What is an arteriovenous malformation?

VCU Baird arteriovenous malformation

Arteriovenous malformations (AVMs) are defects in the vascular system, most easily described as an abnormal tangle of blood vessels connecting arteries and veins.

The vascular system includes arteries, veins, and capillaries. Arteries carry oxygen-rich blood away from the heart to other organs; veins carry oxygen-depleted blood back to the heart. Capillaries connect the arteries and veins. With an AVM, the tangle of arteries and veins disrupts normal blood flow and oxygen circulation.

According to the Mayo Clinic, when an AVM disrupts this critical process, the surrounding tissues may not get enough oxygen, and the affected arteries and veins can weaken and rupture. If the AVM is in the brain and ruptures, it can cause bleeding in the brain (hemorrhage), stroke or brain damage. While AVMs in other areas of the body are generally not a serious health concern, they can often be inconvenient, painful and unsightly.

AVMs can happen anywhere, but they are more common in the brain or spinal cord. Most people with brain or spinal cord AVMs have few, if any, major symptoms. Sometimes they can cause seizures or headaches.

It’s not clear what causes of AVMs. However, researchers believe most people are born with them, but they can occasionally form later in life. While it’s a rare condition to be passed down among families, there are several rare genetic diseases that are associated with AVMs.

AVMs treated at Baird Vascular Institute at VCU Health include those of located on the extremities as well as various locations on the body including the pelvic region. The Interventional Radiologists and Vascular Surgeons at BVI are well equipped to treat these AVMs. Our capabilities also allow us to handle the primary treatment of AVMs that once may have required prolonged hospitalizations. Today, our image-guided expertise makes outpatient care of these conditions possible. Depending on the location and severity of the AVM, we can generally treat these on an outpatient basis by injecting a sclerosing agent – similar to how we might treat some varicose veins. This has the effect of essentially collapsing the vein(s) and having it stick together which prevents blood flow into that area. The body then naturally reroutes blood flow through other vessels to compensate and to keep surrounding tissue healthy.

If you are concerned and think that you may have an AVM, or you have recently been diagnosed with an AVM and would like to speak with us about your options, give us a call at 804-828-2600.

 

 

What are the risks of an IVC filter?

baird IVC filter risk

One of the services we offer our patients is IV filter placements. Inferior vena cava (IVC) filters are small metal devices placed in patients at risk of developing blood clots or deep vein thrombosis in the legs or pelvis; the clots can break off and cause pulmonary embolism, the lodging of an embolus, such as a blood clot, in the lungs. Your doctor may recommend an IVC filter for conditions such as deep vein thrombosis (DVT), pulmonary embolism, trauma immobility or recent surgery or childbirth.

Recently, IVC filters have been a topic of conversation on whether they’re safe or not. We talked to Dr. Brian Strife about IVC filters and here’s what he had to say.

“IVC filters have been placed for the last several decades, developed initially in the 1960’s,” he said. “Originally, they were designed as permanent devices, meaning the filter would be placed in the patient’s vein, and it was designed to remain in place for the life of the patient.”

In the last few years, retrievable filters were developed. They have a hook or some other component to the filter where a physician could grab it and remove it. “Over time, what we learned is that some of these filters were prone to develop problems in a very small number of them,” said Dr. Strife. “The problems included migration, or movement of the filter, fracture or breaking of the filter, and then clotting of the filter.” Those are the 3 main complications that we often hear about with inferior vena cava filters.

“When the filter itself develops a blood clot,” he continued, “it can block the main vein, the IVC, this can lead to significant pain and swelling in the lower extremities. Also, the filters themselves, being made out of metal, over time the metal can stress and fatigue. The filter can break, pieces of the filter can migrate into the patient and damage adjacent organs. Very rarely, pieces of the filter can break off and go to the heart and lungs.”

The filters, whether they are permanent or retrievable types, are meant to stay in the patient for a long time. The filters are made out of stainless steel or some kind of metal alloy that is designed to withstand years of being inside a human body. It’s a rare occurrence that the filters have any problems at all.

