Radiology Procedures

An angioplasty is a way of relieving a narrowing or blockage in a blood vessel without having major surgery. A thin plastic tube (catheter) is inserted through the groin artery and passed through the blockage.

A special balloon on the end of the catheter is placed across the narrowing or blockage. This balloon is inflated momentarily, squashing the blockage to improve the flow through the blood vessel. Sometimes a metal cylinder called a 'stent' is also inserted, which stays permanently within the vessel.

Normally arteries do not show up on an ordinary x-ray so a special dye called 'contrast medium' is injected into the artery through a fine plastic tube called a catheter to make them visible.

Why do I need an angioplasty?

• Your doctor has identified that there is a narrowing or blockage in one or more of your blood vessels that is causing you a problem.
• If the arteries in your legs are affected, this may be causing pain in your calf or thigh. This may occur after you have walked a certain distance or may be causing more severe symptoms such as pain in your foot, especially at night.
• Some patients may develop ulceration due to lack of blood flow.
• Tests such as a Doppler ultrasound scan, a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan may have already been performed.

Urine normally runs through a narrow tube called the ureter from the kidney into the bladder. The ureter can become blocked or can sometimes leak. A ureteric stent is a plastic tube that runs inside the ureter from the kidney to the bladder. This helps the urine drain correctly to the bladder.

When a ureteric stent is placed through the kidney down the ureter into the bladder it is called antegrade.

Why do I need an antegrade ureteric stent?

• Other imaging tests usually have shown that the ureter running from the kidney to the bladder is blocked. This can be for several different reasons including a stone or a tumour. The ureteric stent will allow urine to drain normally from the kidney to the bladder.

Adrenal venous sampling is a procedure which involves inserting a small plastic tube into the veins from the adrenal glands and taking a small sample of blood. This sample is then sent to the laboratory for testing.

Normally veins do not show up on an ordinary x-ray so a special dye, called contrast medium, is injected into the veins through a fine plastic tube called a catheter to make them visible.

Why do I need adrenal venous sampling?

Your doctors have asked for you to have adrenal venous sampling because they suspect that you may have high blood pressure related to the adrenal glands. This may also be related to low levels of potassium in the blood. This disorder is sometimes called primary hyperaldosteronism, or Conn’s Syndrome.

TAE is a procedure where the arteries supplying a liver cancer are blocked-off, which starves the cancer of nutrients and oxygen. This may cause the cancer to stop growing, and in some cases shrink. However, it does not remove the cancer entirely.

Normally arteries do not show up on an ordinary x-ray so a special dye, called contrast medium, is injected into the arteries through a fine plastic tube called a catheter to make them visible.

Why do I need a TAE?

• Patients are referred for TAE when they have cancers growing in the liver. Usually this is hepatocellular carcinoma (HCC), but occasionally other tumours are treated this way too.
• TAE is usually performed when the cancer is not suitable for removal by other forms of surgery.
• In some people, TAE is used to keep a cancer from growing while awaiting a liver transplant.
• It is common to need more than one TAE procedure to get the best result.

A venogram is a procedure where x-ray pictures are taken of the veins in your legs and pelvis.

Normally veins do not show up on an ordinary x-ray so a special dye, called contrast medium, is injected into the veins through a fine plastic tube called a catheter to make them visible.

Why do I need a venogram?

• Some people who have had a previous deep venous thrombosis (DVT) might have damage to the veins. They may have pain or skin ulceration due to post thrombotic syndrome. The venogram is performed to look for damage in your veins.
• Some people who have injury or scarring (blockage_ to the veins may need a venogram to show where the blockage is.

Gastrostomy is a technique where a narrow plastic tube is placed through the skin directly into your stomach. Once in place, the tube can be used to give you liquid food straight into your stomach. Once in place, the tube can be used to give you liquid food straight into your stomach to provide nutrition.

Gastrostomy tubes can be placed endoscopically (PEG) or percutaneously (RIG). RIGs are placed by specially trained doctors called interventional radiologists. X-rays are taken during the procedure. These images will assist the doctors in performing the procedure and obtaining diagnostic information.

Why do I need a RIG?

• You may be unable to eat or drink enough to satisfy your nutritional needs or there may be a problem with swallowing that makes it unsafe for you to eat and drink.
• You may have had a small plastic tube inserted through your nose and down your stomach to help with your feeding. This can only be left in place for a relatively short period of time therefore a RIG needs to be performed.

SIRT (also known as radioembolisation) is a special type of internal radiotherapy that targets liver tumours inside the body with high doses of radiation.

It involves injecting millions of tiny radioactive 'beads' called microspheres into the main blood vessel of the liver. The microspheres travel to the liver where they lodge themselves in the very small blood vessels in and around the liver tumours where they give off high doses of radiation. As the microspheres only give off radiation to a small area, they target the live tumour while doing little damage to the surrounding healthy liver tissue. The action of the radiation destroys the liver tumour cells causing the tumours to shrink. The radiation acts on the tumours for about two weeks before it naturally depletes.

Why do I need a SIRT?

