Diagnostic studies and treatment options
For angiography a contrast agent is injected through a small plastic tube (catheter) into your vessels for visualization of the inside of blood vessels and organs of the body, especially the veins, arteries,�and chambers of the heart. The catheter is usually introduced via the groin artery using local anesthesia. Depending on the need, we alternatively use angiography with computed tomography (CTA) or magnetic resonance imaging (MRA) to visualize arteries supplying the brain, lungs, kidneys, arms and legs.
Uterine fibroid embolization is an alternative to surgical removal of fibroids. Fibroids are benign tumors of the uterus which occur in up to 40% of women older than 35 years. They may remain asymptomatic, but depending on their size and localization they may cause symptoms such as menstrual, abdominal, back or leg pain. Other symptoms can be constipation, urgency or dysparenuria. In the past, symptomatic fibroids had to be removed surgically, either the fibroid alone or the entire womb. At present, we perform minimal-invasive percutaneous fibroid embolization in close collaboration with our gynecologists.
Vertebroplasty and kyphoplasty
Vertebroplasty is a minimally invasive procedure using image guidance to inject cement into a vertebral body to stabilize it and provide long-lasting pain reduction. It is performed for both osteoporotic fracture and tumor affection. With kyphoplasty a balloon or stent is used to elevate the vertebral body prior to cement injection (see figures). Most patients treated with kyphoplasty experience relief from pain shortly after the procedure. They can get out of bed and start rehabilitation.
Chemoembolization of liver cancer
Chemoembolization is a targeted chemotherapy for liver cancer that delivers a high dose of chemotherapy directly to the tumor while at the same time cutting off the tumor's blood supply. A small plastic tube (catheter) is inserted through the groin artery and advanced to the artery that supplies the liver. A cytostatic drug and small particles the size of grains of sand are injected through this catheter directly into the liver tumor. The particles cut off the liver's blood supply, a process known as "embolization". Because this therapy is selective, there are fewer side effects than with conventional chemotherapy. This therapy may be repeated if necessary.
Radioembolization (SIRT) of primary liver cancer and metastasis
The liver can maybe affected by tumor spread, in particular of tumor within the gastrointestinal tract. Other tumor metastases maybe those of breast and lung cancer. Primary liver cancer is another form of hepatic malignancy, which occurs less frequently than liver metastasis. "Selective Internal Radio-Therapy (SIRT)" is a treatment option for patients that cannot be treated surgically or do not respond to chemotherapy.
During SIRT small radioactive particles (Yttrium-90-Microspheres) are injected into the tumor tissue using a small plastic tube (catheter), which is introduced into the liver artery via a femoral artery in a minimal invasive fashion. We perform SIRT as a multidisciplinary team in cooperation with nuclear medicine.
Radiofrequencyablation of liver tumors
If a liver tumor cannot be removed surgically due to its location within the liver, minimally invasive percutaneous Radiofrequencyablation (RFA) may be applied to destroy the tumor. Using CT or ultrasound guidance, a small needle electrode is placed close to the liver tumor. High-frequency alternating current is then applied to produce heat within the tumor, destroying the tumor cells but largely sparing healthy liver tissue. Following this intervention, most patients require only a short observation period.
Percutaneous varicocele embolization
A varicocele is an abnormal distention of testicular veins which may cause pain and infertility. Minimally invasive percutaneous varicocele embolization treatment can be performed under local anesthesia in an outpatient setting. A small plastic tube (catheter) is introduced via the groin vein and advanced towards the distended testicular veins using image guidance with minimal radiation exposure for the patient. Embolization with a coil is then performed to restrict or block the supply of blood to the dilated veins and their draining vessels.
Figures demonstrate minimal invasive occlusion of dilated testicular veins using a small catheter and a coil.
Placement of a filter within the vena cava
Patients at high risk of developing a blood clot within the lungs (pulmonary embolism) are generally treated with medication. If this therapy is not effective, a small filter (see figure) can be placed within the vena cava to catch dangerous blood clots before they enter the lungs. If it is no longer needed, the filter can generally be removed from the body.
Minimally invasive treatment of radicular pain
Using image guidance minimally invasive selective treatment of painful nerve roots can be performed. Under image guidance, a thin probe is introduced and medication is injected. This treatment results in pain relief in most of the patients and alleviates inflammation.
Facet joint block and sacroiliac joint infiltration
The facet joints (small vertebral joints) or the sacroiliac joint of the pelvis may become inflamed and painful. Minimally invasive percutaneous treatment can alleviate this pain. Under image guidance, a thin probe is introduced and medication is injected.
Central venous catheter placement (port catheter, PICC line, etc.)
Using local anesthesia, central venous catheters can be placed, either for short or long-term use for chemotherapy or other treatments. In most patients, these catheters are placed at the chest or arm in an outpatient procedure. They can also be used for frequent blood draws.
Percutaneous biliary drainage (PTCD)
If there is narrowing of the biliary duct, the biliary flow can be reconstituted using a drainage catheter placed through the skin into the small bowel under anesthesia. This helps to alleviate symptoms such as jaundice or itching. In some patients, a small tube (stent) can be inserted, which allows the drain to be removed.
Drains or biopsies (including transjugular liver or kidney biopsies)
In order to diagnose a disease and offer the appropriate treatment, body fluid or tissue samples may need to be obtained using a probe under image guidance and local anesthesia. Occasionally sampling is performed via the neck vein (jugular vein) if a patient has a coagulation disorder or ascites. If necessary, a plastic tube can be placed for continuous drainage of body fluid in order to avoid surgery.