INTERVENTIONAL RADIOLOGY

VASCULAR PROCEDURES

Diagnostic tests, advanced endovascular procedures and hybrid techniques are performed, working closely with the Hospital's vascular surgery clinics and using state-of-the-art equipment.

Diagnostic Angiography (arteriography, venography)

Study and imaging of the body’s vessels to identify abnormalities of the walls, stenoses, aneurysms etc.
It is performed using the most contemporary method, without waiting. Patients are admitted to the one-day clinic for one hour.

Angioplasty (balloon, stent)

In the event of vascular disease, the case is assessed by a multidisciplinary medical team and the indicated method is proposed.

For the endovascular treatment of a narrowed or completely blocked vessel, the treatment of choice is angioplasty and/or stent placement, i.e. opening of the artery.

The procedure is painless and is performed under local or twilight anesthesia.

In our department, the materials we use (balloons, stents, etc.) are procured from the best manufacturers in the world.

Treatment of Aneurysms

In the case of aneurysmal disease, a multidisciplinary team of specialists recommends the best treatment (endoluminal, hybrid or open repair). At Metropolitan Hospital, we have the experience that is required to encounter complications or dysfunctions with grafts have been placed at any site (treatment of endoleaks).

Thrombolysis / Thrombectomy

Thrombolysis is the technique whereby specific agents are infused into the vessel via fine catheters and the obstructing thrombus is dispersed.

We have extensive experience in endovascular or combined treatment of arterial thrombosis, with special intra-arterial thrombolysis techniques.

Treatment of Deep Venous Thrombosis / Pulmonary Embolism

Treatment of both acute and chronic deep vein thrombosis by thrombolysis, thromboaspiration, stenting and treatment of severe pulmonary embolism.

Inferior Vena Cava Filter

Placement of a temporary or permanent inferior vena cava filter under local anesthesia.

We also safely and painlessly remove ICF filters without this requiring hospitalization.

Embolization for Vascular Malformations, Hemangiomas, etc.

At our department, a team of qualified doctors treat various types of vascular malformations, including hemangiomas, arteriovenous communications, venous malformations, etc.

We have extensive experience in superselective embolization, sclerotherapy, etc. for both children and adults.

Hemorrhagic Management

Intra-arterial embolizations in emergency hemorrhagic cases. These may be spontaneous, postoperative, post-traumatic, etc.

We manage hemorrhaging of the lungs, bones, soft tissue, upper and lower GI, kidneys, lower urinary system, pelvis, uterus and more.

Management of Pseudoaneurysms

The management of pseudoaneurysms is performed percutaneously with simple aspiration, intra-arterially, or a combination of both methods.

Endovascular Foreign Body Retrieval

Where a foreign body is present in an artery or vein, foreign body retrieval may be performed.

Placement of Central Venous Catheters, Hemodialysis Catheters, PICC Line, Port, etc.

Central venous catheters are used for many reasons, including fluid infusions, parenteral feeding, long-term administration of antibiotics and other medications, chemotherapy, transfusions, hemodialysis, and more.

Catheter insertion does not require hospitalization. It is performed painlessly under guided ultrasound and digital subtraction angiography.

LIVER - BILE DUCTS

Percutaneous Transhepatic Cholangiography / Bile Duct Drainage and Placement of Stent (Rendez-Vouz Technique)

The entire range of percutaneous procedures on the biliary duct is performed under ultrasonic guidance and fluoroscopy.

Procedures include cholangiography (PTC), biliary drainage (PTBD), stenting, management of benign strictures as well as postoperative complications of the biliary ducts, percutaneous lithotripsy of gall stones, rendez-vous technique and biopsies.

These procedures are performed under twilight anesthesia and require at least an overnight hospital stay.

Chemoembolization

Chemoembolization is the intra-arterial delivery of anticancer drugs directly to the tumor.

This method is indicated for various primary liver tumors and for some metastatic tumors.

An overnight hospital stay is usually required.

Liver Tumor Ablation (RF & Microwave Ablation)

For inoperable liver tumors, RF ablation or MW ablation provide minimally invasive local treatment since the tumor or tumors are destroyed with heat in just a few minutes.

Percutaneous Placement of Selective Intra-Arterial Chemotherapy Port

A port may be placed for the injection of intra-arterial chemotherapy for certain liver tumors.

Transjugular Liver Biopsy

ΣWhere conventional liver biopsy is not possible due to coagulation disorders or due to ascites, etc., transjugular biopsy under digital subtraction angiography and ultrasound-guided plugged biopsy are safely performed.

Percutaneous Cholecystostomy

Percutaneous cholecystostomy is used in the management of acute cholecystitis in patients whose general medical condition does not permit cholecystectomy, which is the usual treatment. It is painless and is performed in minutes. In the case of acalculous cholecystitis, the definitive treatment is cholecystectomy.

