Highlighted Specialty Interventional Procedures

Uterine Fibroid Embolization(UFE) - Alternatives to Hysterectomy
Varicose Vein Treatments
Vertebroplasty for pain fromSpinal Fractures caused
Oncological Therapies and Regional Tumor Therapy

Angioplasty

Angioplasty In this technique, the interventional radiologist inserts a very small balloon attached to a thin tube (catheter) into a blood vessel through a small nick in the skin. The catheter is threaded under X-ray guidance to the site of the blocked artery. The balloon is inflated to open the artery.

Balloon
Sometimes, a small metal scaffold / tube, called a stent, is inserted to hold the blood vessel open. (information provided by the Society of Interventional Radiology)

More information from the Society of Interventional Radiology

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Aortic Endograft/stent grafts

An aortic aneurysm is a weak area in the aorta, the main blood vessel that carries blood from the heart to the rest of the body. As blood flows through the aorta, the weak area bulges like a balloon and can burst if the balloon gets too big.

A small aneurysm may require no immediate treatment other than "watchful waiting" - checking the aneurysm regularly to be certain it does not grow. If an aneurysm reaches a certain size, however, there is a danger that it will burst and bleed uncontrollably (hemorrhage). In these cases treatment is necessary.

The following information was prepared by the Society of Interventional Radiology (SIR) to provide general information about abdominal aortic aneurysm - the most common type of aortic aneurysm. This site reviews the signs and symptoms, how it is diagnosed, and when it may require treatment.

Treatment of an abdominal aortic aneurysm may require surgery. For some patients, however, a new, non-surgical treatment called "stent-graft repair" can be performed by an interventional radiologist. This site gives an overview of treatment options, and specific information about stent-graft repair, the new, interventional radiology treatment that does not require surgery.

Q: What is an aneurysm?

An aneurysm is a weak area in the wall of a blood vessel that bulges like a balloon when blood flows through the vessel. Aneurysms can occur throughout the body, and sometimes they are harmless. But sometimes they are life-threatening. Aneurysm occurs most commonly in the brain (cerebral aneurysm) or the aorta, the main blood vessel that supplies blood to the body. An aortic aneurysm may be in the chest cavity (thoracic aortic aneurysm), but it is most commonly seen in the abdomen (abdominal aortic aneurysm).

Q: What is an abdominal aortic aneurysm (AAA)?

An abdominal aortic aneurysm (AAA) is a weak area in the wall of the abdominal aorta - the artery that carries blood from the heart to the rest of the body. The aorta is the body’s largest blood vessel; when an area is weak, it may bulge like a balloon when blood flows through it. The most common site for an aortic aneurysm to occur is below where the aorta divides to supply blood to the kidneys and above where it divides to supply blood to the pelvis and legs. An aneurysm that occurs in this location is called an abdominal aortic aneurysm. The normal diameter of the aorta is about 1 inch or less. Small aneurysms - less than 2 inches (5 centimeters) rarely rupture and may pose little risk to the patient. If the aneurysm grows larger, however, the risk of rupture and life-threatening bleeding (hemorrhage) increases. In most cases, physicians recommend treating aneurysms that are 5.5 centimeters or greater in diameter.

Q: How Common is AAA?

Abdominal aortic aneurysms occur in from 5 percent to 7 percent of people over the age of 60 in the United States. Males are at least four times more likely to have AAA than females, and some studies have shown the rate in males to be even higher. According to one study, the incidence of AAA has increased three-fold over the past 40 years, making it the 13th leading cause of death in the U.S.The condition accounts for nearly 15,000 deaths each year.

Approximately one in every 250 people over the age of 50 will die of a ruptured AAA. Fortunately, when AAA is diagnosed early it can be successfully treated and rupture is prevented. Depending on the individual, treatment may require surgery. Often, however, the aneurysm can be repaired with a new,interventional radiology technique that does not require open surgery.

