Areas of Interventional Radiology in Vascular Treatments

An abdominal aortic aneurysm, known as an AAA, is a weakening in the wall area in the aorta, the main artery that carries blood from the heart to the rest of the body. As blood flows through the aorta, the weak area bulges and can rupture.

Symptoms

Most often, an AAA presents no symptoms and is referred to as a silent killer. But when symptoms occur, they may include:

• Abdominal pain, which may be constant or intermittent.
• Lower back pain that may extend to the buttocks, groin or legs.
• A feeling of a heartbeat, or pulse in the abdomen.

Once an aneurysm bursts, symptoms may include:

• Severe back or abdominal pain that begins suddenly
• Paleness
• Dry mouth and skin with excessive thirst
• Nausea and vomiting
• Signs of shock such as sudden weakness, dizziness, fainting, shaking, sweating and rapid heartbeat

Anyone experiencing symptoms associated with a burst aneurysm should seek immediate medical care.

Diagnosis

In some cases, an AAA can be diagnosed when a physician feels the aneurysm as a soft mass in the abdomen - near the belly button - that pulses with each heartbeat. Several tests may be used to diagnose an AAA but the most common are an ultrasound or CT (computerized tomography) scan. Ultrasound screening involves a device about the size of a computer mouse being passed over the abdomen while sound waves create images that can detect the AAA. A CT scan compiles a series of X-ray images and creates cross-sectional pictures of the area being screened.

Treatments

Patients have three treatment options for an AAA:

• Watchful waiting - small AAA's, less than 5 centimeters or about 2 inches, that are not growing quickly or causing symptoms may just be monitored with ultrasound screenings at regular intervals.
• Interventional repair - with this minimally invasive technique Holy Name Medical Center's Interventional Radiologists use X-ray imaging to guide a catheter through the groin and femoral artery into the aortic. A stent graft is then advanced through the catheter and into the artery to reline the weakened aorta. This method of treatment eliminates the need for a large abdominal incision and is now the standard of care for treating most AAAs.
• Long held as the only treatment for an AAA, open surgery requires an incision from just below the breastbone to the top of the pubic bone. Physicians then clamp off the aorta and place a plastic graft into the weakened area to protect the artery wall. General anesthesia is used and patients are hospitalized for several days.

Recovery

After an interventional repair, patients typically spend one night in the hospital and most return to normal activity within two weeks of their procedure.

Surgery repairs usually require the patient to spend several days in the hospital and then a six-to-eight week interval before all daily activities can be resumed.

Benefits

• No abdominal surgical incision or sutures
• Faster recovery with less time in the hospital
• Some cases require no general anesthesia
• Less pain and reduced complications

Angioplasty is an interventional non-surgical procedure to open blocked or narrowed blood vessels in the body caused by peripheral arterial disease or other conditions.

Treatment

Holy Name Medical Center's Interventional Radiologists insert a very thin catheter through a small incision in the skin to the blocked blood vessel. They are guided by X-ray imaging to the site of the blockage. A balloon is sent through the catheter and inflated, or a small metal tube known as a stent, is put at the site of the blockage - keeping the blood vessel open so blood can flow freely. Recent advancements include the use of medicated balloons and stents to provide better healing after treatment.

Benefits

• In most cases, patients are not required to stay overnight at a hospital and general anesthesia is not used.
• No surgical incision is made and no stitches are needed.
• Patients may resume normal activities shortly after the procedure.

Peripheral artery disease in the lower limbs can cause patients to have wounds or ulcers that won't heal. It may also lead to atherosclerosis, or hardening of the arteries. These conditions decrease blood flow and oxygen to the lower leg, ankle and foot. Left untreated, they may result in gangrene - when the tissue dies - and the need for limb amputation.

Early detection of poor circulation is the key to wound healing and preventing limb amputations. Physicians at the Interventional Institute at Holy Name Medical Center work to restore circulation and the flow of oxygen using minimally invasive procedures that clear a path to the wound and allow effective treatment.

Advanced Symptoms of Non-healing Wounds:

• A foot wound that does not show signs of healing in 2 - 4 weeks
• Persistent, increased pain in the area of the wound
• Discoloration of the wound near its edges, often a dark or bluish color
• Increased drainage from the wound
• Redness or swelling around or spreading away from the wound
• A foul odor coming from the wound
• Early gangrene (death of the tissue)

Treatments

Some patients with PAD can be treated with lifestyle changes such as smoking cessation and exercise while others can take medications. For those who need further treatment, Holy Name Medical Center's Interventional Radiologists can perform minimally invasive procedures to increase blood flow.

