During Inferior Vena Cava (IVC) filter placement, a filtering device is placed within the IVC, a large vein in the abdomen that returns blood from the lower body to the heart. Blood clots in the veins of the legs and pelvis can occasionally travel to the lungs where they may cause a pulmonary embolism or blockage. IVC filters help reduce the risk of pulmonary embolism by trapping large clots and preventing them from reaching the heart and lungs. They have a high rate of success in patients who don’t respond to or cannot be given conventional medical therapy
Endoleak, repair may include:
- Special balloon stents
- Extending the stented area of the aorta by placing stents beyond the leaking end of the graft
- Placing special cuffs at the end of the graft
- Use of special glue-like materials to close off the graft
- If the graft cannot be repaired using an endovascular technique, you may need an open repair/surgery to remove the stent graft and repair the aneurysm in standard open fashion
Vertebroplaty is a surgical procedure designed to stop the pain caused by a spinal fracture. This involves making a small incision in the back through which the doctor places a narrow tube. Using fluoroscopy to guide it to the correct position, the tube creates a path through the back into the fractured area through the pedicle of the involved vertebrae. The doctor then uses specially designed instruments under low pressure to deliver a cement-like material to stabilize the facture.
Pelvic fractures (sacral) are common particularly in patients with osteoporosis. When the sacrum fractures, pain is produced that can be debilitating. Unlike and extremity fracture we cannot provide a direct plaster or fiberglass cast. Conservative therapies such as rest and analgesics can help but many fractures do not respond to such treatment. Sacroplasty is a technique that “internally casts” a sacral fracture with liquid cement and provides significant pain relief.
Radiofrequency ablation (or RFA) is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area.
Cryoablation is used for palliative pain control of tumors that involve the bone and/or soft tissues.
Liver Radiofrequency ablation is a treatment used in the treatment of inoperable primary liver cancer or metastatic tumors. Using Ultrasound guidance a probe is placed which will then deliver a High-frequency electrical current is used to destroy cancer cells.
Cryoablation is the process of using freezing temperatures to destroy cancer cells. It is used to treat tumors that have originated in the liver or have spread to the liver from another site. Cryoablation is often used as an alternative or an adjunct to conventional surgery.
During cryoablation, a probe circulating liquid nitrogen is placed in contact with the tumor, causing the cells to freeze. The tumor is frozen, thawed, and refrozen until the malignant cells are completely destroyed. This process is monitored with ultrasound in order to preserve as much nearby healthy tissue as possible.
Microwave ablation (MWA), destroys liver tumors using heat generated by microwave energy. With microwave ablation, a small laparoscopic port or open incision is used to access the tumor. A CT scan or ultrasonic guidance is used to pinpoint the exact location of the tumor. A thin antenna, which emits microwaves, is then inserted into the tumor. The probe produces intense heat that ablates (destroys) tumor tissue, often within 10 minutes.
Microwave ablation has a number advantages when compared to traditional RFA, a standard method for ablating liver tumors, These include:
- Speed – Microwave ablation (MWA) is faster than RFA, destroying tumors more efficiently, and reducing the time patients remain under general anesthesia.
- Simultaneous Tumor Ablation – With MWA, surgeons can ablate multiple liver tumors at the same time.
- Larger Tumor Size – MWA can ablate larger tumors than are possible with RFA.
Uterine fibroid embolization (UFE) is a minimally invasive procedure used to treat fibroid tumors of the uterus which can cause heavy menstrual bleeding, pain, and pressure on the bladder or bowel.An incision, the size of a freckle, is made in your upper thigh. A tiny catheter is inserted through this incision and into the femoral artery. Using x-ray guidance, a trained physician locates the arteries which supply blood to each fibroid. Microscopic inert particles are injected into the vessels, blocking blood supply that nourishes the fibroid. Without a steady blood supply, the fibroids begin to dwindle and shrink.
Gonadal Vein Embolization is used for women with pelvic congestion syndrome (varicose veins in the pelvic area) and men with varicoceles (varicose veins in the scrotum). This minimally invasive treatment is a catheter-based technique used to treat abnormal vessels or veins.
During the procedure, which is performed under local anesthesia or mild sedation, your interventional radiologist will thread a catheter from the femoral vein or the jugular vein in the neck into the faulty varicose veins.
Through the catheter, the doctor will insert one or more coils, along with a sclerosing agent, that clots the blood and seals off the faulty vein(s). The sclerosing agent also travels into the tiny secondary branches of the blood vessels to close them off (these vessels typically cause recurrences with surgical ligation).
When the patient stands up, the vein is closed and blood no longer fills the varicose veins in the scrotum or pelvic area. The veins and pain from the varicosities goes away. For many men, their sperm count and motility also improve.
Renal Tumor Cryoablation is a treatment used to kill cancer cells with extreme cold.
During cryoablation, a thin, wand-like needle (cryoprobe) is inserted through your skin and directly into the cancerous tumor. A gas is pumped into the cryoprobe in order to freeze the tissue. Then the tissue is allowed to thaw. The freezing and thawing process is repeated several times during the same treatment session.
Cryoablation may be used to treat cancer when surgery isn’t an option.
Chronic venous occlusion can develop as a result of underlying DVT resulting in swelling, pain, ulceration and venous claudication of the lower extremity. Venous stenting as directed a restoring normal venous flow.
