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Adrenal Vein Sampling

The adrenal gland is a small hormone producing organ that sits above the kidney. There are two in the body, one right and one left, located above each kidney. One of the many hormones the adrenal glands make is called aldosterone. This important hormone helps your body balance the amount of sodium and potassium in the blood. If one or both adrenal glands produce too much of this hormone, the body can retain too much water, which can cause high blood pressure. If one gland is responsible for producing too much aldosterone, it can be removed surgically. By sampling the hormones produced by each gland separately, it can be possible to identify the overactive gland.

Under a combination of ultrasound and x-ray guidance, a needle is advanced into the vein of the leg. A wire is advanced through that needle, and the needle is exchange for a catheter. That catheter can then be used to find the vein drain each of the adrenal glands. Blood samples are obtained from each vein and from the systemic veins. These samples are then sent for special lab tests to evaluate the amount of hormones in them and thereby identify which of the glands is overproducing.

Patients may need to stop certain blood pressure medications prior to the procedure. Additionally, they will need to arrive well before the procedure to receive an infusion that helps us identify the overactive gland. The procedure usually has a low risk of bleeding, infection, and damage to nearby organs. Rarely, one of the veins cannot be located in one try and the procedure will need to be repeated. Patients should refrain from eating and drinking for at least 6 hours prior to the procedure so that we may give them medications to help them relax (moderate sedation). We perform this procedure typically on outpatients, who usually can return home later that day.

Lymphangiography/Embolization

The lymphatic system is a series of small vessels that collect the tiny amount of fluid that leaks out of the blood stream, filters it through lymph nodes, and collects nutrition from the gut and pushes it into the blood stream. If there is a malformation or the system gets injured from trauma or a large surgery, the collected fluid can leak into the neck, chest, and/or abdomen. The loss of fluid and nutrition can make it hard for the patient to heal.

When this happens, it may be helpful to obtain pictures of the lymphatics to identify the location of the leak, which is known as a lymphangiogram. This is usually done by introducing a small needle into the lymph nodes of the groin. An oil-based contrast is slowly injected while x-rays are taken to watch how and where it moves.

If a leak is identified, it may then allow direct access of the injured lymphatic vessel/thoracic duct. This can be done by using x-ray, ultrasound, and/or CT guidance to advance a needle across the abdomen or back into the injured vessel. Alternatively, a catheter can be directed into the vessel from the inside of a vein. In either case, once the lymphatic vessel is accessed, contrast is injected to confirm needle location and then the vessel can be blocked off from the inside with coils and/or glue thereby diverting flow away from the leak so the patient can heal.

The procedure usually has a low risk of bleeding, infection, and damage to nearby organs. Patients should refrain from eating and drinking for at least 6 hours prior to the procedure so that we may give them medications to help them relax (moderate sedation). We perform this procedure typically on inpatients, who usually can return to their room later that day.

Malformation Management

The vascular system is composed of different types of vessels: arteries, veins, and lymphatics. As a patient develops, these vessels can develop abnormally. When this occurs, it is known as a vascular malformation. These malformations can cause symptoms such as pain, swelling, altered appearance, and even affect the way an organ or muscle functions. Several common types of malformations are: lymphatic malformation, venous malformation, pulmonary arteriovenous malformation, and systemic arteriovenous malformation.

From contrast ultrasound to multiphase CT or multiparametric 3T MRI, the musculoskeletal and interventional radiologists at HRA are privileged to use cutting edge imaging technology and protocols to non-invasively diagnose these malformations. Once a malformation has been diagnosed, if it is causing symptoms, the Interventional Radiologists at HRA can treat them with various percutaneous (through the skin) and/or endovascular (through an artery or vein) techniques. The details of these procedures vary significantly between malformation type, location, and severity.

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