Peripheral Arterial (Vascular) Disease (or PAD/PVD), is a common condition where narrowed arteries in the leg or legs prevent regular blood flow. This usually causes pain and/or cramping in the muscles of the hip, thigh or calf when walking or exercising. The pain can go away when resting, but will return with exercise and movement.
If left untreated, the narrowed arteries prevent blood flow to the leg or legs, and can essentially “choke” the leg. This can cause the skin to change color, difficulty walking, ulcers and sores on the leg and foot, and lead to gangrene and possible amputation.
Click HERE for a brief video about PAD.
Venous insufficiency occurs when the valves in the veins are not functioning properly (or insufficient), and the blood which should be going back to the heart pools in the legs. This can also be caused by compression of veins in the pelvis, which causes back-pressure. These conditions result in back-pressure in the veins, which causes spider veins, varicose veins, swelling, skin discoloration, and in more severe cases, ulceration.
People mostly know varicose veins as the large, bumpy veins seen snaking down the leg. These enlarged veins are caused when the valves in the veins–that help move the blood from the feet back upward toward the heart—don’t work properly. This causes blood to pool in that area, causing the varicose veins to grow.
For many people, the only problem with varicose veins is cosmetic: they don’t like the way it looks.
For some, however, the varicose veins cause aching pain and discomfort, bruising, heavy and itchy legs, and swelling.
Deep Vein Thrombosis (DVT) is a blood clot which forms within the deep veins of the leg (AKA thrombus), which usually results from slow blood flow in the legs, and sometimes from blood clotting disorders. Slow flow is caused by sitting for long periods of time without movement or exercise, which is why people often get these on long airline flights or road trips. Common symptoms include:

  • Pain in the leg, foot or calf
  • Swelling in the leg
  • Tenderness
  • Warm skin
“Vascular Malformation” is a general term that refers to a number of abnormalities resulting from abnormal development in blood vessels, veins and/or arteries. They often affect the proper function of the area by causing:

  • physical disfiguration
  • pain
  • swelling
  • bleeding

Vascular malformations are treated in a variety of ways, depending on the location, severity, and areas affected by the malformation. Treatments include:

  • Atherectomy

    Atherectomy is a non-surgical procedure to remove the plaque and calcium deposits that sometimes block arteries.

    Through a small incision, your physician places a catheter into the blocked artery. This catheter has a small device with a tiny, rotating blade or spinning crown which is advanced through the plaque in your artery.

    The device is then activated, which removes the plaque off the artery wall. Once the procedure is complete, the artery flow is restored, without the need for invasive surgery.

    SilverHawk

    Jetstream

    Phoenix

    CSI

  • Angiography

    Angiography is an X-ray exam of the arteries or veins to diagnose blockages and other blood vessel problems.

    During the angiogram, an interventional specialist inserts a thin tube–known as a catheter–into the artery through a small incision in the skin (about the size of the tip of a pencil). A liquid called contrast (X-ray dye) is injected to make the blood vessels visible on the X-ray.

  • Angioplasty

    Angioplasty is a minimally-invasive vascular procedure that opens up blocked veins or arteries. Often associated with the coronary artery in the heart, angioplasty can be used throughout the body to open blood flow. For example, it is often used to restore blood flow in blocked leg arteries.

  • Stent placement

    Interventional Radiologists restore blood flow to various arteries or organs using a stent. Stents are metal mesh structures that expand to open arteries. Stents are placed when X-Ray guidance helps identify the blocked artery. Once done, the metal stent is deployed, restoring flow.

    A small incision is made in the skin through which a small wire is directed into the blocked artery. A deflated balloon is then passed over the initial wire, and when the deflated balloon gets to the blockage it is inflated. A metal structure called a stent is placed in the blockage to keep the artery walls open.

    Once the stent is in place, the balloon is deflated and the catheter is removed.

    Click HERE to see how stents work

  • Saphenous vein ablation

    The great saphenous vein is one of a pair of the longest veins in the body: it starts in the foot and travels all the way up the leg to the thigh (femoral vein). Because it is so long, the great saphenous vein has between 10-20 valves, and when one or several of these valves weaken, varicose veins appear, often causing pain, heaviness and discoloration in the leg.

    To ablate the saphenous vein, an Interventional Radiologist makes a small incision into the greater saphenous vein, and a small wire is inserted into the saphenous vein. A special catheter that generates heat from radiofrequency energy, collapsing the saphenous vein.

    Eventually, the vein “scars down,” and the body naturally diverts blood flow from the now-closed saphenous vein into the deep veins, improving circulation.

