Peripheral arterial disease (PAD) is a narrowing of the peripheral arteries of the body but most commonly in the arteries of the legs. PAD is similar to coronary artery disease (CAD). Both PAD and CAD are caused by atherosclerosis of the arteries in various critical regions of the body. Atherosclerosis is caused by plaque buildup in the arteries which can narrow and harden the arteries and eventually even cause a complete blockage. If left untreated, PAD can lead to painful cramping, limited mobility, poor healing, gangrene, infection, amputation, and death. Typically, this pain goes away with rest and returns when you walk again. In more severe cases, PAD can lead to pain in your feet at rest, particularly when you are in bed. Fortunately, there are several highly effective therapies if PAD is detected early.
Risk factors for PAD include coronary artery disease or stroke, smoking, high blood pressure, high cholesterol, diabetes/metabolic syndrome, family history, being overweight and your age (over 50). African Americans are at a higher risk for PAD. Quitting smoking significantly reduces your risk of developing PAD within 10 years.
PAD often goes unnoticed and undiagnosed by healthcare providers. Another challenge is that the symptoms of PAD are easily mistaken for other conditions, such as neuropathy or just the aches and pains of getting older. PAD is also commonly under diagnosed in women. As a result, when women are eventually diagnosed with PAD, the disease is more likely to have become severe.
The good news is that PAD is easily diagnosed with quick, easy and painless tests. These can include physical examination, ankle-brachial index (ABI), ultrasound (duplex), and angiogram scans. At CVOI, we offer the full spectrum of service. As radiologists, we will review your prior imaging tests with you and if necessary, we have screening tests right here in the office. As interventional doctors, we can then perform an angiogram to identify the precise location and severity of the blockages within the peripheral arteries as well as provide very precise therapies to try to improve or fix any problem sites you may have.
If the disease is not severe, PAD can be treated with medication and/or lifestyle changes. If it has progressed to the point where an intervention is needed, there are likely several procedures available to you. The interventional radiology experts at Capitol Vascular and Oncology Institute offer these minimally invasive treatments for PAD that do not require surgery, need minimal to no recovery time and have great success rates.
Venous insufficiency is a condition where the flow of blood through the veins is inadequate, causing blood to pool in the legs. Your veins carry blood back to the heart and valves in the veins stop the blood from flowing backward. When your veins have trouble sending blood from your limbs to the heart, it is known as venous insufficiency. It can be caused by several different vein disorders, but can often be caused by or associated with either blood clots or varicose veins. If you have lower extremity swelling with or without bulging superficial veins, you need to be evaluated by a doctor. Your treatment options depend on what’s causing the condition, but your doctor may first recommend compression stockings and prescription medications. In more serious cases, you may need to have an intervention. Don't wait until it is too late and the symptoms are too severe. At CVOI, we provide expert consultation on venous disease by doctors with sub-specialization in diagnosing and treating vascular diseases. Schedule an appointment to learn more and see what options are available and how they may help.
Wounds on the lower leg are often caused by problems with veins or arteries, or a combination of both. The further away from the heart, the longer wounds may take to heal, particularly in people over 50 years of age.
Around one per cent of the American population suffers from vascular leg ulcers (chronic venous leg ulceration). This percentage increases in adults aged 65 or older. The most common cause is poor blood circulation, particularly the inability of the veins to pump blood back to the heart
Other causes or risk factors include prolonged pressure on an area (such as long-term lying-in bed in one position, which may cause bed sores), badly managed diabetes, high cholesterol, smoking, dietary problems, increased risk of infection, sepsis, gangrene and poor arterial circulation.
There are 2 types of vascular ulcers: venous and arterial. common symptoms that are usually present with venous ulcers are:
Common Symptoms Present With Arterial Ulcers Are:
Vascular ulcerations are common in adults with certain health problems, mainly related to the heart and circulatory system. Some conditions are Diabetes, obesity, PAD, heart disease, high blood pressure, and smoking.
Here at CVOI, we aim to help treat our patients suffering from vascular ulcerations and wounds through changes in diet, exercise, use of compression garments, and medication. If the symptoms have progressed to the point where these lifestyle changes alone cannot treat the problem, we employ advanced techniques such as revascularization to remove blockages in crucial blood vessels helping existing wounds heal while preventing new wounds from forming.
Interventional Oncology (IO) is a type of medicine that includes a number of minimally-invasive image-guided procedures to diagnose and to treat various types of cancer. Most procedures can be done on an outpatient basis and occasionally may require overnight hospital stay. This includes performing biopsies to diagnose and restage the disease, placement and removal of chemotherapy ports, and all the way to innovative non-surgical therapies that can treat solid tumors that can affect the liver, lung, bone and kidney. Treatments in IO generally fall into two categories, ablation and embolization. Thermal or chemical ablation treats solid tumors within organs directly with a needle and imaging guidance, while embolization is a treatment directly from within the liver arteries that is feeding primary or metastatic cancer involving the liver. This treatment can shrink and destroy tumors directly without surgery and minimal recovery time. At CVOI, the doctors are board-certified specialists who can offer top-notch consultation and recommendations. There are several types of ablation and embolization which are all different and it is important to seek expert advice for your condition and potential options for interventional therapies. We work together with your cancer doctors to determine the best treatment course including how to time and combine all your treatment options for optimal results.
