Aneurysms

Aneurysms are localized areas of abnormal expansion of a blood vessel due to weakness in the vessel wall. They can leak or rupture, often with catastrophic results. They can also lead to blockages in smaller vessels, causing loss of blood flow to the legs and feet. Conventional surgical repair of abdominal aortic aneurysms (AAA) has a relatively low complication rate but involves major surgery and has a long recovery period. Endovascular AAA repair is an exciting new technique that has been studied extensively in research trials worldwide. Texas Radiology Associates is one of the few groups in the Metroplex that will offer this exciting new approach to aneurysm repair. The procedure will be done in conjunction with Vascular Surgeons and offers a dramatically shorter recovery period and lower risk compared to open surgical repair. 

Angiography (arteriography and venography)

Angiography is a general term, referring to study of blood vessels. Arteriography refers specifically to arteries, while venography is the study of veins. The terms angiography and arteriography are often used interchangeably. 

Angioplasty (balloon angioplasty)

Balloon angioplasty is used to treat localized areas of abnormal vessel narrowing (stenosis) due to plaque or scar tissue. A small catheter is inserted into the abnormal vessel, and a tiny balloon on the catheter tip is inflated to expand the stenotic area. In some cases, a metallic device called a stent is placed into the vessel before or after balloon angioplasty. The stent, which is a permanently implanted device, acts as a scaffold to hold the treated area open, and can improve long-term outcome significantly. Angioplasty and stenting can both be used in either arteries or veins if necessary. Our long-term success rate for re-establishing blood flow is excellent, and these endovascular techniques may help you regain the active lifestyle you once enjoyed. 

Arteriography

Arteriography is used to diagnose arterial problems, such as atherosclerosis ("hardening" of the arteries or plaque), abnormal bleeding, aneurysms, inflammatory conditions, and many other conditions. It is also used to evaluate tumors and to look for vascular injury in trauma patients. Arteriography is done by placing a tiny catheter into an artery in the groin or upper arm through a tiny skin nick, and maneuvering the catheter into the vessel to be studied. X-ray guidance is used to help direct the catheter. Contrast material or "dye" is then injected to allow the vessels to be seen, while pictures are taken. The procedure is most often done on an outpatient basis, and is virtually pain-free.

Chemoembolization

Chemotheraphy

Gastrostomy

Gastrostomy entails placement of a tube into the stomach or small intestine through a small incision in the skin over the abdomen, usually on the upper left side. Most often, gastrostomy tubes are used for feeding, in patients who are unable to eat because of surgery, stroke, or other problems. Tube placement is done by using x-ray guidance, under local anesthesia. It can be done on an outpatient basis, and has a very low complication rate.

Infertility

Infertility affects over 3 million couples in the United States. Fallopian tube disease is the most common cause, and is seen in 30-40% of these couples. This means about 1 million women may be infertile due to Fallopian tube problems.

Hysterosalpingography (HSG) is used to evaluate the Fallopian tubes, and is done by inserting a thin catheter through the cervix into the uterine cavity. Dye is then injected and x-rays are taken to show the uterus and tubes. HSG is a fundamental part of any infertility work-up, and shows a blockage in one or both tubes in 20-25% of patients. When the blockage is at the uterine (proximal) end of the tube, it may be amenable to nonsurgical recanalization (re-opening). This procedure, called transcervical Fallopian tube recanalization (TFTR), is done by Interventional Radiologists and can be done in conjunction with HSG if scheduled with one of our Interventional Radiologists. This can save time, cost, and hassle of having 2 separate procedures. HSG is done, and if there is a tubal blockage, TFTR can then be performed without having to schedule another appointment. The TFTR procedure is done with IV sedation and takes about an hour; patients typically go home 1-2 hours later. An oral antibiotic is taken beginning 2 days before the procedure and continued for 2 days afterwards. At least one tube can be reopened about 85-90% of the time; in most cases, the blockage is due to a small mucus plug and the tube itself is normal. The reported pregnancy rate after TFTR is between 35-40%. TFTR does not preclude or interfere with any further infertility treatment that may be needed. It is significantly less expensive, and less invasive, than in vitro fertilization, embryo transfer, and tubal microsurgery, and does not involve the use of fertility drugs or other hormones. In 1993, the American Fertility Society released practice guidelines recommending TFTR prior to these more invasive techniques in cases of proximal tubal obstruction.