Endovenous laser ablation (also called EVLT for endovenous laser treatment) is a minimally invasive procedure performed in a physician’s office or clinic, for the treatment of varicose veins. During an endovenous ablation procedures, your doctor inserts a laser fiber through the skin and directly into the varicose vein. The laser heats the lining within the vein, damaging it and causing it to collapse, shrink, and eventually disappear. Because these veins are superficial, they are not necessary for the transfer of blood to the heart. This technique typically is used to treat the large varicose veins in the legs and takes less than 30 minutes to perform.
Varicose Radiofrequency Ablation is a minimally invasive procedure performed in a physician’s office or clinic, for the treatment of varicose veins. During an endovenous ablation procedures, your doctor inserts a thin tube (catheter) through the skin and directly into the varicose vein. Radiofrequency energy is then delivered to the lining within the vein, damaging it and causing it to collapse, shrink, and eventually disappear. Because these veins are superficial, they are not necessary for the transfer of blood to the heart.
A hemodialysis access, or vascular access, is a way to reach the blood for hemodialysis. The access allows blood to travel through soft tubes to the dialysis machine where it is cleaned as it passes through a special filter, called a dialyzer.
Angioplasty and stenting are performed by making a small incision in the skin above an artery in the arm or groin in order to access the artery. The physician then threads a balloon-tipped catheter from the incision site through the arterial system to the leg artery that is blocked or narrowed.
Once the balloon is positioned under the plaque, the physician inflates it to break up and compress the plaque and widen the blood vessel, improving blood flow through the artery. In some cases, the physician may then insert a stent, a small metal-mesh tube, to prop open the artery following angioplasty.
When angioplasty is successful, it has excellent results. Approximately 60 to 70 percent of patients who have an angioplasty have patent vessels, or vessels that remain open to provide adequate blood flow to the legs, 2 years after the procedure.
The initial failure rate for angioplasty in patients with leg artery disease is only about 10 percent. Failure may occur if the catheter is unable to move through the blockage or a weakened artery collapses after angioplasty and is impossible to keep open.
For patients who have deep vein thrombosis (DVT) or pulmonary embolism (PE), an endovascular thrombectomy may be performed. This procedure is designed to rapidly break up the clot, restore blood flow within the vein, and potentially preserve valve function to minimize the risk of post-thrombotic syndrome.
Using image guidance, a vascular surgeon inserts a catheter into the popliteal (located behind the knee) or other leg vein and threads it into the vein containing the clot. The catheter tip is placed into the clot and a “clot busting” drug is infused directly to the thrombus (clot). The fresher the clot, the faster it dissolves, usually in one to two days.
Any narrowing in the vein that might lead to future clot formation can be identified by venography, an imaging study of the veins, and treated by the physician with a balloon angioplasty or stent placement.
For patients who are not good candidates for a thrombectomy and for whom blood thinners are not medically appropriate, the physician can insert a vena cava filter, a small device that functions like a catcher’s mitt to capture blood clots but allow normal liquid blood to pass.
For the treatment of DVT and to prevent a blood clot from traveling to the lungs, vascular surgeons like Dr. Julien can perform a minimally invasive procedure to break up the clot.
There are a growing number of patients who survive end-stage renal disease for long periods because of improvement in patient care. The central veins are the sites of many complications that are unavoidable by these patients. Endovascular management, including angioplasty and/or stent placement, is the treatment of choice
A port is a small medical appliance that is installed beneath the skin. A catheter connects the port to a vein. Under the skin, the port has a septum through which drugs can be injected and blood samples can be drawn many times, usually with less discomfort for the patient than a more typical “needle stick”. Ports are used mostly to treat hematology and oncology patients.
A peripherally inserted central catheter (PICC or PIC line) is a form of intravenous access that can be used for a prolonged period of time (e.g. for long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition).
For most vascular conditions, we can perform a minimally invasive treatment called embolization. It is used to treat abnormal vessels or veins.
Under local anesthesia, possibly with a mild sedative, we make a tiny incision to access the blood stream through the femoral artery in the groin or the jugular vein in the neck. A tiny catheter and needle are inserted through the blood stream and navigated to the vein where we can address the problem.
We may need to close off a vein or insert a device to open the vein, and there are several ways to do that, depending on the location and type of vein problem.
Embolization procedures reduce or cut off the supply of blood to a tumor or abnormal growth. To perform embolization, interventional radiologists use imaging guidance to insert a catheter into a primary artery and advance it to blood vessel leading to a tumor or other area where the bloody supply needs to be blocked. Special substances which clot and form a blockage are then injected.
Embolization is often used to treat internal bleeding and help prevent heavy bleeding during surgery. In some cases, embolization may be a treatment option for difficult-to-reach, inoperable tumors. It may also be used to treat tumors that are too large to be ablated.
Embolization can be used to treat:
- Metastatic cancer in the liver
- Neuroendocrine tumors
- Uterine fibroids
The sphenopalatine ganglion and its association with various pain disorders has been well established. The Shenopalatine block delivers an anesthetic through the nasal cavity, effectively blocking migraine pain without the use of needles, cotton swabs or harsh medications. This low risk simple treatment is a game-changer for anyone who experience four or more severe headaches a year. Some patients may feel a slight nasal irritation upon delivery. Patients can usually return to normal activities within 15 minutes. Other conditions such as migraines, cluster headaches, TMJ pain, head/neck pain, and trigeminal neuralgia have shown excellent response to this therapy.