Angioplasty, Stenting, and Atherectomy

Angioplasty, or opening up blocked blood vessels, was first used on patients with PAD. Interventional radiologists, using imaging for guidance, thread a catheter from the groin to the blocked vessel in the leg. They then inflate a balloon to open the vessel where it is narrowed or clogged. At times, the area is held open with a stent graft, a tiny metal cylinder covered with fabric, which remains permanently in place. New advances allow the use of medicated balloons and stents to improve healing.

Atherectomy involves threading a tiny catheter to the site of the blockage and then shaving or cutting the plaque from the artery wall and removing it.

These procedures have been shown to be successful when other treatment methods have failed.

Clinical Study for Advanced Peripheral Artery Disease

Holy Name Medical Center's team of Interventional Radiologists is involved in many clinical trials for the advanced treatment of PAD. Currently, Holy Name is one of the first hospitals in the U.S., and only one of two in New Jersey, to participate in a groundbreaking clinical study, called STOP-PAD, which may help patients grow tiny blood vessels in their feet to provide better circulation. Advanced peripheral artery disease in the legs and feet may lead to wounds that don't heal and eventually, limb amputation. STOP-PAD offers patients a chance for oxygen-rich blood to reach the feet and allow the repair process to continue.

Patients are injected with a gene therapy, called JVS-100, near the site of the non-healing wound, after physicians perform a minimally invasive procedure to open up the blockage. JVS-100 helps the body build tiny vessels for the blood to travel, a process that occurs naturally in most people without artery disease. The combination of clearing out the blockage plus the injected gene therapy should bring blood to the extremities.

This clinical trial, given Fast Track designation by the Food and Drug Administration (FDA), follows a previous study showing a majority of patients experienced less pain, a reduction in wound size and an improvement of their overall feeling of wellness.

For more information on this clinical trial, call 201-833-7268 or email [email protected].

A pulmonary embolism (PE) is a serious condition that can be fatal. It occurs when a blood clot travels from another area of the body - known as deep vein thrombosis - and settles in the lung, blocking the oxygen supply and causing heart failure.

Symptoms

• Shortness of breath
• Sweating
• Sharp chest pain
• Bloody sputum (coughing up blood)
• Rapid pulse
• Fainting

Treatments

Individuals who experience any of the symptoms of a pulmonary embolism should seek medical care immediately.

Pulmonary embolisms are typically treated with medications to break up the clot. But when a PE is life threatening, Holy Name Medical Center's Interventional Radiologists may guide a catheter to the clot to take it out or deliver medication that will dissolve it. Rarely, surgery is used to remove the clot.

Benefits

• This procedure rapidly brakes up the clot, restoring blood flow.
• It has a low complication rate.
• Pain and swelling are reduced.

Varicose veins are twisted, swollen vessels that appear blue and are usually found in the legs. They occur when the veins, which carry blood back to the heart, have faulty valves. These valves, when working properly, keep blood flowing to the heart. When they malfunction, the blood can back up and pool, causing the veins to swell. At times, they may cause pain, blood clots and sores, but often produce no symptoms except for their unattractive appearance.

Treatment

Endovenous Laser Ablation

Endovenous laser ablation is a minimally invasive procedure that uses a highly concentrated beam of light to close the damaged vein. Holy Name Medical Center's Interventional Radiologists insert a thin fiber that emits a laser light into the vein. The light hits the targeted tissue without damaging any surrounding areas and seals the vein shut. Blood is automatically rerouted to other healthy veins with no adverse effects. A local anesthetic is used and some patients may experience temporary soreness or slight swelling that typically subsides within five days. Patients can usually resume normal activities the day of the procedure.

Sclerotherapy

Sclerotherapy is a minimally invasive procedure that closes the damaged veins. Holy Name's Interventional Radiologists inject a solution - typically it is a salt solution - directly into the blood vessels. The solution irritates the lining of the targeted veins and causes them to swell and shut down.

Over time - usually between six to eight weeks - the varicose and spider veins die off, becoming lighter in color and less noticeable until they completely disappear while the body reroutes blood to other healthy vessels. The injected veins initially disappear as the blood is pushed out and then return before fading over time. One injection may eradicate several dozen veins at once since many vessels are interconnected.

Over time - usually between six to eight weeks - the varicose and spider veins die off, becoming lighter in color and less noticeable until they completely disappear while the body reroutes blood to other healthy vessels. The injected veins initially disappear as the blood is pushed out and then return before fading over time. One injection may eradicate several dozen veins at once since many vessels are interconnected.

Microphlebectomy and Transilluminated Powered Phlebectomy

Microphlebectomy is a minimally invasive technique that removes the damaged veins. Holy Name's Interventional Radiologists make tiny nicks or incisions in the skin and pull out the section of the vein that is swollen. A local anesthesia is used and patients can return to their normal activities almost immediately.