“Although these complications are extremely uncommon,” said Dr. Strife. “It is a source of patient anxiety and we often receive a number of phone calls from patients asking if they should have their filter removed to avoid these complications.”

“In 2010, the FDA recommended that physicians who placed these filters, and physicians who follow patients with these filters, make an attempted to consider IVC filter retrieval when the filter is no longer needed,” he continued. “Sometimes that’s a tough question to answer, because we don’t necessarily know which patients are best suited to have a filter in for the rest of their lives. When a patient calls our office and says ‘I have an inferior vena cava filter and I’d like to have it removed,’ we typically have the patient come in for a consultation, discuss why they have the filter in the first place, and try to make an informed decision on whether retrieval is appropriate for them or not. Sometimes, that’s a very easy question to answer, sometimes we need to do additional tests and consult with other physicians before making that decision.”

If you need an IVC filter, our would like to talk to us about one you currently have, call us at (804) 828-2600 to discuss your options.

Conscious Sedation

baird conscious sedation

One of the first questions that our patients ask us when they are scheduled for a procedure is, “Will I feel pain?” This is an understandable concern for someone getting ready to undergo a minimally invasive procedure, especially if it’s their first time having a medical procedure performed. Minimizing pain and discomfort is one of our primary concerns here at BVI. We want to do everything possible to ensure that our patients have a positive experience during their visit which is why we use conscious sedation during many of our procedures.

What is conscious sedation?

Conscious sedation is when a combination of medicines is administered to help you relax (a sedative) and to block pain (an anesthetic) during a medical procedure. Conscious sedation is safe and effective for people who need a minimally invasive procedure. Here at BVI, these medicines are given through an intravenous line (IV) by one of our nurses under the direct supervision of a physician. You will begin to feel drowsy and relaxed very quickly. You may fall asleep, but you will wake up easily to respond to people in the room. You may be able to respond to verbal cues. You will be monitored throughout the entire procedure by our medical team to make sure that your blood pressure, heart rate and oxygen levels stay within safe limits.

The medicine will wear off quickly and recovery after the procedure is generally very fast. After conscious sedation, you may feel drowsy and not remember much about your procedure including any associated pain. Afterwards, you will feel sleepy and may have a headache or feel sick to your stomach. During recovery, your finger will be clipped to a special device (pulse oximeter) to check the oxygen levels in your blood and your blood pressure and heart rate will be monitored. You should be able to go home 1 to 2 hours after your procedure.

Is conscious sedation the same as general anesthesia?

No. General anesthesia (also known as deep sedation) is when you are administered drugs that put you in a totally unconscious state. Under general anesthesia, you have no awareness of the procedure or your surroundings at all. General anesthesia is usually reserved for more complex and lengthy procedures or when your provider deems in necessary. General anesthesia also comes with higher associated risks. Only licensed anesthesiologists or nurse anesthetists are able to administer general anesthesia. Recovery times are usually longer than conscious sedation and may present more unpleasant side-effects. BVI does NOT use general anesthesia.

Before the Procedure

Be sure to tell us if you are or could be pregnant. We also want to know what medicines you are taking, even drugs, supplements, or herbs you bought without a prescription. A day or two before the procedure, one of our nurses will contact you to go over pre-procedural instructions. This generally includes:

  • Not eating or drinking six hours prior to the procedure
  • Be sure to have someone accompany you to the procedure. You will not be in any shape to drive home
  • Discussion of any lab work that will be required prior to your procedure
  • Arrive at the time instructed

You will be given an instruction packet with more detailed information prior to your procedure. And as always, if you have any questions you can give us a call at (804) 828-2600 to talk with one of our providers. Conscious sedation is a safe and effective way to minimize pain and anxiety for our patients.

4 questions you may have about ports

VCU Health Baird Port

Many conditions, such as cancer treatment, long-term IV medication or kidney dialysis, require frequent or constant access to your veins. Repeated needle sticks in the same area can be hard on you and hard on your veins. That’s why we specialize in placing vein access ports, so that doctors don’t have to stick you with a needle or restart an IV line every time you need treatment. That makes care easier — and your life easier.

