Venous Intervention

Inferior Vena Cava (IVC) Filter

An inferior vena cava (IVC) filter is placed in the large vein that returns the blood from the abdomen to the right side of the heart, which then pumps blood into the lungs. Blood clots that develop in the legs or pelvis, known as deep vein thrombosis (DVT), can break off and travel into the heart and lungs. This could result in severe complications or even death. Your physician will discuss if blood thinners are still necessary. During the procedure, your heart rate, blood pressure, oxygen level and respiratory rate will be monitored. A thin catheter will be placed in either the right side of your neck or your groin region after the site is numbed. This procedure can help prevent potential clots traveling to the heart and lungs.  

Your physician may suggest a consultation with an Interventional Radiologist to discuss filter removal.  The Interventional Radiologists at RRIA have extensive experience in both the placement and removal of IVC filters.  They employ newer techniques such as laser excision and large bore sheaths to remove different types of IVC filters.

Deep Vein Thrombosis (DVT)
The symptoms of a DVT may include the following:
  • Calf or leg pain or tenderness
  • Swelling of the leg or lower limb
  • Warm skin
  • Increased visibility of surface veins
  • Leg fatigue
  • Discoloration of the legs

Risk Factors of DVT may include:

  • Previous DVT or family history of DVT
  • Immobility, such as bed rest or sitting for long periods of time
  • Recent surgery
  • Age above 40
  • Hormone therapy or oral contraceptives
  • Pregnancy or post-partum period
  • Previous or current cancer
  • Orthopedic procedures
  • Coagulation abnormalities
  • Obesity
Catheter-directed Thrombolysis

Catheter-directed thrombolysis (breaking up or dissolving the blood clot) is performed under image guidance by Interventional Radiologists. This procedure is designed to rapidly break up the clot, restore blood flow within the vein, and potentially preserve valve function to minimize the risk of post-thrombotic syndrome. After deciding that thrombolysis is indicated in the patient, the Interventional Radiologist inserts a catheter into the popliteal or other leg vein and threads it into the vein containing the clot using image guidance. The catheter tip is placed into the clot and a clot-busting drug is infused directly into the thrombus (clot). The fresher the clot, the faster it dissolves. Early removal of the blood clots is likely to give patients their best chance to avoid disabling symptoms such as pain, swelling, and ulcer formation. Any narrowing in the vein that might lead to future clot formation can be identified by venography. This can be treated by the Interventional Radiologist with balloon angioplasty or stent placement. In patients in whom this is not appropriate and blood thinners are contraindicated, an Interventional Radiologist can insert an inferior vena cava filter.

Renal Vein Sampling

Venous sampling is a diagnostic procedure that involves insertion of a catheter into a specific vein under imaging guidance to remove blood samples for laboratory analysis. Abnormal levels of certain substances in the blood, such as hormones, may indicate the presence of disease in the organ or tissue that produces them. A renal venogram is an imaging test to look at the veins in and around your kidneys. Your doctor may also use the test to find out what is causing your high blood pressure (hypertension). The Interventional Radiologist may also take a blood sample (renin assay) from each vein in your kidneys. The Interventional Radiologist will see how much of a certain enzyme (renin) is in each sample. This can help him or her find what is causing your high blood pressure.

Adrenal Vein Sampling

Venous sampling is a diagnostic procedure that involves insertion of a catheter into a specific vein under imaging guidance to remove blood samples for laboratory analysis. Abnormal levels of certain substances in the blood such as hormones may indicate the presence of disease in the organ or tissue that produces them. Adrenal venous sampling (AVS), is when blood samples are taken from the veins of the adrenal glands. This is commonly done for patients with a particular form of high blood pressure called primary aldosteronism to guide treatment between surgery and medical therapy. It is less commonly done for patients with Cushing syndrome, an endocrine disorder in which high levels of cortisol may be found in the blood.

Varicocele Embolization

A varicocele is an enlarged vein in a man's scrotum that may cause pain, swelling or infertility. Varicocele embolization uses image guidance and a catheter to place tiny coils and/or embolics in a blood vessel to occlude the enlarged vein. It is less invasive than conventional surgery. A clinical examination can confirm the presence of a varicocele and an ultrasound examination may allow further evaluation of the findings. Varicocele embolization safely relieves the pain and swelling and may help with infertility issues.

Tunneled Catheter for Long Term Access

A tunneled central line is a catheter (a thin tube) that is placed in a vein for long term use. It is most commonly placed in the neck (internal jugular) but may also be placed in the groin (femoral), liver (transhepatic), chest (subclavian) or back (translumbar). The catheter is tunneled under the skin. It has a cuff attached to it that allows tissue and skin to grow around it, giving the line more stability an reducing the risk for infection. Tunneled central lines are used when access to a vein is necessary for a long period of time.

Some medications can't be given through regular IV lines and require frequent, painful needle insertions. A tunneled central line is a more comfortable way for patients to receive medications, chemotherapy, nutrition and fluids.  This allows the medical team to obtain blood samples without placing a new IV. Using ultrasound and fluoroscopy for guidance, the Interventional Radiologist will insert the catheter into a vein, usually in the neck, and thread it into the large vein that carries blood into the heart. The other end of the catheter is tunneled under the skin and exits from the side of the chest.