What I treat

Acute ischaemic stroke

Mechanical thrombectomy

A clot blocks a large artery supplying the brain, causing sudden weakness, facial droop or loss of speech. A catheter is passed from the groin or wrist up into the brain artery and the clot is pulled out with a stent retriever or suction.

Timing

Hours, not days — the sooner the better

Anaesthesia

Usually general

Brain aneurysm

Coiling, stent-assisted coiling or flow diverter

A weak bulge in a brain artery, which may be found before it bursts or after a bleed. It is sealed from the inside by packing it with fine platinum coils, or by placing a flow diverter across its neck so blood stops entering it.

Access

Through an artery, no opening of the skull

AVM, dural fistula and carotid-cavernous fistula

Embolisation

Abnormal connections between arteries and veins, which can bleed or cause a red, bulging, noisy eye. They are closed off by injecting glue or other embolic material through a microcatheter.

Narrowed carotid or intracranial artery

Angioplasty and stenting

A narrowing in the neck or brain arteries that causes mini-strokes or raises stroke risk. The narrowing is widened with a balloon and held open with a stent.

Painful spinal compression fracture

Vertebroplasty

A collapsed vertebra, usually from osteoporosis or a tumour deposit, causing severe back pain. Bone cement is injected into the vertebra through a needle to stabilise it.

Severe or repeated nosebleed

Embolisation

Bleeding that will not stop with packing or cautery. The small artery responsible is blocked from inside with tiny particles.

Bleeding from a head and neck tumour or after surgery

Embolisation

An emergency in which a vessel is bleeding into the airway or wound. The bleeding vessel is found on angiography and sealed.

Pre-operative devascularisation

Tumour embolisation before surgery

For vascular tumours such as juvenile angiofibroma or paraganglioma, blocking the blood supply a day before surgery reduces blood loss during the operation.

Coughing up blood

Bronchial artery embolisation

Often from old tuberculosis, bronchiectasis or fungal infection. The abnormal artery feeding the bleed is blocked through a catheter, which stops the bleeding without removing lung tissue.

A lung nodule or mass needing a diagnosis

CT-guided biopsy

A needle is passed through the chest wall under CT guidance to take a small tissue sample for the pathologist, so treatment can be planned on a definite diagnosis.

Fluid or pus around the lung

Image-guided drainage

A thin drain is placed under ultrasound or CT guidance to remove infected or malignant fluid.

Jaundice from a blocked bile duct

Percutaneous biliary drainage and stenting

When a stone or tumour blocks the bile duct and endoscopy has failed or is not possible, a drain is placed through the skin into the bile ducts, and later a stent can be left to keep the duct open.

Bleeding in the stomach or intestine

Embolisation

When endoscopy cannot find or control the bleeding, angiography locates the bleeding vessel and it is blocked with coils or glue.

Portal hypertension, vomiting blood, resistant ascites

TIPS

In advanced liver disease, a channel is created inside the liver between the portal and hepatic veins to lower the pressure, which reduces variceal bleeding and fluid accumulation.

Abscess or collection in the abdomen

Image-guided drainage

A catheter is placed into the collection under ultrasound or CT guidance, often avoiding a re-operation.

A dialysis fistula that is failing

Fistuloplasty and salvage

Poor flow, high venous pressures or a fistula that has just clotted. The narrowed segment is opened with a balloon, and a clotted fistula can often be cleared — keeping the existing access working instead of creating a new one.

Usually

Day-care, local anaesthetic

Dialysis without a working fistula

Tunnelled dialysis catheter (permcath)

Placed under imaging guidance into a central vein, including in patients whose usual veins are already blocked.

A blocked kidney

Percutaneous nephrostomy and antegrade stenting

When a stone or tumour obstructs the ureter and the kidney is swelling or infected, a drain is placed directly into the kidney to relieve the obstruction.

Kidney biopsy

Ultrasound-guided biopsy

A tissue sample taken for the nephrologist to diagnose the cause of kidney disease.

Uterine fibroids

Uterine fibroid embolisation

Heavy periods, pain or pressure from fibroids. The arteries feeding the fibroids are blocked with small particles so the fibroids shrink. The uterus is not removed. Suitability depends on the number, size and position of the fibroids and on whether you want a future pregnancy — this needs to be discussed individually, usually alongside your gynaecologist.

Enlarged prostate

Prostatic artery embolisation

An option for urinary symptoms from prostate enlargement in men who cannot have or do not want surgery. The prostate's blood supply is reduced so the gland shrinks over the following months.

Heavy bleeding after childbirth

Uterine artery embolisation

An emergency procedure that can stop postpartum haemorrhage and, in many cases, avoid hysterectomy.

Varicocele

Embolisation

Enlarged veins in the scrotum associated with discomfort or infertility, closed from inside the vein through a small puncture in the neck or groin.

Chronic pelvic pain from pelvic congestion

Ovarian vein embolisation

Long-standing dragging pelvic pain, worse on standing, caused by refluxing pelvic veins.

Blocked leg arteries, diabetic foot and non-healing ulcers

Angioplasty and stenting

Pain in the calf on walking, rest pain, or a foot wound that will not heal because of poor blood supply. The blocked artery is crossed with a wire and opened with a balloon, sometimes with a stent, to restore flow to the foot. In diabetic foot disease this is usually done alongside wound care and, where needed, the surgical team.

Varicose veins

Endovenous laser, radiofrequency ablation or glue

Aching, swelling, skin darkening or ulceration from refluxing leg veins. The faulty vein is sealed from inside through a needle puncture, with no groin incision and no vein stripping.

Usually

Day-care; walking the same day

Deep vein thrombosis and leg swelling

Catheter-directed thrombolysis, venoplasty, IVC filter

For extensive clot in the leg veins, the clot can be dissolved or removed through a catheter and any underlying narrowing stented. A filter can be placed in the main abdominal vein when blood thinners cannot be used.

Liver tumours

TACE, TARE and ablation

Chemotherapy or radioactive beads can be delivered directly into the artery feeding a liver tumour, or the tumour can be destroyed with heat through a needle. Used for primary liver cancer and for some secondary deposits, as decided in a tumour board with the oncology team.

Getting a tissue diagnosis

Image-guided biopsy

Targeted sampling of a mass anywhere in the body under ultrasound or CT guidance.

Long-term chemotherapy access

Chemoport and PICC insertion

A port placed under the skin so chemotherapy can be given without repeated cannulation.

Preparing the liver for major surgery

Portal vein embolisation

Blocking the portal vein to one side of the liver makes the other side grow, so a larger resection becomes safe.