Intervention

IN WHICH CASES DO WE RECOMMEND IT?

Intervention means medical interference, in this case the examination. Radiological intervention is an interference (examination) process not to explore (diagnostics) a disease, but the treatment (therapy) of an already explored (diagnosed) disease. In fact it is a surgery interference aiming to heal the vascular lesions or the diseases of other organs through the vascular system. However, contrary to open surgeries, in case of radiologic intervention the therapy takes place through one or two punctures and further through needles, catheters or any other means using these punctures.

Radiologic interventions do not need – apart from rare exceptions – the anesthesia of patients.

The question, if open surgery or the radiologic intervention shall be applied in case of a certain vascular disease shall be decided upon consultation with a doctor and the intervention radiologist specialist.

FOR WHAT AGE?

For any age where appropriate

IS THERE ANY RISK?

Every medical intervention, every surgery has a risk. The risk of interventions is almost equal to that of angiography. This risk is different for every individual, depending on the diseases of the patient or the seriousness of the deviation. It is suggested only when risks are considered to be lower than the risk of an open surgery.

HOW TO APPLY FOR EXAMINATION?

Radiology interventions can be initiated by specialists treating the patient only.

ARE THERE ANY SIDE-EFFECTS?

Side effects are events in the course of the surgery intervention which are caused by the intervention itself. For example, if minor bleeding occurs at the place of puncture which heals in a couple of weeks, it is called side effect. However, if bleeding is of higher extent, leading to the loss of a limb or any other serious consequences, then it is called a complication which has to be recovered in time and has to be treated. We make omission if we don’t recognize bleeding and accordingly don’t start treating it. The side effect may be different for various types of radiological interventions which we introduce at the types of individual interventions.

HOW DOES THE EXAMINATION TAKE PLACE?

It depends on the type of intervention. We ask the patient in every case about his complaints and revise the results of our previous examinations. The patient comes to the examination upon previous appointment. In course of the appointment the doctor in charge of the treatment is informed about the status of the patient and his previous diseases. In many cases it is decided during these consultations if the intervention treatment is suitable for the healing of the patient or not. Before the examination the patient is informed about the process of the examination and receives written documentation as well. The patient can pose questions accordingly. During the course of the examination the patient is constantly informed about what is happening and what he or she may feel.

WHAT SHALL WE DO BEFORE EXAMINATION?

Before the examination we tell your doctor what to do. Performing laboratory examinations is compulsory from which we can check the bleeding – coagulation parameters and the results of other connected examinations.

Anticoagulant medicines are not allowed to be taken before examinations, but instead other medicines for high blood pressure, heart- and lung diseases. Plenty of fluids have to be consumed on the day before examination.

WHEN WILL FINDINGS BE AVAILABLE?

The specialist receives the findings within a couple of hours after the examination. If consultation in needed, this time may be extended.

APPOINTMENT TIME?

• On the expense of health insurance, with referral 3-10 days
• For charged service not available for Hungarian patients.

FURTHER INTERVENTION EXAMINATIONS

• More frequent interventions: dilatation of narrowed blood vessels
• More frequent interventions: abnormal blood cut in liver tumors
• More frequent interventions: making biliaries permeable
• More frequent interventions: cell and tissue sample taking

More frequent interventions: dilatation of narrowed blood vessels

IN WHAT CASES IS IT RECOMMENDED?

Today, dilatation of blood vessels usually means a short section of narrowed vein or its obstruction is bored by an inserted guide wire. A catheter is then inserted into the opening (balloon catheter) and the stenosis is widened by blowing up the balloon. Vasodilation is usually recommended when a single, short section of stenosis (7 cm) or obstruction (5 cm) has been identified. In some centres the dilatation of multiple stenosis is also possible. The vasodilation performed in course of radiological intervention is to be considered effective if the inner layer of the vascular is slit successfully. In case of calcic uneven surface stenosis lying close to the vascular junctions it is advised to use stent implantment in order to prevent accidently occurring side effects. Stent is a cylindrical, thin metal mesh. It is made of medical metal alloy (nitinol) or stainless steel. Its task is to prevent the wide spreading of pathological fracture of the vascular as well as the drifting of vascular sediments, further to support the widened vascular section from inside.