The doctors looking after you have decided the best way to treat your type of liver cancer (cancer arising from the liver calls themselves (hepatocellular carcinoma) or spread to your liver from another cancer (typically bowel cancer)) is to have SIRT.

Transjugular liver biopsy is a way of obtaining a specimen of your liver through a vein in your neck.

Hepatic wedge pressures are sometimes taken during this procedure to obtain pressure readings within the veins of the liver, inferior vena cava (IVC), and heart.

Why do I need a transjugular liver biopsy?

• The doctors looking after you have decided that you need a liver biopsy to obtain more information about your liver problem.
• The information gained from the biopsy will help the doctors in the treatment of your condition.
• This method is used in patients who have abnormal clotting of the blood or fluid collecting within the abdomen, called ascites.
• If any wedge pressures are taken, these will assist in diagnosing your condition and treating your disease.

Fibroid embolisation is a way of treating fibroids by blocking the arteries that feed the fibroids (uterine arteries). Cutting off the blood supply causes the fibroids to shrink, which can relieve symptoms. It is an effective alternative to surgery for many women.

Why do I need a Uterine Fibroid Embolisation?

• The doctors looking after you have decided that this is the most effective way to treat your fibroids.
• Fibroid embolisation may be offered if you have symptoms of heavy bleeding, pain or pressure.

A fistulogram is a procedure where x-ray pictures are taken of your fistula to look for any vessel narrowing that may be affecting the function of the fistula. Normally veins do not show up on an ordinary x-ray so a special dye, called contrast medium, is injected into the veins through a fine plastic tube called a catheter to make them visible. The interventional radiologist interprets the images to decide on whether any further treatment is needed to improve the fistula function.

Why do I need a fistulogram/fistuloplasty or venoplasty?

• Occasionally, the blood vessels that make up a fistula can develop a narrowing which is diagnosed with a fistulogram.
• To treat this narrowing, a special balloon called an angioplasty balloon is introduced into the area of narrowing inside the fistula. This balloon is inflated momentarily to improve the narrowing. If this is in the fistula is it called a fistuloplasty, if it is in a central vein, it is called a venoplasty.

Gastrojejunostomsy feeding tube insertion is a procedure where a feeding tube is inserted into the first part of the bowel through an existing gastrostomy (a hole between the skin and stomach, which has been formed surgically). These feeding tubes will be subsequently changed usually every 3-4 months. Tube changes are usually much quicker than the initial insertion as the tip of the tube is usually in the correct position, and the tube can simply be swapped.

The feeding tube has three ports:

• One for the balloon
• One for the stomach
• One for the jejunum (small intestine)

One of the specialist nurses will educate you in using the tubes, the different ports and maintaining and checking the tube. Normally, bowel does not show up on an ordinary x-ray, so a special dye called contrast medium is injected into the bowel through a fine plastic tube called a catheter to make it visible.

X-rays are taken during the procedure. These images will assist the doctors in performing the procedure.

Why do I need a Gastrojejunostomy feeding tube insertion/change?

• A GJ feeding tube is usually suggested after gastrostomy feeding has been unsuccessful.
• Some people cannot tolerate feeding directly into the stomach, so a GJ tube can be helpful as it bypasses the stomach.
• A GJ tube can be helpful for people with gastric motility problems, where food does not pass through the stomach to the intestines as it should.
• Children or young people with gastro-oesophageal reflux may benefit from GJ feeding as the feed is delivered directly to the jejunum rather than the stomach. This stops stomach contents travelling back (reflux) up the oesophagus (food pipe), causing pain and potentially chest infection if the liquid is inhaled into the lungs (aspiration).

Nephrostomy is a medical procedure where a small tube is placed through the skin of your back directly into your kidney to allow urine to drain from the kidney into a bag outside your body, instead of flowing through the ureter to the bladder. Normally the procedure is done under local anaesthetic using Ultrasound and x-rays guidance to place the tube safely into the kidney.

Why do I need a nephrostomy?

• The doctors looking after you decided that you need a nephrostomy when urine cannot drain normally from the kidney to the bladder. If urine becomes blocked it can damage the kidney or cause infection.
• Most common reasons include:

1. Blockage of the ureter, often caused by kidney stones, tumours or scar tissue.
2. Severe infection with obstruction, where infected urine is blocked inside the kidney.
3. Cancer affecting the urinary tract, for example, bladder cancer or cervical cancer blocking urine flow.
4. Injury or damage to the ureter.
5. Temporary drainage after surgery.

Is it permanent?

Often no. Many nephrostomies are temporary until the blockage is treated (e.g. stone treatment), a stent is placed in the ureter or swelling/ infection settles. Some patients with long-term blockage may need nephrostomies for a longer period.

A nephrostomy tube change is a procedure where the nephrostomy (the plastic tube in your kidney) is changed.

Why do I need a nephrostomy tube change?

• The decision to place a nephrostomy had already been made and discussed with you prior to insertion.
• The nephrostomy (plastic tube) can get blocked or can move. To prevent problems such as pain, infection or a leaking tube, we regularly change the tube.