Vascular/Interventional Radiology

Angiography is a medical imaging technique that is used to view the veins and arteries of the body while they are functioning to look for blockages, flow disturbances, and other problems. It is used to diagnose peripheral artery disease, atherosclerosis (plaque build-up), thrombosis (blood clots), stroke, and many other vessel disorders.

To perform angiography, a long thin flexible catheter is inserted into one of the major arteries in the arm or groin, and then advanced to the area of interest. Once the end of the catheter is in position, an x-ray contrast agent is released. Images are taken at two to three frames per second, and then these images can be viewed in sequence so that blood flow can be analyzed.

Angiography is a catheter-based procedure that our doctors perform at our hospitals or outpatient facilities. The procedure takes about an hour and requires no overnight stay.

Angioplasty is used to widen narrowed or obstructed blood vessels, such as can be caused by peripheral artery disease.

To perform angioplasty, a balloon catheter is inserted into a vein or artery and guided through your circulatory system to the narrowed section of the artery or vein, and then the balloon is expanded to compress plaque and widen the blood vessel. Once the vessel has been widened, a stent may be placed in the vessel to hold it open and prevent future problems.

Angiography is a catheter-based procedure that our doctors perform at our hospitals or outpatient facilities. The procedure takes about an hour and requires no overnight stay.

In the case of an abdominal aortic aneurysm (AAA), a section of the aorta has a weakened area of vessel wall that has stretched out and developed into a bulge that pulses with each beat of your heart. This bulge can eventually rupture, which can cause death. Aneurysms that are greater than 5cm in size are generally treated via surgery or aortic stent graft. A stent graft is a stent that is placed into the blood vessel at the area of the aneurysm not to widen the artery, but to create a sturdy replacement vessel wall to contain the blood flow.

Aortic stent grafting is a catheter-based procedure that our doctors perform at our hospital inpatient facilities. The procedure takes one to two hours and a short hospital stay is expected.

An arteriovenous fistula (AV fistula) is a linkage or short circuit between an artery and a vein in which the blood from the artery loops back directly into the vein. Naturally occurring AV fistulas may be diagnosed by angiography and can be repaired by inserting plugs or coils into the linkage.

Arteriovenous fistulas may be evaluated with AV fistulograms, in which an x-ray contrast medium is placed in the AV fistula so that the blood flow may be viewed on a monitor to evaluate the health of the fistula.

If your medically-created AV fistula has narrowed or become occluded, our doctors can repair and widen it using AV angioplasty, in which the connection between the artery and the vein is widened using a balloon catheter.

AV fistulogram and AV angioplasty are catheter-based procedures that our doctors perform at our hospitals’ outpatient facilities. These procedures take about an hour and no overnight stay is required.

Chemoembolization is a procedure in which chemotherapy drugs are delivered directly to a cancerous tumor, most often in the liver. In addition to the chemotherapy drugs, the blood vessels feeding the tumor are embolized, reducing the tumor’s ability to thrive.

During the procedure, an angiogram is performed so that the arteries that are supplying blood to the tumor can be identified. The chemotherapy drugs are then delivered into the artery so that they move directly to the tumor. After the drugs have been delivered, polyvinyl particles are released in the artery to further starve the tumor of oxygen and nutrients.

Chemoembolization has several benefits over traditional chemotherapy: the drugs are injected directly to the tumor and are more concentrated, the drugs continue to affect the tumors for up to a month, there are fewer side effects because the drugs do not circulate through the body, and the tumors are starved of oxygen and nutrients because the blood supply is compromised.

Chemoembolization is a catheter-based procedure that our doctors perform at our hospital inpatient facilities. The procedure takes about an hour and a short hospital stay is expected.

For patients undergoing chemotherapy treatment for cancer, a chest or arm port is often the most comfortable and convenient way to administer the chemotherapy drugs.

Subcutaneous venous ports are currently the preferred type of port because of their low infection rate and because they provide the greatest comfort for the patient. Placement of these ports has traditionally done via open surgery, but our doctors can use radiology imaging techniques to put the ports in more quickly and less invasively, resulting in fewer complications.

Chemotherapy port placement is a procedure that our doctors perform in our hospital outpatient facilities. The procedure takes about an hour and no overnight stay is required.

Deep vein thrombosis (DVT) is the formation of a blood clot, known as a thrombus, in the deep leg vein. It is a very serious condition that can cause permanent damage to the leg, known as post-thrombotic syndrome, or a life-threating pulmonary embolism. In the United States alone, 600,000 new cases are diagnosed each year. One in every 100 people who develops DVT dies.