FOR WHAT AGE?

For any age if necessary.

ARE THERE ANY RISKS?

Factors increasing the risk of the examination during angiography may occur here as well. Besides the risk of widening stenosis of an uneven surface, irregulate structure calcic vascular is higher, since a pathological crack of the vascular may occur. Small particles and irregular structure sediments may easily drift from then uneven surface, which then are swept away by the circulation. Afterward, where these are blocked may cause vein blockage (infarct). In order to avoid complications combined with bleeding this intervention shall be carried out only when bleeding-coagulation parameters are checked by laboratory examinations and are satisfactory. Thanks to this only minor bleeding may occur around the puncture. In cases when stenosis /obstruction is caused by sediments of higher risk factors, a metal mesh is first inserted before the dilatation and the process shall be performed only afterwards.

To reduce the chance of occurence of incidental complications we do the following:

• After the intervention the referral department shall observe the patient, so that incidental complications (bleeding, sudden vein blockage) can be recognized and treated in time
• interventions are carried out by highly experienced specialists and assistants
• high-tech, technically regularly controlled equipment is used
• only internationally accepted equipment and contrast material is used during our examinations. Thanks to the cooperation of patients, keeping the professional rules, the up-to-date technical equipment and the practice of assistants and specialists, complications hardly occur.

HOW CAN EXAMINATIONS BE APPLIED?

Only the specialist treating the patient can initiate radiological interventions.

ARE THERE ANY SIDE EFFECTS?

Local anesthesia is combined with tensioning, stinging feeling. Skin disinfectants may cause skin inflammation for sensible persons. You may obtain further information before intervention from our colleagues.

HOW DOES THE EXAMINATION TAKE PLACE?

The intervention takes place under small operation room circumstances, in lying position, with empty stomach. After local anesthesia either the elbow or the loin curve artery shall be punctured and a special catheter is led into the narrowed (diseased) vein section. Stopping the catheter at a certain point of the narrow section and blowing up the balloon the narrowed vein section is becomes dilatated, the stenosis can be reduced or ceased accordingly. If needed the stenosis shall be supported by stent from inside, stabilizing it. After the delitation we shall perform angiography to get assurance of the permeability of the previously narrow vein, its appropriate diameter. Afterward the catheter is pulled from the vein and we press the place of puncture until the bleeding ceases. A pressure bandage may be applied as well.

After the intervention bed rest in suggested.

Puncturing and dilatation of veins may be combined with short occasional pain. In the organ with reduced blood supply due to stenosis, the improvement of blood circulation may cause a warm, occasionally burning feeling.

Depending on which organ does the vein supply there is a difference in medical pre-treatment and post-treatment as well. Of course this also means a different level of risk as well. We have to be aware of the fact that in case of non-treated vascoconstriction the organ fails and a heart attack occurs, where depending on the organ in question, may lead to the loss of limbs, paralysis or even to death. Therefore it is necessary to perform the intervention maintaining the circulation (vasodilator) which can be made by open surgery or radiological intervention. However, this therapy intervention also has its own risks: in case of unsuccessful vasodilation the loss of lower limbs, in case of blockage of vessels supplying the brain paralysis or death, in case of coronary arteries heart attack may occur.

WHAT SHALL WE DO BEFORE THE EXAMINATION?

On the day before the examination no food should be eaten after dinner and only non-fizzy water may be consumed. If you feel anxious or frightened, which can be considered as natural, take sedatives or a sleeping pill for the night. Consult your doctor about it! In the morning of the intervention do not eat or drink. If you suffer in diseases of high blood pressure or take pills regularly due to a heart condition, you should take them. Taking anticoagulants and certain medicines for diabetes are prohibited. Ask your doctor or the radiologist specialists in charge of the examination!

