VASCULAR TREATMENTS – ARTERIAL INTERVENTIONS
Arteries and Veins are creating a network of blood carrying vessels from the heart to our organs and back. Connected to the heart, the pump, they are important life sustaining parts of our cardio-vascular system.
The arteries are thick vessels carrying oxygenated blood from the heart to the rest of our body.
Treatment
Leg Artery Angiogram and Angioplasty (Stent/Balloon Dilatation)
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When the leg arteries are diseases, showing narrowing and blockages inside, the blood flow is compromised, and we notice it because of pain in the legs when we are walking.
What is Arterial Angioplasty and how does it work?
Reopening these blockages is the main task of this intervention. As with all minimally invasive endovascular procedures, we enter through a small needle puncture in your groin or your wrist. Small catheters and very fine soft wires will be introduced all the way to the blockage, while injecting contrast media to visualize the entire performance on the monitor.
Once the blockage has been found, we proceed with the treatment: In general, we can dilate the narrow area with special balloons, or we can place a stent inside the artery, which will remain afterwards. Stents are thin metal devices that will keep the artery open.
What intervention is right for you will be decided by your Endovascular specialist performing the procedure, based on your individual problem. At times, if the blockage is very calcified, we may need to drill through the narrowing first, before being able to place the balloon or stent.
At the end, everything except the stent may be removed and the access point will be closed with special arterial devices or with a simple pressure bandage. In case of groin access, you will have to spend the night in the hospital.
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Why would you need it?
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Leg artery blockages can cause difficulty walking, pain in the calf area, or thighs and sometimes, even higher up in the hips. The reduced blood flow to our leg muscles Because of reduced blood flow, the muscles of our legs start aching, this way calling for attention and help.
In case of severe blockages or complete blockages, the lower part of your legs, the toes and the feet, start becoming necrotic, causing non-healing leg ulcers or even gangrene of toes and the feet.
If a significant narrowing or a blockage is being diagnosed by Echo-doppler exam or Angio-CT scan, you need an intervention for reopening the vessel.
Risk involved
The Balloon/Stent angioplasty is a minimally invasive procedure. Our ability to use imaging guidance and cutting-edge technology minimizes patient risk. However, your doctor will inform you in detail about your individual risks involved.
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Conditions to let us know about
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As with all procedures involving X-rays and contrast media, let your doctor know if you are currently pregnant or breast feeding and inform your doctor about possible allergies.
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Preparing for your procedure
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You may be sent for an Angio-CT scan prior to planning the intervention. You must be fasting at least 6 hours prior to the procedure.
Please discuss with your doctor what medications you are taking on a regular basis. Some, like blood thinning medications and diabetes medications may need to be paused some days prior.
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Insurance coverage
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Leg artery angioplasty is covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.
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Recovering from your procedure
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You will not undergo general anesthesia. You will be returned to your regular room right after the intervention. The vascular access will be monitored for bleeding complications overnight. You will have to keep your leg straight.
You will be given written post procedure discharge instructions that will advise you about return to normal physical activity.
Other locations of atherosclerosis
Other arteries in the body may also be affected by atherosclerosis. In this case, the same procedure will be performed only in different anatomic areas.
For example:
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Mesenteric Artery Angioplasty
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The main artery to the stomach and small intestine is often affected by atherosclerosis causing the typical symptom of abdominal angina: stomachache after food ingestion
In this case, angioplasty may be indicated. Again, we access the body from the radial artery or the groin and navigate to the mesenteric artery, where we will proceed with balloon dilatation or a stent insertion, exactly the same way as described above under “leg artery angioplasty”.
Risks involved, preparation and post procedure care and recovery are also similar to the “leg artery angioplasty” procedure described above.
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Renal Artery Angioplasty
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When the main renal arteries are affected by severe atherosclerosis causing significant blockages, (renal artery stenosis) the kidney function will deteriorate. Another aspect is increased blood pressure. The kidneys are being tricked into „thinking“ that the Blood pressure is rather low, therefore counter-regulating to higher blood pressure levels.
Standard medications to lower the Blood pressure often are not successful if renal artery stenosis is present. In this case, angioplasty may be indicated. Again, we access the body from the radial artery or the groin and navigate to the renal arteries, injecting contrast media and determining the location of the arterial blockage.
Then we will proceed with balloon dilatation or a stent insertion, exactly the same way as described above under “leg artery angioplasty”.
Risks involved, preparation and post procedure care and recovery are also similar to the “leg artery angioplasty” procedure described above.
