Interventional Radiologists at MedStar Georgetown University Hospital use minimally invasive techniques with image guidance to diagnose and treat many venous diseases. Interventional Radiologists are involved in the diagnosis and treatment of deep venous thrombosis, varicose veins, pulmonary arterio-venous malformations (AVMs) and pulmonary thrombosis. Blood clots in the legs (deep venous thrombosis) and lungs (pulmonary embolism) can be a source of significant adverse consequences and interventional Radiologists may reduce/remove the clot using catheter-directed thrombolysis. Additional treatments may include placement of an IVC filter and/or stents. Interventionalists are also able to close abnormal connections between arteries and veins which may occur in the lungs (arterio-venous malformations) that can be the source of poor oxygenation, infection of the brain, and even stroke. Similarly, interventional radiologists can close abnormally functioning veins in the legs (varicose veins) that can cause pain and, if severe, ulceration.
For further information or to schedule a consultation with an interventional radiologist, please contact the interventional radiology department at 202-444-5478.
Decreased blood flow from the leg veins to the heart may cause symptoms such as aching and fatigue, requiring elevation of the legs to relieve symptoms. If severe, the wounds may form on the lower part of the legs called ulcers. The reason for the abnormal flow is that the one-way valves in the veins do not perform their function and blood can flow backwards or reflux. This reflux results in what is known as venous insufficiency. One treatment for venous insufficiency is endovenous (or vein) ablation using a minimally invasive outpatient treatment where ultrasound guidance is used to place a small catheter in the vein and apply laser or radiofrequency energy to the inside of the vein to seal it closed. The goal of treatment is for flow to no longer go through the abnormal varicose vein and it to be taken up by other healthy veins.
Deep Vein Thrombosis
Blood clots may form in the veins, called Deep Vein Thombosis or DVT. The consequences of DVT vary from the patient having no symptoms to a patient having a life threatening event if the clot or thrombus is to move from the legs to the lungs. In some patients, methods are used to treat DVT by stopping the clot from traveling to the lungs by placing a filter in a deep vein called the IVC. In some patients, methods are also used to actively break down and remove the clot using minimally invasive catheter directed thrombolysis (CDT). This may involve mechanically breaking down the clot as well as the administration of “clot-busting” drugs. Reasons for performing CDT may be to prevent or treat the consequences of pulmonary embolism or to prevent the long term consequences of clot forming I leg veins. Depending on the location/amount of clot patients may be at higher risk for developing pos-thrombotic syndrome. Post-thrombotic syndrome is an under-recognized effect of having DVT if treated with blood thinners. Patients develop irreversible damage in the leg veins and their valves, resulting in abnormal pooling of blood in the leg leading to pain/swelling and in severe cases, leg wounds/ulcers.
Pulmonary Arteriovenous Malformations (AVMs)
Pulmonary arteriovenous malformations (AVMs) are rare lesions with significant clinical complications. An abnormal connection between arteries and veins in the lung may lead to trouble breathing (i.e., hypoxia), bleeding or the clogging of blood vessels from the abnormal blood flow which may lead to the development of stroke or brain abscess. Interventional radiologists can often treat these abnormalities without surgery, using minimally invasive techniques, to block the abnormal flow of blood through the AVM.
Left untreated, clot within the deep veins (i.e., a deep vein thrombosis (DVT)) can lead to several adverse consequences. The most concerning is a life-threatening event called pulmonary embolism (PE) which occurs when the clot breaks free and travels to the lungs. PE can have minor consequences where the patient doesn’t feel the effects (i.e., is asymptomatic) or PE can be major and lead to death. Interventional Radiologists offer a number of treatments for the treatment and prevention of DVT and PE. Many PE patients are treated with blood thinners (e.g., heparin, Coumadin) to keep more clot from forming while their body naturally breaks down the existing clot over the course of weeks/months. For patients who may be at high risk for use of blood thinners or who may not be able to tolerate reduced blood flow to the lungs, use of a filtration device, called an Inferior Vena Cava (IVC) filter may be considered. Using minimally invasive techniques, an Interventional Radiologist may place a device in a large vein near the heart to trap clot that may break off from the DVT before it goes to the lungs. Interventional Radiologists may also offer minimally invasive methods to break down clot that has already formed by injecting “clot-busting” drugs (e.g., TPA) and mechanically breaking down/removing clot that is in the lung blood vessels (pulmonary arteries) in a procedure called catheter-directed pharmacomechanical thrombolysis (CDT). This procedure is generally considered for patients who have significant PE or are at risk from the long term consequences of PE. Interventional Radiologist may also perform CDT in situations that are not life-threatening to reduce longer term complications that may arise (e.g., post-thrombotic syndrome, pulmonary hypertension).
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For further information or to schedule a consultation with an interventional oncologist, please contact the interventional radiology department at