The deep veins that lie near the center of the leg are surrounded by powerful muscles that contract and force deoxygenated blood back to the lungs and heart. One-way valves prevent the back-flow of blood between the contractions. (Blood is squeezed up the leg against gravity and the valves prevent it from flowing back to our feet.) When the circulation of the blood slows down due to illness, injury or inactivity, blood can accumulate or “pool,” which provides an ideal setting for clot formation.

Risk Factors

• Previous DVT or family history of DVT
• Immobility, such as bed rest or sitting for long periods of time
• Recent surgery
• Above the age of 40
• Hormone therapy or oral contraceptives
• Pregnancy or post-partum
• Previous or current cancer
• Limb trauma and/or orthopedic procedures
• Coagulation abnormalities
• Obesity
  

  Symptoms

• Discoloration of the legs
• Calf or leg pain or tenderness
• Swelling of the leg or lower limb
• Warm skin
• Surface veins become more visible
• Leg fatigue
  

  Post-thrombotic Syndrome

Post-thrombotic syndrome is an under-recognized, but relatively common sequela, or aftereffect, of having DVT if treated with blood thinners (anticoagulation) alone, because the clot remains in the leg.  Contrary to popular belief, anticoagulants do not actively dissolve the clot.  They just prevent new clots from forming. The body will eventually dissolve a clot, but often the vein becomes damaged in the meantime.  A significant proportion of these patients develop permanent irreversible damage in the affected leg veins and their valves, resulting in abnormal pooling of blood in the leg, chronic leg pain, fatigue, swelling, and, in extreme cases, severe skin ulcers.  While this use is to be considered an unusual, long-term sequela, it actually occurs frequently, AS HIGH AS 60-70 percent of people, and can develop within two months of developing DVT. There is increasing evidence that clot removal via interventional catheter-directed thrombolysis in selected cases of DVT can improve quality of life and prevent the debilitating sequela of post-thrombotic syndrome.

Pulmonary Embolism

Left untreated, a deep vein thrombosis (DVT) can break off and travel in the circulation, getting trapped in the lung, where it blocks the oxygen supply, causing heart failure. This is known as a pulmonary embolism, which can be fatal. With early treatment, people with DVT can reduce their chances of developing a life threatening pulmonary embolism to less than one percent. Blood thinners like heparin and Coumadin are effective in preventing further clotting and can prevent a pulmonary embolism from occurring.

It is estimated that each year more than 600,000 patients suffer a pulmonary embolism. PE causes or contributes to up to 200,000 deaths annually in the United States. One in every 100 patients who develop DVT dies from pulmonary embolism. If pulmonary embolism can be diagnosed and appropriate therapy started, the mortality can be reduced from approximately 30 percent to less than ten percent.

Symptoms of Pulmonary Embolism

The symptoms are frequently nonspecific and can mimic many other cardiopulmonary events.

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

  Deep Vein Thrombosis Treatments

Early in treatment, blood thinners are given to keep the clot from growing or breaking off and traveling to the lung and causing a life-threatening pulmonary embolism by blocking the oxygen supply causing heart failure.  Contrary to popular belief, blood thinners (anticoagulants) do not actively dissolve the clot, but instead prevents new clots from forming.  Over time, the body will dissolve the clot, but often the vein becomes damaged in the meantime.  To prevent permanent leg damage, patients can get catheter-directed thrombolysis treatment. Patients should seek a second opinion from an Interventional Radiologist if leg pain continues beyond seven days.

It is important for DVT patients to be evaluated by an interventional radiologist to determine if catheter-directed thrombolysis is needed to remove the clot. This treatment is highly effective when performed within 10 days after symptoms begin.

Catheter-directed Thrombolysis (Clot-Busting) Treatment

Catheter-directed thrombolysis is performed under imaging guidance by interventional radiologists. This procedure, performed in a hospital’s interventional radiology suite, is designed to rapidly break up the clot, restore blood flow within the vein, and potentially preserves valve function to minimize the risk of post-thrombotic syndrome.  The interventional radiologist inserts a catheter into the popliteal (located behind the knee) or other leg vein and threads it into the vein containing the clot using imaging guidance. 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 – 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 interventional radiologist with a balloon angioplasty or stent placement.