In some cases, male factor infertility may be related to the presence of a varicocele (a collection of abnormal, dilated veins in the scrotum). Varicoceles can be treated surgically, or by Interventional Radiologists with embolization. This procedure, which is generally done on an outpatient basis, involves placing small metallic coils or other materials into the abnormal veins to block them. The procedure is generally done by making a tiny incision in the neck and directing a small catheter into the abnormal veins from the neck; no scrotal incision is required and the procedure causes very little pain. The effect of varicocele treatment, whether surgical or radiologic, on fertility is unclear but some studies suggest that it may be valuable. Low sperm counts and abnormal sperm shape or movement may be improved following varicocele treatment.

Intermittent Claudication

Liver Disease/Tumors

The most common cause of significant liver disease in the US is cirrhosis, generally due to alcohol abuse or chronic viral hepatitis, particularly hepatitis B or C. Cirrhosis of the liver can lead to accumulation of fluid in the abdominal cavity (ascites), bleeding into the gastrointestinal tract from dilated veins (varices), and other problems. Varices are due to elevated pressure in the veins, which results from formation of scar tissue in the liver. There are several treatment options for bleeding varices. The first treatment is generally endoscopy with banding or cauterization of the varices. If this is not successful, however, other treatments may be needed. Surgical creation of a shunt between the liver's veins (the portal venous system) and the other major veins in the abdomen (the systemic veins) is a mainstay of therapy for variceal bleeding, and works by relieving the abnormal pressure in the portal veins that makes them fragile and more prone to bleeding. Surgical shunt creation is a major operation with significant risk, though it does produce good results in selected patients. A newer, minimally invasive procedure done by Interventional Radiologists can be done with less risk to the patient and faster recovery. This procedure, called TIPS (transjugular intrahepatic portosystemic shunt), relieves the elevated pressure and can also reduce ascites. It is done through a tiny incision in the neck to gain access to the venous system, after which a shunt is made between the portal and systemic veins by using balloon angioplasty. Stents are then placed to hold the shunt open. Elevated pressure in the portal veins is relieved immediately. TIPS can be done in patients with alcoholic or viral cirrhosis, and in patients awaiting liver transplantation.

Certain liver tumors may be amenable to endovascular or other interventional therapy. Metastatic tumors (malignant tumors that have spread to the liver from another site, such as the colon or lung) can be treated with chemo-embolization (injecting a mixture of chemotherapy drugs and sponge-like particles into the arteries feeding the tumors to block off their blood supply) or by direct injection of pure alcohol into the tumors to kill them. Another, newer, technique called radiofrequency ablation (RFA) involves inserting small probes into the tumors to deliver radiofrequency energy, which heats and kills the tumors. Not all of these methods may be applicable for a given patient. Please contact us if you'd like to find out more.

Needle Biopsy

Needle biopsy is often needed to determine the nature of a finding on physical exam, ultrasound, or other imaging studies. Biopsy can be done with x-ray, ultrasound (US), or computed tomography (CT) guidance, depending on the location and size of the area to be biopsied. Our Interventional Radiologists are all highly skilled in performing needle biopsy of virtually any organ, using small needles to obtain tissue samples. Needle biopsy is very safe when done with imaging guidance, and can be done on an outpatient basis.

Peripheral vascular disease (PVD)

PVD is caused by formation of plaque (abnormal deposits of cholesterol and other materials) and/or blood clots within arteries, a process known as atherosclerosis. PVD may affect any artery in the body, but the most commonly affected vessels are those in the legs, neck, and kidneys. Plaque or clot buildup can reduce or even completely block blood flow, resulting in a variety of problems, depending on which arteries are involved. Blockages in the neck vessels can lead to stroke, while blockages in the kidney arteries can cause high blood pressure (hypertension). Blockages in the leg arteries can result in severe disability or even gangrene and amputation if not treated. Intermittent claudication, or pain in the legs whle walking or climbing stairs, is a common symptom of PVD in the leg arteries.

The causes of atherosclerosis are still unclear, but many risk factors have been identified. These include smoking, hypertension, elevated cholesterol and other blood lipids, diabetes, obesity, family history of heart or vascular disease, and inactivity. Symptoms of vessel blockage in the legs include pain or cramping in the legs while walking or climbing stairs or at night, and numbness or tingling. People with any of these risk factors who are experiencing such symptoms should consult one of our Interventional Radiologists to determine if they have PVD and discuss treatment options. Initial evaluation of suspected PVD is simple, quick, and painless, and is done by using ultrasound and blood pressure measurements at several areas on each leg. If the ultrasound test indicates a high likelihood of significant PVD, an arteriogram can be performed to determine the specific areas of abnormality. The arteriogram can also be used to identify areas of disease that may be amenable to endovascular treatment such as balloon angioplasty, which can be done as part of the same procedure in most cases.

