Office-based Interventional Suite (OIS)

In medical jargon, endo simply means “inside” and “vascular” implies arteries or veins. An endovascular procedure is one which is performed within the blood vessel itself.

Typically, the femoral artery in the groin is accessed with little more than a needle stick and there is no major incision.

To navigate the vascular system, surgeons use specialized x-ray equipment and contrast dye to highlight vascular anatomy. Wires with different characteristics are inserted. Some of these wires are very slick, others are floppy, some are very stiff, and they have different shapes on the end. We also use catheters which are similar to very long straws through which we place the wires. They too have various properties and come in a large array of sizes, shapes, and stiffness.

To revascularize, or open a blockage in a blood vessel, we use a different tool kit which includes small balloons inflated within, or stents which are made of alloy metals formed into tubes to keep the artery open. A third option to treat a blockage is a catheter with a specialized tip that spins at very high RPMs to open a channel in the vessel. This is called an atherectomy, (ather-from atherosclerosis, and “ectomy” means to remove), or you may hear the term “roto-rooter.” At times, all three options are needed for revascularization.

An angiogram is a diagnostic procedure to evaluate arterial anatomy and assess the severity of any blockages. For patients with AIOD or PAD, an angiogram is required before any treatment can be performed, but it is done at the same time as angioplasty or stenting.

Contrast dye is injected into the blood stream to define the anatomy. The dye absorbs x-rays, thereby making the blood vessels appear dark. Based on the findings, we then determine the best treatment option in real-time. In some cases, there is no suitable endovascular option and open surgery is necessary. In these instances, the angiogram provides all the necessary information to plan an open surgery.

CO2 angiography is reserved for patients with kidney disease. Regular contrast dye is generally very safe, but it can be damaging to the kidneys, particularly in patients with severe pre-existing renal problems. In our OIS, we offer an excellent alternative: CO2 angiography.

Rather than dye, carbon dioxide is injected as the contrast agent to define the arterial anatomy. CO2 has no ill-effects on the kidneys, yet is still very effective. If an intervention such as angioplasty, atherectomy, or stenting is required, a small amount of contrast will ultimately be needed, but the overall amount is reduced to a fraction of what would otherwise be required.

Intravascular ultrasound, or IVUS (eye-VUS), is an invaluable tool we use to assess blood vessel anatomy from within the vessel itself. A tiny ultrasound probe is inserted into the blood vessel to obtain high-resolution images of all three layers of the vessel wall. IVUS also allows for real-time imaging of a blockage to evaluate its severity, and for immediate assessment of the effectiveness of angioplasty or stenting.

IVUS has an added benefit in that we use it together with either contrast angiography or CO2 angiography to further reduce the total amount of contrast required for a procedure.

During an angioplasty, a blocked artery is opened using an inflatable balloon. These balloons come in a variety of sizes and lengths which we match to the diameter of the artery and length of the blockage. A channel in the artery is created to restore flow. After an angioplasty, nothing is left behind in the artery. If a blockage is severe, it may be used in combination with stenting and/or atherectomy.

The iliac arteries are found in the pelvis and supply the entire blood volume to the legs. Blockages here are frequently calcified, dense, and inelastic. Because of these characteristics, iliac stenosis is most commonly treated with stents. Whenever a stent is placed, we also perform an angioplasty with a balloon. The balloon ensures the stent is dilated sufficiently enough to maximize blood flow.

Peripheral arterial stenting refers to stents placed in the legs. It is an effective option to treat severe lifestyle-limiting claudication and critical limb ischemia in patients with significant blockages in the arteries. The stent is advanced through the blockage and then expanded to essentially force the artery open. Angioplasty is then performed to ensure the stent achieves the appropriate diameter.

Atherectomy is a procedure in which a specialized rotating catheter is inserted into a blocked artery to actually remove atherosclerotic plaque and open a channel through which blood will flow. The tip of the catheter spins at more than 100,000 RPMs to pulverize the blockage. The catheter also has suction to remove the minute fragments. Angioplasty is then performed to help expand the vessel, and in some cases, a stent may also be used.

Patients with a history of iliofemoral DVT, venous stenosis, or May-Thurner Syndrome have a blockage in the iliac veins in the pelvis. These veins are the main drainage for the leg and if flow is compromised, severe lower extremity swelling may result. We are able to diagnose and treat this condition in the OIS with a venogram and stenting.

Venography is identical to angiography, but it is used to evaluate the veins. Once the venous anatomy and blockage is identified, a stent is frequently needed. Venous stents are identical to arterial stents, but are usually a bit larger in diameter.

Patients with fistulas or AV grafts may develop problems during dialysis. If you have noticed prolonged bleeding after dialysis or low flow during dialysis, there may be a treatable problem. It is always better to treat these issues before your access stops functioning. We are pleased to offer an outpatient option for our dialysis patients in our OIS, helping you to avoid a hospital visit or admission.

A fistulogram is a procedure to diagnose and treat access problems. Contrast dye is injected to identify any blockage or narrowing. Most commonly, angioplasty is performed to improve blood flow and allow dialysis to continue. For recurrent blockages that have required several interventions, or narrowing of the large central veins in the chest, a stent may also be needed.

Once a fistula or graft develops problems, they frequently recur. Our team will ensure you have frequent follow-up for any necessary maintenance.