Pharmacomechanical Thrombectomy

New devices allow for the safe, effective removal of thrombus.  Trellis thrombectomy device has resulted in less use of lytic,reduced treatment times, fever complications and lower costs compared to CDT.  The physicians of MBB offer this procedure at ou hospital inpatient facilities. In patients in whom this is not appropriate and blood thinners are not medically appropriate, an interventional radiologist 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.

Efficacy

Clinical resolution of pain and swelling and restoration of blood flow in the vein is greater than 85 percent with the catheter-directed technique.

Acute Venous Thrombosis: Thrombus Removal With Adjunctive Catheter-directed Thrombolysis (ATTRACT) Trial http://www.attract.wustl.edu

Information can also be found on the SIR Foundation Web site.

When kidneys fail, the body loses its ability to keep the blood clean. The function of the kidneys can be replaced by hemodialysis, in which the blood is removed from the body, filtered to remove impurities, and then returned to the body. This procedure can maintain healthy blood, but it causes wear and tear on the veins that are frequently pierced to remove and return the blood.

A hemodialysis catheter can be placed directly into the large vein at the base of the neck (jugular vein), allowing the blood to be filtered without weakening the veins. Traditionally, these catheters have been implanted surgically, but our doctors can use a minimally invasive procedure to place the catheter, reducing complications and risks.

If the jugular vein is unavailable for any reason, our doctors can usually find an alternative site for placement.

Hemodialysis catheters are often placed only as a temporary measure because they are prone to infection and blood clots over a long period of time. An arteriovenous fistula is a stronger and more resilient solution, but it takes several months while forming a secure enough connection. A catheter is a good way to bridge the gap until the AV fistula is ready.

Hemodialysis catheter placement is a procedure that our doctors perform at our hospitals or outpatient facilities. The procedure takes less than an hour and requires a short hospital stay.

Embolization is the selective blocking of blood vessels by placing tiny particles in the vessel. Once the particles are in place, the blood flow along that vessel is diminished or stopped entirely. Embolization is used for many purposes, such as cutting off the blood supply to malignant tumors or uterine fibroids, or to stop hemorrhaging in the lungs or nasal passages.

The particles are about the size of a grain of sand, and they are made of a plastic substance that is similar to the material used to make hard contact lenses, called polyvinyl alcohol (PVA). This is a medical-grade material that is FDA approved for embolization and has been used for embolization in the human body for over 20 years.

Embolization is a catheter-based procedure. The catheter is guided via fluoroscopy (live x-ray) to the location to be blocked. The particles are released until the blood flow has been reduced to the appropriate level. The catheter is withdrawn and the procedure is done.

ALL ABOUT FIBROIDS

What are fibroids?

Fibroids, also known as uterine fibroids, leiomyomas, or myomas, are benign (non-cancerous) tumors that grow within the muscle tissue of the uterus.

Who is at risk?

Since uterine fibroids are the most common tumors within the female reproductive system, all women are at a potential risk of developing them. The majority of uterine fibroids are diagnosed in women between the ages of 35 and 54. However, fibroids can occur in women younger than 35.

What does the research say?

Studies demonstrate the prevalence of fibroids in 20-40% of women older than 35 years of age.

Evidence suggests that African-American women are three times more likely to develop uterine fibroids2-4 than other women, with an earlier age of onset.

Most clinicians believe fibroids shrink when a woman goes through menopause.

REFERENCES:

• Wallach EE. Myomectomy. In: Thompson JD, Rock JA, eds. Te Linde’s Operative Gynecology, 7th ed. Philadelphia: J.B. Lippincott, 1992; pp 647-662.
• Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. Am J Obstet Gynecol. 2003;188:100–107.
• Marshall LM, Spiegelman D, Barbieri RL, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997;90:967–973.
• Wise LA, Palmer JR, Stewart EA, Rosenberg L. Age-specific incidence rates for self-reported uterine leiomyomata in the Black Women’s Health Study. Obstet Gynecol. 2005;105: 563–568.
• Huyck KL, Panhuysen CI, Cuenco KT, et al. The impact of race as a risk factor for symptom severity and age at diagnosis of uterine leiomyomata among affected sisters. Am J Obstet Gynecol. 2008;198:168 e161–169.

SYMPTOMS

Common symptoms associated with uterine fibroids.