For long term IV access, placing a semi-permanent catheter such as a “port-a-cath,” chemotherapy port or IV access port into a large vein in the upper arm or neck can make treatment easier for patients undergoing treatments that require frequent or constant vein access such as:

  • Chemotherapy or anti-cancer drug infusions
  • Hemodialysis
  • Long-term intravenous antibiotic treatment
  • Long-term intravenous feeding
  • Repeated drawing of blood samples

Unlike most other types of catheters, a port-a-cath is implanted completely underneath the skin. This type of port allows you to bathe and swim without the risk of infection. Port-a-caths can remain in place for months or even years.

If you’ve been told you need a port, you may have questions – here are 4 questions people want to know.

Is having a port painful? Having a device implanted under your skin can seem frightening to many people as is concern for ongoing pain. As with any medical procedure, you can expect some pain after the insertion, but ongoing pain is minimal, and relative to each individual patient’s level of pain tolerance. We talked to Dr. Shep Morano about ports. “You’ll notice that you can see and maybe even feel the reservoir of port area under the skin,” said Dr. Morano, “you can also sometimes feel and see part of the catheter as it runs over the clavicle and into the vein into the base of the neck.” For most people, he continued, “They don’t even notice the port after a while, it just becomes part of their body and it doesn’t bother them or even notice it that much.”

What is a cancer port pillow? A cancer port small pillow with a strap is sometimes used to cover seat belts, purse handles, cross body bags, or other straps that may rub against the port. They can be handmade or found at several online retailers.

Can my port get infected? Just like any other medical device, certain precautions must be taken to care for your port. We wrote a blog post a while back on port care, but the best thing to remember is follow the instructions from your physician and care team, and be sure to contact us if anything seems out of the ordinary.

What is a cancer port tattoo? When we went to research questions related to ports, a cancer port tattoo was something that was frequently searched online. Like many life experiences, some people commemorate their cancer journey through body art like tattoos. A cancer port tattoo is simply a tattoo that uses artwork to cover or minimize the appearance of the scar where the port was placed. Whether or not to have one is a deeply personal choice, but many cancer survivors view their tattoo as a badge of strength, or a symbol of renewal and hope.

If you need a port, or have questions, call us at (804) 828-2600 to discuss your options.

Who’s at risk for varicose veins?

Baird whos at risk for varicose

Varicose veins are enlarged veins in the legs near the surface of the skin, ranging from tiny to large. Spider veins are small, surface veins, which, while embarrassing, are relatively minor.

Varicose veins are easy to see, especially when you stand up. If you have signs of a deep vein problem like DVT or plan to have treatment for spider veins or symptomatic varicose veins, you may need more tests, such as a vascular ultrasound exam.

We talked to Dr. Brian Strife about who may be at risk for varicose veins. “Varicose and spider veins may have a familial component or an inherited component,” said Dr. Strife. “We often take a family history when interviewing new patient to see if other members of their family suffer from abnormal or painful leg veins.”

Particular situations may also contribute to varicose vein risk. Dr. Strife continued, “Women who are postpartum may have an increased appearance of abnormal veins in the legs, as well as people who have an occupation that requires prolonged standing may be at risk of developing abnormal leg veins.”

Advanced age and obesity can also contribute to an increased risk for varicose veins. Varicose veins may also be a sign of a blockage in deeper veins called deep vein thrombosis (DVT), a serious, sometimes deadly condition in which blood clots forming in your leg veins can break loose and move to your lungs, blocking blood flow (pulmonary embolism). It is always a good idea to talk to your physician if varicose veins appear.

The good news is that most insurers typically cover treatment of the more serious, symptomatic varicose veins. If your diagnosis indicates that you need a specific treatment, our staff will submit all relevant information to your insurance company for pre-authorization, or provide you with the approximate cost of treatment.

Call us at (804) 828-2600 to discuss your options.

How we can help with your overall health

Baird overall health

There are 60,000 miles of blood vessels in the body.
Pointing us toward a lot of answers.

