Our three board certified, fellowship trained physicians include Dr. Tim Daniel, Dr. Craig Yokely and Dr. Fred Johnson. They are all interventional radiologists specializing in the vascular system. They specialize in minimally invasive procedures, using very small incisions to do procedures guided by x-rays, ultrasound, or CAT scanners. Many of these procedures are alternatives other treatments, and have the advantage of being safer, with less recovery time. Most of our interventional procedures are outpatient or require only overnight hospitalization.
Peripheral Vascular Disease, (PVD), sometimes also called Peripheral Arterial Disease(PAD), affects many millions of patients each year. There are other terms that are better recognized for this disease including “poor circulation”, “clogged arteries”, “hardening of the arteries”, and others. But they all describe a process of plaque building up in the arteries of the body, causing decreased blood flow and circulatory problems. If you smoke, have high cholesterol, high blood pressure, or have diabetes, you are at risk for having PVD. The most common place this causes problems is in the legs.
PVD in the legs causes cramping and pain in the legs, especially with exercise or walking. This can range from mild to severe, sometimes disabling people to the point of not being able to work or function in life. When the blockages become really severe, they can lead to pain all the time, or even amputation.
The good news is that PVD is treatable. The first and best thing you can do to treat PVD is to stop smoking and treat high cholesterol. Regular exercise and control of diabetes will go a long way in treating the disease. However, sometimes that is not enough, and you may need the blockages opened.
There are two ways of opening blocked arteries: with surgical bypass, or with minimally invasive methods including angioplasty, stenting, or atherectomy. This is where our vascular interventional physicians have expertise. They specialize in opening blocked arteries in the legs with these technologies, and others. Our methods are not surgery; rather, we use tiny incisions in the groins to place catheters, or small tubes, and other devices into the arterial system to find and to open blocked arteries. In most cases, people are treated and released the next day to resume normal activities. The results are immediate; patients begin healing and walk without pain almost immediately after the procedure.
Most patients with non-healing foot wounds have some degree of PVD contributing to their sores. After opening up the arteries to the legs, even the small arteries below the knee, there is healing that occurs at a very rapid pace because the blood is once again flowing into the foot. This healing actually helps avoid amputation, or minimizes the amount amputated, in a significant number of patients.
If you believe you have PVD causing leg problems, contact us for an evaluation. There are non-invasive tests that can screen for PVD easily and comfortably.
Performing angiography can help to diagnose many conditions of the arteries, but the main disease studied by angiography is atherosclerosis, or blockages in the arteries. In the heart, blockages can cause heart attacks. In the brain, blockages can cause stroke. In the kidneys, blockages can cause high blood pressure and poor renal function. In the legs, blockages can cause leg pain or non-healing skin ulcerations.
The catheters (tubes) used in angiography are very small, about the size of the tip of a pencil. They make a small hole in the artery in the hip area, which heals with gentle pressure applied after the procedure, and a few hours of bedrest. The x-ray dye used in modern angiography is very gentle on the body, now causing minimal discomfort and minimal effect on the kidneys, in small doses. Our physicians always attempt to use as little as possible, only the amount to diagnose and treat artery conditions.
Our vascular physicians are board certified in the performance and interpretation of angiography, having completed many years of training and recertification in these techniques.
The main interventional techniques to open clogged arteries, are balloon angioplasty, stents, stent-grafts, and atherectomy. These techniques can be applied to almost any region of the body, including the arms and legs, the carotid arteries to the brain, the kidneys, the stomach and intestines.
Balloon angioplasty is the technique of inserting a small balloon catheter over a wire into the clogged area, and opening the balloon, which in turn opens the artery.
Stenting involves placing a metallic tube through tiny catheters inserted into the clogged artery. The stent opens and helps to keep the clogged artery open. The stents are typically permanent, helping to keep the artery open for the rest of the persons life. Some stents are bonded with medicine that helps keep the artery from re-clogging. This is referred to as a drug-eluting stent.
Stent-grafting is the same as stenting, except the stent is covered with a cloth-like graft material, which further helps to keep the artery open in some situations.
Atherectomy involves placing a small cutting catheter into the clogged artery, again over a wire, and removing the plaque causing the clogged artery through the catheter. The plaque is actually removed from the body, opening the clogged area for improved blood flow. The main device used in this technique is the Silverhawk Atherectomy device.
Uterine artery embolization, or UAE, is becoming a routine alternative to hysterectomy for the treatment of symptomatic uterine fibroids. Many women do not wish to lose their uterus, or do not want the longer recovery from surgery. Yet many of these women suffer the symptoms of uterine fibroids such as heavy menstrual bleeding and pain or suffer from looking or feeling pregnant because of an increase in size of the uterus caused by the fibroids. For these women, UFE can be the right choice.
The procedure is very similar to a heart catheterization, except it is the uterus that is catheterized, with a small tube entering the groin area artery and advanced into the uterus using x-rays. When the catheter is placed into the artery that feeds the fibroids, thousands of tiny particles are injected through the catheter into the artery to the fibroids, causing the artery flow to the fibroids to be disrupted. This destroys the fibroids, while preserving the uterus. This is all accomplished using a quarter inch incision in the hip area. It requires only overnight hospitalization, and almost all women are back to normal activities in less than one week.
In around 90% of women treated with UFE, the symptoms of pain and bleeding resolve to normal levels such that no additional treatment of the fibroids in necessary. The fibroids shrink over time to around one half their original size.
