Varicose Veins & Spider Veins
Varicose veins are caused by weakened valves and veins in your legs. Normally, one-way valves in your veins keep blood flowing from your legs up toward your heart. When these valves do not work as they should, blood collects in your legs, and pressure builds up. The veins become weak, large, and twisted.
Spider veins (also called telangiectasias) are clusters of tiny blood vessels that develop close to the surface of the skin. They are often red, blue, or purple; and they have the appearance of a spider web. They are commonly found on the face and legs.
Treatment in Interventional Radiology
Dr. Yadav Munde, Consultant Interventional Radiologist recommends following 2 types of non-surgical procedures for varicose or spider veins.
Laser Ablation Treatment (Non-surgical) / Radiofrequency Ablation
Endovenous (or vein) ablation is a minimally invasive outpatient treatment for venous insufficiency that is performed using ultrasound guidance. After applying local anesthetic to the skin over the vein, an interventional radiologist inserts a thin tube known as a catheter, about the size of a strand of spaghetti, into the abnormal saphenous vein. Through this catheter, laser or radiofrequency energy is applied to the inside of the vein to seal it closed.
Sclerotherapy
Sclerotherapy is a medical procedure used to eliminate varicose veins and spider veins. Sclerotherapy involves an injection of a solution (generally a salt solution) directly into the vein. The solution irritates the lining of the blood vessel, causing it to swell and stick together, and the blood to clot.
Angiography & Angioplasty for Peripheral Artery Disease
Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD), is a very common condition. PAD develops most commonly as a result of atherosclerosis, or hardening of the arteries, which occurs when cholesterol and scar tissue build up, forming a substance called plaque inside the arteries.
Angioplasty and stenting
Interventional radiologists pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease. Using imaging for guidance, the interventional radiologist threads a catheter through the femoral artery in the groin, to the blocked artery in the legs. Then the interventional radiologist inflates a balloon to open the blood vessel where it is narrowed or blocked. In some cases this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip.
Dialysis Access
Patients suffering from chronic kidney disease or renal failure need to under renal replacement therapy in the form of dialysis. Dialysis forms the lifeline of patients suffering with kidney disease. This dialysis can be performed either as haemodialysis (blood dialysis) or peritoneal dialysis (through the abdomen).
For haemodialysis, either a dialysis catheter is placed in one of the neck/ upper limb veins(subclavian vein) or even rarely in the leg veins in the groin, or a artificial joint is created between the artery and vein the upper limb, called as Arterio-Venous Fistula (or AVF for short).
AV Fistuloplasty (Dialysis Access Salvage)
An AV (arteriovenous) fistula is the best means of access to the blood stream for long-term haemodialysis. It is created by connecting an artery to a vein, usually in your wrist or upper arm, and it helps to transfer blood into the dialysis machine and back again during haemodialysis.
Sometimes, even when you are very careful, your fistula may become infected, blocked or narrowed. If an infection occurs, you will need a course of antibiotics. If there is any blockage or narrowing in your fistula, you may need to have a fistuloplasty.
A fistuloplasty is performed by an interventional radiologist (a doctor who uses x-rays to diagnose and treat illnesses). He/she will use dye (contrast agent that shows up on x-rays) to help locate the blockage or narrowing in your fistula. The blockage is then relieved by stretching the blood vessels with a special balloon.
Non-surgical treatments for Cancer
Oncology is a branch of medicine that deals with tumours. Oncology is concerned with the diagnosis of any cancer in a person (pathology), therapy (e.g. surgery, chemotherapy, radiotherapy and other modalities),follow-up of cancer patients after successful treatment and palliative care of patients with terminal malignancies.
