Angioplasty, stenting, and thrombolysis/ thrombectomy.

Peripheral Arterial Disease (PAD) is caused by a decrease in blood flow to their arms, legs, or feet. If left untreated, this systemic, whole body condition can lead to heart attack, stroke, severe leg pain, ulceration, infections, and/or amputation. PAD accounts for the majority of leg and foot amputation in the United States.

Risk Factors:

Over Age 50

Diabetes

Tobacco abuse/ Smoking History

Overweight

Lack of Activity

High Blood Pressure

High Cholesterol

Family History of Vascular Disease (PAD, aneurysm, heart attack, or stroke)

Symptoms:

Intermittent claudication is painful cramping in the leg that occurs when walking, and typically disappears when the activity stops

Numbness, tingling, and weakness in the lower legs and feet

Burning or aching pain in feet or toes when resting

Pain in the legs or feet that awakens you at night

Slow healing sore on leg or foot

Lower temperature in one leg

Loss of hair on legs

Color change in skin of legs or feet

Disease progression:

Claudication

Rest pain

Ulceration

Gangrene

Limb loss

Diagnosis:

We offer ABI screening to screen all patients, especially high-risk patients for PVD.

CT angiography (CTA): If the screening ABI was positive, then we can further evaluate/confirm your disease by doing CT angiography which is a test that uses CT scanner to produce detailed views of the arteries in your abdomen, pelvis and legs, after injecting contrast agent through peripheral IV line. This test is particularly useful to provide us with the needed information of how to treat your peripheral vascular disease.

Treatment:

Smoking Cessation

Lifestyle changes that increase activity

Medication to lower cholesterol

Medication to control blood pressure

Surgery to bypass the blocked artery

Minimally invasive treatments including balloon angioplasty, stent placement, and/or atherectomy to remove the plaque from the inside of the blood vessels.

An angiogram is a high resolution picture of your arteries, performed using a colorless dye and an x-ray machine to outline your blood vessels. By clearly identifying where and how severe the blockages are, your doctor will be able to advise you on what treatment may be necessary. In the Vascular & Interventional Institute of Louisville, we offer all kind on Endovascular treatments:

ANGIOPLASTY:

Angioplasty uses inflatable devices called balloons to open up narrowed arteries.

STENTING:

Stenting uses small metal tubes to hold open narrowed arteries that are closing.

THROMBECTOMY:

When a blood clot suddenly blocks blood flow, a treatment known as a thrombectomy will remove the clot from the body using various medical tools that can draw out, pull out, or vaporize the clot. The method chosen depends on the preference of the physician and the location of the clot.

THROMBOLYSIS:

Thrombolysis delivers medication slowly, over 12-24 hours, to a blood clot through a thin tube that is inserted next to or within the clot.

ATHERECTOMY:

An atherectomy is a procedure that utilizes a catheter with a sharp blade on the end to remove plaque from a blood vessel.

Before the procedure:

We will arrange for you to have some simple blood tests. The IR doctor needs to see a list of all of your medications (tablets, inhalers, creams), so please bring a copy of your current prescriptions with you.

Sometimes, certain medicines need to be stopped before your procedure. The IR doctor or nurse will be able to advise you whether you need to stop any medicines. These medicines can be restarted after your angiogram – but the IR doctor or nurse will advise you on this.

Kyphoplasty is a minimally invasive surgery used to treat a spinal compression fracture.

Spinal compression fractures occur primarily in spinal vertebrae that have been weakened by osteoporosis or cancer.

A biopsy is a medical test commonly performed by an interventional radiologist involving the extraction of sample cells or tissues for examination to determine the presence or extent of a disease. Relatively small needles are used and it is considered an advance over an open surgical biopsy.