Q: What are the symptoms of AAA?

AAA is often a silent disease. Many patients do not experience any symptoms, particularly when the aneurysm is small. If there are symptoms, the most common ones are:

Symptoms of a ruptured aneurysm may include:

Q: Who is at Risk for AAA?

The most common cause of an aortic aneurysm is atherosclerosis (often called "hardening of the arteries"). Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called "plaque" that weakens or damages the walls of the blood vessels and makes them more vulnerable to an aneurysm. Other risk factors are high blood pressure, smoking and a family history of AAA. Less frequently, aneurysms may be caused by connective tissue diseases, inflammation of the blood vessels (vasculitis) and some congenital disorders. Aortic aneurysms most frequently occur in white males between the ages of 50 and 60. (information provided by the Society of Interventional Radiology)

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Percutaneous Vertebroplasty

A New, Interventional Radiology Treatment For the
Pain of Spinal Fractures Caused by Osteoporosis

Click here to watch the Vertebroplasty Video

LJR doctors were among the first in San Diego to perform this procedure and we have one of the largest experiences in town with percutaneous vertebroplasty.

Vertebroplasty is a new, image-guided procedure performed by Interventional Radiologists as a treatment for painful spinal compression fractures and for some types of spinal cancer. The procedure involves placing a needle into a fractured vertebral body and injecting a special type of bone cement. Many patients experience a dramatic decrease in their pain.

Approximately 700,000 vertebral, or spinal bone, fractures occur each year — usually in women over the age of 60. Researchers estimate that at least 25 percent of women and a somewhat smaller percentage of men over the age of 50 will suffer one or more spinal fractures. Younger people also suffer these fractures, particularly those whose bones have become fragile due to the long-term use of steroids or other drugs to treat a variety of diseases such as lupus, asthma and rheumatoid arthritis. Of particular concern are spinal fractures caused by a progressive weakening of the bone -- a condition called osteoporosis. The pain and loss of movement that often accompany bone fractures of the spine are perhaps the most feared and debilitating side effects of osteoporosis. For many people with osteoporosis, a spinal fracture means severely limited activity, constant pain and a serious reduction in the quality of their lives.

Fractures of the vertebrae have traditionally been much more difficult to manage than broken bones in the hip, wrist or elsewhere. These broken bones can often be successfully treated with surgery. But because surgery on the spine is extremely difficult and risky, it has typically not been used to treat vertebral fractures associated with osteoporosis except as a last resort. Until recently, reduced activity and pain medications, many of which cause problematic side effects, or invasive (and often unsuccessful) back surgery were virtually the only treatments available. Today, however, there is a safe, non-surgical interventional radiology treatment called vertebroplasty (ver-TEE-bro-plasty) that has been shown to be extremely effective in reducing or eliminating the pain caused by spinal fractures.

The following information was prepared by the Society of Cardiovascular & Interventional Radiology (SIR) to provide general information about vertebroplasty, how it is performed, and which patients may benefit from the procedure. The site also contains general information about osteoporosis, and information about new research on the horizon that may improve treatment. (information provided by the Society of Interventional Radiology)

Click here to watch the Vertebroplasty Video
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Stroke - Prevention & Treatment

Stroke is a "Brain Attack" and a Medical Emergency.

Time is brain. At the first sign of stroke, Call 911

Immediate emergency care can greatly improve recovery from stroke.

Every minute counts!

Who is at risk?

Stroke is the third leading cause of death in the United States behind high blood pressure and cancer. Every 45 seconds someone in the United States has a stroke and every three minutes someone dies from a stroke. In the U.S. alone, an estimated 600,000 individuals will suffer a new or recurrent stroke each year -- 160,000 will die. More than one million American stroke survivors struggle with serious disabilities, including loss of speech and/or language problems, weakness or paralysis, loss of balance or coordination, and confusion and memory loss. All are common impairments in the aftermath of a stroke.

