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Intervention

Everything about Radiological Interventions
What is an intervention?

An intervention is a surgical procedure which aims to treat lesions of the vascular system or certain diseases of a specific organ accessed via the vascular system. Its advantage compared to open surgeries is that during radiological intervention, the therapy is performed only through the inserted needle, catheter or other device. Therefore, no anaesthesia is required for radiological intervention – apart from rare exceptions.
The attending physician and the interventional radiologist consult whether a radiological interventional solution is applicable for a certain vascular disease or open surgery is needed.

What risks does the procedure involve?

Radiological intervention can be performed in all age-groups if needed, but, just like every medical procedure, it poses risks: its dangers are similar to angiography. A catheter is introduced into the vessel, and a bruise often develops at the puncture site, but it disappears wthiin a short time. When the catheter is introduced, the wall of the vessel might be damaged, and bleeding or vascular occlusion might occur. The risk is different in each individual; it also depends on additional conditions of the patient and the severity of the lesion. The procedure is only recommended if the risk is considered to be smaller than the risk of open surgery.

What side effects might the procedure have?

A smaller bruise may appear at the puncture site, which heals in a few weeks even without medical treatment. Bleeding can occur during the procedure; our colleagues are prepared to treat it. Different side effects may occur for the different types of radiological interventions; these will be described at each procedure.

How should I prepare for the examination?

We will inform your attending physician about the preparations before the examination. Laboratory tests are compulsory, because these allow us to check your blood coagulation parameters and other results related to the examination.
The procedure is always performed on an empty stomach. You should not take your anticoagulant medications before the examination, but you have to take your other medications (for example for high blood pressure, heart disease and lung disease). Drink plenty of fluids the day before the interventional procedure. You can read about other tasks in detail at the description of each examination.

Types of Radiological Interventions
DILATION OF NARROWED VESSELS

During the dilation of vessels, a short segment of the vessel with narrowing or occlusion is perforated with a guide wire; a balloon catheter is inserted into the opening, and the narrowing is dilated by inflating the balloon. Vessel dilation is usually recommended if there is a single narrowing or occlusion in a short segment. Dilation of multiple narrowings is also performed in some of our diagnostic centres. Vessel dilation performed during the radiological intervention is effective if the inner layer of the vessel wall is successfully cracked. Implantation of a stent is recommended for narrowings or occlusions which are atherosclerotic, have an uneven surface or are located in the vicinity of a vessel bifurcation. A stent is a cylindrical thin metal mesh, which supports the dilated vessel segment from the inside and prevents propagation of the abnormal rupture of the vessel wall.

How is the procedure performed?

Our colleague asks the patient about his/her complaints, and the results of previous examinations are reviewed. The patient’s attending physician informs us about the patient’s health condition. These consultations will determine whether or not the intervention is applicable. The patient is informed about the interventional procedure. The patient is also given a written information sheet, based on which the patient can ask questions. Throughout the whole examination, the patient will be informed about the ongoing events and what he/she might feel.
A radiological catheter vessel dilation is performed in a small operating room, in a supine position, on an empty stomach. Under local anaesthesia, the artery in the cubital area or the groin is punctured, and a special catheter is inserted through it into the narrowed vessel segment. The balloon is inflated in the narrowing, the narrowed vessel segment is dilated and the narrowing is eliminated or reduced. If needed, the narrowed vessel segment might be supported and stabilised with a stent from the inside. After dilation, control angiography is performed to check if the previously narrowed vessel is now unblocked, then the catheter is removed, and the puncture site is compressed until the bleeding stops. A compression bandage is applied.
Puncture and dilation of the vessel can sometimes cause short pain. One may experience temporary warmth, sometimes a burning sensation due to the improvement of circulation in the organ with reduced blood supply that occurred because of the previous narrowing.
The examination usually lasts 30 to 60 minutes. Relaxation and bed rest is recommended after the procedure.