Should you have any other questions, please consult with your radiologist specialist before having the examination. You should inform the specialist if during previous examinations where contrast agent were used and it has become evident that you are hypersensitive to such agents or metal (bijou, metal watch strap, etc.)! Hypersensitivity on contrast agents may cause serious, even fatal complications! The sensitivity for metal may cause the early obstruction of the implanted stents!

WHEN WILL FINDINGS BE AVAILABLE?

The specialist receives the findings a couple of hours after the examination. If consultation in needed, this time may be extended.

APPOINTMENT TIME?

• On the expense of health insurance, with referral 3-10 days
• For charged service not available for Hungarian patients.

More frequent interventions: abnormal blood clot in liver tumors

IN WHAT CASES IS IT RECOMMENDED?

The essence of the method is that we are ingesting medicine into the artery of the liver through thin plastic tubes (catheters), which on one hand inhibit the proliferation of tumor cells, while on the other hand they obstruct the tumor areas from the blood circulation activating the immune cells of the liver. A great advantage of this method is that medicines are ingested directly into the veins supplying the tumor and a higher efficiency can be achieved this way. Due to the fact that only minimal amount of medicine shall be ingested into other organs through the circulation, this may significantly reduce the side effects.

This kind of treatment is recommended in case of tumors exceeding 1-2 centimetres, since the supply of tumors exceeding 1 cm are rather effected by the arteries, while minor deformations are supplied by the portal (arteries arriving from the intestines and the spleen) system. Since several tumors of different sizes may simultaneously occur in the liver, this treatment is advised to be effected together with the infusion treatment, as a combined therapy.

FOR WHAT AGE?

For any age if necessary.

ARE THERE ANY RISKS?

The risk is equal to that of angiography. If the catheter unsuccessfully led into the appropriate vein, or if other contraindications of the treatment are found, the intervention is not performed. In order to avoid complications combined with bleeding this intervention shall be carried out only when bleeding-coagulation parameters are checked by laboratory examinations and are satisfactory.

Medicines shall only be ingested only if we are convinced that following angiography ingesting these into the adequate artery is possible. During medicine ingestion continuous EKG control is carried out to promptly detect occasional rhythm disorders. The ingestion of medicine shall be checked by screening. Interventions are performed by specialists and assistants with considerable practice using cutting edge, technically controlled equipment. We use exclusively internationally accepted equipment and contrast materials of the highest quality for our examinations.

HOW CAN WE APPLY FOR EXAMINATION?

Examinations are applied by oncologist specialists on the basis of the results of other examinations effected. The oncologists specialist shall compose the list of medicines depending on the type of the tumor, while taking into consideration if there are other co-diseases which may contraindicate certain medicines. The exact combination and composition of medicines shall be defined on the basis of exact calculations.

ARE THERE ANY SIDE EFFECTS?

Beside the side effects described for the angiography the medicines applied may also have certain side effects. These may be: stomach ache, nausea, vomiting, wearing, dizziness, disorder of heart rhythm. A few days after the treatment fever, nausea, vomiting is possible. These side effects can be treated by antipyretics and nausea reducing medicines.

HOW DOES AN EXAMINATION TAKE PLACE?

The intervention takes place under small operation room circumstances, in lying position, with empty stomach. After local anesthesia either the left elbow or the right loin curve artery shall be punctured and a special catheter is led into the artery of the liver. Liver angiography is carried out then by leading the catheter into the appropriate vein medicines are introduced. The ingestion of medicines shall be monitored by screening and EKG because of the possible occurrences of heart rhythm disorders. We also perform a control angiography after the ingestion of medicines, then catheter shall be pulled out of the vein and the place of the puncture shall be provided with a pressure bandage.

After this treatment bed-rest is recommended.

WHAT SHALL WE DO BEFORE THE EXAMINATION?

On the day before the examination no food should be eaten after dinner and only non-fizzy water may be consumed. If you feel anxious or frightened, which can be considered as natural, take sedatives or a sleeping pill for the night. Consult your doctor about it! In the morning of the intervention do not eat or drink. If you suffer in diseases of high blood pressure or take pills regularly due to a heart condition, you should take them. Taking anticoagulants and certain medicines for diabetes are prohibited. Ask your doctor or the radiologist specialists in charge of the examination!

