About the Kidney Interventions performed by RIA Endovascular interventional radiologists
Dialysis Catheters
For a patient whose kidneys have failed, venous access, or access to the blood system, must be established and maintained for dialysis treatments. Placement of a chronic dialysis catheter (CDC) can provide this access. The catheter is placed in one of the large veins.
A common site is superior vena cava, also referred to as SVC. An SVC catheter is placed by puncturing the internal jugular vein in the neck (most often on the right side. A catheter is then advanced downwards toward the chest.
Alternatively an SVC catheter can be inserted via subclavian veins right behind the clavicle (the collar bone), often on the right. If the access of SVC is difficult, the femoral veins can be used.
The procedure is performed by an interventional radiologist. Some common malfunctions of dialysis catheters include clotting, infection, and kinking.
Nephrostomy Tubes
A nephrostomy tube is one that is placed into the kidney. Normally, urine from the kidney drains through the ureter, a narrow tube, into the bladder. When a stone or a blood clot blocks that tube, the kidney can be damaged.
It is sometimes possible to drain the urine by inserting a fine plastic tube, called a catheter, through the skin and into the kidney under a local anesthetic. In this case, the urine will drain from the kidney into a collecting bag outside the body.
The procedure takes usually place in an x-ray room but it may be done in an operating room or interventional radiology suite. The patient lies face down on the x-ray table. Sedation and-or pain medication is administered through an IV. A monitoring device is attached to your chest and finger, and you may be given oxygen. The procedure is done in a sterile environment.
The radiologist will use the x-ray or ultrasound equipment to guide the fine plastic tube (catheter). Usually this will be in your back, just below your ribs. Your skin will be anesthetized with local anesthetic and a fine needle inserted into the kidney.
Nephrostomy tube placement is a safe procedure but some risks and complications can arise, as with any medical treatment. In almost all cases some blood will appear in the urine. This is not dangerous as usually stops within a few hours.
Ureteral Stents
The ureters are the tubes that connect each kidney to the bladder. When these tubes become blocked, it is necessary to place a stent to improve urinary drainage from the kidney(s). A stent is a small, soft hollow tube that opens a passageway. The stent is placed by an interventional radiologist who will insert a small scope through the urine channel (urethra) into the bladder, then up through the ureter. The procedure is performed in the hospital setting using image guidance.
Reasons for having a ureteral stent include:
- To relieve a kidney or ureter blockage caused by a stone, stricture, tumor, or swelling.
- To allow healing after kidney stone surgery.
- Improves the passing of stone fragments, passage of stone fragments, and prevents stricture formation.