Interventional oncology has many treatment options for cancer in the liver, which can be primary liver cancer or metastatic disease to the liver that is more common. The liver is one of the most common sites of spread of many types of cancer, including colorectal, breast, pancreatic, lung and biliary adenocarcinomas. The treatment of cancers which have spread to the liver include medical, surgical and minimally invasive therapies which aim to improve the survival and quality of the life of patients. Recently, multiple new advanced therapies to treat cancer that has spread to the liver have been developed and are minimally invasive. Studies have shown that these treatments are safe, well-tolerated and can improve both the quality of life and survival of the patients treated.
Cancer that arises in the kidneys comes from either the functional tissue of the kidney or from the lining of the collecting system. Renal cell carcinoma arises from the functional tissue of the kidney and is far more common than other types of kidney cancer. Frequently, RCC is found incidentally on imaging for other reasons. Treatments for RCC range from watchful waiting or minimally invasive therapies to open surgery with or without chemotherapy. Some treatments such as surgical resection of all or part of the resected kidney has the potential side effect of causing worsening kidney function or the initiation of dialysis. Stage I RCC (measuring less than 7 cm in diameter) is potentially cured with minimally invasive treatments such as percutaneous ablation with or without transcatheter embolization. This treatment largely avoids the added risk of open surgical procedures and is the treatment most likely to preserve the most kidney function.
Fibroids are common benign, non-cancerous growths, that frequently develop within the walls of the uterus. In fact, 3 out of 4 women may get fibroids in their lifetimes but few know that they may be at risk. Nearly half of all women have fibroids although not all fibroids may cause symptoms and often women may not know they have them. Many women haven't heard of fibroids, but even of the women diagnosed with uterine fibroids, studies have shown that 44% of diagnosed women have never heard of uterine fibroid embolization. We believe patient education and consent is extremely important and all patients should know their options. These are the most frequent symptoms of uterine fibroids:
Uterine fibroid embolization is an important pillar in the treatment of fibroids in a non-surgical and uterus-preserving fashion using minimally invasive image-guided techniques. Although most women have not heard of this procedure, it can play a vital role in improving the quality of life of women with this disease, and best of all, this can be performed in an outpatient setting with minimal recovery time. If you would like to learn more or even if you are unsure about undergoing a procedure, we encourage you to schedule a consultation so we can teach you as much as possible about this condition and innovative therapy.
Chronic Pelvic Pain is extremely common, effecting up to one-third of all women during their lifetime. One of the most common causes of chronic pelvic pain is due to hard to detect varicose veins in the pelvis, otherwise known as pelvic congestion syndrome. Pelvic congestion syndrome is similar to the varicose veins that some women develop in the legs instead is caused by enlarged veins that arise from the ovarian veins in the pelvis. These bulging swollen veins can involve the uterus, ovaries and even the vulva, groin and buttocks. These veins are often missed because they collapse when lying down during physical examination. Chronic pelvic pain associated Pelvic Congestion Syndrome is typically dull and achy and involves the belly and back. The pain is usually worse during your periods, after standing all day, and following intercourse.
Ovarian vein embolization is a minimally invasive outpatient procedure which treats pelvic congestion syndrome by closing the vein responsible for causing the pelvic varices. It's an elegant procedure with minimal to no time needed for recovery. The patient may begin to feel relief as early as the same day and even return to work or duties the next day. Schedule a consultation to learn more.
Prostate artery embolization (PAE) is a minimally invasive procedure that targets the arteries supplying the prostate gland to help shrink the prostate and improve urinary symptoms with a lower risk of sexual side effects which can occur from surgery. The procedure is performed through a tiny incision in the wrist or leg which allows the physician to inject tiny particles into the arteries supplying the prostate to reduce the size of the gland.
Pain within the hips, knees, ankles, heels, elbows and shoulders are treated with a few techniques, including steroid injections, facet injections or viscosupplementation, which reduce inflammation and relieve pain within the tendons and soft tissues within joints. We also treat sacroiliac (SI) joint pain caused by pregnancy, weight gain, arthritis and other conditions, as well as other painful joints.
There are many treatment options for chronic knee pain including pain killers, joint injections and total knee replacement surgery; however, the majority of these treatment options only proved temporary relief of the patient’s knee pain symptoms. Now, a new treatment has been developed that offers long-lasting relief of chronic knee pain caused by osteoarthritis through a minimally invasive procedure called genicular artery embolization.
Genicular artery embolization (or GAE) is a minimally invasive procedure that targets the arteries supplying the lining of the knee to reduce inflammation and associated pain from the patient’s osteoarthritis. This procedure is performed through a tiny incision in the leg which allows the physician to inject tiny particles directly into the arteries supplying the knee to reduce inflammation and pain associated with osteoarthritis. Providing long-lasting pain relief in the treated knee.
