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DEEP VEIN THROMBOSIS (DVT)

What is the Treatment for a Deep Vein Thrombosis?
You have been diagnosed with a deep vein thrombosis, which is a clot that has formed in your blood vessel. These clots are typically located within the deep veins of the legs and are at risk for traveling to the lung (pulmonary embolism). Treatment may include using a medication that breaks down the clot (thrombolytic) and/or using a mechanical device that breaks up the clot while removing it.

How Should I Prepare?
You should not to eat or drink anything for six hours prior to your procedure. You may take your medications as directed. Speak to your doctor if you need to adjust your insulin dosing. Prior to your procedure, you should make sure all medications and allergies are updated. This procedure typically requires hospitalization and monitoring.

How is the Procedure Performed?
The procedure will be performed by an interventional radiologist, who is a physician with specific training in image-guided procedures. The procedure will be performed under fluoroscopy (x-ray). Intravenous medications may be given to make you more comfortable and relaxed. This is called conscious sedation. The skin will be cleaned with a sterilizing solution and numbing medicine injected into the skin. A catheter (small tube) will be advanced into the blood vessel towards the area where the blood clot is located. X-ray dye is then injected and pictures taken to visualize the area of concern. If treating with a medication that dissolves blood clots, a small tube is left near the area of the clot and is attached to a machine that delivers a clot-dissolving medication. This medication is delivered directly into the clot over several hours or even a few days. Often times, the use of a clot-dissolving drug is used before or after the mechanical removal of the clot.

What Should I Expect After the Procedure?
Following the procedure, you will be monitored for a period of time for any complications. If receiving a clot-dissolving medication, the clot will be evaluated daily with x-ray dye to ensure proper resolution.

FISTULOGRAMS

What is a Fistulogram?
Your healthcare provider has requested that you undergo a fistulogram. It has been determined that you are having complications with your dialysis fistula/graft. This procedure involves injecting x-ray dye into the fistula to evaluate for an area of blockage or other complications.

How Should I Prepare?
You should not eat or drink anything for six hours prior to your procedure. You may take your medications as directed. Speak to your doctor if you need to adjust your insulin dosing. Prior to your procedure, you should make sure all medications and allergies are updated. If you are on a blood thinner you may be requested to stop that medication for a period of time. You will want to arrange for a ride home from a responsible adult afterwards should you require sedation.

How is the Procedure Performed?
The procedure will be performed by an interventional radiologist, who is a physician with specific training in image-guided procedures. The procedure will be performed under fluoroscopy (x-ray). Intravenous medications may be given to make you more comfortable and relaxed. This is called conscious sedation.

A fistulogram involves placing a small tube into your fistula/graft. X-ray dye will be injected, and pictures will be taken to evaluate blood flow through the fistula.. If the dye shows an area of blockage then an angioplasty (balloon inflation) may be performed in an attempt to open the blocked area. A metal tube (stent) may also be needed to keep the blockage open. If blood clots are found then a mechanical device or special medications may be used in an attempt to remove or melt the clot.

What should I expect after the procedure?
Once the catheter has been removed, pressure will be applied to the insertion site to stop any potential bleeding. You will then be monitored for a period of time. Most patients go home the same day unless there is an urgent need for dialysis or some other reason for hospitalization.

INFERIOR VENA CAVA (IVC) FILTER

What is an IVC Filter?
Your healthcare provider has requested that you undergo the placement of an inferior vena cava (IVC) filter. You have been diagnosed with having a blood clot or are at risk for developing one. If the clot is in the leg there is a risk of the clot breaking off and traveling to your lungs, causing further complications. The IVC filter is designed to trap clot and prevent it from entering the lungs.

How Should I Prepare?
You should not eat or drink anything for six hours prior to your procedure. You may take your medications as directed. Speak to your doctor if you need to adjust your insulin dosing. Prior to your procedure, you should make sure all medications and allergies are updated. If not staying in the hospital, you will want to arrange for a ride home from a responsible adult should you require sedation.

