FAQ

They are caused because of increased blood pressure in veins. Sitting or standing for long periods can cause blood to pool in the leg veins, increasing the pressure within these veins. The increased pressure stretches these veins. This may weaken and damage the walls of the veins. This results in loss of normal unidirectional blood flow towards the heart.

• Females have more prevalence than males

• Genetic predisposition

• Old age

• Overweight

• Having a job that involves long periods of standing

• Pregnancy

• Other conditions like deep venous thrombosis, some congenital conditions, etc

• Green / blue coloured veins visible on legs

• aching or heaviness in the legs

• cramps, swelling or burning in the legs

• discoloured and thick skin especially near ankles

• an itchy rash (varicose eczema)

• Venous ulcers near ankle

• Restless legs.

• Ulcers - Painful ulcers may form on the skin near the ankles due to chronic stasis of deoxygenated blood. See your doctor immediately in such case.

• Blood clots - Blood may clot within the distended veins giving rise to pain, redness, and swelling - a condition known medically as thrombophlebitis.

• Bleeding - Occasionally, veins very close to the skin may burst due to small injury. Any bleeding requires medical attention.

• Regular Exercising

• Weight control

• Eating a high-fiber, low-salt diet

• Avoiding high heels and tight clothing

• Elevating your legs

• Avoid long standing

• Clinical examination by doctor

• Duplex ultrasound to see the status of deep veins and grade the severity of varicose veins.

1. Compression stockings – Compression stockings are specially designed to steadily squeeze your legs to improve circulation. They encourage blood to flow upwards towards your heart. This is supplementary treatment option and cannot cure varicose veins itself.

2. Endovenous Laser Ablation(EVLT) – procedure is performed under local nerve block and ultrasound guidance. A tiny laser fibre is inserted into a varicose vein through a catheter. The laser is used to deliver heat that destroys the wall of the varicose vein which later becomes fibrosed. The procedure time is around 1 hour and patient can walk after 3-4 hours post procedure.
   Advantages of EVLT - EVLT is a minimally invasive procedure with very high success rate & minimal recovery time. No stitch required and minimal blood loss during the procedure.

3. Ultrasound guided Sclerotherapy - This procedure involves injecting special medicinal foam into your superficial veins under ultrasound guidance. The foam scars the veins, which seals them closed.

Peripheral vascular disease refers to spectrum of conditions caused due to insufficient arterial blood supply to the extremities. It can be acute or chronic in nature.

Acute PVD is caused due to sudden artery occlusion due to blood clot. There is sudden onset pain in the limb with swelling, discoloration of skin and later loss of sensations and power.

Chronic PVD mostly occurs in patients having tobacco addiction. Due to narrowing of blood vessels, the blood flow to calf muscles and toes is less than required leading to pain after walking some distance / rest pain and non-healing ulcers, discoloration of toes.

Your doctor will carefully examine you. There are absent arterial pulses, cold temperature of limbs with severe tenderness.

Further diagnosis can be made using Doppler ultrasound and CT/MRI Angiography.

Acute PVD –

• Aspiration thrombectomy where blood clot is aspirated by suction

• Catheter directed thrombolytic therapy where blood clot is dissolved by injection of special drugs into the thrombus with catheter.

The goal of endovascular treatment is to establish blood flow as quickly as possible to prevent irreversible damage to issues.

Chronic PVD –

• It requires balloon angioplasty in which balloon mounted catheter is taken across the site of narrowing in the blood vessel. The balloon is inflated across the narrowed segment so that it dilates and blood flow is increased. This may be combined with placement of metal stent if necessary to maintain the blood vessel patency. The treatment protocol will be decided by the Doctor as per the severity of disease in each individual case.

Vascular malformation is abnormal growth of blood vessels. It is usually present from birth but may appear any time in life. It may be present on face, limbs, chest/abdomen wall or any site on the body.

The vascular malformation may be diagnosed incidentally. Many of them regress in size with time and require no treatment. But few of them cause swelling, pain, restriction of activity or bleeding due to minor treatment. Therefore consultation with doctor is necessary.

Treatment options depend on flow pattern, extent of involvement & site. Asymptomatic slow flow vascular malformation can be managed conservatively unless patient is apprehensive or wants cosmetic correction. The treatment options include Endovascular Embolisation, Percutaneous Embolisation&Sclerotherapy. In most cases, repeat interval sessions of treatment are needed.

