Centres/Radiology/Interventional radiology

Interventional radiology - embolization, drainage, radiofrequency

Minimally invasive image-guided therapeutic procedures, including embolization, drainage and radiofrequency thermal ablation, offering less demanding alternatives to conventional surgery.

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What is it?

Interventional radiology encompasses all diagnostic and therapeutic procedures performed under medical imaging guidance (fluoroscopy, ultrasound, CT). These minimally invasive techniques make it possible to treat many conditions while avoiding or reducing the need for open surgery, with a significant reduction in postoperative pain, length of hospital stay and complications. Embolization consists of deliberately blocking a blood vessel by injecting embolic agents (particles, metal coils, biological glue) using a catheter introduced through an artery. This technique is used to treat uterine fibroids, stop hemorrhages, devascularize tumors before surgery, and treat vascular malformations or aneurysms. Percutaneous drainage makes it possible to evacuate a fluid collection (abscess, effusion) by placing a catheter under ultrasound or CT guidance, thus avoiding surgery to drain the infection. Radiofrequency thermal ablation uses a high-frequency alternating electric current delivered by a needle electrode inserted directly into the tumor under CT or ultrasound guidance. The heat generated (60 to 100 degrees) causes destruction (necrosis) of the tumor and a margin of surrounding healthy tissue. This technique is validated for the treatment of tumors of the liver, kidney and lung and certain bone tumors, particularly in patients who are not candidates for surgery. At Clinique Pasteur in Tunis, interventional radiology procedures are performed by experienced interventional radiologists in a sterile and secure environment. Latest-generation imaging equipment allows precise guidance of the procedures, guaranteeing treatment effectiveness and patient safety.

When is it indicated?

Embolization of symptomatic uterine fibroids

When fibroids cause heavy bleeding or pain, this technique shrinks them by blocking their blood supply, without an operation and while preserving the uterus.

Embolization of active hemorrhages (postpartum, digestive, traumatic)

In cases of severe bleeding, the radiologist can block the bleeding vessel from the inside using a fine catheter. This rapid procedure often stops the hemorrhage without open surgery.

Chemoembolization of liver tumors (hepatocellular carcinoma)

This treatment delivers a medication directly into the liver tumor while blocking the vessels that feed it, concentrating the effect on the lesion while sparing the rest of the organ.

Radiofrequency thermal ablation of tumors of the liver, kidney and lung

A fine needle placed at the heart of the tumor under imaging guidance destroys it with heat. This option is invaluable for patients for whom surgery is not advisable.

Drainage of abdominal, pelvic or thoracic abscesses

Rather than operating, the radiologist can evacuate a pocket of infection by placing a small drain through the skin, guided by imaging. The patient is thus relieved with a minimally invasive procedure.

Embolization of vascular malformations and visceral aneurysms

Some blood vessel abnormalities carry a risk of bleeding. Embolization makes it possible to close them from the inside, through the natural pathways of the bloodstream, and eliminate this risk.

Vertebroplasty and cementoplasty for osteoporotic vertebral fractures

The injection of medical cement into a fractured, painful vertebra consolidates it quickly. This procedure relieves the pain and allows mobility to be regained more rapidly.

Placement of biliary drains and percutaneous nephrostomies

When bile or urine can no longer flow normally, a drain placed through the skin restores their drainage, relieves the patient and protects the organ concerned.

Preparation

1Prior consultation with the interventional radiologist to explain the procedure and obtain consent

2Prior blood tests: coagulation (PT, aPTT, platelets), kidney function (creatinine), CBC

3Fast for at least 6 hours before the procedure

4Discontinuation of anticoagulants and antiplatelet agents according to the protocol defined by the radiologist

5Report any allergy, particularly to contrast agents and anesthetics

6Report any current treatment and any surgical history

7Plan for hospitalization (outpatient or a few days depending on the procedure)

8Bring the complete imaging file and biopsy results, if applicable

Procedure

The patient is positioned in the intervention room under cardiac and blood pressure monitoring

A peripheral IV line is placed for the administration of medications and sedatives

Local anesthesia is performed at the puncture site (general anesthesia possible depending on the procedure)

For embolization: a catheter is introduced through the femoral artery and guided under fluoroscopy to the target vessel

For drainage: a needle and then a drain are placed under ultrasound or CT guidance into the fluid collection

For radiofrequency: a needle electrode is positioned in the tumor under CT guidance

The procedure is performed under continuous imaging control

A final check is carried out to verify the effectiveness of the treatment

The patient is monitored in the recovery room and then during hospitalization

Duration

45 minutes to 2 hours depending on the complexity of the procedure

Results

The interventional radiologist informs the patient and the referring physician of how the procedure went immediately afterwards. A detailed report is written. A follow-up imaging examination is scheduled in the following weeks to assess the effectiveness of the treatment.

Risks and side effects

Hematoma or bleeding at the puncture site (the most common, generally benign)

Infection at the puncture site or in the treated area (rare, prevented by antibiotic prophylaxis)

Post-procedural pain (managed with appropriate pain relief)

Allergic reaction to the contrast agent (rare)

Non-target embolization (migration of embolic agents to unintended territories - rare)

Post-embolization syndrome: fever, pain, fatigue (common and transient)

Specific complications depending on the organ treated (liver failure, pneumothorax)

Risk of failure or recurrence requiring further treatment

These risks remain rare. Your physician will inform you in detail before the examination.

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At a glance

Duration: 45 minutes to 2 hours depending on the complexity of the procedure

Preparation: Required

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