Treatment
Abdominal Stent Graft
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Abdominal aortic aneurysm stent grafts are performed to treat large aneurysms in the abdominal section of the aorta which could otherwise lead to life-threatening rupture.
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What is an abdominal aortic stent graft?
During the procedure, an interventional radiologist advances a catheter through a small incision in the groin to the site of the aneurysm.
Through the catheter, the radiologist places a fabric metal mesh tube (stent graft) that is long enough to span the bulging area.
The stent exerts outward pressure against the graft and artery to keep the graft snuggly in position. The blood then flows through the graft and bypasses the aneurysm.
Without the pressure of flowing blood, the aneurysm will eventually shrink, and the risk of rupture is greatly reduced.
Why would you need an abdominal aortic stent graft?
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Abdominal aortic aneurysms can weaken the aorta, your body’s largest blood vessel. This can develop into a potentially serious health problem that can be fatal if the aneurysm bursts, causing massive, life threatening internal bleeding.
Sometimes it dissects, ruptures within its own vascular wall layers, causing damage even down to the leg arteries.
Risks involved, preparation and post procedure care and recovery are also similar to the “leg artery angioplasty” procedure described above.
Detailed explanation specific for your case will be given to you prior to the procedure by your doctor.
VASCULAR TREATMENTS – VENOUS INTERVENTIONS
Arteries and Veins are creating a network of blood carrying vessels from the heart to our organs and back. Connected to the heart, the pump, they are important life sustaining parts of our cardio-vascular system.
Veins are low pressure blood vessels that are designed to return low oxygen blood to the heart. Veins have thin walls and use delicate valves to help the blood move.
The most common diseases of the veins usually involve blood clots (Thrombosis of deep veins) and venous reflux (varicose veins).
Catheter-Directed Thrombolysis and Thrombectomy
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Treatment
Blood clots, also known as deep vein thrombosis (DVT), can be a very serious condition. Besides oral blood thinning therapy, minimally invasive procedures may be needed.
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What is Catheter-Directed Thrombolysis and Thrombectomy?
Catheter-directed thrombolysis and thrombectomy is a minimally invasive treatment options that use medication directed into the clot using a medical device to break up and dissolve abnormal blood clots.
In a catheter-directed thrombolysis procedure, X-ray imaging is used to help guide a special medication to the site of blood clots to dissolve the blockage.
During the procedure, an interventional radiologist will insert a catheter through the skin into a vessel (artery or vein) and maneuver it to the site of the thrombosis, or blockage.
The blood clot will then be dissolved by delivering medication directly to the blood clot to break up the clot. Once the blood clot is dissolved by delivering medication directly to the blood clot, a mechanical device at the site is used to break up the clot and aspirate it.
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Why would you need Catheter-Directed Thrombolysis and Thrombectomy?
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Benefits of catheter-directed thrombolysis include improved blood flow, reduction and-or elimination of symptoms and effects without the need for more invasive surgery. Thrombolysis is a safe, highly effective way of re-establishing circulation blocked by a clot. In addition, it is less invasive than conventional open surgery.
The procedure requires only a small nick in the skin as opposed to a traditional surgical incision. In addition, the hospital stay is relatively brief.
Recent medical publications on pharmaco-mechanical thrombectomy have reported the advantages of faster symptom relief, less procedure time, reduced time in the ICU, shorter hospital stays and subsequent cost savings.
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Pulmonary Vein Thrombectomy
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In case of a pulmonary vein intervention, the goal is to rapidly remove the life threatening blood clot from the lung vein and reestablish normal blood flow as soon as possible. Large blood clots stuck in a pulmonary vein can be very dangerous causing respiratory and heart failure at the same time, because the blood flow between heart and lung is completely occluded.
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Risks Involved
Pulmonary Vein Thrombectomy is an emergency procedure
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Our ability to use imaging guidance and cutting-edge technology minimizes patient risk. Prior to your procedure, you will discuss your individual potential risks with your doctor.
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Conditions to let us know about
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As with all procedures involving X-rays and contrast media, let your doctor know if you are currently pregnant or breast feeding and inform your doctor about possible allergies.
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Preparing for your procedure
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You must be fasting at least 6 hours prior to the procedure.
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Please discuss with your doctor what medications you are taking on a regular basis. Some, like blood thinning medications and diabetes medications, may need to be paused some days prior.
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Insurance coverage
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Emergent Pulmonary Thrombectomy is covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.