Types of Minimally Invasive Onco Interventions:
- Percutaneous interventions
- Radiofrequency (RF) ablation
- Cryoablation
- Percutaneous ethanol injection (PEI)
- Microwave ablation
- Transarterial interventions
- Transarterial chemoembolization (TACE)
Hepato-Biliary Interventions
Hepatobiliary tumours are abnormal growths occurring on or in the liver, bile ducts, and biliary tract, the tubes that carry bile from the liver or gallbladder to the small intestine. The interventional radiologists at ruby hall clinic work closely with gastroenterologists and surgeons to provide a variety of treatment methods for patients experiencing biliary and hepatic diseases.
Treatment options for Biliary Disease includes:
- Percutaneous TranshepaticCholangiograhpy (PTC)
- Perctutaneous Biliary Drains (PBDs)
- Cholecystostomy
Treatment options for Hepatic Disease includes:
- Percutaneous Liver Biopsies
- Transjugular Liver Biopsies
- TIPS (Transjugular Intrahepatic Portocaval Shunt)
- Variceal Embolizations
Embolisation for Internal Bleeding
Embolization is a procedure that blocks the flow of blood through a blood vessel. To do this, the procedure deploys an embolic device into the vessel, commonly a small metal coil, latex balloon, or a liquid or solid chemical agent.
Embolization is well known for controlling postpartum hemorrhage (bleeding after childbirth) but also treats a spectrum of conditions, such as severe internal bleeding, liver cancer, and vascular malformations.
In some situations, embolization offers advantages over traditional surgery. In many cases it can control bleeding more easily than traditional surgery. Also, it is typically less invasive, an important factor when open surgery is risky or inappropriate for a particular patient. Embolization can also be used in conjunction with surgery to reduce blood loss.
WHEN IS THE PROCEDURE Required?
Embolization is indicated in a variety of situations, including:
- Cerebral aneurysm
- Trauma
- Bleeding in the liver
- Upper gastrointestinal tract hemorrhage
- Postpartum hemorrhage
- Vascular malformations
- Uterine fibroids
- Liver cancer
- Varicoceles, distended veins in the scrotum
Radiofrequency Ablation (RFA) of various Tumours
Radiofrequency ablation (RFA) is a treatment that uses imaging guidance to place a needle electrode through the skin into a tumor. High-frequency electrical currents are passed through the electrode, creating heat that destroys the cancer cells.
“RFA is an effective treatment option for patients who might have difficulty with surgery and those whose tumors are less than one and a half inches in diameter.RFA can be used for tumors in in lung, liver or peripheral organs etc.” says Dr. Yadav Munde, Interventional Radiologist, Ruby Hall Clinic.
RFA is an alternative to open surgery, interventional radiology procedures may reduce risk, pain and recovery time for patients.
Percutaneous Nephrostomy and DJ stenting
A percutaneous nephrostomy is an interventional procedure in which a small, flexible rubber tube (catheter) through your skin into your kidney is placed to drain your urine. A thin, hollow tube placed inside the ureter during surgery to ensure drainage of urine from the kidney into the bladder. J shaped curls are present at both ends to hold the tube in place and prevent migration, hence the description “Double J stent”.
Mininally Invasive Surgery
Minimally invasive surgery is becoming more and more common in hospitals. These procedures are performed through tiny incisions instead of one large opening. Because the incisions are small, patients tend to have quicker recovery times and less discomfort than with conventional surgery — all with the same benefits. “Most of the interventional procedures tend to require only local anaesthesia, hospital stays are very short, with patients frequently going home on the same day. MIS is bliss for the patients who are unfit for surgery.” says
Dr. Yadav Munde, Interventional Radiologist.
Non-surgical solution for Male/Female infertility
Some common causes of infertility in both women and men can now be treated without surgery by interventional radiologists.
Non-Surgical Solution to Female Infertility: Common cause of female infertility is blockage of the fallopian tube through which eggs pass from the ovary to the uterus. Occasionally, these tubes become plugged or narrowed, preventing successful pregnancy. Interventional radiologists can diagnose and treat a blockage in the fallopian tubes with a nonsurgical procedure known as Fallopian Tube Recanalisation.
