Intervention Radiology
Interventional radiology (IR) is a medical specialty that uses imaging techniques to guide minimally invasive procedures.
This approach allows doctors to perform various diagnostic and therapeutic procedures with smaller incisions or no incisions at all, reducing the risk and recovery time compared to traditional surgery.
Peripheral Procedures | Vascular Radiology | Gynae / Urological Radiology | Oncology
Diagnostic Peripheral Angiogram
A peripheral angiogram is an X-ray test that helps specialists view blood vessels in the pelvis, legs, and sometimes the arms, neck, and brain. It's used to check for conditions like narrowed or blocked arteries (Peripheral Artery Disease), malformed arteries, and other vascular issues. Common reasons for this test include severe leg pain, non-healing ulcers, and abnormal ultrasound findings.
What is Peripheral Artery Disease (PAD)?
Peripheral artery disease (PAD) occurs when arteries outside the heart and brain become narrowed or blocked, usually due to plaque buildup (atherosclerosis). This can lead to serious issues like organ damage or loss of limbs if untreated. PAD often affects the legs but can also impact arteries to the head, arms, kidneys, and GI tract.
Many people with PAD have mild or no symptoms, while others might experience pain in the calf, thigh, or buttock during walking, which eases with rest. As PAD progresses, you may feel pain at rest, experience cold or numb toes, or develop slow-healing sores.
Risk factors include diabetes, smoking, high cholesterol, and high blood pressure, especially in those over 50. Diagnostic tests like vascular ultrasound, CT angiography, or MR angiography can help assess the condition.
Treatment often begins with lifestyle changes, such as diet, exercise, and quitting smoking. In more advanced cases, procedures like angioplasty or bypass surgery may be needed to improve blood flow.
We collaborate with top specialists in interventional Radiology.
Dr Zubayr Zaman
Dr Michael Swarbrick
Dr Xavier Kos
Dr Allan Thomas
Angioplasty – Treatment
Your specialist may refer you for an imaging test, such as an ultrasound, to assess the arteries in your lower limb. If the ultrasound shows treatable narrowing, you’ll be referred for a peripheral arteriogram (angiogram). During this procedure, if a diseased vessel is found, the doctor may perform a percutaneous transluminal angioplasty (PTA) on the spot.
About the procedure
Angioplasty, sometimes with a stent, is a minimally invasive procedure to improve blood flow in narrowed or blocked arteries. It’s typically done in an interventional radiology suite. Using X-ray guidance, the doctor inserts a balloon-tipped catheter to open the blockage. If the blockage doesn’t respond, a stent may be placed to keep the artery open.
Once the procedure is complete, the catheter is removed, and pressure is applied to stop any bleeding from the puncture site. A closure device may be used to seal the artery, allowing for quicker recovery. You will need to lie in bed with your legs straight for a few hours afterwards.
Abdominal Aortic Aneurysm
An Abdominal Aortic Aneurysm (AAA) occurs when the wall of the abdominal aorta, the body's largest artery, weakens and stretches, causing it to bulge.
What is the Treatment - EVAR or Surgical Repair
Endovascular Aneurysm Repair – EVAR
This procedure involves placing a stent graft (a fabric-covered tube) into the aneurysm through small incisions in the groin or sometimes entirely through the skin without any incision. Using X-ray guidance and contrast media, the doctor visualises the aneurysm and guides the collapsed stent graft through the femoral artery to the aneurysm site. Once positioned, the stent is expanded, allowing blood to flow through it instead of the weakened aneurysm.
The procedure usually takes about two hours and is done in an angiography suite under general anaesthesia by a team of specialists. The endovascular approach offers a quicker recovery time since there are no large incisions. Most patients are discharged within 1 to 2 days after the procedure.
Upper Limb Venography
A venogram is a specialised X-ray examination to show images of the veins in your arm. It allows your doctor to check for blockages, blood clots, or vascular issues in the veins of your neck and arms.
How does the procedure work?
During the procedure, the doctor will inject X-ray contrast into your veins via a small needle in a vein in your arm. As the contrast flows through the veins multiple X-rays are taken with your arm in different positions.
The exam is usually done on an outpatient basis and takes about 30-45 minutes.
Vascular Embolisation
Catheter vascular embolization is a minimally invasive procedure that places medications or synthetic materials called embolic agents through a catheter into a blood vessel to block blood flow to an area of the body. It may be used to control or prevent abnormal bleeding, close off vessels supplying blood to a tumour, eliminate abnormal connections between arteries and veins, or treat aneurysms.
Your physician will choose the appropriate embolic agent based on the vessel's size and whether the treatment should be permanent or temporary.
options include:
Gelfoam™: A gelatin sponge used to control bleeding temporarily.