Once it was believed that little could be done to treat stroke. Now we know that if a stroke victim receives emergency care within the first three to six hours of the first symptom, the disabling, long-term effects of stroke may be avoided or greatly reduced. Unfortunately, many people do not recognize the warning signs of stroke or do not know that immediate emergency care can greatly improve their chance of recovery. Studies show that the average person waits 13 hours after experiencing the first symptoms of stroke before seeking medical care, and 42 percent of patients wait as long as 24 hours. It is critical to recognize the symptoms of stroke and seek immediate emergency attention.

What causes stroke?

A stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is blocked by a clot or bursts, causing the brain to starve. If deprived of oxygen for even a short period of time, the brain nerve cells will start to die. Once the brain cells die from a lack of oxygen, the part of the body that section of the brain controls is affected through paralysis, language, motor skills, or vision.

There are two types of stroke:

Blood clots that block the artery are ischemic (is-KEM-ik) strokes and the most common type, causing between 70-80 percent of all strokes.
When a blood vessel ruptures, it causes a bleeding or hemorrhagic (hem-o-RAJ-ik) stroke. Such strokes are usually the result of a ruptured blood vessel or an aneurysm—a weakened area of a blood vessel that bulges or balloons out. Sometimes, abnormal tangles of blood vessels in the brain, called arteriovenous malformations (AVM) can rupture and cause a hemorrhagic stroke. Approximately 20 percent of strokes are hemorrhagic. This is the most common type of stroke in young people.
There are also "mini-strokes" known as TIA's (transient ischemic attacks). People who have one TIA are likely to have another one. TIAs cause brief stroke symptoms that go away after a few minutes or hours. People often ignore these symptoms, but they are an early warning sign and 35 percent of those who experience a TIA will have a full blown stroke if left untreated. TIAs should be taken as seriously as stroke.

A leading cause of stroke and TIA is carotid artery disease (CAD). In CAD, a substance called plaque builds up over time in the carotid arteries, the large blood vessels on either side of the neck that supply blood to the head and brain. The buildup of plaque is a silent disease, until small particles break away and are carried to smaller arteries, where they block the flow of blood. The nature and severity of symptoms depend on how large an area of the brain is affected and whether the blood supply to the brain is completely or partially blocked.

What are the symptoms of stroke?

The most common symptoms of stroke are:

Every minute counts

Although starved of oxygen, brain tissue does not die in the minutes following a stroke. If blocked blood vessels can be opened within three to six hours, the chances of recovery are greatly improved.

What are the risk factors for stroke?

People who are at higher-than-average risk for stroke include those who have:

High blood pressure. High blood pressure, or hypertension, puts stress on the walls of blood vessels and can lead to strokes from blood clots or hemorrhage. Half or more of all stroke victims have uncontrolled high blood pressure. Fortunately, this risk factor for stroke can be controlled. Eating a balanced diet, maintaining a healthy weight and exercising regularly can help control high blood pressure. Medications that lower blood pressure also may be prescribed.

High Cholesterol. High cholesterol can lead to blockage in the carotid artery that takes blood from the neck to the brain. A piece of this plaque can break off and travel to the brain causing a stroke.

Heart disease. Approximately 15 percent of all stroke victims have a common heart rhythm disorder called atrial fibrillation, that causes the upper chambers of the heart (the atria) quiver instead of beating which allows the blood to pool and clot. If a clot breaks off and enters the blood stream to the brain, a stroke will occur
Atherosclerosis. When the carotid arteries, the major blood vessels that supply blood to the brain, become clogged with atherosclerotic plaque, the risk for stroke goes up.

Personal history of stroke or TIA. People who have already suffered a stroke or TIA are at increased risk of having another. Modifying risk factors for stroke, including lifestyle changes (e.g. exercise, stop smoking), medications and/or other treatments can reduce this risk.

