Vascular & Interventional Physicians

Varicose Veins Treatment Options

Patients can make lifestyle changes, such as eating less, exercising more and wearing support stockings. This regimen can be helpful in reducing varicose vein symptoms. Conservative treatment will not remove existing abnormal veins, but it may be the treatment choice for patients who may not be able to undergo other treatment methods.

Treatment Options at Vascular & Interventional Physicians

Our treatments are designed to specifically address your type of varicose veins:

• Sclerotherapy – This method uses a tiny needle placed into small spider veins. A liquid (sclerosant) is infused which causes inflammation of the vein and eventually scarring it down. This results in the vein no longer being open. This may require additional treatments and can result in discoloration over the vein which is temporary.
• Microphlebectomy – This outpatient procedure uses small hooks to remove large varicose veins close to the skin surface. This procedure is done under local anesthetic and does not require any stitches. It is highly effective and durable. It may result in temporary bruising at the site of removal.
• Ultrasound Guided Sclerotherapy – This method takes advantage of our expertise in using image-guidance to treat the deeper veins that cannot be seen or felt at the skin surface but contribute to surface varicose veins. Using ultrasound guidance, a tiny needle is placed into the deeper problematic veins and the same liquid sclerosant infused to cause them to scar down. Larger surface veins may also require this mode of therapy.
• EVLT (Endovenous Laser Therapy) – This state-of-the-art therapy is a minimally-invasive outpatient procedure used to treat the more common sources of varicose veins. After applying a local anesthetic (similar to the numbing medicine used at the dentist’s office), the vascular physician places a thin catheter under ultrasound guidance into the abnormal vein in the leg. Laser energy is then used to heat the vein from the inside and seal it closed. Once this problematic vein is closed blood flow is diverted into the other normal healthy veins and the surface varicose veins disappear.

Benefits of this procedure include:

• No scarring
• Short outpatient procedure
• Little to no recovery time
• Performed by vascular physicians with the most extensive EVLT experience in the region

Click here to SMG EVLT Brochure

Cancer Treatment Options

Tumor Ablation

For patients with small or only a fewer tumors, Radiofrequency Ablation is also an option to kill off the tumors. This technique involves no surgery and only an overnight hospital stay. Under imaging guidance (CT scan or Ultrasound), one of the physicians from Vascular & Interventional Physicians will insert a needle through the skin into the tumor. Once it is in place, the needle will “cook” the tumor to a very high temperature until all the tumor cells are destroyed. At the end, the needle will be removed and a dressing applied.

For most tumors, this technique has a 70-90% chance of killing off the entire tumor in just one session. Side effects are minimal with most patients back to full activity within a few days of treatment if not immediately.

Chemoembolization

In patients with primary or metastatic liver tumors, chemoembolization offers an alternative to patients who cannot undergo surgery. This procedure involves no cutting or stitches and patients often leave the hospital after one night of observation.

A catheter (small tube) is introduced into the arteries supplying the tumor(s) in the liver from an artery in the upper thigh under x-ray guidance. Once in place, very high dose chemotherapy loaded onto near-microscopic particles is delivered under x-ray guidance into the tumors. This allows for two methods of killing the tumor: 1) the particles slow down the blood supply to the tumor, starving it off oxygen which helps kill the tumor 2) the chemotherapy is a much higher dose than could safely be given through a conventional IV and allows for greater tumor kill. Because the chemotherapy is given directly into the tumor gradually the side effects are much less. Most patients feel little of the nausea, low blood counts and hair loss associated with traditional chemotherapy.

Kidney Cancer (Renal Cell Carcinoma)

At Vascular & Interventional Physicians, we are the only physicians in the State of Maine that offer expertise in a non-surgical minimally invasive therapy for kidney cancers. Cryoablation is a method of killing kidney tumors by freezing them. This technique is done without cutting, stitches with little to no recovery time. Under CT scan guidance, we place a needle through the skin into the tumor in the kidney. Once in place, the freezing begins. This procedure is not painful and is performed with moderate sedation. After the freezing is complete, the patient is observed for one night in the hospital and then goes home. There is no recovery period, with most patients resuming full activity within 1 to 2 days. Usually no pain medications are required after the procedure.

Studies so far indicate similar efficacy to traditional surgery for the treatment of small kidney tumors.

Lung Cancer

For patients with non-small cell lung cancers, surgery offers the best option for cure. However, due to lung function, many patients are not surgical candidates. In these patients, the options are limited. Radiation therapy has been offered as the traditional method of treating these patients. Radiofrequency Ablation is a newer technique for the treatment of these tumors. Vascular & Interventional Physicians are the only doctors who are specifically trained and perform this particular treatment in the State of Maine.

