Programs and Services

Vascular and Interventional Radiology

Vascular and interventional radiology, a subspecialty of radiology, involves performing minimally invasive procedures to diagnose and treat disease. Most interventional radiology procedures are performed on an outpatient basis, using a local anesthetic or moderate sedation. Many procedures performed by interventional radiologists today are an alternative to traditional surgery, which requires general anesthesia and often a large incision.

Vascular and interventional radiologists are physicians who use their expertise in interpreting images — X-rays, fluoroscopy, ultrasound and CT — to guide catheters and other instruments through blood vessels or other pathways in the body. Imaging allows interventional radiologists to precisely locate targeted areas to perform a procedure. These minimally invasive methods of diagnosing and treating problems are usually easier for patients because they involve no large incisions, cause less pain than surgery and have shorter recovery times.

About 75 percent of the interventional radiology procedures at Froedtert & The Medical College are performed to treat a problem, and 25 percent are performed to diagnose a problem. Four full-time interventional radiologists work with other Medical College of Wisconsin specialists in multidisciplinary care teams. Team members determine the best treatment options for each patient, which may involve an interventional radiology procedure or other treatment.

All of the vascular and interventional radiologists at Froedtert & The Medical College are fellowship-trained and have been awarded certificates of added qualification (CAQs) by the American Board of Radiology for successfully completing an exam in their subspecialty field. The interventional radiology section directs the only fellowship training program of its kind in Milwaukee.

Medical College of Wisconsin interventional radiologists are nationally and internationally recognized for research, and are leading the way in clinical trials to treat cancer using various interventional therapies.

Technology for Interventional Radiology

Most vascular (blood vessel) interventional radiology procedures use a combination of real-time fluoroscopy with digital subtraction angiography (DSA). In DSA, images of an area of the body are taken in a digital format through a computer. The computer can subtract (remove) various structures in an image to show only the blood vessels. Access to veins and arteries is also performed with ultrasound guidance.

Cancer treatment interventions are performed using computed tomography (CT) guidance as well as fluoroscopic and angiographic guidance.

Interventional Radiology Procedures

At Froedtert & The Medical College, a wide range of vascular and interventional radiology procedures are performed to treat cancer, spinal fractures, uterine fibroids and vascular disease. Procedures include:

Placement of vascular access devices — a vascular access procedure is for patients who need intravenous (IV) access for a long period of time, such as for a course of chemotherapy, hemodialysis, several weeks of IV antibiotic treatment or long-term IV feeding. A vascular access catheter is placed in a vein in the arm, neck or chest, and threaded into a major vein in the middle of the chest.
Image-Guided Cancer Therapy
- Chemoembolization — a method of delivering chemotherapy directly into a tumor. Under X-ray guidance, a catheter is placed into an artery and guided to the specific artery that supplies blood to the tumor. A potent dose of a chemotherapy drug is infused through the catheter to the tumor, and the artery section is plugged to stop further blood flow to the tumor.
- Radioembolization — a method of delivering a high dose of radiation directly to a liver tumor with minimal effect to healthy surrounding tissue (using a product called TheraSphere®). A catheter is placed into an artery and guided with fluoroscopy to the artery that feeds the liver tumor. Microscopic radioactive beads are infused through the catheter into the blood that supplies the tumor. The blood carries the beads directly into the tumor, with minimal injury to surrounding tissue. Froedtert & The Medical College were the first in Wisconsin to offer Therasphere® treatment.
- Radiofrequency ablation — a procedure that uses radio waves to heat and kill a tumor (in the liver, lung, kidney or bone). A special needle electrode is placed in the tumor under ultrasound or CT guidance. A radiofrequency current is passed through the electrode to heat the tumor tissue near the needle tip and ablate — or eliminate — it. The heat also closes up small blood vessels, minimizing the risk of bleeding.
- Cryoablation — a procedure that kills a tumor (in the liver, lung, kidney or bone) by freezing it. This involves placing a metal tube into the tumor while watching the process with ultrasound or CT. The tube is then cooled to -190°C (-360°F), and an ice ball engulfs and kills the tumor.
  
