Arterial and Venous Angiography
An angiogram is x-ray imaging of the blood vessels( arteries and veins). An angiogram provides information about blood vessel abnormalities such as narrowing, blockage, inflammation, abnormal widening, and bleeding. An interventional radiologist or vascular surgeon will insert a catheter( thin tube) into the artery or vein through a small cut in the skin. Then a contrast agent(x-ray dye) is injected to make the blood vessels visible on x-ray.
also known as ‘balloon angioplasty” is a minimally invasive procedure used to widen narrowed or obstructed arteries or veins. Using angiography, a deflated balloon attached to a catheter is inserted into the narrowed vessel and then inflated to a fixed size for a short time. The balloon forces expansion of the blood vessel, allowing improved blood flow.
A stent is a synthetic tube that is inserted into a blood vessel to keep it open and/or reinforce the natural structure. One type of stent MVP uses is a Drug-eluting stent. This is a stent that is coated with medication that releases over time to help decrease the risk of re-narrowing (stenosis) of the artery. A stent is placed using angiography.
Atherectomy is a minimally invasive procedure that removes plaque buildup from blood vessels to improve blood flow. Atherectomy is performed using angiography.
Do you suffer from Peripheral Artery Disease (PAD)? Angioplasty, Stent or Atherectomy may be a solution. Learn more here.
Thrombolysis is a treatment using pharmaceutical drugs to dissolve blood clots in arteries or veins to restore or improve blood flow.
Thrombectomy is a treatment using a device to mechanically remove blood clots from an artery or vein to restore or improve blood flow.
Embolization is a treatment that places medications or synthetic materials called embolic agents through a catheter into a blood vessel to block blood flow to an area of the body. It is used to prevent abnormal bleeding, treat aneurysms and eliminate abnormal connections between arteries and veins.
Endovascular stent grafting ( EVAR) is a form of treatment for Abdominal Aortic Aneurysm. A stent graft, made of fabric and metal is placed inside the aorta to prevent an aneurysm from rupturing. This is a minimally invasive procedure and is done roughly 70% of the time for patients with AAA versus open surgery. MVP also performs open aortic aneurysm surgery as well. ( see surgical procedures).
A dissection occurs when the inner wall of an artery tears and blood flows between two layers of the artery wall, weakening the artery wall. Dissection repair can be done using endovascular treatment with a stent or stent graft, or open technique, depending on the patient and circumstances.
Thoracic Outlet Syndrome ( TOS)
TOS is a disorder that occurs when blood vessels or nerves in the space between your collarbone and your first rib are compressed.
Symptoms can include: Discoloration of the hand, arm pain and swelling, blood clot in the veins or arteries in the upper arm/chest, weak or no pulse in the affected arm, arm fatigue with activity, numbness or tingling in the fingers.
TOS is diagnosed by having an exam with one of our vascular physicians, in addition to angiography of the affected arm using provocative testing to elicit symptoms.
Treatment can include venous/arterial angioplasty, stent placement and surgical 1st rib removal.
TIPS ( Transjugular Intrahepatic Portosystemic Shunt)
TIPS is a procedure that creates new connections between two blood vessels in the liver. TIPS is performed on patients that have scar tissue in the liver, causing the blood flow to be blocked.
Normally, blood coming from the esophagus, stomach, and intestines first flows through the liver. When your liver has blockages, blood cannot move through it easily. This causes portal hypertension- which is where the blood backs up, causing increased pressure and enlarges the veins coming from the esophagus, stomach, and intestines. These veins can then very easily rupture, causing serious bleeding.
Causes of Portal hypertension include hepatitis B or C, blood clots in a vein from the liver to the heart, too much iron in the liver and alcohol use.
An interventional radiologist will perform the procedure using x-ray imaging to guide a catheter(thin tube) into the jugular vein in the neck. This catheter will then be guided to the liver. Using a special x-ray dye, the vessels of the liver are imaged and a stent is placed inside the liver to connect blood vessels. This allows the blood to flow better, eliminating the pressure on the veins of the esophagus, stomach, and intestines.
A varicocele is an abnormal enlargement of a vein in the scrotum that drains the testes. A varicocele forms when the valves inside the veins prevent the blood from flowing properly, causing the vein to enlarge.
Some patients experience no symptoms, while others may have dull pain, swelling, or visibly enlarged veins in the scrotum. Varicoceles are not dangerous but may cause infertility.
Varicocele embolization is an image-guided procedure that uses a small catheter to place a small coil to divert blood flow away from the abnormally enlarged vein in the scrotum.
Venous ablation is a minimally invasive treatment performed at the Minneapolis Vein Center for superficial venous reflux. Using state of the art technology, venous ablation provides an alternative to traditional vein stripping surgery.
