Vascular & Interventional Radiology

Median Arcuate Ligament Syndrome

Median arcuate ligament syndrome (MALS) occurs when the celiac artery (the artery below that diaphragm that stems from the aorta) becomes compressed by the median arcuate ligament. When the median arcuate ligament is restricted, the blood flow is limited to the digestive system which can ultimately lead to significant abdominal pain. This is treated by surgically releasing the median arcuate ligament to restore blood flow. In some instances, additional arteriography (mapping of the blood vessels using x-ray dye) or angioplasty (opening the artery with a balloon) may be needed.

Hereditary Hemorrhagic Telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder that causes malformed blood vessels and can affect multiple organs of the body. Arteriovenous malformation (AVM) occurs most commonly in the lung and, if left untreated, can lead to shortness of breath, brain abscesses or even stroke. To prevent these complications, an embolization procedure can be performed to cut off blood flow to these AVMs.

Prostate artery embolization (PAE) is a minimally invasive procedure for the treatment of an enlarged prostate. The procedure is performed through a small nick in your upper thigh or wrist to gain access to your arterial system. Using x-ray guidance, an interventional radiologist guides a catheter (a small hollow tube) to the vessels that supply blood to your prostate. Tiny particles are then injected through the catheter and into these blood vessels to decrease blood flow to your prostate. This causes the prostate to shrink and improves your urinary symptoms.

Biopsy

Patients may develop masses or tumors that involve the bone. Interventional radiologists can guide a small needle using imaging into the bone to obtain a sample of tissue from it. This procedure, known as a biopsy, is often done as a same day outpatient procedure and allows for diagnosis and appropriate treatment.

Ablation

Tumors that involve the bone can sometimes be treated using image guided therapies by interventional radiologists. One such therapy is called “percutaneous ablation” where a needle is guided into the tumor directly using imaging guidance (i.e. x-ray, ultrasound, CT scan). Once positioned appropriately, the tumor can be frozen or burned away in a process known as ablation. This procedure is also commonly performed as a same day outpatient procedure.

Sacroplasty

Fractures of the pelvis can involve a specific bone known as the sacrum. Fractures of the sacrum can often lead to debilitating pain that limit mobility or require large amounts of narcotic pain medication for treatment. A minimally invasive procedure known as sacroplasty can be performed by interventional radiologists to treat sacral fractures and improve mobility and/or reduce associated pain. The procedure involves placing needles into the fracture using imaging guidance. Once the needles are in position, a cement like substance is injected to fill the cracks created by the fracture to stabilize and heal the bone. This procedure is commonly performed as a same day outpatient procedure.

Pre-Operative Embolization

Tumors involving bone can require orthopedic procedures to remove the tumor and/or reinforce the underlying bone. Occasionally tumors that involve the bone may have a large blood supply that increases the risk of bleeding at surgery. Interventional radiologists can guide a small tube or catheter through a puncture in the groin or wrist to the blood vessels that feed the tumor. Using X-ray guidance, the catheter is placed in the tumor feeding vessels and subsequently closed off using small particles or coils to starve the tumor of its blood supply. This procedure is done as a same day outpatient procedure and minimizes the amount of bleeding that occurs during the surgical procedure.

Vertebral Fractures

Fractures of the spine can cause a lot of pain for patients in addition to impacting their mobility and height. Interventional radiologists can treat vertebral (spinal) compression fractures with a minimally invasive procedure known as a kyphoplasty. In this procedure, a needle is guided using x-ray into the fracture of the spine. A small balloon is placed through the needle and inflated to restore the height of the spine followed by cement to reinforce and heal the fracture site. The procedure is performed as a single session outpatient procedure.

Healthy kidneys clean your blood and remove extra fluid in the form of urine. Dialysis replaces some of these functions when your kidneys no longer work. During hemodialysis, blood is removed from the body, filtered through an artificial kidney machine and then returned to the body. In order to perform hemodialysis, there needs to be proper access to the blood vessels.

Nonsurgical Fistula Creation

An arteriovenous fistula is the preferred vascular access option for patients undergoing long-term hemodialysis. Fistulas are artificial connections between an artery and vein in your arm. Traditionally, fistulas are created by a vascular surgeon in an operating room. Advances in technology have now allowed for minimally invasive fistula creation using tiny catheters and wires, and without the need for any incisions.

Fistula and Graft Maintenance

A fistulogram or graft check is a procedure that uses contrast (x-ray dye) to look at the blood flow in your fistula or graft. This procedure can check to see if it there is any vessel narrowing or blockage. Vessels that are narrowed can be reopened to their optimal size using balloons or even small metal tubes (stents). If your fistula or graft is filled with clots, a declot procedure can be done to remove the clot and restore blood flow.