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Recovering from your procedure
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You will not receive general anesthesia during your procedure; however, sometimes light sedation may be necessary to make you feel more comfortable. You will stay in the monitored observational area for at least 8 hours after the intervention, then you will be transferred to the regular room until you are ready for discharge – all depending on your overall condition.
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Inferior Vena Cava Filter Placement and Removal
Treatment
A little life-saving filter in the main vein
What is a Vena Cava Filter and how does it work?
The filter is a small umbrella-like device which is placed inside the Vena cava, the main vein in our body connecting the leg veins with our heart and lung. Blood clots forming in the legs tend to get displayed and flushed into the lungs passing through the large vena cava.
Placing this filter acts like a barrier stopping the passages of clots while allowing liquid blood to get through. The goal is to prevent major embolization events into the lungs, which may be fatal.
The vein is accessed through the groin, the filter introduced via a thin catheter. Placement will be monitored with contrast media and Xray control, once in place, the device is detached from the catheter and remains in place until it is indicated to get removed.
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Why would you need a Vena Cava Filter?
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We place these filters to prevent blood clots from reaching the lungs (pulmonary embolization). In case standard blood thinning is not sufficient to prevent blood clot formation, or blood thinning is contraindicated due to other conditions, you may need such a device.
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Risks Involved
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Our ability to use imaging guidance and cutting-edge technology minimizes patient risk. Prior to your procedure, you will discuss your individual potential risks with your doctor.
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Conditions to let us know about
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As with all procedures involving X-rays and contrast media, let your doctor know if you are currently pregnant or breast feeding and inform your doctor about possible allergies.
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Preparing for your procedure
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An Echo-doppler exam of your leg veins may be performed prior to starting the intervention. You must be fasting at least 6 hours prior to the procedure.
Please discuss with your doctor what medications you are taking on a regular basis. Some, like blood thinning medications and diabetes medications, may need to be paused some days prior.
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Insurance coverage
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Insertion of a Vena Cava Filter is covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.
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Recovering from your procedure
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You will not receive general anesthesia during your procedure; however, sometimes light sedation may be necessary to make you feel more comfortable. You will be transferred to the regular room until you are ready for discharge. You will be given written post procedure discharge instructions that will advise you about return to normal physical activity.
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Varicose Vein Treatments
Treatment
The delicate valves in the veins do not function properly
What are Varicose Vein treatments?
The other disease we see commonly with regards to veins is referred as varicose veins. This means that the delicate valves in the veins do not function properly and as a result gravity pulls on the blood and causes it to pool in the legs and superficial veins. Reflux often runs in families.
Cosmetic sclerotherapy:
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Injection of sclerotherapy solution into the finest relish/purple veins under the skin, the spider nevi. These are not dangerous condition, but mostly cosmetically bothersome. The procedure is performed with very thin needles, you may or may not even feel slight skin pricks. No local anesthesia necessary.
The little veins disappear over a few days, as they are being sclerosed from the inside.
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Foam sclerotherapy of larger varicose veins:
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Introduction of a small catheter into the thick, visible varicose vein. Under echography control, we will inject a special foam into the vein, which over time will cause the vein to collapse and dissolve. Only local anesthesia is necessary.
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Radio Frequency Ablation (RFA) for leg veins:
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Introduction of a small catheter into the varicose vein we want to treat. A catheter is then introduced and placed all the way to the end of the vein, under Echo control. After thorough local anesthesia, the Radio Frequency Ablation generator will be started, which is applying heat to the vein, causing significant damage which will make the vein shrink and disappear. The catheter is being pulled slowly and removed.
Some discomfort may arise after the procedure, oral pain control however is sufficient. The patient goes home immediately after the procedure, there is no anesthesia involved.
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Why would you need a vein/varicose vein treatment?
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Cosmetic appearance is the most common reason for these procedures. Often however, varicose veins get inflamed causing pain and swelling, venous insufficiency often causes leg swelling and skin ulcerations, which require the treatment of the underlying problem.
We recommend comprehensive venous evaluation and an Echo-doppler exam prior to venous therapy to be able to recommend the right treatment option for you.
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Risks involved
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Depending on the treatment option, your doctor will discuss all possible risks.
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Insurance coverage
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Some procedures are covered by insurance companies.
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Post-procedural care
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You must avoid sun exposure for the first weeks after the interventions. Also, you will wear compression stockings/hose after the vein treatment. We offer individually measured and tailored compression stockings and hose in different colors.
Because of the above post-interventional requirements, we don't perform these vein treatments in the hot summer season.
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