Portal Vein Procedures

Aided by modern imaging guidance, specialized procedures –such as portal vein stenting to treat stenosis or complete blockage of the portal vein usually by tumors or after grafting – are now performed in the portal vein.

Portal vein embolization as preoperative preparation for hepatectomy to allow the healthy part of the liver to grow.

Portal vein thrombolysis in case of acute thrombosis.

Transjugular intrahepatic portosystemic shunt in patients with cirrhosis and variceal bleeding or refractory ascites.

UROGENITAL SYSTEM

Percutaneous Nephrostomy

Percutaneous nephrostomy is a painless and quick procedure which is performed in ureter obstruction due to stones or tumors as treatment of traumatic injury of the ureter, in hemorrhagic cystitis or in other bladder disorders. It is also performed for percutaneous nephrolithotripsy and for percutaneous pigtail catheter insertion.

Placement of Ureteric JJ Stent

Ureteric stents or pigtails can be inserted easily, painlessly and percutaneously by using contemporary imaging.

Treatment of Renal Cell Tumor (Embolization, Radiofrequency, Cryoablation)

We perform all percutaneous procedures for renal cell tumors at our department.

Embolization is performed in advanced renal cell cancer, while preoperative embolization is performed prior to nephrectomy or RF ablation / Cryoablation.

In addition, embolization is used for the treatment of renal angiomyolipomas and postoperative bleeding after biopsies, lithotripies, etc.

Embolization of Spermatic Veins in Varicocele

Varicoceles are enlarged varicose veins that occur in the scrotum. At times, this may cause infertility or pain. Treatment is either performed by a urologist, who ligates the vein, or by an interventional radiologist, who performs a simple, painless procedure with fast recovery (embolization).

Embolization of Ovarian or Iliac Veins in Pelvic Congestion

Pelvic congestion syndrome is a common cause of chronic pelvic pain, namely abdominal pain, which is due to varicose veins in the pelvis. Besides pain, other symptoms of this syndrome include heavier menstrual periods, pain during intercourse, frequent urination, and the formation or worsening of varicose veins. Treatment involves the embolization of the pelvic veins, which is a simple and painless method.

Fibroid Embolization

Embolization is an alternative method for treating symptomatic fibroids. The procedure is performed under local and/or twilight anesthesia under the guidance of digital subtraction angiography.

Urethral Stenting

In the case of urethral stricture or injury, we implant a permanent catheter under imaging guidance to restore urethral patency.

Suprapubic Catheterization

When placement of a urethral catheter is contraindicated or unsuccessful, a suprapubic catheter is inserted in the bladder. This procedure is painless and is performed in minutes under imaging guidance.

RESPIRATORY SYSTEM

Drainage of Pneumothorax, Pleural Fluid Collections

Drainage or diagnostic aspiration of pleural fluid collections is painless and is performed in minutes under imaging guidance.

Embolization for Hemoptysis

In the case of hemoptysis – which is due to a number of reasons such as bronchiectasis, chronic bronchitis, tuberculosis, abscesses, tumors and more – an angiography of the bronchial and pulmonary arteries is performed and depending on the findings, the vessel responsible for the bleeding is embolized.

The procedure is painless and is performed under the guidance of digital subtraction angiography.

DIGESTIVE SYSTEM

Percutaneous Gastrostomy and Gastrojejunostomy

There are a number of reasons for inadequate oral intake, whether temporary or permanent.

These may include patients with swallowing disorders (cerebrovascular accident, multiple sclerosis and other disorders of the nervous system), patients with esophageal or tracheal obstruction, patients with tumors or other severe oral cavity diseases, patients with anorexia, and more.

These cases can be resolved with percutaneous gastrostomy or gastrojejunostomy, namely the insertion of a tube that leads to the stomach for direct feeding.

The procedure is quick and painless.

Abscess Drainage

Drainage of abscesses in any organ and empyemas is performed under image-guided aspiration and the collection of a sample for culture.

Nasojejunal Feeding Tube

When jejunal feeding is required for a certain period of time, a nasojejunal feeding tube is inserted under imaging guidance.

Management of GI Tract Bleeding

In the event of upper or lower GI bleeding, the endoscopic and surgical teams join forces to investigate and treat vascular deterioration.

NECK/THYROID

Nodular Aspiration (FNA, FNB)

Thyroid nodules or cysts are quickly and safely aspired under ultrasonic guidance on an outpatient basis.

Ablation of Thyroid Nodules and Postoperative Recurrences (RF Ablation)

Radiofrequency ablation is a novel and innovative method for treating benign thyroid nodules.

The procedure is done under local anesthesia without incisions and patients are able to leave on the same day.