What are the risks involved with the examination?
The risks associated with angiography may also occur during radiological catheter vessel dilation. Interventional dilation of an atherosclerotic narrowing with an uneven surface and irregular structure has a higher risk, because the wall of the vessel may rupture in a pathological direction. Blood flow may easily carry away small particles from the plaque with an uneven surface and irregular structure, and these particles may cause the occlusion of a vessel wherever they get lodged.
In order to avoid bleeding complications, radiological vessel dilation is only performed if blood coagulation parameters have been checked with laboratory tests. This way only small, local bleeding can occur around the puncture site. If the narrowing/occlusion is caused by plaques with a higher risk, the metal mesh is introduced before the dilation procedure.
We do everything to minimise the possibility of complications.

  • Vessel dilation is performed after careful preparation, and the patient is monitored by the referring ward after the procedure to detect and treat the potentially occurring complications (bleeding, acute vessel occlusion) in time.
  • The procedures are performed by specialists and specialised assistants who have substantial professional experience and practice.
  • We only work with modern equipment subject to regular technical checks.
  • We only use internationally accepted, high-quality devices and contrast medium for our examinations.
What side effects might the examination have?

Prior to the procedure to our colleagues will inform you in detail about the examination and its possible side effects . Local anaesthesia causes a tense, stinging sensation. The skin disinfectant may cause skin inflammation in those who are sensitive to it.

How should I prepare for the procedure?

Extensive liquid intake is recommended the day before the procedure, and you should not eat anything after dinner. If you are worried or anxious because of the examination, you should take a mild anaesthetic or sedative the night before the examination, as discussed with your physician. Do not consume any food or drink on the morning of the procedure. It is forbidden to take anticoagulants and medications for diabetes before the examination, but you should take your other medications (for example for high blood pressure, heart disease and lung disease). Ask your attending physician or the radiologist performing the examination about these medications.
Please make sure to inform the radiologist performing the examination if a previous examination with contrast medium has revealed that you are hypersensitive to a contrast medium or sensitive to metals (fashion jewellery, metal watch bands, etc.). Hypersensitivity to contrast medium may cause severe, potentially fatal complications. Sensitivity to metals may cause the early occlusion of implanted stents.

How do I request an examination?

Radiological interventions can only be initiated by the patient’s attending physician. The examination is only performed on a specialist’s referral, at the expense of public health insurance. General practitioners cannot issue a referral for the examination. The booking time is 3 to 10 days.
The examination cannot be requested in the form of private care.

OCCLUSION OF ABNORMAL VESSELS IN LIVER CANCER/h5>

During this intervention, medications are administered into the arteries of the tumorous liver through a catheter. This prevents the multiplication of cancerous cells, isolate the cancerous area from the circulation, and activate the immune cells of the liver. A big advantage of this method is that medications are introduced directly into the vessels supplying the cancer; therefore, a better therapeutic effect can be achieved. Circulation delivers less medication to other organs, which reduces side effects.
This treatment is recommended for cancers larger than 1 to 2 centimetres in size, as these lesions are mostly supplied by arteries, while smaller lesions are supplied by the portal system (veins coming from the bowels and the spleen). Since there can be multiple cancerous lesions in the liver simultaneously, which are different in size, interventional radiology treatment should be combined with intravenous infusions.

How is the procedure performed?

Our colleague asks the patient about his/her complaints, and the results of previous examinations are reviewed. The intervention is performed in a small operating room, in a supine position, on an empty stomach. Under local anaesthesia, the artery in the cubital area or the groin is punctured after local anaesthesia, through which a special catheter is inserted into the liver artery.
Angiography is performed in the liver, then the medications are administered by inserting the catheter into the appropriate vessel. The administration of the medication is checked by fluoroscopy; in addition, ECG is performed due to the occurrence of potential arrhythmias. Control angiography is performed after the administration of medications, then the catheter is removed from the vessel, and the puncture site is compressed until the bleeding stops. A compression bandage is applied.
Puncture and dilation of the vessel can cause short-lived pain.
The intervention itself is painless; it usually lasts 60 minutes, and relaxation and bed rest is recommended afterwards.

What are the risks involved with the examination?

The risks associated with angiography may also occur during radiological catheter vessel dilation. If the catheter cannot be successfully introduced into the appropriate vessel, or there is another contraindication of the treatment, then it will not be performed. In order to avoid bleeding complications, the intervention is only performed if blood coagulation parameters have been checked with laboratory tests.
Medication is only administered if we ensured during the intervention that it can be administered into the appropriate vessel with the catheter. Continuous ECG control is performed during administration of the medication to immediately detect potential arrhythmia. Administration of the medication is checked by fluoroscopy. The interventions are performed by specialists and specialised assistants who have substantial routine. For our examinations, we use modern, high-quality devices, which are subject to regular technical checks, and high-quality contrast medium.