Excessive Menstrual Bleeding

Heavy menstrual bleeding is one of the most common symptoms associated with uterine fibroid tumors. It is the most prevalent symptom for two of the four types of uterine fibroid tumors: intramural and submucosal. Over time, excessive menstrual bleeding can lead to fatigue and anemia, which is a result of low red blood cell count. If left untreated, excessive menstrual bleeding can eventually lead to the need for blood transfusions.

Pelvic Pain and Pressure

As fibroids grow, they can put additional pressure on the surrounding organs, which can be extremely painful. The growth of the fibroids can cause consistent lower abdominal pain, as well as swelling which is sometimes mistaken for as weight gain or pregnancy. If you are experiencing pelvic pain or pressure or any other type of uterine fibroid symptoms, a full gynecological exam should be done immediately to determine the cause.

Urinary Incontinence or Frequent Urination

One of the organs commonly affected during the growth of fibroid tumors is the bladder. As added pressure is applied to this organ, the risk of urinary incontinence (loss of bladder control) occurs, as well as frequent urination.

Other Symptoms

Other common symptoms include anemia, pain in the back of the legs, pain during sexual intercourse, constipation, and an enlarged abdomen.
If you are experiencing signs and symptoms of uterine fibroids, and are finding it difficult to perform your daily activities and maintain your way of life, contact your primary care physician or OB-GYN immediately.

TYPES OF FIBROIDS

There are four primary types of fibroids.

Intramural

The most common type of fibroids, intramural fibroid tumors, typically develop within the uterine wall and expand from there. When an intramural fibroid tumor expands, it tends to make the uterus feel larger than normal, which can sometimes be mistaken for pregnancy or weight gain. This type of fibroid tumor can also cause “bulk symptoms” which include excessive menstrual bleeding that may cause prolonged menstrual cycles and clot passing, and pelvic pain that is caused by the additional pressure placed on surrounding organs by the growth of the fibroid.

Subserosal

Subserosal fibroids typically develop on the outer uterine wall. This type of fibroid tumor can continue to grow outward and increase in size. The growth of a subserosal fibroid tumor will put additional pressure on the surrounding organs, causing pelvic pain and pressure, and tend not to interfere with a women’s typical menstrual flow. Depending on the severity of the location of the fibroids, other complications may accompany pain and pressure such as bloating, indigestion, constipation, and frequent urination.

Submucosal

These fibroids develop under the lining of the uterine cavity. Large submucosal fibroid tumors may increase the size of the uterus cavity and can block the fallopian tubes, which can cause complications with fertility. Associated symptoms with submucosal fibroids include very heavy, excessive menstrual bleeding and prolonged menstruation. These symptoms can also cause the passing of clots and frequent soiling accidents. Untreated, prolonged or excessive bleeding can cause more complicated problems such as anemia and/or fatigue, which could potentially lead to a future need for blood transfusions.

Pedunculated

This type of uterine fibroid occurs when a fibroid tumor grows on a stalk, resulting in pedunculated submucosal or subserosal fibroids. These fibroids can grow into the uterus and/or outside of the uterine wall. Symptoms associated with pedunculated fibroid tumors include pain and pressure as the fibroid may sometimes twist on the stalk.

A woman may have one or all of these types of fibroids. Some fibroid tumors don’t produce any symptoms at all, while others can be severely symptomatic. It is common for a woman to have multiple fibroid tumors and it may be difficult to understand which fibroid is causing specific symptoms.

TREATMENT OPTIONS

Treatment options associated with uterine fibroids.

If you and your healthcare provider determine that you have uterine fibroids, it is a good idea to discuss the various treatment options available for fibroids, including uterine fibroid embolization (UFE).

Non-invasive treatment options:

Watchful Waiting

If your fibroids do not cause symptoms, there is no need to treat them. Your doctor can best manage your care and can continue to monitor your fibroids for growth.

Hormone Treatment

Medications for fibroids target hormones that regulate a woman’s menstrual cycle and help treat symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids, but may shrink them. The possible side effects of using these medications are similar to the symptoms experienced during and after menopause and include: weight gain, hot flashes, vaginal dryness, mood swings, changes in metabolism, and infertility. In most cases, once hormone therapy stops, fibroids tend to grow back and can reach their original size. This often occurs if hormone therapy is not accompanied by another treatment.