VCU Health at Baird Vascular Institute is a multi-disciplinary collaboration of interventional radiologists and vascular surgeons. By working in tandem, we can use the most advanced imaging technology to give us the fastest, clearest picture of a patient’s peripheral circulatory system and vascular problems and diseases, pointing us precisely to the right diagnosis and treatment plan and procedures.

Because of our advanced diagnostic imaging capabilities and convenient location, many physicians refer patients to see us for outpatient evaluations and preparation for various surgical procedures that must be conducted in the hospital, as well as for follow-up examinations. Seeing us as an outpatient saves you many trips to the hospital – and leads to a shorter hospital stay.

Whether you’re referred to us by your doctor or want to talk with us directly about your concerns and needs, our physicians are always available for consultation appointments to listen, learn and talk about your condition and what we can do to help. Open and clear communication with your doctor and you is a crucial aspect of providing proper treatment and care. We work as a team.

Before your appointment, take a few steps in advance to make sure we have the best background information. During your consultation, we’ll talk through your concerns, review your medical history and make an assessment of your current situation. Once we make our diagnosis, we discuss different options to develop a treatment plan tailored to your individual needs. We make sure you understand every aspect of your care.

Our capabilities also allow us to handle the primary treatment of a number of other conditions that once often required prolonged hospitalizations. Today, our image-guided expertise makes possible primarily outpatient care of these conditions. Depending on the condition, certain procedures are handled at the hospital; in other cases, however, these conditions can now be handled completely on an outpatient basis – without a single hospital visit.

Making an appointment at the VCU Health at Baird Vascular Institute is quick and easy. We try to accommodate patients and referring physicians as efficiently as possible.

To schedule an appointment call (804) 828-2600 to speak to one of our scheduling associates, or send us an email.

What’s the difference between Varicose Veins and Spider Veins?

shutterstock_108879881

Unsightly leg veins, ranging from the blue splotches of spider veins to the thick, ropey and twisted dark varicose veins that can make standing and walking painful, have much in common. They’re unsightly. They can be painful. If left untreated, they can progress to serious health problems. They’re very common: 20 percent of all adults, and 50 percent of adults over 50, experience varicose veins, predominantly women.

And, most important, varicose veins are treatable–with new, non-invasive procedures that are quick, virtually painless, and require little or no recovery time. Our vascular specialists are experts in evaluating and treating varicose veins, from unsightly spider veins using new, gentle and highly effective treatments to the relief of more serious, painful and even dangerous major varicose veins.

For a quick guide to the difference, watch Dr. Strife’s video.

What are varicose veins?

Varicose veins are enlarged veins in the legs near the surface of the skin, ranging from tiny to large. Spider veins are small, surface veins, which, while embarrassing, are relatively minor. Learn more about our advanced treatments for spider veins.

Most people associate varicose veins with prominent, swollen, twisted, and ropelike veins wrapping their legs, often dark blue in color – and often quite painful. These are symptomatic varicose veins. They develop over time, with factors such as age, family history, pregnancy, weight gain, and prolonged standing all possible contributing factors. They’re caused by weakened valves in the leg veins that flow blood back to your heart. When the valves weaken, blood pools and builds pressure in the leg veins, causing them to swell, expand and twist as the walls of the veins are weakened – and the weakened valves and veins are prone to clots or hemorrhaging, which is why treatment is so important.

What are spider veins?

Spider veins are similar to varicose veins, but are milder, involving the smaller veins just below the skin surface. Spider veins are more common among women of any age, and frequently appear during/after pregnancy or when gaining weight. The extra burden weakens the valves in the veins carrying blood back to the heart, so the blood pools and the veins swell. When only small, surface veins are affected, the result is spider veins, which can range from little patches to very large areas. They generally do not bulge or cause pain.

To treat more serious varicose vein problems, we offer several effective and minimally invasive solutions. After diagnosis, we will discuss your options so you can choose the treatment that best suits your needs. Although effective, no varicose vein treatment, whether surgical or minimally – invasive, can prevent new varicose veins from developing in the future. Most health insurance plans cover treatment of significant symptomatic varicose veins, but some consider treatment of spider veins as cosmetic surgery. Call us at (804) 828-2600 to discuss your options.