In all venous procedures we place a needle into a vein, usually in the groin or neck 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. Most procedures can be done under local anaesthetic or sedation which allows quick recovery.
Some men suffer with distended veins in the scrotum which causes swelling and pain. This procedure involves inserting a needle into the vein in the groin or neck, then guiding a catheter under x-ray guidance to the vein draining the scrotum. We then place metal coils or glue into the vein draining the scrotum which relieves the symptoms. We now also perform this procedure for some men with poor sperm function as there is an association with subfertility. Patients for this procedure are referred to us by our urology colleagues or the subfertility clinic. Patients are seen in an IR outpatient clinic prior to the procedure to ensure they understand the procedure and give informed consent. The below x-ray images show a catheter inside the veins and following deployment of coils in the testicular vein. This procedure is performed under local anaesthetic as a day case procedure which allows a very quick recovery.
Some patients need regular intravenous therapy such as chemotherapy or antibiotics or may require a line for dialysis. We insert a needle into a vein and guide a tube over a wire. We then bury the tube under the skin to prevent infection. They are often inserted into the veins in the neck and chest, but can be inserted into the veins in the groin. They are sometimes referred to as Hickman lines, Bard lines, dialysis lines or tunneled central lines. This procedure is usually performed under local anaesthetic and sometimes with sedation. Most are performed as a day case procedure which allows for a quick recovery.
Some patients have a surgically formed connection between an artery and vein in the arm to have dialysis if their kidneys have failed. Sometimes these fistulas develop a narrowing. We insert tiny balloons to open up the narrowings to keep the fistula working. The images below show a balloon being inflated in a narrowed segment in the upper arm, then the narrowing is gone. This procedure is performed under local anaesthetic as a day case procedure which allows a very quick recovery.
Some patients can develop a clot in an artery or a vein. We insert tubes to the affect vessel and slowly drip clot busting drug directly into the affected vessel to dissolve the clot and re-establish blood flow to the affected area. Patients for thrombolysis are usually referred to us by our vascular surgery colleagues and may prevent an open surgical declotting operation. Patients are admitted to the specialist vascular Enhanced Care Unit or General Critical Care for this procedure for close monitoring.
Sometimes when clot forms in an artery or a vein we can insert a tube and either suck out the clot using a vacuum or macerate the clot to break it up to help re-establish flow to the affected area. We often perform this procedure on fistulas which have clotted off but it can be performed in other vessels.
Patients with liver disease can develop dilated veins in the abdomen and around the oesophagus due to high pressure within these veins. These can rupture and lead to life-threatening bleeding. To prevent this, we insert a needle into a vein in the neck and guide a wire into the liver. We then form a communication between the liver and the heart to reduce the pressure in the veins and prevent the chance of catastrophic bleeding. The x-ray images below show how this is performed. Patients for this procedure are referred to us by our gastroenterology colleagues. This is a complex and challenging procedure and is one of very few procedures we perform under general anaesthesia. Patients are cared for on the gastroenterology ward after their procedure for close observation and monitoring.
In patients with DVT (clot in the legs) it’s sometimes necessary to put a filter in the main vein going back to the heart to prevent clot travelling to the lungs, which can be life-threatening. We insert these filters through the vein in the groin or the neck and remove them once the clot in the leg has dissolved. Removing the filter is like playing a game of “hook a duck” where we have to put a loop around a tiny 2mm hook inside the centre of the body, all performed from the neck whilst looking inside you with an x-ray camera. Patients for this procedure are referred to us by our medical and surgical colleagues. This procedure is performed under local anaesthetic and can be done as a day case procedure which allows for a quick recovery.
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