High-Intensity Focused Ultrasound Surgery (HIFU or MRgFUS)

During the treatment, magnetic resonance images are used to help a doctor examine fibroids and surrounding organs in 3-D. High-intensity focused ultrasound waves are then used to heat an area of the fibroid, causing cell death. Pulses of ultrasound energy are also applied repeatedly to treat the fibroid. The procedure takes three to four hours. Patients report abdominal pain, cramping, and nausea throughout the procedure. A few days after the procedure, patients report feeling cramps as well as shoulder and back pain. Most women are able to return to work within one to two days following the surgery.

Less invasive treatment options:

Uterine Fibroid Embolization (UFE)

The UFE procedure, also known as uterine artery embolization (UAE), begins with a tiny incision in the groin area or wrist. Using specialized X-ray equipment, an Interventional Radiologist (IR) passes a catheter (small tube) into the incision to the uterine artery and guides it near the location of the fibroid tumor. When the IR has reached the location of the fibroids, embolic material (small particles) is injected through the catheter and into the blood vessels feeding the fibroid, cutting off its supply of oxygenated blood. This shrinks the fibroid. The embolic material remains permanently in the blood vessels at the fibroid site. The catheter is then moved to the other side of the uterus, usually using the same incision. Once the IR has completed embolization of the uterine artery on both sides, the catheter is removed. The entire UFE treatment typically lasts less than one hour and is typically an outpatient procedure. Recovery typically takes less than one week.

Endometrial Ablation

This procedure destroys the endometrium (the lining of the uterus) with the goal of reducing menstrual flow. In some women, menstrual flow may completely stop. No incisions are needed for endometrial ablation, as a physician inserts a slender tool through the cervix. The tools used for this procedure vary depending on the method used. Some types of endometrial ablation use extreme cold, while others depend on heated fluids, microwave energy, or high-energy radio frequencies. This procedure can only be used to treat submucosal fibroids that are less than one inch in diameter.

Surgical treatments options:

Surgical myomectomy treatments

A myomectomy is the surgical removal of fibroids in the uterus. This treatment is recommended for women who want to become pregnant. There are different types of myomectomy procedures, including:

Surgical hysterectomy treatments

A hysterectomy is a surgical operation to removal all or part of the uterus. There are different types of hysterectomy procedures, including:

CHOOSING UFE

Look beyond hysterectomy and discover UFE.

A highly effective, minimally invasive procedure, UFE typically takes less than an hour to perform. Clinically proven to reduce the major symptoms of uterine fibroids, UFE has become one of the most successful alternatives to hysterectomy procedures.

Interested in learning all about the procedure? Click the play button below to watch the video, then ask your doctor if UFE is the right treatment for you.

[[Embed video: Uterine Fibroid Embolization (UFE)]]

UFE TREATMENT

Uterine fibroid embolization treatment.

Uterine fibroid embolization, also known as uterine artery embolization (UAE), begins with a tiny incision in the groin area or wrist. This incision provides the Interventional Radiologist (IR) with access to arteries that feed the fibroids. Using specialized X-ray equipment, the IR passes a catheter (small tube) into the incision to the uterine artery, and guides it near the location of the fibroid tumor.
When the IR has reached the location of the fibroids, embolic material (small spheres) are injected through the catheter and into the blood vessels feeding the fibroid, depriving it of oxygenated blood. The oxygen deprivation results in fibroids shrinking. The embolic material remains permanently in the blood vessels at the fibroid site. The catheter is then moved to the other side of the uterus. Once the IR has completed embolization of the uterine artery on both sides, the catheter is gently removed.

The entire UFE treatment typically lasts less than one hour, and is typically performed as an outpatient procedure.

KEY ADVANTAGES

UFE is a safe treatment option and like other minimally invasive procedures has significant advantages over conventional open surgery. That’s why 90% of all women were “satisfied” or “very satisfied” at final follow-up after UFE.

A number of benefits:

• Preservation of the uterus
• Decrease in heavy menstrual bleeding from symptomatic fibroids
• Decrease in urinary dysfunction
• Decrease in pelvic pain and/or pressure
• Virtually no blood loss
• Typically performed as an outpatient procedure
• Offers a shorter hospital stay and a faster return to work when compared to having a hysterectomy2
• Safe procedure that involves minimal risk and fewer complications after 30 days when compared to having a hysterectomy2
• Overall, significant improvement in patient’s physical and emotional well-being
• Covered by most insurance companies

REFERENCES:

• Lohle, P. et al. Long term outcome of uterine artery embolization for symptomatic uterine leiomyomas. JVIR 2008; 19:319-326
• Spies J et al. Outcome of uterine embolization and hysterectomy for leiomyomas: results of a multicenter study. American Journal of Obstetrics & Gynecology 2004;191: 22-31.

