In all arterial procedures we place a needle into an artery, usually in the groin but sometimes in the arm to gain access to the labyrinth of vessels to get anywhere in the body we need to get to the target for treatment. We use a variety of catheters and wires with various angles and tensions to allow us to guide around corners and access any vessel we want from those which supply the liver or kidneys, right down to the big toe! Most procedures can be done under local anaesthetic or sedation which allows quick recovery.
Arteries can become narrowed or clogged often due to smoking or a fatty diet, but also due to diabetes and other conditions. Angioplasty involves inserting tiny balloons into narrowed or blocked arteries to re-establish flow, most commonly in the leg arteries. The balloons can be inflated, then deflated, widening the vessel and allowing more blood flow. Metal stents can also be placed in certain types of disease, which reduce the chance of a rebuild up of material. Patients for angioplasty are usually referred to us by our vascular surgery colleagues and may prevent a surgical bypass operation. The procedure is usually performed under local anaesthetic and can often be done as a day case procedure.
This involves passing a tube into a blocked blood vessel and slowly injecting clot busting medication to try to unblock the vessel and re-establish blood flow. If blood flow cannot be re-established as quickly as possible, there is a real risk of limb loss. Patients for thrombolysis are usually referred to us by our vascular surgery colleagues and may prevent an open surgical declotting or bypass operation. Patients are admitted to the specialist vascular Enhanced Care Unit or General Critical Care for this procedure for close monitoring.
Many women suffer with painful, heavy periods caused by uterine fibroids. This procedure involves inserting a needle into the groin, then passing a catheter into the uterine arteries under x-ray guidance. Once we’re in the right place, we inject tiny beads into the arteries which supply the uterus which flow into the fibroids and “clog” them up. This causes the fibroids to shrink as they can no longer obtain nutrients from the blood. Patients for uterine artery embolisation are referred to us by our gynaecology colleagues and may prevent a surgical operation such as myomectomy or hysterectomy. Patients are 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, and requires an overnight stay on the gynaecology ward for observation and nursing care.
Many men suffer with difficulty passing urine due to an enlarged prostate. This procedure involves inserting a needle into the groin, then passing a catheter into the prostate arteries under x-ray guidance. Once we’re in the right place, we inject tiny beads into the arteries supplying the prostate which causes it to shrink and improves symptoms. Patients for prostate artery embolisation are referred to us by our urology colleagues and may prevent a surgical operation. Patients are 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, and can often be performed as a day case procedure without the need for an overnight stay in hospital.
Following childbirth sometimes the uterus fails to contract enough to stop bleeding. There are many ways the bleeding can be stopped by the obstetric doctors but very rarely the bleeding doesn’t stop. In this scenario we can insert a needle into the artery in the groin and pass a catheter into the arteries supplying the uterus. We then inflate tiny balloons which stop the blood flow to the uterus. If this does not work, we can inject particles or a glue-like substance into the uterus to stop it from bleeding. We sometimes also perform this procedure in women who have complex problems with their placenta which puts them at high risk of bleeding during delivery. In those circumstances we insert balloons into the arteries, then inflate them as the baby is being delivered by c-section. This reduces the blood loss during c-section and helps the obstetric team deliver the placenta.
Bleeding into the bowel is commonly controlled by putting a camera through the mouth or up the back passage to find the source and either inject it with glue or place metal clips on the bleeding vessel. Sometimes this fails so we are called to insert a needle into the artery in the groin, direct a catheter under x-ray guidance into the artery which supplies the bowel, then guide the catheter to the source of bleeding and stop it from the inside by using tiny metal coils, particles or glue. The black splodge on the below images shows the source of bleeding which is subsequently stopped. Patients for this procedure are usually referred by our gastroenterology colleagues and can be very sick. Although the procedure can be performed just under local anaesthetic, we often ask our anaesthetic colleagues to attend in case we need help when patients are bleeding profusely. Patients normally go back to the gastroenterology ward or ITU following this procedure for close observation and monitoring.
This involves identifying the source of internal bleeding in patients following trauma and using a variety of materials to stop the bleeding, including glue, beads, metallic coils and covered stents. More often than not, internal bleeding can be stopped without the need for a traditional open operation, thus avoiding the need for open surgery and an associated long recovery. The images below show bleeding into the spleen (black splodge) followed by stopping the bleeding with a single metal coil and disappearance of the black splodge. Although the procedure can be performed just under local anaesthetic, we often ask our anaesthetic colleagues to attend in case we need help when patients are bleeding profusely. Patients always go back to a ward or ITU following this procedure for close observation and monitoring.
This involves inserting large metal stents lined with a synthetic cloth coating into the aorta and vessels in the abdomen to prevent the aorta rupturing in patients with an abdominal aortic aneurysm (AAA) which occurs when the main artery taking blood away from the heart dilates and there is a risk of rupture which often leads to death. This procedure re-lines the aorta and reduces the risk of it rupturing. It is usually performed as a joint procedure with our vascular surgery colleagues under general anaesthesia, where the vascular surgeons open the groins and give us direct access to the arteries so that we can insert these very large stents. However, more recently, we can now perform this procedure under local anaesthetic without the need for opening of the groins which allows for much quicker recovery.
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