Particulate Agents: Like Polyvinyl alcohol (PVA) for permanently blocking small vessels.
Metal Coils: Stainless steel or platinum coils are used for larger arteries.
Liquid Sclerosing Agents: Used to destroy blood vessels and malformations by forming clots.
Liquid Glue: Used to close off abnormal passageways, such as in a fistula or AVM.
Embolisation can treat various conditions, including:
Ovarian Vein Embolisation
Varicocele Embolisation
Pre-surgery tumour blood flow reduction
Vascular malformations and AVMs -
Congenital venous malformations
The procedure helps manage and improve symptoms associated with these conditions.
How does the procedure work?
Enter he doctor will insert a catheter through a small nick in the skin of your groin into your femoral vein or artery. Using x-ray imaging and contrast media injections to guide the catheter tip to the treatment site. Then, an embolic agent—a synthetic material or medication—is placed through the catheter to block the vessel or malformation.
When the procedure is complete, the catheter is removed and pressure is applied to stop any bleeding from the vessel in your groin. Sometimes, your doctor may use a closure device to seal the small hole in the vessel. This will allow you to move around more quickly. The tiny opening in the skin is covered with a dressing.
The procedure usually requires only local anaesthesia and pain relief, though some patients may need general anaesthesia.your content...
See “Vascular Embolisation” for more information
Pelvic congestion syndrome
Ovarian vein embolisation is a minimally invasive treatment for pelvic congestion syndrome, which causes symptoms like pelvic pain, heavy periods, and painful intercourse. This condition occurs when the one-way valves in the ovarian veins don't function properly, allowing blood to flow backwards, and causing your veins to swell and twist. This can lead to pelvic pain, especially before and during menstruation, and is often linked to painful intercourse.
What is the treatment?
Embolisation relieves pain by closing off faulty veins so they can't fill with blood. After the procedure, some pain is common but manageable with medication. Most patients can leave the hospital within 24 hours and return to normal activities within a week. If pain is more severe, a longer hospital stay might be needed.
See “Vascular Embolisation” for more information
Varicocele Embolisation
Varicoceles are enlarged veins in the testicles and scrotum that can sometimes cause pain, infertility, and testicular shrinkage. About 10% of men have varicoceles, most commonly between the ages of 15-35. Among infertile couples, nearly 30% of men are affected.
What is the treatment?
Varicocele embolisation is a highly effective, minimally invasive procedure in which the abnormal veins are blocked, preventing blood from flowing in the wrong direction. Over time, this reduces congestion in the veins and the varicocele disappears. When the abnormal veins are blocked the testicular and scrotal veins will drain normally via other veins.
After the procedure, the catheter is removed, and pressure is applied to prevent bleeding at the puncture site. The procedure usually takes about an hour.
See “Vascular Embolisation” for more information
Nephrostomy Tube Insertion
Our kidneys are part of the urinary system and produce urine, which normally flows through the ureters to the bladder. When the bladder has enough urine, you feel the need to urinate, and the urine exits your body through the urethra.
A percutaneous nephrostomy tube is a catheter inserted through the skin into the kidney to drain urine when the ureter is blocked. This tube collects urine in a bag outside your body.
The staff will provide instructions for caring for your nephrostomy tube. Daily, you'll need to inspect the tube and empty the drainage bag as needed
Blockages in the urinary system can be caused by:
Kidney stones
Injury to the kidney or ureter
Infection
Congenital conditions
tumours
Ureteral Stent Insertion
Urine flows from the kidneys to the bladder through narrow tubes called ureters, which can become obstructed by kidney stones, tumours, infections, or blood clots. To restore urine flow, physicians can use imaging to place a thin, flexible tube called a stent in the ureter. One end of the stent is positioned in the kidney and the other in the bladder, with both ends shaped like a "pigtail" to prevent the stent from moving.
What is the treatment?
The procedure for placing a ureteric stent is similar to inserting a nephrostomy tube. A needle or tube is guided through the skin into the kidney. Using X-ray imaging, the doctor threads a guidewire down the ureter, past the obstruction, and into the bladder. The stent is then placed over the guidewire, with one end in the bladder and the other in the kidney. A nephrostomy tube may also be inserted and clamped off temporarily, to be removed once the stent is functioning well.
Stents are usually needed for a short time, from a few weeks to a few months, but can stay in place for up to three months if positioned correctly. If the issue isn’t a kidney stone, the stent may remain longer. Your specialist will determine the appropriate duration and discuss it with you.
Peripherally Inserted Central Catheter (PICC Line Insertion)
A Peripherally Inserted Central Catheter (PICC) line is a long, thin, flexible tube used for administering intravenous fluids and medications. It's typically inserted into a vein in your upper arm, above the elbow, with the tip positioned just above the heart. Usually, the non-dominant arm is preferred, but this can vary depending on your situation.