RISKS

Understand the risks.

Although UFE complications are rare, any medical procedure carries some degree of risk. Despite the low risk factor, it is important to understand the potential complications associated with UFE. These include:

• Embolization of non-target organs (bowel, bladder, nerves, and buttock)
• Sexual dysfunction related to non-target embolization (cervicovaginal branch)
• Transient amenorrhea (absence of period)
• Common short-term allergic reaction/rash
• Vaginal discharge/infection
• Possible fibroid passage (transcervical passage of fibroid; can cause discharge, cramps, and possible urinary retention)
• Post-embolization syndrome (post-procedure pain, fever, tiredness, and elevated white blood cell count)
• Premature menopause

The effects of UFE on the ability to become pregnant and carry a fetus to term, and on the development of the fetus, have not been determined. As with any medical procedure, discuss all risks and complications with your physician.

TAKE CHARGE

Don’t suffer in silence with fibroids. Instead, reclaim your life! Learn as much as you can about uterine fibroids and treatment options, work together with your family and healthcare team to make the best of your care, and take control of your life.

FIND OUT IF YOU ARE A CANDIDATE

Is uterine fibroid embolization (UFE) right for me?

You may be a candidate for UFE if:

• You are experiencing symptoms associated with uterine fibroids
• You want to retain your uterus and are looking for alternatives to hysterectomy
• You do not want surgery
• You are a non-surgical candidate due to a preexisting conditions such as obesity, bleeding disorders, or anemia
• You are not pregnant and are not planning on having any more children

UFE and Fertility

When researching and reviewing alternatives to hysterectomy procedures and the other fibroid treatment options available, it is important to understand how different treatments can affect you and your lifestyle. If you decide to pursue UFE treatment, becoming pregnant in the future can be difficult. While UFE is an effective treatment for uterine fibroids, there is no conclusive data or scientific results that establish the impact of UFE on fertility and pregnancy. The effects that UFE has on the ability to become pregnant, the development of the fetus, and the ability to carry the fetus to term have not been determined. It is extremely important to tell your doctor if you intend or are considering becoming pregnant after fibroid treatment. If you are not planning on becoming pregnant after UFE treatment, be sure you continue to use a reliable form of birth control to prevent pregnancy. If you have additional concerns about UFE and fertility, find a UFE specialist near you to discuss your specific situation, and determine which treatment option is best for you.

QUESTIONS FOR YOUR DOCTOR

Questions to get the conversation started.

If you decide to make an appointment with your OB-GYN to discuss whether you might be a candidate for UFE, please view the list of questions provided below. The questions will help you to better understand the fibroid treatment options available to you.

Questions about fibroid treatments:

• How do you typically treat symptomatic fibroids? What are the risks and benefits of each of these treatments?
• What are surgical and less invasive options for treating my uterine fibroids? What are the advantages, risks, and benefits of each of these treatments?
• Have all of the necessary diagnostic tests been performed? Trans-vaginal ultrasound or
• MRI? Endometrial biopsy? Blood tests? Why or why not?
• If I want to retain my uterus, what alternatives to hysterectomy are available?

Questions about more invasive surgical options:

• Do I need to have surgery? Will my ovaries be removed? If so, why? Will my cervix be removed? If so, why?
• What are the risks associated with surgery?
• Will I experience earlier menopause? Can the symptoms of menopause be treated?
• What are the risks and benefits of treatment(s) for the symptoms of menopause?
• What are the limitations of surgery?
• Will surgery cure my uterine fibroid tumors?

Questions about UFE:

• Do you refer patients for UFE? If not, why?
• How many patients have you referred for UFE and how many have chosen UFE to treat their fibroids?
• Will you refer me to an Interventional Radiologist for a consultation?

Questions for your Interventional Radiologist (IR):

• How would you coordinate my care with my OB-GYN?
• How often is the procedure successful in treating uterine fibroids?
• Are your patients happy with the procedure?
• How often do complications occur? What are typical complications?
• How will I feel during and after the UFE procedure?
• What is the length of the procedure? What is the normal recovery time?
• How long should I expect to stay in the hospital?
• How long should I expect to be away from work?
• What kind of follow-up care is typical and who manages it?
• What typically happens to the fibroids after the blood supply is cut off? Will the fibroids be expelled vaginally or will the procedure simply result in my fibroids shrinking?
• Will my fibroids, or the symptoms of my fibroids, come back?
• Will I still get my periods after having UFE and what will they be like?
• Will my insurance cover UFE?
• Can you help me determine if I am a candidate for UFE and when can we schedule the procedure?