The treatment of nodules with this method is indicated in consultation with the treating endocrinologist. To date, this method is applied globally in the case of substantiated benign thyroid nodules when surgery is contraindicated or when the patient does not desire the removal of the gland. We also apply this method in patients with recurrence at the surgical site or tracheal lymph node, when a return to the operating room is not an option.

GENERAL

Organ Biopsies

Using state-of-the-art medical imaging devices (ultrasound, CT, MRI, PET, DSA), a sample is retrieved from various organs (liver, pancreas, kidneys, adrenal glands, abdominal and retroperitoneal tumors, lymph nodes, lung, chest and mediastinal tumors, tracheal, soft tissue, extremity tumors, bone tumors).

Transjugular Liver Biopsy and Plugged Biopsy

Where conventional liver biopsy is not possible due to coagulation disorders or due to ascites, etc., transjugular biopsy under digital subtraction angiography and ultrasound-guided plugged biopsy are safely performed.

Vertebroplasty / Kyphoplasty

They are performed on fractures of the spinal column in order to provide almost immediate pain relief.

Aspiration of Collections, Fluids, Abscesses, etc.

Using imaging guidance, such as ultrasound, CT, etc., all diagnostic or drainage aspirations of fluid collections are performed in various parts of the body under local or twilight anesthesia.

Cyst Aspiration

Using imaging guidance, such as ultrasound, CT, etc., the contents of the cyst are aspired using a fine needle and the cyst may be injected with absolute alcohol or other agents to prevent recurrence.

PAIN MANAGEMENT

Injection of local anesthetics, steroids, etc., into joints, infiltrations and nerve blocks; radiofrequency neurolysis.

CAUTERIZATION AND CRYOTHERAPY (RADIOFREQUENCY ABLATION, MICROWAVE ABLATION, CRYOABLATION, IRREVERSIBLE ELECTROPORATION - NANOKNIFE)

These procedures use one or more fine needles under modern imaging guidance. Then, depending on the technique, these needles are connected to a generator (radiofrequency, microwave, cryotherapy, electrical pulses). The tumor is destroyed in just minutes. The procedure is applied to hepatic, renal, pulmonary, pancreatic and soft tissue tumors.

A new radiofrequency application that has been successful at Metropolitan Hospital is that of inoperable, recurrent thyroid gland cancer.

EMBOLIZATIONS AND CHEMOEMBOLIZATIONS (EMBOLIZATION, DC BEADS, TACE, ETC.)

Another method used to treat cancer is the delivery of drugs to the tumor via the vessels that supply it with blood and/or its occlusion to starve the tumor of its blood supply, for the purpose of shrinking the tumor and reducing accompanying complications, such as pain, bleeding, etc.

Embolization can also be applied preoperatively (neo-adjuvant embolization) for safer tumor resection.

PORTAL VEIN EMBOLIZATION

Embolization of the right or left portal vein branch is a procedure that induces regrowth on one side of the liver (future liver remnant) in order to increase the number of hepatectomy candidates and to reduce postoperative complications.

FLUID DRAINAGE (PLEURAL, ASCITES, ETC.)

Fluid in the abdominal area and chest is a common problem in patients. Therefore, diagnostic aspirations, and temporary or permanent drainages are performed using port catheters to treat recurrent fluid collections.

PAIN MANAGEMENT INTERVENTIONAL TECHNIQUES

It is not uncommon for patients to present tumor-related pain. Using modern imaging guidance and twilight anesthesia, infiltrations and nerve blocks are performed with an almost immediate result.

Vertebroplasty (or kyphoplasty) is performed in spinal fractures, i.e. acrylic cement is injected into the fractured bone to manage the pain and to strengthen the bone.

VASCULAR ACCESS AND FEEDING TUBES

Cancer treatment usually requires a number of vein punctures, either for drawing blood or for injecting chemotherapy drugs, blood and other agents, parenteral feeding, etc. Using imaging guidance, temporary central venous catheters, PICC lines, Hickman lines and port catheters are inserted quickly, painlessly and safely.

Percutaneous gastrostomy catheters are safety inserted in patients with tumors in the maxillofacial area, trachea and esophagus who suffer from inadequate oral intake, so that they can receive fluids, medication and food.

NEPHROSTOMY AND URETERAL STENTING

In the event of urinary stricture or obstruction, nephrostomy (urinary diversion), percutaneous ureteral stenting, nephroureteral stents, etc. are placed under ultrasonic guidance and fluoroscopy.

MANAGEMENT OF BILIARY DUCT DISORDERS

Percutaneous stents and internal/external drainage tubes are inserted in the case of biliary duct strictures or obstructions. In addition, the rendez-vouz-ERCP technique in usually used in collaboration with the gastroenterology team.

VASCULAR STENTS

In the event of vascular stenosis – due to pressure or the infiltration of tumors or lymph nodes – stents may be inserted, e.g. in the case of superior vena cava syndrome, iliac vein or portal vein stenosis, etc.