  In addition to interventional radiology procedures, the Froedtert & The Medical College Cancer Center provides many other types of treatments for cancer.
Uterine fibroid embolization or UFE (also called uterine artery embolization or UAE) — an effective, nonsurgical treatment for women with symptomatic uterine fibroids. A small catheter is inserted into an artery in the thigh and guided into a uterine artery. To view the blood vessels, a contrast material that can be seen with fluoroscopy is injected through the catheter into the artery. Next, tiny gelatin particles are injected into the uterine artery. The process is repeated in the other uterine artery. The particles flow into the fibroids, blocking the small arteries and depriving the fibroids of their blood supply. This causes the fibroids to shrink or “die.”
Non-vascular interventions
These are interventions that don’t involve using blood vessels to reach targeted areas in the body. Examples include:
- Opening a blocked bile duct by placing a thin catheter (tube) through the skin and into the bile ducts to drain the blocked duct. The obstruction can also be relieved by placing a stent in the bile duct. (A stent is a small plastic or metal tube designed to keep a passageway open.) Ultrasound or CT are used to guide these procedures.
- Opening a blocked kidney duct (ureter) by placing a thin catheter through the skin into the kidney to allow urine to drain into a collecting bag. A blocked ureter (the duct that runs from the kidney to the bladder) can also be relieved by placing a stent inside to hold the ureter open and allow urine to drain. Ultrasound and fluoroscopy are used to guide these procedures.
- Spine interventions (vertebroplasty and kyphoplasty) — image-guided, minimally invasive procedures that strengthen broken vertebrae weakened by osteoporosis or, less commonly, cancerous tumors of the spine. Both procedures involve injecting an acrylic cement to repair the vertebra under fluoroscopy guidance. Vertebroplasty does not restore the height of the compressed vertebrae, while kyphoplasty is intended to restore some lost height.
Vascular Disease
- Peripheral Vascular Disease (PVD) is a very common condition affecting 12 percent to 20 percent of Americans age 65 and older. This develops most commonly as a result of atherosclerosis or “hardening of the arteries,” which occurs when cholesterol and plaque build up inside the arteries. The clogged arteries can then result in decreased blood flow to the legs or other parts of the body, such as the intestines, kidneys and the carotid arteries in the neck, which supply blood to the brain.
  
  Atherosclerosis can affect the entire body the body, and people with PVD are likely to have blocked arteries in other areas of the body. They are at risk for heart disease, aortic aneurysms and stroke. PVD is also a marker for diabetes, high blood pressure and other conditions.
  
  Interventional Radiologists use specialized CT and MRI scans as well as conventional angiography to evaluate the blood vessels inside the body.
- Angiography of all vessels in the body (except the coronary arteries) — angiography allows viewing blood vessels after injecting them with a “dye” that outlines the vessels on an X-ray. Angiograms require inserting a catheter into a peripheral artery (an artery outside the heart or brain).
  
  Treatment of blockages in the arteries to the legs, kidneys, intestines or the carotid arteries in the neck (supplying the brain) can be treated with a variety of interventional radiology techniques such as angioplasty or stent placement.
- Aortic Aneurysm Repair — an aneurysm is a dilation of a blood vessel caused by disease or weakening of the vessel wall. An aneurysm in the part of the aorta above the diaphragm is a thoracic aortic aneurysm (TAA); below the diaphragm it is called an abdominal aortic aneurysm (AAA).
  
  Repair of aortic aneurysms may be done by open surgery, which involves a long incision in the chest/abdomen or by an interventional radiology (minimally invasive) procedure that uses a stent. A stent (a tube-like device) placed in different parts of the aorta provides a channel over an aneurysm, allowing blood to flow and preventing the aneurysm from bursting.
  
  CT guidance is used to measure the width of the aorta to determine the size of the stent graft. Fluoroscopy and digital subtraction angiography are used to guide a collapsed stent through a small incision in the groin, through the femoral artery and to the aneurysm site. The stent is then expanded in the walls of the aorta, covering the aneurysm.
- Varicose veins — interventional radiologists treat varicose veins using sclerotherapy (injecting a solution into the veins to irritate the lining of the veins, causing them to contract and collapse), microphlebectomy (making tiny incisions in the skin through which the veins are removed) and laser ablation (using laser energy inside a faulty vein to seal it closed, allowing the blood to be diverted to other normal veins).
  
  Treatment of vascular malformations is a very specialized treatment offers by interventional radiologists to control the symptoms of arteriovenous malformations (AVM) which are masses of abnormal blood vessels that grow in various parts of the body.