WVU Medicine interventional radiologists treat a wide range of conditions that formerly require traditional surgery. Our physicians are board certified and use state-of-the-art procedures to treat diseases at their source. They are uniquely trained in specialty areas to treat conditions affecting men and women of all ages.
These procedures and treatments offer a minimally-invasive alternative to traditional surgery and the benefits include:
- Smaller incisions
- Less pain
- Faster recovery
- Most are performed as outpatient procedures
- Reduced risk of complications
Conditions we treat that affect both men and women include:
A varicocele is an enlargement of the veins within the scrotum. It is similar to a varicose vein in the leg and may cause pain, testicular shrinkage, and/or fertility problems. Varicoceles are predominantly seen in men between the ages of 15 and 35. A varicocele embolization is a minimally-invasive, image-guided procedure that redirects blood flow away from the varicocele.
The symptoms of a varicocele include:
- Painful testicles
- Atrophy shrinking
- Fertility difficulties
Many men experience aching pain after standing or sitting for long periods of time because pressure builds up on the affected veins. Typically, painful varicoceles are enlarged. Other men notice the size of their testicles decrease, but once the testicle is repaired, it frequently returns to normal. There may also be a relationship between varicoceles and infertility as noted in:
- Decreased sperm count
- Decreased motility of sperm
- Increase numbers of deformed sperm
Diagnosis and Treatment
A diagnosis is made by means of a physical exam or diagnostic imaging. Physically varicoceles typically occur on the left side of the scrotum and the testicles are shrunken in size or atrophy. However, varicoceles are not always physically obvious. In that case, irregular blood flow can be detected with an ultrasound or x-ray called a venogram.
Surgical ligation tends to be the most common treatment for varicoceles, but an alternative treatment option is varicocele embolization. A minimally invasive treatment performed by an interventional radiologist. The procedure is as successful as surgery with less risk, pain, and recovery time. Varicocele embolization is also advantageous for patients with varicoceles in both testicles; they can both be corrected utilizing one incision, whereas surgery requires two. It often has the added benefit of effectively improving male infertility.
The procedure is a catheter-directed outpatient treatment that requires only minor sedatives and local anesthesia. The procedure is relatively easy. A catheter is guided through the femoral vein to the testicular vein, then contrast dye is inserted to highlight the veins so the physicians can locate the problem and embolize the vein. By embolizing the vein, blood flow is redirected to healthy pathways. Essentially, the useless vein is shut off internally, accomplishing what urologists do, but without surgery.
Once the procedure is complete, you spend an hour or two in recovery and then are permitted to go home. It is recommended that you limit physical activity for about three to four days after the procedure. With surgery, recovery time can last approximately two to three weeks.
Uterine fibroid embolization (UFE) is a safe and effective, minimally-invasive interventional radiology treatment for uterine fibroids. UFE is a possible alternative to hysterectomy and the benefits include: less pain and shorter recovery time. The procedure is suitable for both multiple and/or large fibroids.
Uterine fibroids also known as leiomyoma, myoma, or fibromyoma are common, benign tumors that develop in the muscle wall of the uterus. The fibroids range from the small as a pea to as large as a grapefruit, and occasionally larger. They are the most common tumors in the female genital tract. There are four kinds of fibroid tumors:
Women with fibroids may not necessarily experience symptoms. It depends on fibroid size, location, and number. Approximately 10-20 percent of women with fibroids require treatment. Symptoms are varied and may include the following:
- Pelvic pain and pressure
- Back and leg pain
- Heavy prolonged menstrual periods
- Painful sexual intercourse
- Bladder pressure with a frequent urge to urinate
- Pressure on the bowel, leading to constipation and bloating
- Abnormally large abdomen
- Blood clots in the legs
Diagnosis and Treatment
Women usually see their gynecologist first and undergo an ultrasound to discover if they have uterine fibroids. Next, they see an interventional radiologist for a second opinion. Interventional radiologists use MRIs to verify the presence of uterine fibroids. An MRI can provide a clearer image of any underlying issues. It can also be used to:
- Reveal all fibroids in the uterus
- Determine if fibroids are eligible for embolization
- Rule out misdiagnosis
- Identify which treatments are best for each patients
The procedure does not require general anesthesia, but is performed while the patient is conscious, but sedated. Using x-ray guidance, the physician inserts a catheter into the femoral artery, channels it to the arteries that supply blood to the tumor. Next, they released a tiny sand-sized embolic agent that is used to block blood flow and cause the fibroid tumor to infarct. After the tumor dies, it shrinks and is reabsorbed by the body. The procedure generally takes around one hour and usually requires an overnight hospital stay. Pain medications and drugs that control swelling are typically prescribed following the procedure to treat cramping and pain.
Many women resume light activities in a few days, and the majority of women are able to return to normal activities within seven to 10 days.
Ovarian vein embolization is a safe, effective, and minimally invasive treatment for pelvic congestion syndrome. The procedure is less expensive and less invasive than surgery. Pelvic congestion syndrome is similar to varicose veins in the legs. It affects the uterus, ovaries, and vulva causing pain. Not all women with varicose veins in the pelvis experience symptoms.
Pelvic congestion syndrome is often misdiagnosed since women lie down for a pelvic exam, which relieves pressure on the ovarian veins. The risk for developing pelvic congestion syndrome increases for women with two or more pregnancies, polycystic ovaries, or hormonal problems.
- A dull and/or aching pain in the abdomen and lower back
- The pain increases
- When standing (worse at the end of the day)
- Following intercourse
- During your period
- During pregnancy
- Usual vaginal discharge
- Varicose veins on vulva, buttocks, or thighs
- Need to urinate frequently
- Abnormal periods
Diagnosis and Assessment
To diagnose pelvic congestion syndrome, a pelvic exam is necessary to rule out other conditions or concerns. Then, using imaging techniques, an interventional radiologist verifies that the pelvic varicose veins are the cause of the chronic pain. There are four minimally-invasive techniques used:
- Pelvic venography
- Pelvic ultrasound
- Transvaginal ultrasound
Once the diagnosis is made, if the patient is symptomatic, an embolization is usually performed.
Be sure to tell the doctor about any:
- Medications, including herbal or over the counter
- Allergies to iodine or contrast dye
- Recent illnesses
- Medical conditions
Ovarian vein embolization is performed as an outpatient procedure. After a mild sedative and a local anesthetic, the interventional radiologist uses imaging for guidance and inserts a catheter into the femoral vein in the groin. Next, they guide the catheter to the affected vein and insert a sclerosing agent that seals the vein and relieves the pressure. Once the procedure is complete, you can return home later the same day.
After an ovarian vein embolization procedure, patients generally have pelvic cramping that improves within days, and many women return to their normal routines in a couple of weeks.