What side effects might the examination have?

Prior to the procedure our colleagues will inform you in detail about the examination and its possible side effects. Local anaesthesia causes a tense, stinging sensation. The skin disinfectant may cause skin inflammation in those who are sensitive to it.
The administered medications may also have side effects, such abdominal pain, nausea, vomiting, sweating, dizziness, and arrhythmia. Subfebrile temperature rise, fever, nausea and vomiting may occur for a few days after radiological interventions with medications. These side effects can be treated with antipyretic or anti-emetic medications.

How should I prepare for the procedure?

Do not eat anything after dinner the day before the intervention, but you can drink non-carbonated fluids. If you are worried or anxious because of the examination, you should take a mild anaesthetic or sedative the night before the examination, as discussed with your physician. Do not eat or drink anything on the morning of the intervention. It is forbidden to take anticoagulants and medications for diabetes before the examination, but you should take your other medications (for example for high blood pressure, heart disease and lung disease). Ask your attending physician or the radiologist performing the examination about these medications.

How do I request an examination?

This type of radiological intervention can only be initiated by the patient’s oncologist. The oncologist compiles the medications to be used depending on the type of cancer, taking into consideration any other comorbidities1, which might contraindicate certain medications. The examination is only performed on a specialist’s referral, at the expense of public health insurance. The booking time is 3 to 10 days.
The examination cannot be requested in the form of private care.

UNBLOCKING BILE DUCTS

This intervention might be necessary in diseases where obstruction of the bile ducts prevents bile flow. If the endoscopic examination was unsuccessful, interventional radiology method can be used to ensure normal flow in the bile ducts. The aim of the examination is to ensure bile flow towards the small intestine or – if needed – into an external collecting bag.

How is the procedure performed?

The examination is only performed if initiated by the attending physician for inpatients. The intervention is performed in a small operating room, in a supine position, on an empty stomach. Under local anaesthesia, the skin is punctured in the intercostal space, and the needle is introduced. The needle is used to locate a bile duct and inject contrast medium into it. After filling the bile ducts, we try to get across the narrowed or occluded section of the bile duct with a thin, soft-tipped wire, then a catheter is pulled over this thin wire, which connects the bile duct with the small intestine in the narrowed segment. A few days later, a thin metal mesh or a plastic tube is implanted to support the bile duct from the inside and to ensure bile flow towards the small intestine for a longer period of time.
If the blockage cannot be eliminated, the external bile flow can be achieved using a thicker catheter. Dilation of the occluded bile duct may cause a tense sensation and pain; therefore, an anaesthetic injection might be necessary before the examination. The introduced catheter is attached or sutured to the skin for a few days until the procedure is concluded to make sure it does not slip out from the bile duct.

Introduction of the catheter causes mild, tense sensation. Moving the catheter in the bile duct cannot be felt.

The intervention usually lasts 30 to 60 minutes, and relaxation, bed rest is recommended afterwards.

What risks does the procedure involve?

The bile duct has to be punctured through the liver; vessels may be punctured during the intervention. Consequently, bleeding or pathological connection between the vessels and the bile ducts may occur. Blood or bile may pour into the abdominal cavity after removing the needle. The bile duct might get injured during the perforation of the occluded segment, but this usually heals spontaneously if bile flow is ensured. In order to avoid bleeding complications, the intervention is only performed if blood coagulation parameters have been checked with previous laboratory tests. Bleeding stops spontaneously in most cases. If does not stop, the bleeding vessel is obstructed by angiography.
We do everything to minimise the possibility of complications.

  • The intervention is performed after careful preparation, and the patient is monitored by the referring ward afterwards to detect and treat the potentially occurring complications (inflammation of the bile duct, bleeding or pneumothorax) in time.
  • The procedures are performed by specialists and specialised assistants who have substantial professional experience and practice.
  • We only work with modern equipment subject to regular technical checks.
  • We only use internationally accepted, high-quality devices and contrast medium for our examinations.