Stent placement

TIPS

TPA

Thrombectomy

Thrombolytic therapy

In some cases, blockage in an artery or vein may be due primarily to blood clot rather than plaque or scar tissue. In such cases, the clot can often be dissolved by treatment with a thrombolytic (clot-dissolving) agent such as Urokinase or Tissue Plasminogen Activator (r-TPA). This is done by inserting a catheter directly into the clot to deliver the drug precisely where it is needed. Depending on the age, extent, and location of the clot, the drug may be delivered slowly, over several hours or even days, or more rapidly. Thrombolytic therapy is often used in combination with angioplasty, and sometimes with stent placement as well.

In addition to thrombolytic drugs, there are several mechanical devices that can be used to break up clot that is resistant to drug therapy. Our Interventional Radiologists have experience with all of these devices as well as with the various thrombolytic agents.

Urokinase

Uterine Fibroids

Uterine fibroid tumors are the most common tumors of the female reproductive tract. These tumors are non-cancerous and are frequently found in women in their 30's and 40's. The cause is not known, but their growth is tied to estrogen. Because of this, they will often enlarge during pregnancy and shrink following menopause.

Uterine artery embolization (UAE) is a relatively new procedure, which is an alternative to surgery for fibroids that are causing abnormal bleeding, pain, or other symptoms. UAE involves deliberately blocking blood flow to the fibroids by injecting tiny particles of a sponge-like material into their feeding arteries. It was first used in France in the late 1980s, and has been done in the US since 1995. The Interventional Radiologists at Texas Radiology Associates were among the first to offer this service to women in the Metroplex, and have been featured in the local media as a result. ‘local media’ links to “press and new devel.”

UAE is minimally invasive and has a high success rate, with reduction or elimination of abnormal bleeding in about 90% of patients after UAE. Pain and other symptoms are improved or eliminated in about 80-85% of patients after embolization.

Women who want to maintain their fertility may be ideal candidates for UAE, because this procedure preserves the uterus. While we don't know the precise impact of this procedure on future fertility, we do know that patients have carried normal pregnancies to term and have had normal uneventful vaginal deliveries following UAE.

The procedure takes 1-2 hours and is performed as an outpatient in most cases. The procedure itself produces minimal discomfort, and is done through a tiny nick in the skin of the groin. We use IV drugs to make the patient comfortable during the procedure. The amount of medicine can be adjusted so the patient can be very awake or very sleepy, depending on her preference.

Patients typically feel uncomfortable for the first 10-12 hours after the procedure, with pelvic pain described as similar to severe menstrual cramps. Most patients are pain-free by 2-3 days after the procedure. Patients are given anti-inflammatory and analgesic medications for the post-procedure period.

Other treatment options include observation (for fibroids that do not cause symptoms or cosmetic problems; ultrasound is used periodically to assess the stability of the fibroids), medical therapy (hormonal or anti-inflammatory medications), and various types of surgery, such as myomectomy, laparoscopic myolysis, and hysterectomy. Each of these options has advantages and disadvantages. Our group philosophy is predicated on educating our patients and providing the best medical care possible. If you are considering surgery or other treatment for problematic fibroids, we would be happy to discuss UAE and other options with you.

Varicocele

Venography

Venography is used to diagnose venous conditions, such as blood clots, malfunctioning venous valves (causing "reflux" of blood back toward the legs), varicose veins and venous insufficiency (inadequate drainage of blood from the legs due to venous blockages), and to evaluate venous anatomy in certain conditions.

Venous access

Venous access procedures involve placement of a device into the large veins, typically in the neck or chest, for delivery of antibiotics, chemotherapy, or other drugs, or for blood sampling and hemodialysis. These devices can also be used for delivery of special nutritional formulations for patients unable to eat normally. There are many different types of devices, any of which can be placed by our Interventional Radiologists. These include ports, "PICC" lines, dialysis catheters, Hickman catheters, Groshong catheters, and others. The procedure is generally done under local anesthesia, and patients go home the same day. Ultrasound and x-ray imaging are used to enhance procedure safety and to assure appropriate catheter position. The cost of venous access device placement in Radiology is significantly lower than that of surgical placement, as is the risk of complications related to the procedure.