WHEN WILL FINDINGS BE AVAILABLE?

The specialist receives the findings a couple of hours after the examination. If consultation in needed, this time may be extended.

APPOINTMENT TIME?

• On the expense of health insurance, with referral 3-10 days
• For charged service not available for Hungarian patients.

More frequent interventions: making biliaries accessible

IN WHAT CASES IS IT RECOMMEND?

Securing the interoperability of the biliaries is carried out with this method when endoscopic examination is not successful. The aim of the examination is to secure the run-off of the gall towards the small intestines or if needed towards an external container. This intervention may be applied when run-off of the gall is not secured due to the obstruction of the biliaries.

FOR WHAT AGE?

For any age-group if deemed necessary.

DOES IT HAVE ANY RISK?

To make the biliaries interoperable by this method, a biliary is to be punctured through the liver. During this process veins may also be punctured. As a result bleeding or pathological connection between the veins and the biliaries may occur. After the removal of the needle blood or gall may trickle into the stomach. Puncturing the obstructed section may cause injury to the biliary. Fortunately this usually heals spontaneously, when run-off of the gall is secured. In order to avoid complications combined with bleeding this intervention shall be carried out only when bleeding-coagulation parameters are checked by laboratory examinations and are satisfactory. Thanks to this, the bleeding usually stops in a spontaneous way. Should this not be the case, the bleeding vein can be obstructed by angiography (see: obstruction of veins, emolization).

In order to reduce the occurence of complications to a minimum, we shall do as follows:

• After the intervention the referral department shall observe the patient, so that occasional complications (biliary inflammation, bleeding, pneumothorax) can be recognized and treated in time
• interventions are carried out by highly experienced specialists and assistants
• high-tech, technically regularly controlled equipment is used
• only internationally accepted equipment and contrast material is used during our examinations. Thanks to the cooperation of patients, keeping the professional rules, the up-to-date technical equipment and the practice of assistants and specialists, complications hardly occur.

HOW CAN EXAMINATIONS BE APPLIED?

Interventions are carried out on inpatients only, examinations are applied by doctors.

ARE THERE ANY SIDE EFFECTS?

The local anesthesia may be followed by tension, hipping feeling. Skin disinfectant may cause skin inflammation in case of patients with sensitive skin. The puncture of the liver may cause pain for a short period of time.

HOW DOES AN EXAMINATION TAKE PLACE?

The intervention takes place under small operation room circumstances, in lying position and with empty stomach. After the local anesthesia is administered into the right hand side ribs area or in the place of chosen via ultrasound the needle is inserted. The biliary is searched for with the needle and the contrast material is injected into it. After filling up the biliaries a thin, soft-ended wire is pushed through the narrowed or obstructed biliary. Afterward a plastic tube is pulled onto this wire (catheter), which will be in charge of connecting the biliary with the small intestines. A few days later, the biliary is supported from inside with a thin metal mesh or plastic tube to ensure the effluent exits in the direction of the small intestines over a longer period of time.

Should making the obstruction permeable be unsuccessful, a thicker catheter can be used. The permeability and expansion of the obstructed biliary by tensioning may be followed by pain; a stronger analgesic may also be ingested accordingly. Until the completion of the treatment the introduced catheter can be fixed to the skin for a few days, maybe for even longer time to prevent the slip-out from the biliary. If major gall trickling can be observed at the place of puncture after removing the catheter, it will be locked in the liver so that no gall may be trickled into the stomach cavity.

Minor tensioning feeling may follow introduction of the catheter. The movements of the catheter in the biliary can’t be felt.

WHAT SHALL WE DO BEFORE THE EXAMINATION?

On the day before the examination don’t have a meal after dinner and consume non-fizzy mineral water only. If you fear or you are anxious, which can be considered as natural, take sedatives or a sleeping pill for the night. Consult your doctor about this! In the morning of the intervention don’t eat and drink. If you suffer from high blood pressure or you take pills regularly due to a heart condition, these should be ingested. Taking anticoagulants and certain medicines for diabetes are prohibited. Ask your doctor or the radiologist specialists in charge of the examination!