Non-Surgical Solution to Male Infertility: In males, a varicocele is a varicose vein of the testicle and scrotum that may cause pain and lead to testicular atrophy. Some experts believe that the raised temperature that results from the pooled blood in these blocked veins can decrease sperm count and motility of sperm and increase the number of deformed sperm. In fact, the incidence of varicoceles increases to 30 percent in couples who cannot have children. Varicoceles are fairly simple to detect and diagnose through physical or diagnostic examination.Interventional Radiologist can treat varicoceles without surgery by blocking varicocele(dialted veins along testicles).
Uterine Fibroid Embolization
Fibroids are non-cancerous growth, usually found in the uterus of women in their childbearing age. These fibroids can be more than one and grow in size, with time.
Women may face the symptoms like Excessive bleeding and prolonged, painful periods, bloating sensation, Pelvic pain and pressure in case of uterine fibroids.
Interventional Radiology non-surgical treatment for Uterine Fibroid
Uterine Fibroid Embolization (UFE), also called as Uterine Artery Embolization is a minimally invasive procedure done under local anaesthesia, using fluoroscopy guidance. An Interventional Radiologist inserts a thin catheter inside a thigh artery and guides it to the uterine artery. Tiny round particles called PVA (Poly Vinyl Alcohol) are injected into the blood vessels of the uterine artery for embolization. These particles block blood flow to the fibroids, causing them to shrink. The PVA particles remain permanently at the fibroid site.
Renal Artery Stenting
A subset of hypertension patients have hypertension that is caused by vascular disease, i.e., arterial blockage or narrowing in the renal artery. This renovascular disease causes decreased blood flow to the kidney, which results in systemic (body-wide) constriction of the blood vessels, causing a rise in blood pressure.
Treatment
Interventional radiologists can accurately diagnose renovascular disease. If medical management-medications and lifestyle changes-are insufficient, Interventional Radiologists can perform angioplasty and, if needed, stenting, to improve blood flow to the kidney.
Interventional radiologists also play a role in treating patients with renal failure. In these patients, revascularization with angioplasty has gained acceptance as a treatment to improve or stabilize renal function, with improvement seen in approximately 40 percent of patients.
Osteoporosis Pain Treatment (Vertebroplasty)
Osteoporosis is a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D.
Treatments
Vertebroplasty is a pain treatment for vertebral compression fractures that fail to respond to conventional medical therapy, such as minimal or no pain relief with analgesics or narcotic doses that are intolerable. Vertebroplasty, a nonsurgical treatment performed by interventional radiologists using imaging guidance, stabilizes the collapsed vertebra with the injection of medical-grade bone cement into the spine. This reduces pain, and can prevent further collapse of the vertebra, thereby preventing the height loss and spine curvature commonly seen as a result of osteoporosis.
Vertebroplasty dramatically improves back pain within hours of the procedure, provides long-term pain relief and has a low complication rate, as demonstrated in multiple studies.
Deep Vein Thrombosis
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 pulomnary embolism.
Treatments
Blood Thinners
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.
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 preserve 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.
Portal Hypertension/Budd Chiari Syndrome and TIPSS
Budd-Chiari syndrome (BCS) is a disorder affecting the liver and blood vessels, where blood flowing into the liver has difficulty in being able to flow out, leading to serious complications. After blood has passed through the liver, it flows out through the hepatic veins and into the inferior vena cava, a large blood vessel that carries blood back to the heart. In BCS, this flow is partially blocked, sometimes referred to as ‘an obstruction of hepatic venous outflow’.
Treatment
The aim of treatment for BCS / Portal Hypertension is to keep your liver function stable by maintaining the flow of blood out of the liver. Doctors will be looking to:
- Re-channel the blocked veins if possible
- Prevent recurrence or progression of thrombosis
- Ease or ‘decompress’ the congestion of blood in your liver
- Manage your ascites
- Prevent further damage to your liver and allow liver cells to regenerate
Portal Hypertension : Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas merge into the portal vein, which then branches into smaller vessels and travels through the liver.
