This is a vast area of IR and includes a huge variety of procedures. Fundamentally many procedures share the same steps in that we use ultrasound, CT or x-ray to insert a needle into a particular organ (liver, kidney, stomach, spine etc) then we insert a wire and catheter into that organ, then perform whatever procedure we need to.
If the kidney becomes blocked by stones or tumours we insert a needle through the skin into the kidney using ultrasound to guide us. Once inside the kidney we use x-rays to guide a wire down to the bladder and insert a stent between the kidney and bladder to bypass the blockage. Patients for this procedure are usually referred to us by our urology or oncology colleagues. It is often performed using local anaesthetic or sometimes with sedation in challenging cases. Patients are cared for on a ward following the procedure for close observation and monitoring.
If the liver becomes blocked by stones or tumours we insert a needle through the skin into a tiny duct in the liver using ultrasound to guide us. Once inside we use x-rays to guide a wire through the liver into the bowel and insert a stent between the liver and bowel to bypass the blockage. Patients for this procedure are usually referred to us by our gastroenterology, oncology or hepatobiliary colleagues. It is performed under local anaesthetic and sedation as it can be a challenging procedure. Patients are cared for on a ward following the procedure for close observation and monitoring.
If a patient is unable to eat and drink normally (normally due to a stroke or cancer) we insert a needle through the skin directly into the stomach using x-ray guidance and pass a feeding tube through the skin into the stomach using the wire as a guide. Patients for this procedure are usually referred to us by the nutrition team after careful assessment. It is performed under local anaesthetic and sedation as it can be a challenging procedure. Patients are cared for on a ward following the procedure for close observation and monitoring.
In certain types of spinal fractures or where there is collapse of vertebrae due to cancer, we can insert a needle through the skin and into the spine using x-ray guidance and inject cement into the spine to help stabilise it and prevent further fracture. Patients for this procedure are usually referred to us by our orthopaedic, oncology or neurosurgical colleagues. Patients are usually seen in an IR outpatient clinic prior to the procedure to ensure they understand the procedure and give informed consent. The procedure is performed under local anaesthetic and sedation as it can be a challenging procedure. Patients are cared for on a ward following the procedure for close observation and monitoring.
Using ultrasound or CT guidance we can insert a needle to nearly anywhere in the body and obtain a sample of tissue to assess whether there is infection or tumour or other types of disease present at this location. The image below shows a CT image of a needle being inserted into a lung cancer. Patients for this procedure can be referred to us by any medical or surgical specialty. It is usually performed under local anaesthetic. Some procedures can be performed as day case procedures but often patients are cared for on a ward following the procedure for close observation and monitoring.
Using ultrasound or CT guidance we can insert a needle into fluid collections or abscesses anywhere in the body and insert a drain over a wire to remove the fluid or abscess. The CT images below show a drain being inserted into an abscess in the pelvis. Patients for this procedure can be referred to us by any medical or surgical specialty. It is usually performed under local anaesthetic. Most patients requiring abscess drainage are quite poorly and need post procedure care on a ward for close observation and monitoring.
If the gall bladder becomes blocked with stones or tumour it can make patients very unwell and lead to septicaemia. We use ultrasound or CT to guide a needle through the skin and liver into the gall bladder. We then insert a tube over a wire to allow the gall bladder to drain. This procedure is usually performed under local anaesthetic. Most patients requiring cholecystostomy are quite poorly and need post procedure care on a ward or ITU for close observation and monitoring.
If someone suffers with gallstones, they usually have their gall bladder removed surgically. If they are not fit for surgery, they may be left with a drain in their gall bladder (cholecystostomy) for the rest of their life to prevent gall bladder infections. For these patients it’s sometimes possible to place a drain between the gall bladder and the bowel to reduce the risk of further blockages. This is locally known as a GUPTAS procedure (Gallbladder drain internalisation Using a Percutaneous Trans-Amullary Stent) as Dr Gupta is usually the IR Consultant who performs this specialised procedure. Patients for this procedure are referred by our specialist hepatobiliary colleagues following careful assessment and Dr Gupta often sees them in his outpatient clinic to discuss the procedure. It is performed under local anaesthetic and sedation and can sometimes be performed as a day case procedure to allow quick recovery.
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