During this outpatient procedure, your leg will be evaluated using ultrasound and the affected vein localized. You will receive local anesthesia to numb the skin entry site on your leg and along the treatment path. A thin catheter, or tube, is inserted into the vein through a small opening, using only a single needle stick. The catheter delivers radiofrequency (RF) or laser energy to the vein wall, causing it to heat, collapse and seal shut. Once the diseased vein is closed, other healthy veins take over to empty blood from your legs. As normal blood flow is re-established, your symptoms should improve noticeably. An ultrasound exam will be repeated to verify the vein is completely sealed.
Patients scheduled for venous ablation should arrange for transportation as they will be sedated for the procedure and should not drive for the rest of the day.
The procedures typically take approximately 45-60 minutes.
Ninety-eight percent of patients who have undergone venous ablation would recommend it to a friend or family member with similar leg vein problems.
The vast majority of patients report a noticeable improvement in their symptoms and appearance following the procedure. Expect a short recovery period and then to resume normal activities in a few days with minimal to no long-term scarring.
- After treatment, wear compression stockings for one week.
- You can begin walking the same day; however no vigorous exercise or lifting more than 15 pounds for two weeks after the procedure.
Sclerotherapy is a treatment for spider veins; it involves using a fine needle to inject a solution directly into the problematic veins. The solution starts a process that leads to the vein turning to scar tissue and fading from view. Blood circulation continues through other healthy veins. Larger veins are treated first. Some veins may require several injections and most disappear within two to six weeks.
The number of treatments needed to achieve the desired amount of fading differs for each patient depending on the size of the treated veins and amount of spider veins presented. The average number of treatment is 3 to 4 sessions.
Sclerotherapy typically requires no special preparation. However, you should not shave or apply lotion to the area being treated. Let your doctor know of any medications you may be taking.
The sclerotherapy procedure itself typically takes approximately 30-60 minutes, although we advise patients to plan on spending roughly two hours at the Minneapolis Vein Center.
Patients who have received sclerotherapy report little discomfort. Some experience a slight to moderate burning sensation immediately after the injection, but this disappears within a few seconds.
Patients can expect to return to normal activities the same day since we do encourage walking immediately following the procedure. Strenuous activity, prolonged periods of standing and lifting more than 15 pounds are to be avoided for the first two weeks after the procedure.
- Compression stockings are required for two weeks following your procedure.
- We do not recommend tanning or direct sun exposure for six weeks following treatment since this may increase the prominence of any hyperpigmentation.
- Most patients experience 60-80% improvement within a few months of the procedure.
Phlebectomy is a minimally invasive surgical technique to remove abnormal medium to large veins. Your leg will be evaluated using ultrasound and the veins will be marked using a skin marker. You will receive local anesthesia at the incision site to numb the entire area. Using a special set of tools, the physician makes tiny incisions in the skin to remove the affected veins. Incisions are so tiny that stitches are not required. Once the diseased vein is removed, other healthy veins take over to empty blood from your legs. As normal blood flow is re-established, your symptoms should improve noticeably.
Patients scheduled for phlebectomy should arrange for transportation as they will be sedated for the procedure and should not drive for the rest of the day.
The procedure typically takes approximately 45-60 minutes.
Phlebectomy offers permanent vein removal with virtually no scarring, skin discoloration or ulcers.
- Many physicians recommend walking after treatment. Walking reduces pressure in the veins and increases flow while reducing the risk of forming a blood clot. Typical side effects include mild discomfort, bruising and bleeding.
- After treatment, patients typically wear a compression stocking for two weeks. Your physician will discuss this with you after the procedure.
Treatment and Evaluation of Venous Leg Ulcers
Approximately 70 percent of all leg ulcers are venous ulcers. A leg with venous problems has a very characteristic appearance. The leg is swollen and the skin around a venous ulcer is dry, itchy and sometimes brownish in color—eczema may appear (varicose eczema). The ulcer has a weeping, raw appearance and is usually painless unless infected. These types of ulcers are normally located just above the ankle, usually on the inside of the leg.
To treat ulcers MVC typically starts with a medicated wound wrap or Unna boot to treat and heal the wound. As the healing process begins, some patients will need further treatment to fully control the disease process in order to prevent recurrent ulcers or other problems. A full evaluation using ultrasound should be completed to determine the presence of venous disease.
VenaSeal™ is the most recent technology approved to treat varicose veins and venous insufficiency. It uses a medical adhesive delivered to the vein that closes it. There is less patient discomfort since the procedure does not require local anesthesia, unlike the venous ablation procedure. No exercise restrictions after the procedure and no compression stockings. This procedure is appealing to individuals who want their veins treated right away and do not want any post-procedure restrictions. This procedure is currently not covered by insurance.
Women's Health Procedures
Ovarian Vein/Pelvic Vein Embolization (OVE)
OVE is a procedure used to seal enlarged and faulty veins in the abdomen and pelvis in patients who have symptomatic pelvic venous insufficiency (PVI).