For very complex cases of varicose veins, Holy Name's Interventional Radiologists use the Trivex® System, technology that enables physicians to perform a transilluminated powered phlebectomy. This procedure allows physicians to treat more veins in less time. A tiny light is inserted into the affected area, which illuminates the damaged veins and the interventional radiologist removes the vein with a small surgical device. The patient is given mild sedation and goes home immediately after the procedure. The leg is wrapped for 24 hours and after that, normal activities can be resumed.

Angiography, also known as an angiogram, is an X-ray of the arteries and veins used to diagnose blockages and other blood vessel problems. Holy Name Medical Center's Interventional Radiologists perform this exam by inserting a catheter into the artery with a very small incision in the skin and then injecting a contrast agent, an X-ray dye, to make the vessels visible on the X-ray.

Angiography is most often used to find blockages but it can also be used to determine whether the patient has had a stroke, bleeding in the brain, blood vessel malformations, or an aneurysm, which is a part of a blood vessel that bulges. Frequently, a blocked blood vessel can be treated at the same time by either an angioplasty, which involves putting a small balloon into the artery or vein, or a thrombolysis, when the blood clot is busted.

Deep vein thrombosis (DVT) is a serious condition that occurs when a blood clot forms deep in a leg vein. It can cause permanent damage to the leg or become life-threatening if the clot travels to the lung and blocks blood flow, known as a pulmonary embolism.

DVT often develops in patients who have had surgery or in healthy individuals who have been immobile for a long period of time, such as passengers on a long airline flight. The clot typically forms in a pelvic, thigh or calf vein that returns blood to the heart and lungs, causing leg pain and swelling.

Symptoms

• Pain or tenderness
• Swelling
• Discoloration or redness in the affected area
• Skin that is warm to the touch
• Chest pain
• Shortness of breath

Treatment

Holy Name Medical Center's Interventional Radiologists can break up the clot and restore normal blood flow by guiding a catheter to the site of the clot and delivering a clot-busting drug. At the same time, a stent can be implanted if the vein is very narrow to help prevent future clots.

Benefits

• Low risk of complications
• Quick recovery
• Can be life-saving
• Helps to prevent other clots from forming

Peripheral Arterial Disease (PAD) is a common, though serious condition that typically affects individuals 65 years of age and older. It usually develops as a result of atherosclerosis, or hardening of the arteries, when cholesterol and scar tissue build up and form plaque inside the arteries. This plaque decreases blood flow to the legs, which can cause pain when walking and eventually lead to gangrene and amputation.

Since atherosclerosis is a systemic disease, meaning it affects the entire body, individuals with PAD are also likely to have blocked blood vessels in other areas. They may be at risk for heart disease, aortic aneurysms and stroke.

Symptoms

• Painful cramping in the hip, thigh or calf when walking or exercising that usually goes away when the activity stops
• Numbness, tingling and weakness in the legs and feet
• Burning or aching pain in feet or toes when resting
• Sores on legs or feet that don't heal
• Cold legs or feet
• Loss of hair on legs
• Weak pulse in the legs or feet
• Erectile dysfunction

Treatment

Some patients with PAD can be treated with lifestyle changes such as smoking cessation and exercise while others can take medications. For those who need further treatment, Holy Name Medical Center's Interventional Radiologists can perform minimally invasive procedures to increase blood flow.

Angioplasty, Stenting, and Atherectomy

Angioplasty, or opening up blocked blood vessels, was first used on patients with PAD. Interventional radiologists, using imaging for guidance, thread a catheter from the groin to the blocked vessel in the leg. They then inflate a balloon to open the vessel where it is narrowed or clogged. At times, the area is held open with a stent graft, a tiny metal cylinder covered with fabric, which remains permanently in place. New advances allow the use of medicated balloons and stents to improve healing.

Atherectomy involves threading a tiny catheter to the site of the blockage and then shaving or cutting the plaque from the artery wall and removing it.

These procedures have been shown to be successful when other treatment methods have failed.

Benefits

• Requires only a tiny incision in the skin to insert the catheter.
• Less time in the hospital and faster recovery compared to open surgery.
• Fewer complications than open surgery.

Thrombolysis, also known as thrombolytic therapy, is used to dissolve clots, improve blood flow and prevent damage to tissues and organs. Holy Name Medical Center's Interventional Radiologists use a catheter to either inject clot-busting drugs to the site of the blockage or use a tiny mechanical device to remove or break up the clot.

This treatment is often used as an emergency treatment to dissolve blood clots involving the vessels in the legs, heart, brain or lungs. On eligible patients, the procedure is often successful in breaking up the clot before it causes permanent damage to the organs.