Hepatic Vein Stenting : In medicine, a stent is a tube or other device placed in the body to create a passage between two hollow spaces, and stenting is the placement of a stent. There is a wide variety of stents used for different purposes, from expandable coronary, vascular and biliary stents, to simple plastic stents used to allow the flow of urine between kidney and bladder. Stent is also used as a verb to describe the placement of such a device, particularly when a disease such as atherosclerosis has pathologically narrowed a structure such as an artery.
TIPSS : Transjugular intrahepatic portosystemic shunt or transjugular intrahepatic portosystemic stent shunting (commonly abbreviated as TIPS or TIPSS) is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein. It is used to treat portal hypertension (which is often due to liver cirrhosis) which frequently leads to intestinal bleeding, life-threatening esophageal bleeding (esophageal varices) and the buildup of fluid within the abdomen (ascites). An interventional radiologist creates the shunt using an image-guided endovascular (via the blood vessels) approach, with the jugular vein as the usual entry site.
Aortic Aneurysm Repair
Endovascular the aortic aneurysms are treated by interventional radiologists by using stent graft (metal cylinder covered with nonpermiable material) placement across the dilated part of aorta. aortic aneurysm repair is surgery to repair a widened area in your aorta. This is called an aneurysm. The aorta is the large artery that carries blood to your belly, pelvis, and legs.
An aortic aneurysm is when a part of this artery becomes too large or balloons outward. It occurs due to weakness in the wall of the artery.
The most common location of arterial aneurysm formation is the abdominal aorta, specifically, the segment of the abdominal aorta below the kidneys. An abdominal aneurysm located below the kidneys is called an infrarenal aneurysm. An aneurysm can be characterized by its location, shape, and cause.
Biopsy and Abscess Drainages
A biopsy is a sample of tissue taken from the body in order to examine it more closely. A doctor should recommend a biopsy when an initial test suggests an area of tissue in the body isn’t normal. Doctors may call an area of abnormal tissue a lesion, a tumour, or a mass.
An abscess is a collection of pus that has built up within the tissue of the bodySigns and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid filled when pressed. The area of redness often extends beyond the swelling.
At Ruby Hall clinic these procedures are done regularly as office procedures without hospitalisation.
Gastrostomy(Feeding Tubes)
People with certain diseases or medical conditions sometimes require that tubes be placed into the body so that they can receive medications or nutrients directly into the blood stream or gastrointestinal system, or so blood can be drawn. “A complicated open surgery was required once, to insert these tubes, but its history now. Today these procedures can be done without surgery by an interventional radiologist which is safe and quick”, says
Dr. Yadav Munde.
Central Venous Access Catheters (CVAC)
A CVAC is a tube that is inserted beneath your skin so there is a simple, pain-free way for doctors or nurses to draw your blood or give you medication or nutrients. When you have a CVAC, you are spared the irritation and discomfort of repeated needlesticks. More than 3.4 million CVACs are placed each year, and doctors increasingly recommend their use. There are several types of CVACs, including tunneled catheters (Hickman or Broviac), peripherally inserted central catheters (also called PICC lines or long lines), dialysis catheters, and implantable ports.
Interventional radiologists also open up blocked hemodialysis grafts, using procedures such as angioplasty or thrombolytic therapy.
Pulmonary Embolism
Pulmonary embolism is the sudden blockage of a major blood vessel (artery) in the lung, usually by a blood clot. In most cases, the clots are small and are not deadly, but they can damage the lung.
Treatment in Interventional Radiology
Catheter-directed therapy or catheter-directed thrombolysis—an interventional radiology treatment that uses targeted image-guided drug delivery with specially designed catheters to dissolve dangerous blood clots in the lungs—saves lives and should be considered a first-line treatment option for massive pulmonary embolism. “We are working hard to raise awareness about Modern catheter-directed therapy for acute pulmonary embolism among common people and even among the medicos.” says Dr. Yadav Munde, Interventional Radiologist.