General Questions About Our Specialty

Vascular & Interventional Radiology is a branch of medicine that diagnoses and treats a variety of conditions by using image-guided minimally invasive techniques. Interventional radiologists have been training in treatment and management of diseases as well as being consultants to other physicians.

Using sophisticated radiology images to guide their procedures, interventional radiologists insert thin catheters (tubes) and other tiny instruments through the blood vessels and other pathways in the body to treat a variety of conditions without surgery.

Neuro-endovascular therapy is a minimally invasive procedure used to treat complex vascular lesions in the head, neck, and spine. Using microcatheters and devices such as balloons, platinum coils, liquid adhesive, and stents, the interventional neuroradiologist navigates from the femoral artery or vein to treat the abnormal target vessels. Navigation is assisted by real-time, bi-plane digital-subtraction angiography and real-time fluoroscopy. Patients whose neurovascular lesions have been determined to be untreatable by conventional surgical techniques are often candidates for neuro-endovascular therapy.

Visit our radiologic exams page for an explanation of different types of radiologic tools your radiologist may use in properly evaluating your symptoms and setting up a treatment plan.

Questions About EVLT

Endovenous Laser Treatment (EVLT) is a minimally invasive laser procedure used to eliminate painful and unattractive varicose veins. According to the Society of Interventional Radiology, varicose veins affect 1 of every 2 people 50 years of age and over and about 15% of men and 25% of women overall. Varicose veins can cause aches and pains, cramps, and leg swelling. The condition is caused by an incompetent saphenous vein, the main vessel that runs the length of the inner leg, and is seen as twisting, bulging veins on the outside. Valves in the vein become weak and allow blood to flow backward instead of returning to the heart.

EVLT is performed by having the patient lie on an examining table after which a local anesthetic is administered and a tiny incision is made at the knee. Under ultrasound guidance, a thin laser fiber is inserted and targeted laser energy is delivered to shrink and close the faulty vein. The treatment takes less than one hour and the patient is able to walk immediately after the procedure. This procedure is performed at Spectrum’s Vascular & Interventional Physicians office located at 33 Sewall Street, Portland, Maine.

Since EVLT is a minimally invasive procedure there are few risks compared with the surgical alternative of vein stripping, which requires hospitalization and anesthesia. EVLT may cause soreness and bruising after the procedure. Many patients experience immediate relief of their symptoms.

All patients are evaluated by an interventional radiologist to determine the appropriateness of the procedure. During the consultation, patients will be examined with ultrasound to evaluate all potential therapy options including medical, surgical, and interventional treatments including endovenous laser treatment.

Patients can walk immediately after the procedure and can return to normal daily activity with few limitations. Patients are instructed to wear compression stocking for one week after treatment. The compression stocking prescription will be provided to the patient at the time of consultation. There may be some discomfort which can be treated with over-the-counter, non-aspirin pain relievers as necessary. There is no scarring, however there may be some bruising.

Endovenous Laser Treatment is an image-guided, percutanous procedure which, when compared to surgical stripping, is much less traumatic to the leg, has fewer side effects, no operative scars, does not require hospitalization or anesthesia and has a much quicker recovery time. Unlike conservative management, EVLT cures the problem rather than slowing the progression of varicose veins. The patient may resume normal activities immediately, but should avoid rigorous activities. There is a reported > 97% success rate of first-time endovenous laser treatment.

Questions About Vertebroplasty

Vertebroplasty is a minimally invasive procedure used to reinforce fractured bone, alleviate chronic back pain and prevent further vertebral collapse. After carefully placing a large-bore needle into the collapsed vertebral body, cement-like material (bone mineral substitute) is injected to stabilize and strengthen the weakened or crushed bone. The procedure treats only the fractured vertebra and does not prevent future compression fracture at other levels.

Candidates for evaluation for the procedure include men and women with back pain persisting beyond 3-4 weeks and debilitation due to vertebral collapse. Typically, conservative treatments (bed rest, back brace, oral pain medications) have previously failed. Most patients are elderly (average age 70 years), but younger patients with osteoporosis, due to metabolic disorders or long-term steroid treatment, may also benefit from vertebroplasty. Patients with vertebral destruction from malignant tumors may also be candidates for the procedure.

All patients are evaluated by an interventional radiologist and/or anesthesiologist specializing in pain management prior to vertebroplasty. During the consult patients will be evaluated for all potential therapies including medical, physical, and interventional treatments including vertebroplasty.

Patients must be able to lie prone for one to two hours. Using fluoroscopic guidance, a specially designed large gauge needle is passed into the vertebral body. Iodinated contrast is injected to confirm proper needle placement, followed by the injection of liquid medical-grade cement. If cement does not cross the midline, the procedure is repeated from the contralateral side. The actual injection of cement takes only 10 minutes. Once injected, the cement quickly hardens in 10-20 minutes.

Vertebroplasty is an image-guided, percutaneous procedure that usually provides pain relief and increased mobility within 48 hours. Over several weeks, two-thirds of patients find that they are able to significantly decrease their doses of pain medications. Many patients become symptom-free. Three-quarters of patients significantly increase their mobility and activity levels. Vertebroplasty cannot correct curvature of the spine caused by osteoporosis; however, the procedure may help to prevent worsening curvature. Vertebroplasty may prevent the need for placement of rods and screws to support the spine.