We believe it is very important to talk to your Ob/Gyn doctor about this alternative to hysterectomy. Almost all of our UFE procedures are recommended by the patient’s gynecologist. If you do not have a gynecologist, we can discuss your fibroid issues in clinic, and get you to a gynecologist for a thorough evaluation. The American College of Gynecology has recommended UFE as a Level 1 alternative to hysterectomy.
Drs. Daniel and Yokley have extensive experience with UFE, having performed the procedure for over the past 8 years and treating hundreds of women with this condition.
Our physicians are skilled in the placement and maintenance of vascular accesses for hemodialysis.
Permcatheters are tunneled central dialysis catheters that maintain many people on dialysis when grafts and fistulas are not possible. Our physicians insert permcatheters primarily in the internal jugular veins, thereby avoiding the complications associated with other insertion sites. However, they are skilled in placement of catheters wherever other areas they may need to go. We use Palindrome brand of catheters, which are bonded with heparin (to prevent thrombosis of the catheter), and with antibiotics (to prevent infection).
Dialysis grafts can become partially or fully blocked over time, causing poor blood flow during dialysis. This can result in inadequate dialysis, or loss of the access. VITA physicians study the grafts with angiography, and open the blockages using minimally invasive techniques, such as balloon angioplasty, stenting, or stent-grafting. These procedures are performed as outpatients, and can significantly improve the quality of dialysis and help the graft to work better and last longer.
Dialysis fistulas are the preferred method of hemodialysis access, but are the most difficult to fix when clogged. VITA physicians have devised methods to open clogged fistulas using angioplasty and stents, as outpatient procedures. Patients that would otherwise lose their fistulas can maintain the high performance and excellent dialysis afforded by the fistulas, by undergoing a short outpatient procedure with VITA physicians.
Our physicians place all types of central venous catheters, the most common one being a port catheter. This devise is typically used to deliver chemotherapy for cancer treatment, but can be placed for other reasons as well. A port is a disc-like chamber or reservoir that is placed under the skin of the chest wall, just below the coller bone. The roof of the port is formed by a soft silicone dome that can be accessed with a needle for infusion of chemotherapy. The port is connected to tubing that goes into the central, or chest, veins. Because it is completely under the skin, infection is rare, and it can last for many years. Our physicians use ultrasound and x-ray fluoroscopy to insert the ports, with sedation, not general anesthesia, so complications are rare.
Hypertension, or high blood pressure, can be caused by blockages in the arteries to the kidneys. The kidneys are like the thermostat of the body, except it controls blood pressure. If the kidneys think the blood pressure is low, it produces hormones that raise blood pressure. This is what happens when there is a blockage in the artery to the kidney. The kidney responds to the low blood pressure (actually caused by the blockage), by raising blood pressure, which causes hypertension. People with atherosclerosis, or hardening of the arteries, are at risk for renal artery stenosis and hypertension. The typical patient with this form of hypertension is an older person who has coronary artery disease, carotid artery disease, or peripheral vascular disease in the legs. If you smoke or have high cholesterol, you may be at risk. The good news is that this is one of the most treatable causes of high blood pressure.
Using minimally invasive techniques, physicians use small catheters inserted from the groin, into the clogged kidney artery. The artery is opened using angioplasty and stenting, resulting in improved blood flow in the kidney, and lower blood pressure in the body. Most people who undergo this procedure either have marked improvement in their blood pressure with less medication, or have totally normal blood pressure with no medication. It is usually performed with one night hospital stay.
Our physicians perform minimally invasive biopsy of the organs of the body, including the lung, liver, kidney, thyroid, pancreas, spleen, lymph nodes, bone and neck regions. This is done without making large incisions; sometimes, no incision at all is made for the needle puncture site. Very small needles are used to obtain material from areas where there is suspected disease. Usually, biopsy is performed when cancer is suspected, but many other non-cancerous processes can be found at biopsy.
The physician advances the needle to the suspect area by using x-ray, ultrasound, or CAT scan guidance. By using imaging guidance, the physician visually guides the needle to the right spot, while avoiding surrounding vital organs or trouble areas. Drs. Daniel and Yokley are highly trained in anatomy and also in the appearance of diseases when seen on x-rays, ultrasound, or CAT scans.
The underlying problem with most vein disease in the legs, is incompetence of the greater saphenous vein. That is, the vein closest to the surface of the skin in the leg doesn’t work as it was intended to. It normally only allows blood to flow up the leg, back to the heart, because of one-way valves in the vein. Those valves become broken, and don’t work. This allows blood to pool in the legs, which in turn causes symptoms of vein disease, including leg pain and varicose veins
The first line of treatment of vein disease is usually a tight stocking worn during the day. We use medical grade stockings, called Jobst stockings. These stockings help the diseased veins to work better, and decrease the symptoms of vein disease. They can be knee high, thigh high, or full waist sizes, or they can be custom fit.
If the stockings don’t work, then there is a minimally invasive outpatient procedure to treat the diseased vein. Laser vein ablation is a procedure where a small catheter (tube) is inserted with ultrasound guidance, into the diseased vein in the leg. Laser energy is applied, and this closes the diseased vein and stops the pooling of blood in the leg. Blood returns to the heart through the normal deep vein system, which is not effected by the procedure. The symptoms of vein disease go away with this procedure, and the varicose veins can be removed through a tiny incision if needed.
Sclerotherapy describes the treatment of small, superficial spider veins. This is the injection of a chemical agent that helps to close the small veins. Before this is done, however, it is best to look for the real cause of the problem, which is usually the reflux in the greater saphenous vein.