Complex Vascular Access

Having adequate vascular access is a critical lifeline for patients who are on hemodialysis. Unfortunately, some patients who are on long-term hemodialysis can develop severe scarring and blockage of the central veins in the chest and abdomen. Not only can this prevent adequate hemodialysis, but it can also cause pain and swelling of the arms, legs or head & neck. Using advanced techniques and equipment our interventional radiologists can reopen blockages and even reconstruct the major veins to restore proper blood flow.

Biopsy

Patients may develop masses or tumors that involve the liver. Interventional radiologists can guide a small needle using imaging into the liver to obtain a sample of tissue from it. This procedure, known as a biopsy, is often done as a same day outpatient procedure and allows for diagnosis and appropriate treatment.

Ablation

Tumors that involve the liver can sometimes be treated using image guided therapies by interventional radiologists. One such therapy is called “percutaneous ablation” where a needle is guided into the tumor directly using imaging guidance (i.e. x-ray, ultrasound, CT scan). Once positioned appropriately, the tumor can be frozen or burned away in a process known as ablation. This procedure is also commonly performed as a same day outpatient procedure.

Chemoembolization

Tumors of the liver have a very rich blood supply from arteries that normally go to the liver. Chemoembolization is performed by placing a small catheter from the artery in your groin into the artery that supplies blood to the liver and subsequently into the arteries that directly feed the tumor. This procedure, performed by interventional radiologists, is done using x-ray guidance. Once in position, chemotherapeutic drugs are delivered through the catheter along with an agent that plugs up the artery right at the site of the tumor. The procedure allows for a very high concentration of chemotherapy to be delivered to the tumor without the typical risks of chemotherapy that goes throughout the body. The procedure is typically done as an outpatient procedure with discharge after overnight observation.

Histotripsy

Histotripsy is an innovative, non-invasive treatment for liver tumors that uses a robotic machine to target and destroy cancer tissue with ultra-precise sound waves. It’s a powerful tool for doctors to treat certain tumors without any needles, radiation or surgery, even allowing most patients to go home the same day.

UChicago Medicine is one of the first medical centers in the nation to offer histotripsy for liver tumor treatment. As early adopters, our doctors have deep expertise with the procedure, allowing them to deliver the highest level of care.

Radioembolization (Y90)

Tumors of the liver have a very rich blood supply from arteries that normally go to the liver. Radioembolization is performed by placing a small catheter from the artery in your groin into the artery that supplies blood to the liver and subsequently into the arteries that directly feed the tumor. This procedure, performed by interventional radiologists, is done using x-ray guidance. Once in position, radioactive beads are delivered through the catheter into the site of the tumor. The procedure allows for a very high concentration of radiation to be delivered to the tumor at levels that normally cannot be achieved with standard external radiation. The procedure is typically divided up into two outpatient procedures (with same day discharge for both days).

Transjugular Liver Biopsy

Transjugular liver biopsy is an alternative to traditional biopsies of the liver that are performed through the abdomen. It is often recommended for patients with more significant symptoms of liver disease such as bleeding disorders or abdominal fluid. A catheter (small hollow tube) is inserted into the jugular vein in the neck, and guided into a vein in the liver with the assistance of x-ray imaging. A small needle is inserted into the tube and a sample of tissue is removed from the liver. This sample is then sent to a laboratory for analysis.

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Transjugular intrahepatic portosystemic shunt or TIPS, is a procedure that is performed to relieve increased pressure in the portal venous system. This pressure buildup can result in gastrointestinal bleeding or the accumulation of fluid in the abdomen. This condition is often a result of chronic liver problems leading to cirrhosis (scarring of the liver).

During a TIPS procedure, an interventional radiologist uses imaging guidance to connect the portal vein to the hepatic vein in the liver. A small metal tube (called a stent) is placed to keep the connection open. 

Biopsy

Patients may develop masses or tumors that involve the lung. Interventional radiologists can guide a small needle using imaging into the lung to obtain a sample of tissue from it. This procedure, known as a biopsy, is often done as a same day outpatient procedure and allows for diagnosis and appropriate treatment.

Ablation

Tumors that involve the lung can sometimes be treated using image guided therapies by interventional radiologists. One such therapy is called “percutaneous ablation” where a needle is guided into the tumor directly using imaging guidance (i.e. x-ray, ultrasound, CT scan). Once positioned appropriately, the tumor can be frozen or burned away in a process known as ablation. This procedure is also commonly performed as a same day outpatient procedure.

Biopsy

Patients may develop masses or tumors that involve the kidney. Interventional radiologists can guide a small needle using imaging into the kidney to obtain a sample of tissue from it. This procedure, known as a biopsy, is often done as a same day outpatient procedure and allows for diagnosis and appropriate treatment.

