Catheter based interventions for pulmonary embolism is on the rise. The rise in mainly in patients who present with submassive PE. The intent of intervention is to reduce clot burden. This is done to improve acute symptoms and to reduce long-term complications. A common intervention for pulmonary embolism is infusion of thrombolytics. This can be…
There are several instances to consider anticoagulation for peripheral artery disease. One, is to prevent future events. There are data that show that a small dose of rivaroxaban prevents major adverse cardiovascular events and major adverse limb events. These data also show that anticoagulation is particularly useful in patients after a vascular procedure. A second…
Catheter procedures are very common. They are quickly replacing surgery for many indications. Many vascular problems can be treated with catheters. Cath procedures are safe. Pain after cath procedures is not normal. It can signify a serious problem. For this reason pain after cath procedures should prompt immediate medical attention. What is a Cath Procedure…
There is surprisingly little data available to guide surveillance after endovascular procedures for peripheral artery disease. Simple things are not well described. Should a patient be seen frequently or only symptom based? Should some patient characteristics prompt more or less frequent visits? Is surveillance that relies on ultrasound and segmental pressures and pulse volume recordings…
Chronic mesenteric ischemia can pose a diagnostic and technical challenge for the interventionist. Indications and patient selection for mesenteric artery stenting were covered previously here. This article will outline technical aspects of mesenteric artery stenting. Clinical Vignette A 74-year-old gentleman with a history of antiphospholipid syndrome and celiac artery stenosis treated with a single balloon-expandable…
An angiosome is a three-dimensional anatomic sector of the human body that is perfused by a single source artery (1). Each angiosome is connected to surrounding angiosomes through “choke vessels” that may become important when the perfusion capacity from the source artery is diminished. Appropriate perfusion becomes crucial in patients with critical limb ischemia. What…
Popliteal artery occlusions are common. These occlusions most commonly result from peripheral artery disease. However other potential etiologies of popliteal artery occlusions include thrombosis of a pre-existing popliteal aneurysm (particularly if there is evidence of distal embolization), cystic adventitial disease, trauma or popliteal artery entrapment syndrome. The Popliteal Artery Merits Special Consideration Once other rarer…
A 57-year-old diabetic woman with a history of three-vessel coronary bypass grafting presented with unstable angina in the form of chest pain occurring at rest. Stress PET-CT showed a dense reversible anterior wall defect and she was referred for urgent cardiac catheterization. Cardiac catheterization was performed via a left radial artery approach. Angiography revealed a…
Endovenous Laser Ablation, EVLA, is a minimally invasive treatment of chronic venous insufficiency. EVLA works by selective photothermolysis. A laser emitting fiber of varying wavelengths (810-1470 nm) is placed percutaneously within the treated vein. The laser disrupts the vein both directly and indirectly. Certain wavelengths injure the venous wall directly. Other wavelengths heat venous blood…
Multiple sclerosis (MS) is a potentially devastating condition. The cause of MS is uncertain, as is its treatment course. While treatment options for MS are multiplying they are limited by their side-effect profile, their varying efficacy, and their inability to cure. Internal jugular and azygos venoplasty has emerged as a possible new and exciting treatment…
