One example of the available interventional radiology therapies at ACH involves treatment of venous system conditions. Interventional radiology commonly treats patients with distended malformed veins (venous sclerotherapy), stenotic veins (venous angioplasty), thrombosed veins (venous thrombolysis), and venous system catheter foreign bodies (snare retrieval). Placement of peripherally inserted central catheters (PICC) is the most common venous procedure performed. PICCs allow for prolonged venous access so that pediatric patients can receive stable intravenous therapy inside or outside the hospital.

Interventional radiology technologists prepare this child for a tube change procedure.

Additional organ systems frequently entered percutaneously include the peritoneal cavity (abscess drainage), urinary tract (nephrostomy, ureteral stent placement), and gastrointestinal tract (gastrostomy, gastrojejunostomy, cecostomy). Some of these techniques provide definitive therapy, while others complement existing surgical procedures. For instance, the complete surgical resection of congenital vascular lesions is much more likely following interventional radiology devascularization. Operative time and surgical blood loss are significantly reduced.

Pediatric interventional radiologist monitors progress of procedure under imaging guidance.

Percutaneous Cecostomy
Some of the techniques implemented by the ACH Interventional Radiology service are performed at only a few pediatric centers in North America. For instance, radiologic placement of percutaneous cecostomy tubes is a relatively new technique that establishes a reliable bowel program in patients with fecal incontinence due to an underlying neurologic abnormality (spina bifida, imperforate anus, spinal cord injury, etc.). These patients have spontaneous bowel accidents that have failed multiple therapies such as dietary changes, oral medications, and rectal enemas. As a result, they have limited activities and independence. These patients are referred to the Interventional Radiology service by the Spina Bifida team at Arkansas Children's Hospital or from physicians outside of Arkansas who are becoming familiar with our treatment program.

Satisfied patient moments after a Cecostomy tube change procedure.

A cecostomy tube is placed under intravenous sedation following a two-day bowel preparation. A three-day hospital stay is routine to monitor for any post-procedural complications. One week following discharge, the patient begins antegrade enemas via the cecostomy tube. The scheduled enema regimen eliminates bowel accidents. Long-term follow-up by the Interventional Radiology nurses is imperative in patient education and dealing with problems that may arise with this bowel program. Most patients report significant improvement in their lifestyle while maintaining or resuming activities such as swimming, sports, travel, or maintaining a job. Many patients can administer the enemas independent of parents or caregivers, leading to improved self-esteem.

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