10 Interventional Radiology Procedures—and Why Minimally Invasive Is Not Risk-Free

Interventional radiology remains an established medical specialty built around minimally invasive, image-guided diagnosis and treatment. The Society of Interventional Radiology’s patient guidance, updated in February 2025, describes ultrasound, X-ray, CT and MRI as tools that let physicians navigate and treat conditions inside the body, sometimes avoiding an operation that would require a larger incision.

What needs correcting is the idea that every procedure is painless, requires no hospital stay or is automatically safer than surgery. The benefit depends on the disease, the imaging method, the access route and the alternative treatment. The following ten procedure families are among the most useful ways to understand what interventional radiologists actually do; they are not a ranking, and several may be combined during one episode of care.

Ten major interventional radiology procedure families

The field extends well beyond blood vessels. A current King’s College Hospital service page lists diagnostic biopsies alongside angioplasty, embolisation, ablation and procedures that deliver treatment directly to tumours. It also shows why “interventional radiology” describes a method of reaching a target under imaging, not one treatment for every condition.

1. Angiography. A catheter is advanced into a blood vessel and contrast material is introduced while X-ray images are taken. This maps narrowing, obstruction, bleeding or abnormal vessels and can supply the information needed for an immediate treatment, although a diagnostic angiogram does not itself reopen an artery.
2. Angioplasty and vascular stenting. A balloon mounted on a catheter is inflated across a narrowed vessel to improve its internal channel. A stent may then be placed to support the vessel, but patients may still need medication and follow-up imaging because treated segments can narrow again.
3. Catheter-directed thrombolysis or thrombectomy. Selected blood clots can be treated by delivering a clot-dissolving drug close to the blockage or by removing clot with a catheter-based device. Eligibility is time-sensitive in some emergencies and depends heavily on bleeding risk, clot location and the surrounding clinical circumstances.
4. Embolisation. Particles, coils, plugs or other agents are delivered into selected vessels to reduce or stop blood flow. Applications include controlling haemorrhage, treating some vascular abnormalities and reducing blood supply to certain tumours or uterine fibroids; the intended target and embolic material vary substantially between procedures.
5. Image-guided tumour ablation. A probe is positioned within a tumour using CT, ultrasound or another imaging technique. Heat or extreme cold then destroys targeted tissue. Ablation may be considered for selected liver, kidney, lung, bone or other lesions, but tumour size, number, location and proximity to vulnerable structures affect whether it is suitable.
6. Image-guided needle biopsy. Ultrasound or CT helps the physician direct a needle into an abnormal area and collect tissue for laboratory analysis. This can avoid an open diagnostic operation, but it is a diagnostic procedure rather than a treatment and may occasionally produce an insufficient sample.
7. Percutaneous drainage and organ decompression. A needle and catheter can drain an abscess or fluid collection. Related procedures include nephrostomy, which drains an obstructed kidney, and biliary drainage for an obstructed bile duct. The catheter may need to remain temporarily and requires care to prevent blockage or displacement.
8. Central venous access. Imaging guidance is used to place a peripherally inserted central catheter, tunnelled line or implanted port into a large vein. These devices can provide routes for chemotherapy, long-term antibiotics, nutrition or other repeated treatments; they also carry risks such as infection and thrombosis.
9. Radiologically inserted gastrostomy. A feeding tube is placed through the abdominal wall into the stomach using imaging guidance when oral nutrition is inadequate or unsafe. It provides enteral access without conventional open surgery, but tube-site care and assessment of aspiration, bleeding and infection risks remain necessary.
10. Inferior vena cava filter placement and retrieval. A filter can be positioned in the large abdominal vein to intercept clots before they reach the lungs. It is generally reserved for selected patients in whom pulmonary-embolism protection is needed and anticoagulation cannot be used or has not provided adequate protection; retrievable filters require an explicit follow-up plan.

Where the benefits come from

The central advantage is targeted access. A physician can reach a vessel, organ or lesion through a needle puncture or small skin opening while watching the instrument’s position. Compared with an appropriate open operation, that may mean a smaller wound, less disruption of surrounding tissue and a shorter recovery.

Many procedures use local anaesthesia with pain relief or sedation, and some can be completed as day cases. Those are possibilities rather than guarantees. Complex ablation, emergency embolisation and interventions involving unstable patients may require general anaesthesia, intensive monitoring or an overnight stay.

IR can also complement surgery instead of replacing it. Embolisation may control bleeding before or after an operation, a drain may stabilize an infection before definitive treatment, and a biopsy may identify which therapy should follow. The meaningful comparison is therefore not simply “IR versus surgery,” but the expected outcome and burden of every reasonable option for a specific patient.

The risks that “minimally invasive” does not remove

Small access points do not make a procedure risk-free. Potential complications include bleeding, infection, injury to a vessel or nearby organ, reaction to contrast material, impaired kidney function in susceptible patients and failure to achieve the intended result. Embolisation can affect unintended tissue, ablation can damage adjacent structures, and vascular devices can clot, migrate or become infected.

Imaging also matters. Ultrasound and MRI do not use ionising radiation, whereas fluoroscopy and CT-based procedures may do so. RadiologyInfo’s physician-reviewed radiation guidance explains that exposure varies with procedural complexity and that rare skin injury can occur after lengthy, radiation-intensive interventions. Pregnancy, previous contrast reactions, kidney disease and cumulative imaging history should therefore be raised with the treating team when relevant.

Pain is another area where absolute claims mislead. Local anaesthetic can reduce discomfort at the access site, but pressure, cramping or post-procedure pain may still occur; uterine fibroid embolisation and some tumour ablations can require substantial pain management. Recovery instructions differ accordingly.

How to judge whether an IR procedure is the right option

The most useful consultation compares the proposed intervention with medication, observation, endoscopy and surgical alternatives. Ask what clinical goal is realistic: obtaining a diagnosis, stopping bleeding, restoring flow, relieving an obstruction, controlling symptoms or treating a defined tumour. A technical success—such as placing a stent—does not always guarantee lasting symptom relief.

Patients should also ask which imaging method will be used, what anaesthesia is planned, whether admission is likely and what follow-up is required. Medication review is particularly important for anticoagulants, antiplatelet drugs and medicines affected by kidney function. Instructions about fasting or stopping medication must come from the treating service rather than a general article.

Interventional radiology’s enduring value is precision with limited physical access, not a promise of zero pain, zero complications or instant recovery. Its best use is a carefully selected procedure with a defined objective, an experienced multidisciplinary team and a clear plan for aftercare or further treatment.

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