  • Varicose vein sclerotherapy

    Sclerotherapy is a minimally-invasive treatment used to treat varicose and spider veins. The procedure may also remedy symptoms like aching, burning, and swelling associated with varicose veins.

    A tiny needle is inserted into the vein, and a gentle solution is injected that causes the affected vein to close down, and eventually the vein scars down. Once the affected veins are shut down, the body diverts blood flow into surrounding veins.

    Typically, multiple treatments are required for complete spider or varicose vein removal. Elastic compression hose are worn after each treatment.

  • Ambulatory phlebectomy

    Ambulatory phlebectomy is a minimally-invasive surgical technique used to treat varicose veins, often in conjunction with vein ablation and/or sclerotherapy.

    The abnormal vein is removed through a tiny incision or incisions using a special set of tools. The procedure is done under local anesthesia, and typically takes under an hour. Recovery is fast, and most patients do not need to interrupt regular activity after ambulatory phlebectomy.

  • Venous stenting

    In some patients, venous compression or blockages in the pelvis can cause swelling in the legs, a.k.a. venous hypertension. An interventional radiologist inserts a catheter over a wire through an incision in your leg into the pelvis to deploy a stent to open the blockage or compression. This can be very effective for reducing swelling and other symptoms of hypertension such as varicose veins, skin pigmentation, and swelling.

  • Venous embolization (vericocele, pelvic congestion and venous malformations)

    Varicocele

    A varicocele is an enlarged vein in a man’s scrotum, causing pain, swelling and infertility.

    To treat varicocele, the enlarged vein is shut down through embolization. An Interventional Radiologist places a catheter from an access site in the neck or leg into the gonadal veins with a small catheter, then uses small coils and material to close the problematic vessel. The body then diverts the flow into other healthy vessels and the symptoms resolve quickly.

    Pelvic congestion

    An Interventional Radiologist physician embolizes (or shuts down) the fault ovarian vein(s) by inserting a catheter through an access site in the leg or neck into the ovarian veins using x-ray image guidance. Small coils or other embolic devices can be used with a foaming agent to permanently close the problematic vein.

    Once the problematic vein is shut down, the body diverts the flow of blood into nearby healthy vessels. Enlargement and pain resolve quickly.

    Venous malformation

    Venous malformations are birthmarks or growths made up of arteries, veins, capillaries, or lymphatic vessels. Venous malformations range from cosmetic to painful and problematic. venous malformations are typically treated with sclerotherapy. During sclerotherapy, a needle is typically inserted under ultrasound guidance into the malformation, after which foam sclerotherapy is injected into the malformation. This causes the malformation to thrombose and scar down. For larger malformations, we sometimes use glue and in some cases chemotherapy.

  • DVT thrombectomy and thrombolysis

    Catheter-directed thrombolysis and thrombectomy are procedures from removing DVT, which is performed under imaging guidance by an Interventional Radiologist.. Thrombectomy and thrombolysis are designed to rapidly break up the DVT clot, restore blood flow within the vein, reduce swelling and pain, and to preserve valve function in the veins.

    An Interventional Radiologist inserts a catheter into the popliteal (located behind the knee) or other leg vein and directs it into the vein containing the blood clot using X-Ray guidance.

    The catheter tip is then placed directly into the clot and a “clot busting” drug is infused directly to the clot with a thrombectomy device. Often a thrombectomy device is used to remove the clot from the vessel.

    Click HERE for a brief video about thrombectomy.

    Any narrowing in the vein that might lead to future clot formation can be identified and treated by the physician with a balloon angioplasty or stent placement.

  • Cryoablation for FAVA venous malformations

    Fibro-adipose vascular anomaly (FAVA) is a variant of vascular malformation, which is primarily fibrous and fatty tissue and does not respond to traditional sclerotherapy for traditional vascular malformations. These do, however, respond well to cryoablation or freezing of the malformation. This is performed by an Interventional Radiologist placing a cryoablation probe under ultrasound or CT guidance into the malformation and freezing the lesion. Frequently this results in dramatic reduction in pain.

  • Bleomycin injection for venous malformations

    Bleomycin is most commonly used in cancer treatments. It is particularly useful in areas where swelling may be dangerous such as near the eye, airway, or near important nerves.

    Prior to injection, the venous malformation is checked under either ultrasound or x-ray. While looking at the imaging, an Interventional Radiologist injects the needle through the skin directly into the malformation and the bleomycin in injected. There is no major incision, sutures, or resulting surgical scars.