Ablation

Tumors that involve the kidney can sometimes be treated using image guided therapies by interventional radiologists. One such therapy is called “percutaneous ablation” where a needle is guided into the tumor directly using imaging guidance (i.e. x-ray, ultrasound, CT scan). Once positioned appropriately, the tumor can be frozen or burned away in a process known as ablation. This procedure is also commonly performed as a same day outpatient procedure.

Chest Port (Chemotherapy)

Chest ports are a type of central venous catheter. They are placed completely under your skin, just below your clavicle and connect to a vein in your chest. Chest ports reduce the number of times a nurse needs to insert a needle in your vein. They also allow for treatments that are longer than one day. Ports can remain in place for weeks, months or years.

Gastrostomy

Gastrostomy refers to the placement of a feeding tube through the skin and into the stomach. It is performed for feeding and nutritional support. In some cases a longer type of tube – a gastrojejunostomy – is placed so that the tip of the tube is in the intestine and nutritional feeding can bypass the stomach.

Nephrostomy

Nephrostomy refers to the placement of a tube from the back, through the skin and then into the kidney. It serves to drain any urine that is blocked and prevented from emptying into the bladder. This allows the kidney to function properly and protects it from further damage. It also helps clear any infection. In some cases a longer type of tube – a nephroureterostomy – is placed so that the tip of the tube is in the bladder.

Biliary Drains & Stents

Biliary drainage is the insertion of a tube into the bile duct. This is performed when the bile ducts are blocked. Blockage of the bile ducts can occur for a number of reasons, including gallstones, scarring of the bile ducts after prior surgery or even cancer in the liver. Biliary drains are placed through the skin into one of the bile ducts in the liver and then down into the small intestine. This allows bile to drain either externally into a bag or internally into the intestinal tract. In some cases, a metal tube (stent) can be placed so that no device protrudes outside the body.

Cholecystostomy

Choleystostomy refers to the placement of a plastic drain into the gallbladder. This is performed when the gallbladder is infected or inflamed (cholecystitis). If left untreated, cholecystitis may lead to more serious infection or even gallbladder rupture, both of which can be life-threatening. Cholecystostomy can relieve symptoms until surgery can be safely done at a later time.

Uterine fibroid embolization (UFE) is a minimally invasive procedure for the treatment of uterine fibroids. The process typically lasts less than an hour and requires only a small nick in the skin. The procedure works by blocking the blood supply to the uterine fibroids, which causes them to shrink. UFE offers a shorter hospital stay, a faster return to work and fewer complications compared with traditional surgery

Clot Removal 

Clots commonly form in the leg veins of patients but can occur in any blood vessel throughout the body. When severe, this condition can be life threatening. Fortunately, these clots can be extracted from the body using minimally invasive methods known as “thrombectomy” or “thrombolysis”. These procedures, performed by interventional radiologists, involve the use of medications (i.e. clot busting drugs) to dissolve clot or mechanical devices to physically remove it from the body. These procedures are often done when patients are hospitalized but can also be done as outpatient in less severe cases.

Vein Reconstruction

Patients with long standing clots can develop a condition known as “chronic DVT” or “post-thrombotic syndrome” of their legs that results from old blood clots that did not adequately clear from their legs. The result is painful swelling of the legs and other symptoms associated with blocked veins (i.e. discoloration or ulceration). Interventional radiologists can perform a procedure known as “recanalization and reconstruction” to unblock the veins using a combination of wires, balloons, and stents. This procedure can restore the normal blood flow of the legs and help relieve some of the symptoms associated with chronic DVT or post-thrombotic syndrome. This is commonly done as a same day outpatient procedure.

Complex IVC Filter Retrieval

Most patients with IVC filters only require their filters to be in place for a temporary period of time after which removal of the filter is recommended. In a subset of patients, “standard” methods of filter removal may be unsuccessful or not possible due to the development of filter-related complications. For these patients, “advanced” or “complex” techniques are needed to remove the filter and treat (or prevent) complications that may occur from having a filter in place for too long. Interventional radiologists use a variety of techniques to remove virtually any type of filter that may need to be removed. At the University of Chicago, interventional radiology has all the technology available at experienced centers needed for complex IVC filter retrieval. This is commonly done as a same day outpatient procedure.

May Thurner Syndrome

May Thurner Syndrome is a unique condition where the vein in pelvis that drains the left leg (also known as the left iliac vein) can become compressed by an artery adjacent to it. When this occurs, the blockage can cause the left iliac vein to become clotted. Interventional radiologists can clear the clot from the vein using minimally invasive methods known as “thrombectomy” or “thrombolysis”. These procedures involve the use of medications (i.e. clot busting drugs) to dissolve the clot or mechanical devices to physically remove it from the body. In addition, interventional radiologists can treat the compression of the vein from the artery by placing a metal stent to reinforce the vein and keep it open. This procedure is commonly done while patients are hospitalized and/or may require 1 or 2 nights in the hospital.