How is the Procedure Performed?
The procedure will be performed by an interventional radiologist, who is a physician with specific training in image-guided procedures. The procedure will be performed under fluoroscopy (x-ray). Intravenous medications may be given to make you more comfortable and relaxed. This is called conscious sedation. The placement of the IVC filter involves accessing a vein in either your neck or groin. During the procedure, x-ray dye will be injected and pictures taken of the targeted area for placement. You may experience a temporary warm feeling or strange taste in your mouth during this process. A catheter (small tube) will be placed into the large vein called the inferior vena cava where the filter will be placed. Following placement, the catheter will be removed and pressure will be applied to the insertion site to prevent any bleeding.

What Should I Expect After the procedure?
You may be asked to lie in a specific position for up to 4 hours with monitoring for any complications. IVC filters may be either temporary or permanent devices. If this is a temporary device the removal should ideally be performed within 4-6 weeks.

PULMONARY EMBOLISM (PE)

What is the Treatment for a Pulmonary Embolism (PE)?
You have been diagnosed with a pulmonary embolism, which is a clot that has formed in your blood vessel and traveled into the lung. Treatment from this complication may include the use of a medication that breaks down the clot (thrombolytic) and/or using a mechanical device that breaks up the clot while removing it.

How Should I Prepare?
You should not eat or drink anything for six hours prior to your procedure. You may take your medications as directed. Speak to your doctor if you need to adjust your insulin dosing. Prior to your procedure, you should make sure all medications and allergies are updated. This procedure typically requires hospitalization and monitoring.

How is the Procedure Performed?
The procedure will be performed by an interventional radiologist, who is a physician with specific training in image-guided procedures. The procedure will be performed under fluoroscopy (x-ray). Intravenous medications may be given to make you more comfortable and relaxed. This is called conscious sedation.

The skin will be cleaned with a sterilizing solution and numbing medicine injected into the skin. A catheter (small tube) will be advanced into the blood vessel towards the area where the blood clot is located. X-ray dye is then injected and pictures taken to visualize the area of concern.

If treating with a medication that dissolves blood clots, a catheter is left near the area of the clot and is attached to a machine that delivers a clot-dissolving medication. This medication is delivered directly into the area of the clot over several hours or even a few days. A mechanical device used to vacuum the clot out may also be used in conjunction with the clot-dissolving medication.

What Should I Expect After the procedure?
Following the procedure, you will be monitored in the hospital for any complications. You will be evaluated each day to ensure that the clot is dissolving appropriately.

TIPS

What is a TIPS procedure?
Your healthcare provider has requested that you undergo placement of a transjugular intrahepatic portosystemic shunt (TIPS). It has been determined that your liver disease is blocking the flow of blood through your liver. As a result, the backed-up blood may be leading to bleeding into your stomach or the accumulation of fluid in your abdomen. To relieve the blockage, a TIPS procedure involves placing a stent which creates a new channel of blood flow through the liver.

How Should I Prepare?
You should not eat or drink anything for six hours prior to your procedure. You may take your medications as directed. Speak to your doctor if you need to adjust your insulin dosing. Prior to your procedure, you should make sure all medications and allergies are updated. If you are on a blood thinner you may be requested to stop that medication for a period of time.

How is the Procedure Performed?
The procedure will be performed by an interventional radiologist, who is a physician with specific training in image-guided procedures. The procedure will be performed under fluoroscopy (x-ray). These procedures are typically performed under general anesthesia.

The procedure involves placing a catheter (small tube) into a vein at the base of the neck. The tube is then guided into a vein in the liver under x-ray guidance. X-ray dye will be injected while pictures are taken. A needle is then passed through the small tube and is used to connect to the portal vein (a vein delivering blood to the liver). This channel through the liver will be enlarged by a balloon, and a stent (metal mesh tube) is inserted to keep this channel open. At the completion, the catheter will be removed and pressure will be applied to the insertion site. A sterile bandage is then applied.

What Should I Expect After the Procedure?
You will be monitored in the hospital for complications for one or more days following the procedure. Ultrasound exams will often be performed to ensure that the channel through the liver remains open.

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