NEWS

Find out important information regarding uterine fibroid embolization (UFE). Direct pickup of current blog articles located here: https://ask4ufe.com/blog/

Paracentesis is a procedure in which excess peritoneal fluid that has built up in the belly is removed through a long thin needle.

Fluid buildup may occur once as a result of an injury or infection, but some disorders, such as cancer or cirrhosis, may cause fluid to build up continually. When fluid buildup is chronic and paracentesis is required on a regular basis, a port may be installed to allow for easier removal of the fluid.

This procedure may be performed to relieve pressure in the belly or to gather peritoneal fluid for analysis.

Paracentesis is a needle-based procedure that our doctors perform in our hospital outpatient facilities. The procedure takes about 30 minutes and no overnight stay is required. Peritoneal catheter placement is a procedure that our doctors perform at our hospital inpatient facilities. The procedure will take one or two hours, and a short hospital stay is expected.

Percutaneous gastrostomy is the procedure in which a gastrostomy tube (G-tube) is put in place to allow interal feeding when feeding by mouth is likely to be impossible or contraindicated for four or more weeks.

The tube is placed into the stomach through the abdominal wall using fluoroscopic guidance, a lighted instrument, for guidance.

G-tube is a procedure that our doctors perform at our hospital inpatient facilities. The procedure will take one or two hours. A short overnight stay is expected.

Percutaneous transhepatic biliary drainage (PTBD) is a procedure to drain the bile ducts in the presence of a blockage or damage that prevents normal bile drainage. Blockage can be diagnosed with a percutaneous transhepatic cholangiogram (PTC).

Using fluoroscopy (live x-ray), a needle is guided into the bile ducts, where a contrast agent is injected to allow visualization on a monitor. A catheter is placed into the bile duct to allow the bile to drain out into a bag outside the body. To prevent further drainage difficulties, a stent may be placed in a blocked or restricted bile duct to hold it open and allow bile to flow freely.

PTBD is a needle-based procedure that our doctors perform at our inpatient hospital facilities. The procedure takes one to two hours and a short hospital stay is expected.

Renal artery stenting is a procedure to treat renal artery stenosis, the narrowing of the renal artery due to atherosclerosis (plaque build-up) or fibromuscular dysplasia. The narrowed artery is unable to carry blood effectively and can result in hypertension or acute renal failure. A balloon angioplasty can be used to open the narrowed artery, and a mesh stent can be placed to hold the artery open.

Renal artery stenting is a catheter-based procedure that our doctors perform at our hospital inpatient facilities. The procedure takes about an hour and a short hospital stay is expected.

A stent is a tiny mesh tube that is inserted into a vessel to reshape the vessel walls. They are often inserted into blood vessels that have been narrowed by plaque buildup (atherosclerosis) or due to collapse. Angioplasty is often performed to widen the blood vessel, and then a stent is placed inside the blood vessel to prevent the blood vessel from collapsing or narrowing again. Stents are also placed as stent grafts to create new vessel walls in the case of abdominal aortic aneurysm (AAA).

Stent placement is a catheter-based procedure. The catheter carries the stent to the location of the narrowed or collapsed blood vessel, and then the stent is placed in position, possibly as part of the balloon angioplasty procedure.

Portal hypertension is high blood pressure (hypertension) in the portal vein and branches. The portal system is located in the abdomen near the stomach and liver. Portal hypertension can occur when the liver is unable to process the blood from the bowels (due to liver failure or cirrhosis), forcing the blood from the bowels to pool or force its way through other paths to return to the circulatory system. The fragile veins that often bear the brunt of the rerouting are likely to rupture under increased pressure.

A transjugular intrahepatic portosystemic shunt (TIPS) creates a new path from the portal vein directly into the main venous system through a vein in the liver. It uses a flexible tube called a stent to form this new vessel.

TIPS is a catheter-based procedure that our doctors perform at our hospital inpatient facilities. The procedure takes about an hour and a short hospital stay is expected.

The ureters are narrow tubes that carry urine from the kidneys to the bladder. This tube may become blocked or damaged, preventing urine from flowing freely. Blockage may be caused by kidney stones, cancer, blood clots, or infection.