The mentioned complications occur very rarely nowadays, thanks to following professional guidelines, the compliance of the patients, modern technical devices, as well as the routine of the assistants and specialist.

What side effects might the examination have?

Our colleagues will inform you in detail about the examination and its possible side effects prior to the procedure. Local anaesthesia causes a tense, stinging sensation. The skin disinfectant may cause skin inflammation in those who are sensitive to it. Puncturing the liver can sometimes cause short-lived pain. The contrast medium can cause allergic reactions in some patients; our colleagues are prepared to treat these.

How should I prepare for the procedure?

Do not eat anything after dinner the day before the intervention, but you can drink non-carbonated fluids. If you are worried or anxious because of the examination, you can take a mild anaesthetic or sedative the night before the examination, as discussed with your physician. Do not consume any food or drink in the morning of the procedure. It is forbidden to take anticoagulants and certain medications for diabetes before the examination, but you should take your other medications (for example for high blood pressure, heart disease and lung disease). Ask your attending physician or the radiologist performing the examination about these medications.
Please make sure to inform the radiologist performing the examination if you have hypersensitivity to the contrast medium or metals.

How do I request an examination?

Radiological interventions can only be initiated by the patient’s attending physician. The examination is only performed on a referral, at the expense of public health insurance. The booking time is 3 to 10 days.
The examination cannot be requested in the form of private care.

TAKING A CELL OR TISSUE SAMPLE

The aim of taking cell or tissue samples is to take a sample from a lesion that was detected with another method, but its histological structure and its malignancy is unknown. The sample is sent for histological examination, because the treatment of the detected disease depends on its histological nature. A big advantage of this method is that surgical exploration (operation) is not required for sampling. There might not be abnormal cells in the sample. However, if the laboratory and clinical results do not confirm the negative histological finding – i.e. malignancy is highly suspected –, the sampling has to be repeated.

How is the procedure performed?

In order to take a cell sample, a thin needle is introduced into the pathological organ after anaesthesia, through which cells are aspirated with the help of a syringe. These cells are fixed on a slide and sent for analysis. For histological sampling, a piece of tissue is excised through the inserted needle with the help of a special cutting tool. In this case, not only cells, but smaller pieces of tissue can also be sent for histological evaluation. If the obtained sample is noticeably too small or is not of sufficient quality, the puncture will be attempted again. The specialist consults with the patient during the sampling.
The examination may cause mild pain, and usually lasts 5 to 30 minutes.

What risks does the procedure involve?

Sampling basically does not have any risks. Smaller bruising can occur in some cases, which disappears in a few weeks; it heals without a trace, and does not cause any damage. Bruising is more common for histological sampling, when a thin roll of tissue is excised from the target organ. If the wall of the artery is included in the sample, major bleeding may occur, and in very rare cases, occlusion of the artery might be necessary.
Cell and tissue sampling is performed by specialists and specialised assistants with substantial routine, using equipment subject to regular technical checks. We only use internationally accepted, high-quality devices and contrast medium for our examinations.

What side effects might the examination have?

Local anaesthesia causes a tense, stinging sensation. The skin disinfectant may cause skin inflammation in those who are sensitive to it. Rarely, other side effects might occur when taking cell or tissue samples, which are typical for the target organ: damage to the bile duct in the liver, damage to the cavity system in the kidney, damage to the alveoli or the respiratory tract in the lung. These usually heal spontaneously or after medical treatment. These cannot be considered complications, since they can occur during sampling, albeit rarely. In order to avoid bleeding complications, the intervention is only performed if blood coagulation parameters have been checked with laboratory tests.

How should I prepare for the procedure?

Do not eat anything after dinner the day before the intervention, but you can drink non-carbonated fluids. If you are worried or anxious because of the examination, you should take a mild anaesthetic or sedative the night before the examination, as discussed with your physician. Do not consume any food or drink on the morning of the procedure. It is forbidden to take anticoagulants and certain medications for diabetes before the examination, but you should take your other medications (for example for high blood pressure, heart disease and lung disease). Ask your attending physician or the radiologist performing the examination about these medications.

How do I request an examination?

The intervention can be requested by the attending physician based on the results of the performed examinations. The examination is only performed on a referral, at the expense of public health insurance. The booking time is 3 to 10 days.
The examination cannot be requested in the form of private care.