Pelvic Venous Insufficiency (PVI)
PVI refers to pelvic varicose veins and labial varicose veins. Pelvic Venous Insufficiency (PVI) is a commonly overlooked condition that can cause pelvic pain and be debilitating for many women. Common symptoms include:
- dull chronic pelvic pain
- pressure and heaviness associated with dilated pelvic varicose veins
- occasionally labial and vulvar varicose veins
Symptoms are worse with menses, after intercourse, prolonged standing and at the end of the day.
Consultation and further imaging (CT/MRI) are done first to evaluate if a patient is an ideal candidate for the procedure.
Uterine Fibroid Embolization (UFE)
UFE is a minimally invasive way of treating fibroids. Using image-guidance, the doctor closes down the blood flow to the fibroids causing them to shrink.
Uterine fibroids are benign, non-cancerous growths in or on the wall of the uterus. They can range in size from less than an inch to several inches in size.
Most cause no symptoms and are discovered during a routine pelvic exam, but when they do cause symptoms these may include:
- heavy, prolonged menstrual bleeding
- pain/pressure in the pelvis and back
- pain during intercourse
- frequent urination
Consultation and MRI are done first to evaluate if a patient is an ideal candidate for UFE.
As Interventional Oncologists, we cure cancer and help patients with cancer live longer while enabling a high quality of life. We work directly with Oncologists, Surgical Oncologists, and Pathologists in order to evaluate the current state of disease and come up with the best treatment protocols to maximize positive outcomes. This multidisciplinary approach involves evaluating past/current treatments, disease pathology, and imaging during meetings such as Tumor Boards. We customize treatment protocols for each case and have established systems to streamline formal consultations, imaging protocols, and post-procedure follow up including overnight observation admissions (if needed) and follow up clinic visits. We take ownership of our patients and are in direct communication with the referring physician before and after the procedure.
Liver-Directed Cancer Treatment
Cancer that has metastasized to the liver or primary liver cancer can be effectively treated with intra-arterial liver-directed treatments. Cancers in the liver that have shown a good response to intra-arterial therapies include cancers that originate in the liver such as hepatocellular carcinoma, cholangiocarcinoma, or metastatic disease to the liver from colon cancer, breast cancer, neuroendocrine cancer, lung cancer, and melanoma.
There are three primary modes of intra-arterial treatment which include Radioembolization, Chemoembolization, and Bland Embolization. The treatment that the patient receives depends on a multitude of factors including cancer type, liver function, the volume of disease in the liver, patient’s functional status and liver arterial anatomy.
Radioembolization is used to treat primary liver cancer and other cancers that have metastasized to the liver. Radioembolization is used to deliver targeted internal radiation therapy directly to the tumor.
Chemoembolization therapy is used to treat liver tumors or for postsurgical adjunctive treatment. Chemotherapy medicines are injected into the liver through blood vessels, delivering a high local dose of cancer-killing medicine directly to the tumor or tumor area.
Percutaneous Ablation of Cancer
Percutaneous ablation is an outpatient procedure. It involves treatment of tumors by placing one or multiple probes through the skin into the tumor and then using heat (radiofrequency or microwave), cryotherapy or chemicals such as alcohol to kill the tumor cells. A small amount of healthy tissue around the tumor is also ablated to achieve clear margins similar to surgery. There are other percutaneous ablative therapies including high intensity focused ultrasound and electroporation that have limited use at this time.
These outpatient procedures, if performed appropriately, completely eliminate the tumor leading to cure without the need for large incisions or lengthy, often painful, recovery times. They are the perfect alternative to surgery and have minimal to no side effects.
We use two of the following percutaneous ablation procedure in most cases.
Microwave ablation is a treatment that uses electromagnetic waves to create heat and directs the heat through a needle probe which is inserted into a collection of abnormal cells or tumor.
Cryoablation is a treatment that freezes abnormal or tumor cells. A needle probe is inserted into the tumor using CT or Ultrasound guidance and releases a gas which decreases the temperature of the treatment area and destroys the abnormal cells.
Vascular Access Catheters
Central Venous Catheters
A central venous catheter is a long, thin, flexible tube inserted into a large vein typically in the neck, chest or groin through the skin into a large vein. These catheters are used to give medicines, fluids, nutrients or blood products need to be given on a long-term basis.
PICC stands for ‘peripherally inserted central catheter’, often called a PICC line, is a catheter inserted into a vein in the arm. These catheters are used to give chemotherapy regimens, antibiotics or nutrients on a long-term basis.
A Port catheter, or Portacath, is an implanted device giving access to veins for a patient who needs regular long-term antibiotics or chemotherapy drugs. Ports can also be used to withdraw blood for blood tests.
A dialysis catheter is a long, thin, flexible tube that can be tunneled under the skin into a large vein in the neck, chest or groin. MVP also places Peritoneal dialysis catheters. A peritoneal dialysis catheter is a long, thin, flexible tube placed through the wall of the abdomen in the peritoneal cavity. (more info vascularphysicians.com)