Lifestyle risk factors. Smoking, excessive alcohol consumption and being overweight are all significant risk factors for stroke. High cholesterol can lead to blockage in the carotid artery that takes blood from the neck to the brain. A piece of this plaque can break off and travel to the brain causing a stroke.

Age, gender and race. The risk of stroke goes up with age, with two-thirds of all strokes occurring in individuals 65 years or older. Twenty-eight percent of stroke occur in people under the age of 65. Males have a slightly higher risk than females although more women die from them. African Americans are at a much higher risk in part because they are at increased risk for obesity, high blood pressure and diabetes which increase the risk for stroke.

Family history of stroke or TIA. If others in your family have suffered stroke, you may be at higher risk. Regular physical exams, lifestyle changes and medical treatments may reduce this risk.

Diabetes. People with diabetes are at increased risk for stroke, although keeping diabetes under control with diet and/or medication may help to decrease the risk.
Sickle Cell Anemia. Sickle cell anemia makes red blood cells less able to carry blood to the body's tissues and organs, as well as stick to the walls of the blood vessels which can block arteries to the brain causing a stroke.

Hyper-homocysteinemia. Elevated homocysteine levels in the blood have been identified as a risk factor for heart attack and stroke that may be as important as high cholesterol. Homocysteine is a by-product of the process that metabolizes methionine, an amino acid essential in human nutrition. (information provided by the Society of Interventional Radiology)

- More information from the Society of Interventional Radiology

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Uterine Fibroid Embolization (UFE)

Uterine fibroid embolization is a new therapy for the treatment of symptomatic uterine fibroids in many symptomatic women. The procedure is an alternative to hysterectomy and has a very high success profile as a treatment for bulk-related symptoms and bleeding related to fibroids.
LJR was one of the first Interventional Radiology services in San Diego to offer this therapy and is one of the most experienced. Our treatment plan is founded upon a close working relationship with experienced gynecologists and includes the personalized care of a staff radiologist and clinical coordinator. Our staff is very experienced in the UFE procedure and we tailor both care and follow-up to the needs of each patient.

For questions, please contact our Clinical Coordinator Lynette Furnald, R.N.
Pager: (760) 414-4690

Overview:

• 20-40% of women 35 and older have fibroids of significant size
  
• Most frequent indication for hysterectomy in pre-menopausal women
  
• 600,000 hysterectomies performed annually in US; 1/3rd due to fibroids
  
• Most common tumor of the female genital tract
  
• Prevalence in female population of childbearing age: 30% or higher
  
• 10-20% of women with fibroids require therapy

  Diagnosis

• Suspected on pelvic examination
  
• Confirmed with imaging (Ultrasound, MRI)

  History

• Embolization first performed 30 years ago
  
• 1990's French gynecologist first requested uterine fibroid Embolization (UFE) prior to hysterectomy
  
• Introduced into the USA in 1995 by Drs. McLucas and Goodwin
  
• As of 2005, 50,000 UFE procedures performed worldwide

  The Fertility Issue

• It is unclear how fertility is affected
  
• Multiple reports of successful pregnancies post embolization
  
• Large multi-center trial needed
  
• Myomectomy recommended for those wanting to preserve fertility

  Child-bearing Age: Exceptions

• Poor candidate for myomectomy: fibroids are too large and/or numerous
  
• Failed myomectomy: symptoms reoccur or persist despite myomectomy
  
• Poor surgical candidate

  Results

• Technical success: 98%
  
• >87% effective in reducing bleeding
  
• >93% effective in alleviating pain associated with fibroids
  
• Expected decrease in fibroid volume is 50%
  
• Patient satisfaction post UFE is 94%
  
• 73% of women continue to have improvement in symptoms after 5 years.  This duration of symptom control is equal to or better than that of myomectomy

Just the Facts……

• Fibroid reoccurrence is exceedingly rare
  
• UFE is not harmful to the uterus
  
• In the setting of multiple fibroids, all are treated

  Pre-embolization Evaluation

• Gynecology evaluation.
  
