Diagnostic and Interventional Peripheral Procedures
Angiography – All body arteries and veins
Peripheral Angiography and Venography is a medical imaging technique used to visualise the lumen (inside) of blood vessels of the body.
Peripheral Angiography is undertaken at MCVS when a patient is referred by a consultant Vascular Surgeon . Indications for an angiogram are;
- claudication that is lifestyle limiting
- rest pain
- non healing ulcer
- ultrasound evidence of flow limiting lesion
- limb ischaemia
Peripheral artery stenosis (narrowings) can be treated by balloon angioplasty alone, or with the placement of a stent or stents if necessary.
The decision to insert a stent rather than only balloon angioplasty is usually based on the length of the lesion, the type of vessel and the location of the lesion. Unlike coronary angioplasty which almost always involves stenting unless the lesion is less than 2mm. In the peripheral setting a stent is generally only inserted where there is likelihood that the balloon angioplasty will not remain patent, or the lesion is longer than 10cm, at the bifurcation of the iliacs where bilateral stents may be inserted to ensure patency of both iliacs long term.
The procedure is traditionally done by injecting a radio-opaque contrast agent into the blood vessels and imaging using X-Ray based techniques such as fluoroscopy. The blood vessel either Artery or Vein are accessed by direct cannulations often using ultrasound guidance.
Stent angioplasty: Peripheral Stenting is an interventional technique used to increase the size of a vessel lumen by placing a metal stent to ensure vessel patency.
This is done by either placing a balloon expandable stent or a self expanding stent into the blood vessel and either inflating the balloon to the desired length and width or allowing the stent to self expand.
EVAR: Endovascular Aortic Repair. This is done through the femoral artery rather than by a surgical approach. It is done for placement of stent grafts for abdominal aneurisms. It is carried out by a Vascular Surgeon and an Interventional Radiologist under general anaesthetic.
Embolisation: This is a non surgical, minimally invasive procedure and involves the selective occlusion of blood vessels. This is done by introducing embolic agents –liquids such as Onyx, ethanol(alcohol), particulate such as gelfoam, microspheres and mechanical occlusion devices such as coils and ‘plugs’.
Embolisation is used to treat a wide variety of conditions affecting different parts of the body.
e.g. Embolisation for Uterine Fibroids , Ovarian veins, tumour resection(to reduce blood flow in affected area prior to sugery)
IVC Filter placement: Implantation of an Inferior vena caval filter is to prevent thrombus reaching the lungs. It is implanted in people who have a DVT and are at high risk of developing a clinically significant PE and cannot be sufficiently anticoagulated.
Neurological Diagnostic and Interventional Procedures
Facet joint injection: This procedure is to inject steroid in the facet joints of patients with chronic back pain to provide extended pain relief.
Vertebroplasty: This is a procedure for stabilizing compression fractures or weakness in the spine. Percutaneous Vertebroplasty is a minimally invasive method in which a special medical-grade cement mixture (Polymethylmethacrylate) is injected into a fractured vertebra due to osteoporosis or in a pathological verebra invaded by tumour and is weak. The cement hardens, stabilizing the fractures and supporting the spine. Vertebroplasty can greatly reduce pain. This procedure is usually done under general anaesthesia.
PICC Line Insertion
Peripheral Inserted Central Catheter (PICC): This is a large bore long term I.V line. They are usually placed in the basillic vein(most preferable), cephalic or brachial vein and sit in the distal Superior Vena Cava.
This procedure is done in our Lab and ultrasound is used for placement and fluoroscopy (X-ray ) for checking the position.
Several of our nurses and trained in the technique of inserting these lines. They are headed by Jane Marsh (RN) a nurse with extensive experience in this area.
Once the nurses have inserted the line, the position is checked by a Radiologist.