Uses of a PICC Line:
Prolonged intravenous (IV) antibiotic treatment
Chemotherapy
Total Parenteral Nutrition (TPN), providing nutrition intravenously
Continued treatment at home, such as fluids and medications
Risks: Your doctor will discuss potential risks, including infection at the site or inside the line, bleeding, nerve injury, and the possibility of a small clot forming around the catheter.
Procedure
The catheter is inserted by specially trained nurses using ultrasound guidance under sterile conditions to prevent infection. This outpatient procedure takes about an hour to guide the insertion and is performed in a room equipped with X-ray machines.
The PICC line is inserted using local anaesthetic. Ultrasound is used to locate the vein, and after the PICC line is introduced, X-ray images are taken to confirm its position. The catheter is then secured with a sterile dressing to keep it in place and prevent infection. The PICC line can be used immediately after insertion.
A PICC line may have one or two lumens (channels), allowing for different treatments to be administered simultaneously. The external end of the catheter has a special cap that can be attached to a drip or syringe. Sometimes a clamp is used to keep the line closed when not in use.
Post-Procedure
You can go home with a PICC line in place, which can remain for weeks or even months. It’s particularly helpful if your veins are difficult to access or if they've been affected by previous treatments like chemotherapy.
PICC Line Removal:
When your treatment ends, a doctor or nurse will gently remove the PICC line. This reduces the risk of complications like infection. However, if you need the line again, it might be left in place to avoid repeated insertions, which can damage veins.
Some tenderness at the insertion site is normal and should subside within a few days.
TACE – Trans Arterial Chemo Embolisation
TACE is a minimally invasive procedure used to treat cancerous tumours by delivering chemotherapy directly to the tumour's blood supply and blocking it with embolic agents. This approach traps the chemotherapy within the tumour and cuts off its blood supply, most commonly targeting liver cancer, though it can be used for other cancers that have spread to the liver.
Procedure Overview
TACE is typically used when cancer is primarily in the liver, either originating there or spreading from another organ.
It can be a stand-alone treatment or combined with surgery, ablation, chemotherapy, or radiation therapy.
Cancers Treated by TACE
Primary liver cancers like hepatocellular carcinoma (HCC) and cholangiocarcinoma
Liver metastases from colon cancer, breast cancer, neuroendocrine tumours, pancreatic islet cell tumours, ocular melanoma, sarcomas, and other vascular tumours
How TACE Works
TACE targets cancer in two ways:
Direct Chemotherapy Delivery:
High concentrations of chemotherapy drugs are injected into the artery feeding the tumour, minimising exposure to the rest of the body.
Blood Supply Blockage:
The embolic agents block the blood flow to the tumour, trapping the drugs and depriving the tumour of nutrients and oxygen needed to grow.
The liver's unique blood supply allows TACE to target tumours effectively. Tumours in the liver receive blood mainly from the hepatic artery, while the rest of the liver is supplied by the portal vein. Blocking the hepatic artery impacts the tumour more than healthy liver tissue.
Procedure Details
Performed by an interventional radiologist using X-ray imaging to guide the catheter from the femoral artery in the groin to the hepatic artery in the liver.
Contrast material is injected to map the blood vessels feeding the tumour, and then the chemotherapy and embolic agents are delivered.
The procedure typically lasts a few hours, and once complete, the catheter is removed, and pressure or a closure device is used to stop any bleeding.
Common Side Effects
Post-embolization syndrome, including pain, nausea, vomiting, fever, fatigue, and loss of appetite. These are usually temporary.
Serious Complications: In rare cases, infection, liver damage, or even death may occur, particularly if liver function is already compromised.
Benefits
TACE can stop tumour growth or cause shrinkage in about two-thirds of cases, often for 10 to 14 months, and the procedure can be repeated if necessary.
It can preserve liver function and quality of life by preventing tumour growth, especially in cases where the cancer is confined to the liver.
TACE can stop tumour growth or cause shrinkage in about two-thirds of cases, often for 10 to 14 months, and the procedure can be repeated if necessary.
It can preserve liver function and quality of life by preventing tumour growth, especially in cases where the cancer is confined to the liver.
What are the Risks?
Infection, bleeding, or damage to the blood vessel where the catheter was inserted
Possible embolization material lodging in the wrong place, depriving normal tissue of blood
Allergic reactions to the contrast material, risk of kidney damage, and typical chemotherapy side effects, though these are usually mild
What are the Limitations?
TACE is not suitable for patients with severe liver or kidney dysfunction, blood clotting issues, or previous bile duct surgery.
It is a treatment, not a cure, and while 70% of patients see liver improvement, survival rates and quality of life may improve depending on the cancer type.
