urine backs up into the kidney. Serious, irreversible kidney damage can occur because of this backflow of urine. Infection is also a common consequence in this stagnant urine.
Nephrostomy is performed in several different circumstances:
- The ureter is blocked by a kidney stone.
- The ureter is blocked by a tumor.
- There is a hole in the ureter or bladder and urine is leaking into the body.
PROCEDURE
First, the patient is placed on their stomach on the procedure table. Both local anesthetic and conscious sedation are given to provide adequate pain control. The doctor then inserts a needle into the kidney. There are several imaging technologies such as ultrasound and computed tomography (CT) that are used to help the doctor guide the needle into the correct place. Next, a fine guide wire follows the needle. The catheter, which is about the same diameter as IV (intravenous) tubing, follows the guide wire to its proper location. The catheter is then connected to a bag outside the body that collects the urine. The catheter and bag are secured so that the catheter will not pull out. The procedure usually takes one to two hours.
» back to sites
^ return to top |