A ureteral stent is a tube that is placed in the ureter to allow urine to flow from the kidney to the bladder. It is generally left in place until the ureter has healed or the reason for the blockage has been treated.

Ureteral stents are usually inserted through the urethra and threaded up to the ureter. If this insertion method fails, it can be inserted through the skin in a needle-based procedure similar to nephrostomy catheter placement.

Ureteral stenting can be performed in our hospital facilities. The procedure takes about an hour and no overnight stay is required.

A varicocele is an enlargement of a vein or veins of the scrotum, much like varicose veins in the legs. It occurs primarily in young men, and is caused by incompetent valves in the blood vessels that allow blood to flow backward. It can cause pain, shrinking of the testicles, or infertility.

Varicocele can be treated by open surgery, but our doctors can treat them with a minimally-invasive procedure called varicocele embolization, in which the malfunctioning blood vessels are blocked by tiny polyvinyl particles, forcing healthy veins to take over the transport of blood.

A long flexible catheter is inserted into your blood vessel through a tiny incision and guided via fluoroscopy (live x-ray) to the site of the varicocele. Small coils are released, blocking the flow of blood, and the damaged veins are then bypassed. This procedure is as successful as open surgery at treating varicocele, requires no hospital stay, and has fewer side effects. The symptoms of varicocele are typically reversed by varicocele embolization.

Varicocele embolization is a catheter-based procedure that our doctors perform at our hospital outpatient facilities. The procedure takes about an hour and no overnight stay is required.

Vertebroplasty and kyphoplasty are minimally-invasive procedures that are used to treat vertebral fractures, usually caused by osteoporosis or bone tumors. The pain of vertebral fractures is caused by the compression and shifting of the damaged vertebrae, so vertebroplasty and kyphoplasty treat the pain and the fracture by shoring up the vertebrae with bone cement.

Vertebroplasty and kyphoplasty are minimally invasive procedures in which fluoroscopy (live x-ray) imaging is used to precisely place a needle at the location of the fracture. The bone cement is injected directly into the vertebrae, and then allowed to harden so it can strengthen and support the vertebrae.

Vertebroplasty is appropriate for cracked or broken vertebrae, but for vertebrae that have suffered compression fractures, kyphoplasty is more successful. Kyphoplasty involves the insertion of a balloon catheter into the compressed vertebrae. The balloon is filled with bone cement and allowed to harden. This restructures and rebuilds the vertebrae so that it can provide support for the spine again.

Both vertebroplasty and kyphoplasty not only relieve the pain of damaged vertebrae, but they also prevent further damage from the original fracture.

We also offer RF Kyphoplasty. This procedure utilizies ultra-high viscosity cement and a directional device which allows for precise placement of the cement into tumors and fractures.

It requires no stitches, no general anesthesia, and it has a very quick recovery time. Most people experience complete pain relief immediately after the procedure, others report that their pain was gone or significantly reduced within 48 hours.

This is a needle-based procedure that our doctors perform at our hospital and outpatient facilities. The procedure takes about an hour and requires no overnight stay.

A retrievable inferior vena cava (IVC) filter is a tiny mesh filter that can be placed in the IVC to prevent blood clots in the legs from traveling up to the lungs to cause a pulmonary embolism.

Typically, when a deep vein thrombosis (blood clot in the leg) has been diagnosed, blood thinners will be prescribed first, to prevent the clot from moving and help it to dissolve without danger. If the blood thinners are not proving effective or if you cannot take blood thinners for some reason, a filter may be implanted.

A long flexible catheter is inserted into your blood vessel and the guided via fluoroscopy (live x-ray) to the inferior vena cava. The filter is deployed by the catheter and left in place to catch any clots that start traveling to your lungs. The filter may be left in place or it may be removed when the clot has dissolved.

IVC filter placement is a catheter-based procedure performed by our doctors at our hospital inpatient facilities. The procedure takes about an hour and a short hospital stay is expected.

MBB Radiology provides a broad range of musculoskeletal procedures, including state-of-the-art imaging, diagnostic and therapeutic injections, and image-guided interventional procedures. These services are ordered by your neurosurgeon, orthopedic surgeon, or primary care physician for the diagnosis and/or therapeutic treatment of all pain in the areas of the spine or joints.

Many of these procedures are used in conjunction with each other, particularly CT and MRI, enabling accuracy and safety, while minimizing patient discomfort.