Embolisation is a minimally invasive treatment performed by Interventional Radiologists which uses materials to deliberately block the affected blood vessel so as to stop ongoing bleeding. Based on the site of bleeding this procedure has different names

• Bronchial artery embolisation for bleeding from lungs seen as blood during cough

• Gastro Intestinal artery embolisation for bleeding in intestines seen as blood in stools and vomiting

• Splenic artery embolisation

• Uterine artery embolisation for post delivery hemorrhage

• Renal artery embolisation for bleeding from kidney seen as blood in urine

• Embolisation of arteries of hands / legs in cases of traumatic bleeding which is life threatening.

• Embolisation can be done for tumors prior to surgery to prevent excessive blood loss.

The procedure aims to halt the ongoing blood loss by blocking the source blood vessel. At same time, the normal blood supply to surrounding organs has to be preserved. For this purpose, a tiny catheter is taken as distally into the blood vessel as possible and synthetic material released to block the vessel. The results are excellent, especially in emergency cases, which if untreated may be life-threatening.

• Stenosis

• Thrombosis / blood clotting inside the fistula

• Swelling of the entire hand having the dialysis fistula due to stenosis of large draining veins in chest.

There is suboptimal blood flow during the dialysis.
Also if left untreated, the fistula may get clotted along its entire extend and become non-functional eventually.

• Angioplasty and Vascular stenting: Using imaging guidance, an inflatable balloon mounted at the tip of a catheter is inserted through the skin into the fistula and advanced to the blockage. There, the balloon is inflated and deflated. In this process, the balloon expands the vessel wall, increasing blood flow through the fistula. A metal stent may be placed to hold the vessel open in some cases.

• Catheter directed thrombectomy and thrombolysis: Using imaging guidance, a catheter is inserted through the skin into a vessel and taken near the site of blockage to deliver the medicine. The blood clot will then be dissolved in one of two ways:
  - by delivering medication directly to the blood clot (thrombolysis).
  - by positioning a mechanical device at the site to break up the clot (thrombectomy).

1. No surgical incision.

2. These procedures are performed under local anesthesia

3. Short recovery time.

4. Less blood loss.

Deep venous thrombosis refers to abnormal clotting of blood in major veins of the lower limbs. The underlying causes include long time immobilization (bed ridden patients), cancer, oral contraceptive pills, dehydration, trauma, etc.

The patient has swelling, severe pain and redness in the limb. In this condition complete bed rest is advisable because if this blood clots from the leg veins move to lungs they may cause blockage of blood supply to lungs, condition known as pulmonary embolism, which may be life threatening.

The advanced treatment options include –

• Aspiration Thrombectomy in which the blood clots are aspirated by suction process.

• Catheter directed thrombolysis in which the blood clots are dissolved by special medicines delivered with use of small catheters into the veins.

• IVC filter placement – Inferior vena cava (IVC) is large vein situated in abdomen which brings blood back to heart fromabdomen & legs. In patients with recurrent DVT / no response to treatment / contraindication to treatment, IVC filter can be placed. IVC filter is umbrella like metallic structure which traps the blood clots migrating from leg veins to lungs. After the necessary time period, IVC filters can be removed back from the body.

The goal of advanced endovascular treatment is to reestablish the blood flow and give early symptomatic relief to patient, reduce future post thrombotic complications & chances of pulmonary embolism.

Transarterial chemoembolization or TACE is procedure to deliver the chemotherapy drugs directly to arteries supplying the tumor in the liver. In addition, synthetic material called an embolic agent is placed inside the blood vessels that supply blood to the tumor which results in trapping the chemotherapy drugs inside the tumor and blocking blood flow to the tumor. This results in loss of blood supply to the tumor plus high dose delivery of chemotherapy drug to the tumor cells resulting in death of these cancerous cells.

TACE is used to treat -

• Hepatocellular carcinoma (primary liver cancer)

• cholangiocarcinoma (primary cancer of the bile ducts in the liver)

• Metastasis (spread) to the liver from cancers elsewhere in the body

1. Local delivery of chemotherapy drugs inside the tumor. This leads to high response rate and lower side effects.

2. Minimally invasive procedure

3. Faster recovery

4. Usually performed under local anesthesia.

5. Faster recovery time

If you are unfortunately diagnosed with any tumor of the liver, your doctor will have to diagnose the type of tumor and its spread outside the liver to other parts of body. Also blood tests have to be performed along with consideration of general health status of the patient to consider eligibility for the TACE procedure. Also post TACE, close follow-up with the treating doctor is necessary to evaluate the response and plan for repeat session if necessary.

