Peripheral Interventions

Varicose Vein LASAR Ablation

The pathophysiology of venous disorders can be classified into two types i.e. uncomplicated and complicated.

Failure of competence of venous valves will lead to retrograde flow down the limb when the patient stands up or after exercise movement has resulted in slack vein in lower leg.

The term 'varicose vein' refers to vein that are abnormally large and tortous, and applies to both large protruding veins beneath the skin & smaller spder veins that occur beneath epidermis. In telangiectasias, dilatation develop between the epidermis & hypodormis in subpapillary dermal plexus and usually measures between 0.1 and 1mm. In chronic venous insufficiency all telengeictasias are accompanied by reticular veins.

Superficial venous insufficiency is caused by reflux via venous junctions or via perforating veins of superficial veins or Small saphenous vein.

Complicated chronic venous disease includes chronic venous insufficiency which is a condition of inadequate venous return & hypertension when patient is upright.

Increase in venous pressure results in corresponding increase in capillary pressure & changes in skin. This leads to swelling in lower limbs with reduced microvascular circulation leading to skin pigmentation, venous eczema and dermatitis, lipodermatosclerous and finally venous ulcer which may take months or years to develop.

The role of superficial venous insufficiency is important in development of venous skin changes.

Uterine Fibroid Embolization

Uterine fibroid embolization, or UFE, is a technique for cutting off the blood supply of uterine fibroids to get them to shrink. It is sometimes referred to as Uterine Artery Embolization, or UAE. This procedure is performed exclusively by Interventional Radiologists -- doctors who are specially trained to do minimally invasive vascular procedures, such as angioplasty and embolization, to treat a variety of conditions.

UFE is performed in a manner similar to a heart catheterization, whereby a small catheter (plastic tube) is introduced into the right femoral artery through a tiny skin nick in your groin. The catheter is guided using an x-ray camera into each uterine artery, where microscopic particles are injected, killing all of the fibroids at the same time.

You will not be aware of anything happening on the inside and the groin area is thoroughly numbed before starting. You will also feel very relaxed from potent medicines given to you through an intravenous line and may fall asleep.

UFE is 90% effective in relieving symptoms. Risks are discussed in detail below. Please see the additional resources on page 6 for reputable websites and bring any unanswered questions to your appointment.

GI Bleed Embolization

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IVC Filter Deployement for DVT

Arteries bring oxygen-rich blood from your heart to the rest of your body, whereas your veins are the blood vessels that return oxygen-poor blood back to your heart. You have three kinds of veins. Superficial veins lie close to your skin, and the deep veins lie in groups of muscles. Perforating veins connect the superficial veins to the deep veins with one-way valves. Deep veins lead to the vena cava, your body's largest vein, which runs directly to your heart. Deep vein thrombosis (DVT) is a blood clot in one of the deep veins. Usually, DVT occurs in your pelvis, thigh, or calf, but it can also occur less commonly in your arm, chest, or other locations.

DVT can cause sudden swelling, pain or a sensation of warmth. DVT can be dangerous because it can cause a complication known as pulmonary embolism. In this condition, a blood clot breaks free from your deep veins, travels through your bloodstream, and lodges in your lungs. This clot can block blood flow in your lungs, which can strain your heart and lungs. A pulmonary embolism is a medical emergency. A large embolism can be fatal in a short time.

It can sometimes be difficult to recognize the symptoms of DVT. However, the condition can be effectively treated once your physician diagnoses it.

Peripheral Angioplasty & Stenting

During an angioplasty, your vascular surgeon inflates a small balloon inside a narrowed blood vessel. The balloon helps to widen your blood vessel and improve blood flow. After widening the vessel with angioplasty, your vascular surgeon sometimes inserts a stent depending upon the circumstances. Stents are tiny metal mesh tubes that support your artery walls to keep your vessels wide open.

Angioplasty and stenting are usually done through a small puncture, or sometimes a small incision, in your skin, called the access site. Your vascular surgeon inserts a long, thin tube called a catheter through this access site. Using X-ray guidance, your physician then guides the catheter through your blood vessels to the blocked area. The tip of the catheter carries the angioplasty balloon or stent.

Angioplasty most often is used to treat peripheral arterial disease (PAD), which is another name for hardening of the arteries supplying blood to your limbs or to organs in your body other than your heart. Angioplasty can also be used, in some circumstances, to treat narrowed areas in your veins, which are blood vessels that drain blood out of your limbs or organs and return the blood to your lungs and heart.

Your arteries are normally smooth and unobstructed on the inside, but as you age, plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up this plaque. As more plaque builds up, your arteries can narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries. Eventually, enough plaque builds up to reduce blood flow through your arteries causing pain or damage to the part of the body that the artery supplies.

Depending upon the particular circumstances, your physician may recommend angioplasty as an alternative to bypass surgery, which also treats narrowed arteries. For certain types of blockages, angioplasty has some advantages when compared to bypass surgery. For example, angioplasty does not require a large incision. Because of this, angioplasty patients usually spend less time in the hospital and recover at home faster than bypass surgery patients. Also, your physician can usually perform angioplasty while you are awake, whereas bypass surgery requires general or regional anesthesia. Nevertheless, in some circumstances, especially for extensive PAD, bypass surgery may be a better option. Your vascular surgeon will help you decide what alternative is best for your particular situation.

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