What are Biliary Interventions?

Biliary interventions are minimally invasive procedures performed to treat blockages or narrowing and injury of bile ducts. In addition, minimally invasive techniques can be used to treat an inflamed or infected gallbladder.

Bile, a fluid that helps digest fat in foods, is produced in the liver and flows through ducts or tubular passageways leading to the gallbladder where it is stored. When needed, the gallbladder contracts and releases bile through ducts into the small intestine.

If the bile ducts become blocked, bile cannot pass into the intestine and this may result in jaundice (in which the level of bile products in the blood becomes elevated). If the jaundice becomes severe, the patient will appear to have a yellowish hue, particularly in the whites of the eye. If the duct that connects the gallbladder to the rest of the bile ducts becomes blocked (usually due to gallstones in the gallbladder), this results in inflammation or infection (cholecystitis). This is generally treated by surgical removal of the gallbladder — either laparoscopically (minimally invasive) or by conventional open surgery. However, when patients are too ill to undergo surgical cholecystectomy, a percutaneous cholecystectomy (placement of a small tube through the skin into the gallbladder) may be performed by an interventional radiologist.

Biliary interventions include:

Percutaneous

transhepatic

cholangiography (PTC), an x-ray procedure that involves the injection of a contrast materialdirectly into the bile ducts inside the liver to produce pictures of the bile ducts. This procedure is usually performed by an interventional radiologist. If a blockage or narrowing is found, additional procedures may be performed, including:

insertion of a catheter to drain excess bile out of the body.

removal of gallstones, stone-like objects that form in the gallbladder or bile ducts.

stent placement, in which a small plastic or metal tube is placed inside a duct to help it remain open or to bypass an obstruction and allow fluids to drain internally.

What are some common uses of the procedures?

There are several conditions that can cause a blockage or narrowing in bile duct, including:

inflammation – pancreatitis (inflammation of the pancreas), sclerosing cholangitis (inflammation of the bile ducts)

tumors – cancer of the pancreas, gallbladder, bile duct, liver, or enlarged lymph nodes due to a variety of different tumors

gallstones, either in the gallbladder or in the bile ducts

injury to the bile ducts during surgery

infection

In general, PTC and ERCP can be used to treat all of the above causes of bile duct blockage or narrowing except for actual removal of the gallbladder — this requires surgery (cholecystectomy).

UTERINE FIBROID TREATMENT’

 

10.What is Uterine Fibroid Embolization (UFE)?

Uterine fibroid embolization (UFE) is a minimally invasive treatment for fibroid tumors of the uterus. The procedure is also sometimes referred to as Uterine Artery Embolization (UAE), but this term is less specific and, as will be discussed below, UAE is used for conditions other than fibroids.

Fibroid tumors, also known as myomas, are benign tumors that arise from the muscular wall of the uterus. It is extremely rare for them to turn cancerous. More commonly, they cause heavy menstrual bleeding, pain in the pelvic region, and pressure on the bladder or bowel.

In a UFE procedure, physicians use an x-ray camera called a fluoroscope to guide the delivery of small particles to the uterus and fibroids. The small particles are injected through a thin, flexible tube called a catheter. These block the arteries that provide blood flow, causing the fibroids to shrink. Nearly 90 percent of women with fibroids experience relief of their symptoms.

Because the effect of uterine fibroid embolization on fertility is not fully understood, UFE is typically offered to women who no longer wish to become pregnant or who want or need to avoid having a hysterectomy, which is the operation to remove the uterus.

What are some common uses of the UAE procedure?

Uterine artery embolization has been used for decades to stop severe pelvic bleeding caused by:

trauma

malignant gynecological tumors

hemorrhage after childbirth

Uterine fibroid embolization is a specialized form of UAE for treating symptomatic fibroids.

How does the procedure work?

The procedure involves inserting a catheter through the groin, maneuvering it through the uterine artery, and injecting the embolic agent into the arteries that supply blood to the uterus and fibroids. As the fibroids die and begin to shrink, the uterus fully recovers.

How is the procedure performed?

UFE is an image-guided, minimally invasive procedure that uses a high-definition x-ray camera to guide a trained specialist, most commonly an interventional radiologist to introduce a catheter into the uterine arteries to deliver the particles. The procedure is typically performed in a cath lab or occasionally in the operating room.

You will be positioned on the examining table.

You may be connected to monitors that track your heart rate, blood pressure and pulse during the procedure.

A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously. Moderate sedation may be used. As an alternative, you may receive general anesthesia.

The area of your body where the catheter is to be inserted will be sterilized and covered with a surgical drape.

Your physician will numb the area with a local anesthetic.

A very small skin incision is made at the site.

Using x-ray guidance, a catheter is inserted into your femoral artery, which is located in the groin area. A provides a roadmap for the catheter as it is maneuvered into your uterine arteries. The embolic agent is released into both the right and left uterine arteries by repositioning the same catheter that was originally inserted. Only one small skin puncture is required for the entire procedure. See the Catheter Embolization

At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.

Your intravenous line will be removed.

You will most likely remain in the hospital overnight so that you may receive pain medications and be observed.

This procedure is usually completed within 90 minutes.