The liver procedures bile which flows through biliary ducts into the intestines to help digestion. When this normal flow of bile from biliary ducts to the intestines is blocked due to stones/tumor/any other cause, there is development of Jaundice which is known as Obstructive Jaundice. Signs obstructive jaundice include yellowing of the skin, dark urine, white colored stools, itching over body, nausea and poor appetite.

To relieve the obstruction in such conditions, interventional radiologists under ultrasound and fluoroscopy guidance, insert small plastic draining tubes through the skin into the dilated biliary ducts. This helps to drain the accumulated bile outside the body. Further step ahead, with help of small catheter and guidewires, the obstruction can be crossed to enter the intestines and if needed metal/plastic stent can be placed across the narrowed segment of biliary tract to maintain its patency. This restores the normal flow of bile into the intestines and patient gets relief from obstructive jaundice.

Radiofrequency / Microwave ablation for cancer is a minimally invasive procedure that uses electrical energy and heat to destroy cancer cells.

It is performed by Interventional Radiologists using thin needles inserted through the skin under ultrasound / CT scan guidance into the cancer tumor. High-frequency energy passes through the needle and causes the tissue to heat up thereby killing the cells.

Radiofrequency/ microwave ablation is most commonly used for treatment of cancer tumors in the liver though it can be used elsewhere in the body like osteoid osteoma of bones, kidney/thyroid/ lung tumors.

It has the advantage of being minimally invasive, less blood loss, less operative time and early recovery as compared to surgery. Also it is only treatment option when patient is not fit for surgery.

FNAC stands for fine needle aspiration cytology. When a person is unfortunately diagnosed with some tumor in the body, the doctor needs to know the type of tumor to initiate any treatment. To characterize the type of tumor, an Interventional radiologist removes small portion of tumor using ultrasound/CT scan guidance using small needle(FNAC) or by use of special guns(biopsy). This small portion of tumor is then studied by pathologist to give detailed report about the tumor type and morphology which is known as histopathology and IHC (ImmunoHisto Chemistry). Based on this detailed report, the Medical Oncologist/Onco-surgeon initiates further treatment.

Interventional Radiologist performs these procedures under guidance of ultrasound / CT scan using local anesthesia. Hence there is less chance of complications and high success rate.

It refers to removing of excess fluid in chest / abdomen by insertion of small needle under local anesthesia for symptomatic improvement and to perform diagnostic tests on that fluid.

Interventional Radiologist performs these procedures under guidance of ultrasound / CT scan using local anesthesia. Hence there is less chance of complications and high success rate.

Hydronephrosis refers to abnormal accumulation of urine in the kidneys due to any obstruction to normal flow of urine through the ureter into the urinary bladder. The urine from kidney drains through a narrow, muscular tube, called ureter, into the urinaybladder.In such condition, it is necessary to drain that accumulated urine from the kidney outside the body to prevent infection and permanent damage of renal function. Percutaneous nephrostomy is procedure in which small plastic pipe is inserted into the kidney from the skin surface to drain the urine outside the body. It is performed by Interventional Radiologist under ultrasound/fluoroscopy guidance under local anesthesia.

Nephro-ureteric stent placement refers to placement of small pipe (stent) in the ureter which connects the kidney and urinary bladder. One end of this pipe is in the kidney and other inside the urinary bladder. It helps drainage of urine from kidneys to urinary bladder bypassing the mechanical obstruction (stone/tumor). This is performed by Interventional Radiologist under ultrasound/fluoroscopy guidance under local anesthesia.Regardless of the stent composition, it is recommended to exchange these stents at 3 to 6 month intervals.

Ultrasound guided nerve block refers to injection of special drugs along the targeted nerve under ultrasound guidance for pain relief. The aim is to decrease inflammation and "turn off" a pain signal along a specific distribution of nerve. A nerve block may allow a damaged nerve to heal, provide temporary pain relief and help identify a more specific cause of pain.

Ultrasound guided tendon sheath injection refers to injection of special drugs along the sheath of muscle tendon under ultrasound guidance for pain relief in inflammatory condition known as Tenosynovitis.