In select patients with small peripheral tumors, a doctor from Vascular & Interventional Physicians will insert a needle through the skin into the tumor under CT guidance. Once in place, the tumor will be “cooked” to a very high temperature to kill off all the tumor cells. Afterwards, the patient will be observed in the hospital, usually for one night. No surgery is involved, no stitches are needed.

For patients with metastatic lung cancer, traditional chemotherapy is the usual method of treatment sometimes along with surgery to remove these tumors. In identical fashion, Radiofrequency Ablation can be performed to treat these tumors selectively and in a non-surgical manner.

Painful Bone Metastases

Cancers that spread to the bone can cause severe pain and poor quality of life to many patients with advanced cancers. This can result in the need for narcotic medications, loss of sleep, fractures of the bone and decreased mobility. Our goal at Vascular & Interventional Physicians is to restore the quality of life by alleviating the pain from these tumors.

Spine Compression Fractures

Depending on the location and involvement of the bone, we offer several modalities to treat the pain. Most commonly this will involve injection of a bone-grade cement called “vertebroplasty”- if this is performed in the spine, or “osteoplasty” – if this is performed in another type of bone.

This is done without surgery on an outpatient basis. A needle is introduced into the affected bone under CT scan guidance or X-ray guidance. A bone-grade cement is then introduced slowly. As the cement sets it does two things: 1) it heats up as it sets with soothes the irritated nerve endings from the tumor 2) it stabilizes the bone to prevent further fractures.

Most patients experience significant pain relief within 24-48 hours of treatment and this pain relief is durable.

Cryotherapy

In other patients, “freezing” the affected bone offers significant pain relief. No surgery is involved and this procedure is performed on an outpatient basis. Under CT scan guidance, a needle is introduced into the affected bone. Once in place, the tumor is frozen which kills the tumor and also soothes the inflamed nerve endings along the bone that are irritated. Most patient experience significant and durable pain relief within 48 hours of treatment.

Radiofrequency ablation of tumors is a new technique being used by interventional radiologists to destroy cancer deposits deep in the body without invasive surgery. A thin needle is placed into a tumor using ultrasound guidance. Electromagnetic energy is emitted from the needle destroying the cancer. This technique is only used for relatively small tumors in certain organs. We use these methods to treat tumors of the liver, kidney and lung, most commonly. Cryotherapy is used to freeze tumors, using imaging guidance.

(Left) RFA probe entering a liver tumor. (Center) Energy-emitting tines emerge from the probe, inside the tumor. (Right) 3d Heat energy killing the tumor.

Vertebroplasty

Under mild IV sedation, using local anesthesia, a needle is painlessly advanced into the fractured vertebral body. This is done under fluoroscopic guidance. Next, a small amount of X-ray dye may be injected to confirm the position of the needle. Finally, a quick setting sterile bone cement is injected, stabilizing the fracture and relieving the pain.

Vertebroplasty can eliminate the need for prolonged bed rest and narcotics after trauma. Patients suffering from persisting debilitating pain often can “get their life back.” Vertebroplasty is highly effective, and extremely safe. There’s a less than 1 % incidence of serious complications.

Kyphoplasty

Kyphoplasty is a similar procedure where balloons are inflated inside compressed vertebra prior to cement injection to attempt to restore some lost height. It also is very effective and safe.

DVT Treatment Options

Standard medical therapy for proximal DVT patients consists of the use of anticoagulant drugs. This form of therapy is highly effective in preventing pulmonary embolism (PE). However, anticoagulant drugs do not actively eliminate thrombus. As a consequence, PTS occurs frequently (25-50%) in anticoagulated DVT patients.

Catheter-directed thrombolysis (CDT) refers to thrombus removal by administration of a “Clot-Busting” drug directly into the clot via a device/catheter which is embedded within the thrombus using imaging guidance. It is an added therapy to anticoagulation.

CDT is a minimally-invasive procedure that is performed with the patient under conscious sedation. NO surgery is involved. There is no cutting or stitches. After the patient is sedated and local anesthetic is applied, a tiny needle is inserted into a vein in the lower leg. Under x-ray guidance, a catheter is placed into the clot. Using a combination of clot-busting drugs and devices designed to break up clots and remove them, CDT provides RAPID clot removal in >80% of patients.

Typically, within 48 hours, patients experience significant relief of pain and swelling in the affected limb because the clot has been removed from their veins. In addition, the damage to the veins and valves is prevented which is expected to then prevent the risk of developing PTS down the road.

Our physicians have the most experience with DVT “clot-busting” therapy in the entire State of Maine. We provide complete pre-procedural inpatient and outpatient evaluation along with longitudinal post-procedure outpatient follow-up care. Due to our expertise in this field and our interest in furthering knowledge about DVT, we are also helping run a NIH-sponsored clinical trial using this clot-busting technique.

Thrombolysis

A tiny catheter is entered into the clot and delivers a “clot-busting” drug directly into the clot. The catheter then breaks up the clot with highly pressurized fluid and sucks it out of the patient.