Minimally Invasive Procedures

Lake Medical Imaging provides minimally invasive procedures that often replace traditional surgery.

Venous Ablation:  Varicose Veins

Venous ablation is performed in our office using imaging guidance. After applying local anesthetic to the vein, one of our interventional radiologists inserts a thin catheter, about the diameter of a strand of spaghetti, into the vein and guides it up the greater saphenous vein in the thigh. Then laser energy is applied to the inside of the vein. This heats the vein and seals it. By closing the greater saphenous vein, the twisted and varicosed branch veins, which are close to the skin, shrink and leg appearance improves. Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, thereby re-establishing normal flow.

Benefits of Venous Ablation Treatment

You may return to normal activity the next day with little or no pain (there may be minor soreness or bruising, which can be treated with over-the-counter pain relievers). Because the procedure does not require a surgical incision – simply a nick in the skin about the size of a pencil tip – there are no scars or stitches. Traditionally, surgical ligation or vein stripping was the treatment for varicose veins, but these procedures can be quite painful and often have a long recovery time. The success rate for venous ablation is substantially higher than that for surgery (meaning the recurrence rate is low); in fact, the success rate for venous ablation ranges from 93% to 95%.

Sclerotherapy:  Spider Veins

Sclerotherapy is the most common treatment for spider veins. The procedure takes about one hour, during which time a solution called a “sclerosing agent” is injected into the veins. This causes the inter-lining of the vein to adhere, which results in scar tissue that acts like ‘glue’ to seal off the unwanted veins. There are a few side effects, such as bruising around the injection site, or temporary discoloration of a light brown color along the vein. However, you may resume normal activity immediately.

How many treatments will it take?

The number of treatments depends on the individual and extent of the spider veins; one or possibly more treatments. Typically, the average number of treatments required are three.

J. Laird McMullen, III, M.D.

Image-Guided Needle Biopsy

In many cases, tissue samples can be obtained without open surgery by utilizing interventional radiology techniques. Nearly all biopsies performed by interventional radiologists are image-guided needle biopsies. This means that a needle is placed into an area of abnormality directly through the skin. The needle placement is confirmed with the use of a variety of equipment used by the radiologists including ultrasound (used most often), CT or x-ray fluoroscopy.

Needle biopsies are almost always performed as an outpatient procedure with a short (one hour) observation period thereafter.

For more information, visit: radiologyinfo.org Image-Guided Needle Biopsy

Paracentesis and Thoracentesis

Patients with a variety of illnesses may develop an area of excessive fluid in a body cavity, such as the abdomen or chest. The fluid can be drained by inserting a thin tube (catheter) through a small nick in the skin. In an effort to determine the cause of the fluid build-up or to relieve the symptoms of the excess fluid, interventional radiologists insert a small tube (less than 1/12 of an inch in diameter) through the skin, after numbing the skin with a local anesthetic. The fluid may be sent to the laboratory for analysis.

Planning for your Paracentesis and Thoracentesis procedure

During
After
During

An ultrasound will be used to help decide where to insert the needle. Your skin will be cleaned and the area around the procedure site covered with a clean sheet. Local anesthesia makes you more comfortable during your procedure and is used to numb the insertion area and dull your pain. However, you may still experience pressure or pushing during the procedure.

A needle will be inserted into your abdominal or chest cavity. A catheter is attached to the needle and the needle is removed. The catheter tubing will be attached to a container with a suction device (a gentle vacuum) to help drain the fluid. Removing large amounts of fluid may take a couple hours. After the procedure is completed and the catheter removed, the site will be covered with a bandage. Your referring physician may request that the ascites or pleural fluids be sent to a lab for tests.

After

Once the procedure is completed and the catheter removed, the site will be covered with a bandage. Your referring physician may request that the ascites or pleural fluids be sent to a lab for tests.

A catheter approximately the size of a pen tip is guided under fluoroscopy into the desired vessels in your liver. Ionizing radiation via millions of tiny glass beads is then delivered into the tumor.

For more information, visit: Radiologyinfo.org Thoracentesis

Pairoj Sae Chang, M.D. Ph.D.

Vertebral Augmentation

Vertebral Augmentation (VA) is a procedure performed by an interventional radiologist in order to reduce the discomfort associated with vertebral body fractures in the spine.    These fractures are typically secondary to osteoporosis; however, sometimes these fractures can be caused by trauma or tumors.    Vertebral body fracture is often associated with vertebral body height loss.  Studies have shown that if the vertebral body height loss can be improved, then there is less associated morbidity, such as pain and decreased mobility.

