Venous Interventions

Catheter-directed DVT thrombolysis

Deep vein thrombosis (DVT) is a blood clot in a vein, most often in the leg. Left untreated, it can lead to leg pain, swelling, leg ulcers and even the loss of mobility. Over time, the clot can break up and travel to the lungs, where it can lead to a serious condition called pulmonary embolism (PE).

Catheter-directed DVT thrombolysis is a minimally invasive procedure to treat DVT. An interventional radiologists guides a small catheter to the site of the DVT, where a special drug is administered directly into the clot, effectively dissolving it to remove the danger to the patient.

DVT thrombolysis has been shown to completely break down DVT blood clots more effectively than anticoagulation medication, as well as maintain better blood flow within the veins. Risks are minimal, and it can help to minimize future scarring of the veins from DVT. It is an outpatient procedure, and may require a 1-2 night hospital stay depending on the age of the clot.

Our interventional radiologists also specialize in chronic DVT (clots that are more than 2 months old). We also treat May-Thurner disease, including stenting of the iliac vein.

Inferior vena cava filter placement/removal (including complex extra caval filters)

An IVC filter is a small filter that is placed within the inferior vena cava, the large vein that transports blood back to the heart from the legs. It effectively “traps” clots within it, causing them to break up into smaller and less threatening pieces while also allowing blood to flow around it. IVC filters may be placed on a permanent or temporary basis to decrease the risk of pulmonary embolism.

During the procedure, an interventional radiologist uses imaging to guide a catheter into the inferior vena cava that contains the filter. A contrast material is injected into the vein to help assess the ideal location. The IVC filter is then placed in the correct position, where it expands to affix itself to the walls of the blood vessel.

If the placement of the IVC filter is not permanent, a future procedure to retrieve the filter will be necessary. This will happen when the threat of a pulmonary embolism has passed.

As a minimally invasive procedure, no surgical incisions are necessary. IVC filters have a high success rate when it comes to protecting patients from a pulmonary embolism. It is also an effective treatment for patients who are not able to control clots from forming with medication. Risks are rare, and include the potential for infection and an allergic reaction to the contrast material that is used to help position the filter.

In some cases, if an IVC filter remains in the body too long, it can move or fracture within the vein. AMIC interventional radiologists have specialized experience with the complex retrieval of fractured, embedded and penetrating IVC filters.

Varicose Veins and Spider Veins

Varicose veins are very common; about half of all adults aged 40-69 have them. That equates to about 20 million people in the United States who are suffering from varicose veins or spider veins, which appear on the surface and give the skin a discolored appearance. Varicose veins are the result of a venous insufficiency (also known as venous reflux), a condition resulting from decreased blood flow from the leg veins to the heart, and which causes blood to “pool” within the veins, causing them to bulge.

Vascular malformations

Vascular malformations are abnormalities within blood vessels that are present at birth, but may not become apparent until later in life when they begin to cause symptoms. Venous malformations are the most common type of vascular malformation, and are comprised of abnormally formed, dilated veins. They may appear on the skin as a birthmark or a dark blue bulge. Over time, blood clots form within the malformation and they can become hard and painful. Venous malformations may enlarge in response to puberty, pregnancy, certain types of oral contraceptives or injury.

Vascular malformations are treated by interventional radiologists using either sclerotherapy or a procedure called embolization. Sclerotherapy involves the injection of a special medicine directly into the malformation, which causes it to dissolve over time. Embolization involves the injection of tiny microspheres into the blood vessel to block the flow of blood, eventually causing the vessel to shrink or disappear.

Both methods are highly effective and are recommended based on the type of malformation and the severity of the symptoms. They are an excellent alternative to vascular surgery in many cases.

Pulmonary AVM/HHT

A Pulmonary arteriovenous malformation (AVM) is a rare anomaly of the blood vessels within the lung. Believed to be a hereditary condition, it involves abnormally dilated vessels within the lung that, if left untreated, may rupture and cause internal bleeding, and possibly result in a stroke or brain abscess. AVMs are most commonly seen in individuals with hereditary hemorrhagic telangiectasia (HHT), a condition that increases the risk of a pulmonary AVM rupture, especially during pregnancy, where the resulting loss of blood can be fatal.

An embolization procedure may be performed on a pulmonary AVM to reduce this risk. Using x-ray to guide a small catheter into the pulmonary arteries, and interventional radiologist will inject a contrast agent into the vessel to identify the precise location of the AVM. Once identified, tiny microspheres are injected into the vessels to reduce the flow of blood into the AVM.

The procedure is effective and the risk for complications is low. A follow up CT scan may be performed 1-3 months after the procedure to ensure the AVM remains blocked, and then every few years to check for the growth of new AVMs.

Dialysis interventions

When a person experiences kidney failure, it means that the kidneys are no longer able to cleanse the blood of wastes through urination. As a result, a treatment called dialysis is required to cleanse the blood and remove wastes from the body.

When a patient chooses hemodialysis, a special machine is used to withdraw blood from the body to filter wastes and remove extra fluid from the blood, and then return it to the body. Because dialysis is required several times per week, a special access point—capable of withdrawing and replacing large amounts of blood—must be developed.

In some cases, and usually at the start of dialysis, the access point may be in the form of a dialysis catheter connected to a blood vessel in the neck. But for the comfort and convenience of the patient, an access point known as a fistula will be created in the forearm.

An arteriovenous (AV) fistula is created by surgically connecting an artery to a vein in the forearm or upper arm. Within 1-3 months, the vein enlarges to the point where it can receive the needles used to perform dialysis. A fistula can last for many years, and with proper maintenance, it can remain healthy and free of infection.

Some patients have blood vessels that are not suitable for making a fistula. An alternative approach is called a dialysis graft. This is a special tube that is connected by a surgeon to connect the artery to the vein. Unlike a fistula, a dialysis graft does not require time to develop, so they may be used right away for hemodialysis.

Over time, problems with fistulas and dialysis grafts can occur, such as vein narrowing, clotting or stenosis—a buildup of plaque within the access point. AMIC interventional radiologists use diagnostic imaging techniques to identify the problem and may use angioplasty or thrombolysis to treat the problem.

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