• Routine pre-angiography blood work
  
• Pelvic MRI or ultrasound for baseline sizing and localization of lesions
  
• Yearly pap smear
  
• Endometrial biopsy if bleeding is the primary problem

How Does It Work? Two uterine arteries supply the uterus Tiny microspheres decrease blood flow to these hypervascular tumors Starvation of fibroids results in shrinkage UFE Procedure Procedure time: 1.5 hrs Patient asleep throughout entire procedure Normal activity in 5-7 days Procedure performed in radiology suite Patient comfort is a high priority Overnight observation for pain control. Discharged to home the following morning

Post-Procedure Management

Routine overnight admission for pain control

Discharge after 24 hours

Expected Clinical Course

Pelvic pain and discomfort which should progressively decrease and resolve over 2 weeks

Fibroid size decreases over several months time

Uterine Cramping

All will experience a certain degree of uterine cramping following embolization.

Low grade cramping for up to 2 weeks; "roller-coaster" like.

Cost

Equivalent to cost of hysterectomy or open myomectomy

Covered by most insurances

Conclusion

Uterine artery embolization is safe and effective for alleviating symptoms from fibroid disease

>87% success at decreasing or resolving heavy bleeding or pressure symptoms

>93% effective in reducing pain

94% patient satisfaction

Effect on future fertility has not been thoroughly studied

For questions, please contact our Clinical Coordinator Lynette Furnald, R.N.
Pager: (760) 414-4690

Print LJR Patient Brochure
Print Ask4Ufe Patient Brochure here

Find more information at:

Ask 4 UFE
National Uterine Fibroids Foundation
Society of Interventional Radiology

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Varicose Vein Treatment

Indications for treatment:

• Pain: Aching, Burning, Heaviness
  
• Swelling: Foot, Ankle, Leg
  
• Dermatitis: Focal, Extensive
  
• Lipodermatosclerosis
  
• Ulceration: Present or Healed
  
• Superficial Thrombophlebitis
  
• External Bleed
  
• Appearance

Disease process:

• Nonfunctional, incompetent valves of various sizes
  
• Leads to the pooling of blood and dilation of veins in lower extremities
  
• Disease manifestation depends on the size of vein involve

Treatment options:

• Conservative therapy
  
• Sclerotherapy
  
• Surgical excision
  
• Endovenous Laser Ablation
  *Alone or in combination

  Endovenous Laser Treatment

  What to expect: History and Physical Ultrasound - Confirms clinical diagnosis - Helps to determine the best treatment pathway - Usually not required in the work-up of spider veins 45 minute outpatient procedure. - Outpatient setting - Ultrasound guided fiber placement - Local anesthesia - Ultrasound used to confirm closure of vein - Minimal discomfort during the procedure

  A tiny catheter is inserted into the vein and laser energy is directed toward inner vessel to collapse the vein.

  Results

• Almost all resume all activity < 24 hr.
  
• 95% elimination of pain and fatigue
  
• 7/8 without edema
  
• Minimal patient discomfort
  
• Minimal complication
  
• 95% Efficacy
  
• All patients would recommend procedure to a friend

Vein Institute of La Jolla:

• A treatment plan is designed specifically to suit your goals
  
• Comprehensive approach
  
• Minimally invasive technique
  
• Shortest recovery time possible
  
• Strive for best results with minimal risk

We do the procedure at each Scripps hospital (Encinitas, La Jolla and Chula Vista).

Schedule your consultation today! 760-414-4690

Print Vein Brochure here
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Venous Access

The Radiology Venous Access program at Scripps was formally established in August of 1997 and since that time has cared for and enrolled nearly 1000 patients into whom we have placed catheters at Scripps Memorial La Jolla and Encinitas.

LJR Interventional radiologists are experts at the placement, maintenance, and salvage of venous access devices including PICC lines, dialysis catheters, implantable ports, and tunnelled lines.

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