At the present time, Medicare and other third-party insurers authorize vertebral augmentation for pain management.  Both vertebroplasty and kyphoplasty are outpatient procedures that also can be performed on an inpatient basis. Vertebroplasty is a delivery of an orthopaedic “cement” (polymethylmethacrylate) mixed with barium. Under fluoroscopy or CT guidance, the orthopaedic cement is administered into the fractured vertebral body through placement of one to two needles. There is often no height restoration of the fractured vertebral body.

Kyphoplasty is a delivery of PMMA mixed with barium into the vertebral body after balloon dilation of the vertebral body.   There are other forms of kyphoplasty that can improve the height of a compressed vertebral body.  VA can be safely performed on up to three fractured vertebral bodies at any given time.

Planning for your procedure

Vertebroplasty:

Before
During
After
Before

The interventional radiologist will review your imaging studies and he or she may require additional imaging studies and/or a consultation.  You may be asked to stop certain anticoagulants several days prior to the procedure, and may be directed to consult the physician who prescribed them.  You may continue to take your other medications, as usual.   Eight hours prior to the procedure, stop eating solid foods. You may continue drinking liquids up to four hours prior to the procedure and taking your oral medications with few sips of water up to an hour prior to the procedure.   

 

On the day of the procedure, wear loose comfortable clothing. Arrange for a designated driver to drive you home post-procedure.

During

An IV is started and an antibiotic administered pre-procedure.   You are escorted to a fluoroscopy suite where the procedure is performed.   You lie on your stomach and conscious sedation is administered intravenously. After sterile prep of your back, a local anesthetic is administered. Under fluoroscopy, two needles are placed – one through each pedicle of the fractured vertebral body while the orthopaedic cement is introduced. The needles are then removed and adhesive bandages are placed over the puncture sites.  For one level, the procedure time is approximately 30 minutes.   For two or three levels, the procedure time is approximately 60 minutes.

After

Depending on how quickly you recover from the sedation post-procedure, recovery is one to two hours. You may experience complete pain relief; however, some pain may return after 12 to 24 hours.  The immediate pain relief may be due to the long-acting local anesthetic.   A 50% pain relief post-procedure is considered a success.   Arrange for a designated driver to drive you home. During your first night home, we prefer that you are not alone and have an adult with you. You are required to schedule a consultation with us two to three weeks post procedure, so that we may assess your progress.

A catheter approximately the size of a pen tip is guided under fluoroscopy into the desired vessels in your liver. Ionizing radiation via millions of tiny glass beads is then delivered into the tumor.

Kyphoplasty:

Before
During
After
Before

The interventional radiologist will review your imaging studies and may require additional imaging studies and/or a consultation. You may be asked to stop certain anticoagulants several days prior to the procedure.  Before you stop taking your anticoagulants temporarily, you may be required to consult with the physician who prescribed them.  You may continue to take your other medications as usual.   Eight hours prior to the procedure, stop eating solid foods. You may continue drinking liquids up to four hours prior to the procedure and taking your oral medications with few sips of water up to an hour prior to the procedure.   

 

On the day of the procedure, wear loose comfortable clothing.  Arrange for a designated driver to drive you home post-procedure.

During

An IV is started and an antibiotic administered pre-procedure.   You are escorted to a fluoroscopy suite where the procedure is performed.   You lie on your stomach and conscious sedation is administered intravenously. After sterile prep of your back, a local anesthetic is administered. Under fluoroscopy, two needles are placed – one through each pedicle of the fractured vertebral body – and the balloon device deployed followed by the “cement”. The needles are then removed and adhesive bandages are placed over the puncture sites.  For one level, the procedure time is approximately 45 minutes.   For two or three levels, the procedure time is approximately 60 to 90 minutes.

After

Depending on how quickly you recover from the sedation post-procedure, recovery is one to two hours. You may experience complete pain relief; however, some pain may return after 12 to 24 hours.  The immediate pain relief may be due to the long-acting local anesthetic.   A 50% pain relief post-procedure is considered a success. Arrange for a designated driver to drive you home. During your first night home, we prefer that you are not alone and have an adult with you. You are required to schedule a consultation with us two to three weeks post procedure, so that we may assess your progress.

A catheter approximately the size of a pen tip is guided under fluoroscopy into the desired vessels in your liver. Ionizing radiation via millions of tiny glass beads is then delivered into the tumor.