Venous Disease

Endovenous Radiofrequency Ablation

During radiofrequency ablation, a small catheter is thread into the malfunctioning vein through a tiny incision.  The catheter then heats up the vein walls causing the vein to collapse and close.  The blood is then rerouted to healthier properly functioning veins. The patient is able to return to most normal activities right away.

Sclerotherapy

Sclerotherapy is the injection of a chemical irritant through a tiny needle directly into smaller veins such as telangiectasia (spider veins) causing them to shrink and close.

DVT Thrombolysis

Catheter directed thrombolysis and thrombectomy have an increasing role in the treatment of Deep Vein Thrombosis (DVT).  Depending on the severity, location, and acuity of clot, different approaches may be taken but generally a small catheter is passed into the vein and a clot busting drug is delivered into the clot (thrombolysis) potentially followed by passage of a device which mechanically breaks up and sucks out the clot (thrombectomy).

IVC Filter Placement

When there is concern that part of the clot in the leg, DVT, may break off and head to the lungs or heart, an inferior vena cava (IVC) filter can be placed.  Usually these are placed temporarily.  Using imaging guidance, the interventional radiologist places the IVC filter, which acts like a sieve, into the IVC, the largest vein in the abdomen, to catch any possible traveling clots.

Interventional Oncology

Chemoembolization

Transarterial chemoembolization (TACE) is used to treat certain types of inoperable primary liver cancer. Through a tiny hole in the groin or wrist, an interventionalist threads a catheter, thin tube, into the blood vessels supplying the liver tumor.  The catheter delivers a high dose of a cancer-killing drug (chemotherapy) directly to the tumor.  The chemotherapy is attached to small particles which then serve to block the artery, starving the tumor of its blood supply and preventing the chemotherapy from washing away and affecting normal healthy cells throughout the rest of the body.

Y-90 Embolization

Radioembolization, also known as Selective Internal Radiation Therapy (SIRT) is very similar to chemoembolization but with injection of small spheres of radioactive substance.  It is used to treat both primary and certain metastatic liver tumors. The radioactive isotope Yttrium-90, attached to tiny spheres, is delivered directly into a liver tumor through a small catheter thread through the blood vessels. The spheres become lodged in the tumor and emit high doses of radiation from within.

Microwave ablation

Microwave ablation is a minimally invasive technique that uses electromagnetic waves to generate heat to destroy tumors. Using CT or ultrasound guidance, a small needle electrode is advanced through a tiny skin incision directly into the tumor. Ablation is less traumatic than surgery, so it is an alternative for those patients or tumors which are not amenable to surgery. It is often performed on an outpatient basis.

Pain Management

Kyphoplasty

Kyphoplasty is a minimally invasive treatment for painful vertebral compression fractures that do not respond to conventional medical therapy. Using x-ray guidance, a small needle is inserted into the fractured vertebrae. A balloon is inserted through the needle and inflated to help restore height to the bone and create a cavity for subsequent cement injection. The procedure provides a near immediate relief in pain and can prevent further collapse of the vertebrae, helping to avoid the spine curvature sometimes seen with osteoporosis. A similar procedure is performed for sacral insufficiency fractures called sacroplasty.

Liver disease

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

The blood vessels which drain the intestines, the portal veins, empty into the liver.  When the liver hardens due to cirrhosis, blood flow is obstructed and pressure builds in the portal vein like a kinked hose leading to bleeding and/or ascites (excess fluid in the abdomen).  A TIPS acts as a bypass around the hardened liver.  An interventionalist enters a blood vessel at the neck through a small incision, using x-rays, a catheter is guided through the blood vessel, through the heart, and into the liver. From there a needle is passed through the liver into the portal vein.  Using that access, the interventional connects the portal vein to the hepatic vein which eventually drains into the heart, bypassing the diseased liver. Patients are kept in the hospital for a few days afterwards to assess the success of the complex treatment and monitor for any complications.

Kidney failure

Hemodialysis Access and AVF maintenance

When patients reach the final stage of Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD), they will require renal replacement therapy.  We are able to provide temporary hemodialysis catheter placement as well as maintain already established access points. An arteriovenous fistula is a surgically created connection between an artery and vein which “arterializes” the vein and creates enough blood flow in your vein to allow your blood to be circulated and filtered by a dialysis machine.  If your AVF malfunctions or clots, a patient may not be able to receive adequate dialysis. We work with our referring nephrologists, dialysis centers, and patients to provide optimal surveillance, maintenance, and when necessary declot of AVFs.

Women’s Health

Pelvic venogram and embolization

Pelvic venous congestion syndrome is chronic pelvic vein and heaviness caused by faulty pelvic veins where blood flows backward into the pelvis.  An interventionalist advances a small catheter into a blood vessel in the groin via a tiny incision and manipulates the catheter into the pelvic veins. Contrast is injected into the veins to confirm the abnormal flow. Once confirmed, the interventionalist closes the vein through various methods, often using a small coil, to force the blood to flow out from the pelvis through other normal healthy veins.

Uterine Fibroid Embolization (UFE)

UFE is a procedure to treat benign growths in the uterine wall by starving them of their blood supply. A small catheter is advanced through a blood vessel in the groin or wrist down into the uterine artery in the pelvis. Once there, tiny particles are injected to block the artery and cut off the fibroids from their oxygen and nutrition causing them to shrink. The procedure usually requires an overnight admission for pain management. Patients are discharged with oral pain medications and can usually return to normal activities in a week. Nine out of 10 women report significant if not complete resolution of symptoms.

Men’s Health

Varicocele embolization

Through a tiny incision in the groin, a thin catheter is passed through the vein and directed toward the abnormally enlarged malfunctioning vein in the pelvis.  Once there, the interventionalist delivers tiny coils into the blood vessel to obstruct them and force blood flow through normal healthy veins. Patients are discharged home the same day.

Prostatic Artery Embolization

While surgical options exist for the management of benign prostatic hyperplasia (BPH), more and more patients are opting for a new procedure, Prostatic Artery Embolization (PAE), due to decreased recovery time, decreased pain, and decreased risk of sexual side effects. Using x-ray guidance, a small catheter is advanced through an artery in the groin into the blood vessel that supplies the prostate. Once identified, the blood vessel is occluded. Without nutrients and oxygen, the prostate shrinks.