WHEN ARE FINDINGS AVAILABLE?

The examining doctor receives the findings after a couple of hours following the examination. If consultation is requested, this time may be extended.

TIME FOR APPOINTMENT?

• On the expense of social security, with referral 3-10 days
• For charged services not available for Hungarian patients

More frequesnt intervetions: cell and tissue samples

IN WHAT CASES IS IT RECOMMENDED?

The aim of taking samples is to gain insight to the deformations of unknown origin detected by other methods. These samples then undergo cytological examination. This is necessary because the treatment of the diagnosed diseases shall be fundamentally defined by its histological nature. A great advantage of this method is that there is no need for surgery exploration for taking samples. It may occur that pathological cells are not found in the gained samples. However, if the negative histological or cytological result is not confirmed by laboratory and clinical results, but there is still the disease is suspected, then the sample-taking process has to be repeated.

FOR WHAT AGE?

For any age-group if indicated.

DOES IT HAVE ANY RISKS?

Cytological sample taking has practically no risk. Accidentally minor bleedings may occur which is probable after several sample excisions only. This may be a bit unpleasant, but will be absorbed within a few weeks, and completely healed without causing any damage. In case of tissue samples thin tissue cylinders shall be cut out from the given organ and sent to tissue processing. In such cases hemorrhage may occur more often. If the wall of the artery is included in the sample, a major bleeding may also occur. In these very rare cases, the blockage of the artery may be necessary.

Rarely other side effects may occur as well, these are characteristic to the given organ: i.e. the injury of biliary in the liver, the injury of cavity system within the kidney, the shaping of alveoli in the lung and respiratory. Generally these are resolved spontaneous or upon medical interaction. These are not to be considered as complications since they may rarely occur during sample taking. In order to avoid bleeding complications this intervention is performed only after bleeding-coagulation examinations have been performed and found satisfactory.

Specialists and professional assistants perform interventions with remarkable practice using cutting-edge, technically regularly controlled equipment. For our examinations we use only internationally accepted instruments and equipment as well as contrast material of excellent quality.

HOW CAN THE EXAMINATION BE APPLIED?

The intervention is applied by the specialist in charge of the treatment on the basis of the results of other completed examinations.

ARE THERE ANY SIDE-EFFECTS?

The local anesthesia is followed by a slight tension, stinging feeling. Skin disinfectants may cause skin inflammation for patients with sensitive skin. The puncture of the liver may cause short occasional pain.

HOW DOES AN EXAMINATION TAKE PLACE?

During the course of sample acquisition a thin needle is led into the pathological organ after appropriate anesthesia, through which the cell effluent exits with the help of a respective injector. The cells acquired are sent for further processing fixed to a plate.

In course of sampling a tissue (tissue cylinder) shall be cut out across the inserted needle by the assistance of a special cutting instrument. In this case we can transfer not only the cells but also minor pieces of tissue for histological evaluation.

If the gained sample is noticeably (macroscopically) insufficient, or the quality is low the process has to be repeated. Naturally you will be informed about this in the process.

WHAT SHALL WE DO BEFORE THE EXAMINATION?

On the day before the examination no food should be eaten after dinner and only non-fizzy water may be consumed. If you feel anxious or frightened, which can be considered as natural, take sedatives or a sleeping pill for the night. Consult your doctor about it! In the morning of the intervention do not eat or drink. If you suffer in diseases of high blood pressure or take pills regularly due to a heart condition, you should take them. Taking anticoagulants and certain medicines for diabetes are prohibited. Ask your doctor or the radiologist specialists in charge of the examination!

WHEN WILL FINDINGS BE ISSUED?

The doctor receives the findings within few hours after the examination. If consultation is necessary, this time can be prolonged.

A cytological and histological results require a few days waiting time.

BOOKING FOR APPOINTMENT?

• On the expense of health insurance, with referral 3-10 days
• For charged services not available for Hungarian patients