To drain infected fluid collections (abscesses) or non-infected fluid collections (seroma, cysts, lymphocele) percutaneously (through the skin)

  • Varicose vein treatment, also known as endovenous ablation, uses radiofrequency or laser energy to cauterize and close varicose veins in the legs.
  • Symptoms:
    • Mild symptoms may include: Heaviness, burning, aching, tiredness, or pain in your legs. Symptoms may be worse after you stand or sit for long periods of time.
    • More serious symptoms include Leg swelling after you sit or stand for long periods of time. Skin changes, such as Color changes, dry and thinned skin, inflammation, scaling, open sores, or you may bleed after a minor injury.
    • Conservative treatment may be all you need to ease your symptoms and keep the varicose veins from getting worse. You can: Wear compression stockings. Elevate your legs. Avoid long periods of sitting or standing. Get plenty of exercise..
    • If you need further treatment or you are concerned about how the veins look, options may include:
      • Radiofrequency ablation (RFA), or Endovenous laser ablation (EVLT)

When stem cells are injected into an area that needs healing, your body’s natural response is to accelerate the process and repair the damage. It is a non-surgical procedure that involves the removal and then injection of your own naturally occurring stem cells AND platelets.

This cutting-edge treatment uses Platelet-rich plasma and bone marrow-derived stem cells to treat painful joints due to osteoarthritis and tendinopathy.

Stem cell injection and PRP Injection (Regenerative medicine) or steroid injections for tendinitis or tendinosis or tendon/s injury, like:

Supraspinatus syndrome; Other rotator cuff tendons (infraspinatus, subscapularis, teres minor) – Rotator cuff tendinopathy;

Lateral epicondylitis (Tennis Elbow)

Like epidural injections (no narcotics will be prescribed in our clinic to our pain patients)

  • Back or Leg Pain Procedures:

Low Back Pain / Injury

Lumbar Radiculopathy (Sciatica)

Post Laminectomy Syndrome

Facet Joint Syndrome

Lumbar spine Degenerative Disc Disease

Lumbar Herniated Discs

Spinal Stenosis

Spondylolisthesis

Spinal Arthritis

Muscle Spasm

Nerve Impingement (Radiculopathy)

Piriformis Syndrome

Sacroiliac Joint Dysfunction

  • Cancer Pain Procedures:

Celiac plexus block and Splanchnic Nerve block: is used to eliminate or drastically reduce the excruciating epigastric and generalized abdominal pain caused by cancer of the pancreas, stomach, gallbladder. or other upper abdominal viscera.

Superior Hypogastric Plexus Blocks: to treat pelvic and genital cancer pain.

Thoracic Sympathetic Block: for intractable pain caused by carcinoma of the esophagus or lung

Lumbar Sympathetic Block: for severe persistent tenesmus and pain caused by cancer of the pelvic viscera, like the uterus and cervix cancers.

Kyphoplasty: to treat painful metastasis to the spine.

Percutaneous Cementoplasty or radiofrequency ablation for metastatic tumors.

Pudendal Nerve Block: For pain origination from lower central pelvic areas. These are the anal region, perineum, scrotum and penis or vulva.

  • Other Pain Procedures:

Genitofemoral nerve block

Iliohypogastric nerve block

Femoral nerve block

Obturator nerve block

Lateral femoral cutaneous nerve block

Superior gluteal nerve block

Sciatic nerve and piriformis muscle

Pudendal nerve Sciatic nerve and piriformis muscle

Inferior rectal nerve block

Posterior femoral cutaneous nerve

Inferior cluneal nerve block

Selective nerve root block

Epidural Blood Patch

Joint Injections: Hip Injections. Knee Injections. Shoulder Injections. Ankle Injections. Elbow and wrist injections

Lumbar sympathetic blocks for Reflex Sympathetic Dystrophy (also known as Complex Regional Pain Syndrome)

Trigger Point Injections

Cervical Sympathetic Block to treat post-traumatic stress disorder (PTSD).

Like: Nephrostomy tube placement/exchange, ureteral stent placement, Supra-pubic drain placement, renal tumor embolization.

Nephrostomy tube placement: Percutaneous nephrostomy (PCN) tube is a catheter (plastic tube) that is inserted through your skin into your kidney. The nephrostomy tube is placed to drain urine from your body into a collecting bag outside your body.

You may need a percutaneous nephrostomy tube when something is blocking the normal path that your urine takes to leave your body. Urine from your kidneys passes through thin, narrow tubes called ureters. Your ureters are connected to your bladder where urine is stored for a time before you urinate.