Visit the Society of Interventional Radiology website for more information about vertebroplasty.

Questions About Uterine Fibroid Embolization

Uterine fibroids (leiomyomas) are benign tumors of the uterine muscle. These tumors form when the uterine muscle cells begin to grow as circular masses. In some women, large uterine fibroids can cause symptoms. These symptoms can include heavy menstrual bleeding, pelvic pain, pressure, pain during sexual intercourse, or a frequent and urgent need to void.

Uterine fibroid embolization (UFE) represents a relatively new approach to treating fibroids. UFE is a minimally invasive procedure used to treat symptomatic fibroids by blocking the supply of blood to the fibroids. Using angiographic techniques similar to those used in heart catheterization, the interventional radiologist places a catheter into the uterine arteries. By injecting small particles into the arteries, the arteries feeding the fibroids are blocked. By cutting off the blood supply, the fibroids shrink and symptoms are resolved.

Women with symptomatic fibroids are candidates for UFE. Any woman, regardless of the size and location of her fibroids, can undergo UFE. Some women have been able to achieve pregnancy after having UFE. UFE offers a minimally invasive option to surgery.

An interventional radiologist sees the patient for consultation at either Spectrum’s Vascular & Interventional Physicians Office or at Eastern Maine Medical Center. During the evaluation, patients are fully informed about the risks and benefits of the procedure, as well as about expected results.

The procedure is done in the hospital with an overnight stay after the procedure. The patient is sedated using intravenous medications. In general the procedure takes 1 to 1 ½ hours. Initially a needle is used to enter the femoral artery. The catheter is advanced over the branch of the aorta and into the uterine artery on the opposite side of the puncture. A second arterial catheter is then placed from the opposite femoral artery to the other uterine artery. Using an angiogram, the uterine arteries are located. After the arteriogram, particles of poly vinyl alcohol are injected into the artery until blood flow to the fibroids stops. The catheter is then repositioned into the other uterine artery and the process is repeated. After the procedure, the patient is on bedrest for 6 hours to allow the puncture site to heal sufficiently.

The expected average reduction in the volume of fibroids is 50% in three months, with reduction in the overall uterine volume of 35%. This reduction may be greater in some patients and less in others. Bleeding symptoms usually resolve immediately.

Complications are anticipated in less than 3% of patients. Serious possible complications include injury to the uterus from decreased blood supply or infection. Hysterectomy to treat either of these complications occurs in less than 1% of patients. The chance of other significant complications is less than 1%.

As the outcome of pregnancy following UFE is unknown, we do not recommend the procedure for women who plan to have children.

Complications are anticipated in less than 3% of patients. Serious possible complications include injury to the uterus from decreased blood supply or infection. Hysterectomy to treat either of these complications occurs in less than 1% of patients. The chance of other significant complications is less than 1%.

As the outcome of pregnancy following UFE is unknown, we do not recommend the procedure for women who plan to have children.

Preparing for Your Visit

Your doctor’s office will provide you with information on how to prepare for your scheduled test, procedure, or treatment. In addition, general information on preparing for your specific exam is provided in the procedures section of our web site. If you have any questions, please feel free to call the the site where your appointment is scheduled.

You should arrive 15 minutes before your scheduled appointment. This allows time for you to complete any necessary paperwork, change your clothes, if needed, and answer questions from one of our technologists about your medical history.

You should wear loose, comfortable clothing on the day of your exam or procedure. Depending on the exam or procedure, you may be asked to change into a hospital gown. You will be instructed beforehand if there is anything special you should not wear. For more detailed information about how to prepare for a specific exam, feel free to call our office at (207) 956-6650.

Rapid results are essential not only for your peace-of-mind, but also for your physician to begin planning your treatment immediately. We forward your results to your physician who will discuss them with you.

Please feel free to contact us at Spectrum’s Vascular & Interventional Physician’s Office at (207) 956-6650 any time you have questions.

Preparing for Your Visit

Questions about billing should be directed to the following offices:

Spectrum Medical Group

Radiology Division 
482 Congress Street 
Portland, Maine 04101 
800-308-2321 (Telephone Toll Free)

For patients who were seen at a Northern site of service:

Fax: 207-753-2100 
Email: gale.shannon@mckesson.com

For patients who were seen at a Southern site of service:

Fax: 207-874-9822 
Email: diane.henson@mckesson.com

Billing Overview

Radiologists are physician specialists, like your primary care physician and surgeon. Your bill will reflect our physicians time spent in three areas: examination, interpretation of test results and/or consultation. If there is a radiology charge on your hospital bill, it is for the facility staff, any medications, supplies and equipment, not for physician services.

How Services are Billed

The total cost of radiology services is typically split into “technical” and “professional” components. The technical component is the hospital or facility fee, which includes the technical staff’s time, use of the radiology equipment and facilities, and any supplies used for the test. The professional component is the fee for the radiologist, the physician who provides supervision of the examination, interpretation of the test results, and also includes a written report of the results for both the medical record and the doctor who ordered the test.

Spectrum participates with most insurance plans. If you have any questions about your coverage, or if you need assistance in making arrangements to pay your bill, please contact our billing office.

For your convenience, you can access your billing account with us on-line anytime. Visit our billing site at http://www.PerYourHealth.com and enter your account number and password. (You can find these on your patient statement.)