The most common cause of chronic heel pain is plantar fasciitis which is inflammation of a band of tissue that runs along the bottom of the foot called the plantar fascia. Plantar fasciitis is caused by overuse of this tissue which eventually causes tiny tears and inflammation which, in turn, causes pain to the heel. Pain is most often worst with the first few steps of the day, but can progress to cause chronic heel pain throughout the day.
Treatment for plantar fasciitis includes conservative management such as rest, medications, orthotic inserts, injections, and physical therapy; however, some patients will experience chronic heel pain despite these treatments. While surgery used to be the only option for patients whose pain did not resolve with non-invasive techniques, a new treatment performed through a tiny incision in the foot called plantar fasciitis embolization is providing patients with a non-surgical therapy when other treatments have failed.
Plantar fasciitis embolization is a minimally invasive procedure that targets the arteries supplying the plantar fascia of the foot to reduce inflammation and pain caused by plantar fasciitis. The procedure is performed through a tiny incision in the foot or leg which allows the physician to inject tiny particles into the artery supplying the plantar fascia to reduce inflammation and pain associated with plantar fasciitis.
Conditions within the spine—such as a herniated disc—can cause inflammation that puts pressure on the nerves which results in numbness, tingling or pain. We offer a series of epidural and facet injections that treat the inflammation with lasting effects. Lower back and leg pain caused by swelling around the sympathetic plexus can also be treated.
Compression fractures of the spine are also known as insufficiency fractures and are a major cause of pain and suffering most often in the elderly and cancer patient populations. Prompt evaluation and treatment can immediately improve the pain and suffering caused by spinal compression fractures. Risk factors for compression fractures includes metastatic cancer to the spinal bones, multiple myeloma, trauma, osteoporosis and side effects from certain medications.
Kyphoplasty and vertebroplasty are minimally invasive procedures which stabilize the fractured or diseased bones. Most often, these procedures are performed in the bones of the spine. A small metal rod is passed through a tiny opening in the skin and into the affected bone using X-ray guidance. Next, a small balloon is then inserted through the tube and into the bone where it is inflated to create a cavity. The balloon is removed and a special cement is injected into the bone to stabilize and strengthen it. This procedure is called kyphoplasty and pain relief may be appreciated as soon as the same day. Best of all, this is can be an outpatient procedure with minimal recovery. Schedule a consultation today to learn more about your options.
Nerve pain can be a result of damage to the nerves following a disease or injury. The damage might cause the nerves to misfire and send pain signals to the brain. This usually happens due to a disease (such as diabetes or vitamin B12 deficiency) or an injury to the brain, spinal cord or a nerve. A nerve block relieves pain by interrupting how pain signals are sent to your brain. It is done by injecting a substance, such as alcohol or phenol, into or around a nerve or into the spine that blocks pain from specific nerves.
When an AV fistula or AV graft clots or narrows, blood flow through the access is decreased, which could prevent a person from undergoing a scheduled dialysis treatment. When your access becomes dysfunctional, our interventional radiologists can improve the blood flow through your access. There are several minimally invasive procedures available that can treat a dysfunctional access and allow a person to return to their regularly scheduled dialysis treatments quickly such as a thrombectomy or angioplasty and stenting
A thrombectomy removes the blood clot through a catheter-guided procedure. Our Interventional Radiologists will remove the clot from the fistula or graft using an instrument specifically designed to do so, eliminating the need for a more invasive procedure.
A catheter is inserted into your dialysis access and used to break up and remove the clot. In some cases a specialized instrument will be inserted through the catheter to aid in breaking up an removing the clot. The catheter is removed when the clot has been retrieved and the procedure is complete. This procedure efficiently removes the clot and restores blood flow.
A biliary drain is used to treat a blockage in the biliary tube or ducts, which can be caused by a stone inflammation or cancer. During biliary drainage catheter placement, a tube is placed directly into the bile ducts of the liver in order to drain bile directly from the liver. Sometimes, this tube drains bile from the liver directly outside of the body (external drainage). If that is the case, the bile will drain directly into the bag that is attached to the tube. If possible, the radiologist may be able to position the tube so that it extends internally from the liver to the intestines (internal drainage). If that is the case, the bile will drain normally into the intestines. Your physician or radiologist will provide you with instructions for care of the drainage tube and bandage.
A paracentesis is a procedure that removes ascites (build-up of fluid) from your abdomen. The fluid buildup can be painful. Ascites may be caused by cancer, inflammation, an abdominal injury, or cirrhosis of the liver (scarring of the liver). During your paracentesis, your doctor will place a catheter (small, flexible tube) into your abdomen. The extra fluid will drain out through the catheter. The catheter will be removed after the procedure and a replaced with a small bandage at the access site.
The Capitol Vascular and Oncology Institute is a leading ambulatory care clinic in Maryland and the tri-state area which is dedicated to the care of disorders relating to circulation, oncology, women's health, urology, gastrointestinal and spine care as well as a number other various conditions and procedural needs.