A ureteral stent placement: the stent is a thin, hollow tube that is placed in the ureter to help urine pass from the kidney into the bladder.

Like: Gastrostomy tube placement or exchange.

Like Gastrostomy tubes placement, which is feeding tubes placed through the abdomen into the stomach. Gastrostomy tubes are used to give patients formula, liquids, and medicines. These tubes are placed by Interventional radiologist, surgeon or GI physicians.

What are fibroids?

Uterine fibroids are non-cancerous (benign) growths in or on the walls of the uterus. They can range in size from less than an inch to more than 12 inches in diameter.

Up to 70% of women have fibroids, but if they’re not causing symptoms of pain and discomfort, they don’t need to be treated.

Women typically seek treatment for fibroids when they experience these symptoms:

  • Pain in the lower abdomen, lower back or pelvis
  • Heavy, abnormal or irregular menstruation
  • Frequency or difficulty with urination

Why Fibroid Embolization?

Uterine Fibroid Embolization (UFE) is a non-invasive, outpatient procedure that relieves bleeding, pain and discomfort caused by fibroids.

UFE is an outpatient alternative to a hysterectomy for fibroid treatment, so you can keep your uterus and avoid the pain, time, hospitalization, recovery, costs and possible complications of surgery.

UFE is covered by most insurance, and the vast majority of patients experience full relief of their symptoms. If considering hysterectomy, see if UFE can get you easier, faster relief.

Who performs UFE? How?

Dr. Mahmoud Samman is a board-certified, Interventional Radiologist. His Vascular & Interventional Institute of Louisville in Louisville is the first in Kentucky and Indiana to offer UFE as a one-hour procedure.

In a UFE procedure, a small, non-surgical incision is made to insert a catheter through a vein to the site of the fibroid. A therapeutic particle is then injected to shrink the fibroid to a size which eliminates or greatly reduces symptoms.

An inferior vena cava filter is a type of vascular filter, a medical device that is implanted by interventional radiologists or vascular surgeons into the inferior vena cava to presumably prevent life-threatening pulmonary emboli

Tunneled dialysis catheter placement. Angioplasty, stenting, and thrombolysis/ thrombectomy (declot procedures)

Dialysis and Access Interventions are minimally invasive procedures performed to improve blood flow in the graft and fistula placed in the blood vessels of dialysis patients. Dialysis allows people with kidney failure (renal failure) a chance to live productive lives. When kidney function decreases to a critical level or complications arise, a person may need to start dialysis. It involves a special machine and tubing that removes blood from the body, cleanses it of waste and extra fluid and then returns it back to the body.

Your doctor may recommend a Dialysis and Access Intervention to treat:

– Narrowing of dialysis fistula or grafts. When there is decreased flow in a graft or fistula, angioplasty or angioplasty with Vascular Stenting may be performed.

– Thrombosis of dialysis fistulas or grafts. When blood does not flow smoothly, it can begin to coagulate, turning from a free-flowing liquid to a semi-solid gel, called a blood clot or thrombus. When blood clots in a fistula or graft prevent dialysis from being performed, catheter-directed thrombolysis with clot-dissolving drugs may be performed.

In these procedures, X-ray imaging equipment, a balloon catheter, catheter, guidewire, sheath, stent and a medical device that dissolves blood clots may be used:

– A balloon catheter – is a long, thin plastic tube with a tiny balloon at its tip.

– A stent – is a small, wire mesh tube.

There also are medical devices that can be used to dissolve the clots mechanically. Your interventional radiologist will decide which technique is most appropriate for you.

Kyphoplasty. Portacath. PICC Line placement. Biopsies.

Vascular and non-vascular ultrasound

Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from “normal” sound in its physical properties, except that humans cannot hear it. This limit varies from person to person and is approximately 20 kilohertz in healthy young adults.

From head to toe, and certainly including CTAs.

A computed tomography (CT or CAT) scan allows doctors to see inside your body. It uses a combination of X-rays and a computer to create pictures of your organs, bones, and other tissues.