Posted by - J. Rand Baggesen, M.D.

As the director of the Executive Health Evaluation program at CJW’s Levinson Heart Hospital, I have the opportunity to access any treatment area within one of the nation’s top 100 medical centers. Recently, one of my patient’s parents was brought to CJW with a cold painful foot, a clear sign of an arterial blockage. As any reader of this column would know, the complications of vascular disease are the cause of death of greater than half of all Americans.

My patient called me and was very worried about what was going on with his dad, so I hurried down to the interventional vascular suite of CJW to find out how he was doing. There I found my good friend, Dr. Jeff Hull, one of the best interventional vascular radiologists around. He pulled up the images of the patient’s right leg which showed the entire arterial system, including a spot where a blood clot was causing the problem. Dr. Hull had threaded a tiny tube just above the clot and was slowly dripping a clot busting medicine right on the point of occlusion. I had Dr. Hull burn a CD with all these images and went out to find the family to show them the problem on my laptop and give them the good news that the clot was dissolving.

My patient’s dad spent the night in the ICU but went home just a day or two later with a stent, which opened up the narrowed artery, restoring blood flow to his lower leg. As a result of improved blood flow to his leg and foot, he feels better than he has in some time.

This is a great example of what new interventional radiology procedures are able to treat. In the past, so many vascular problems would have to be treated surgically, often requiring large incisions and long recovery times. With the help of today’s technology, skilled physicians like Dr. Hull are able to treat arterial blockages with just a needle instead of a scalpel.

Cholesterol accumulation in the arteries that supply blood to the brain can cause transient ischemic attacks, TIA’s. These attacks cause symptoms of numbness, tingling, speech impairment, confusion or vision loss and last for 15 minutes or less. Often the warning sign of a larger stroke, it is imperative not to ignore these signs and seek care at a certified stroke center (CJW is the only one in Richmond) immediately! A vascular ultrasound of the carotid artery is often performed to provide an image of the pipes that bring blood to the brain. If the images show a clog of 50-70% of the area of the artery or greater, often a CAT scan angiography, a CTA, is performed to confirm the diagnosis. The newest high-tech GE Lightspeed 64 slice VCT is the scanner of choice to take pictures that are up to .4mm in detail, helping physicians decide on the necessary course of treatment.

If a cholesterol accumulation or plaque is seen that looks rough or ulcerated, a stent can be placed that both opens up the artery and stabilizes the plaque, preventing any further arterial debris falling off and causing TIA’s or worse yet, a stroke. This is all done without surgery using new intravascular procedures through a small needle hole as opposed to a large incision. Patients often spend just one night in the hospital instead of weeks recovering.

There are multiple applications of this technology today. Interventional radiologists are able to open clogged leg arteries, repair aortic aneurisms, repair cerebral aneurisms, destroy uterine fibroids and even treat compression fractures from osteoporosis.

Aortic aneurisms are dilations of the main blood vessel of the body carrying blood from the heart to the lower body. As the size of these dilations enlarge, the chance of rupture increases. Found by ultrasound, these dilations have been historically treated with a large abdominal surgery which requires an incision from the chest to below the belly button. Today a repair can be done through a needle inserted through the upper leg, allowing patients to go home the next day!

Cerebral aneurisms are weak areas in the blood vessels of the brain that, like a balloon, can rupture and bleed. Interventional radiologists are now able to place a small coil within these weak areas, which causes a small scar to form, closing and strengthening the weak spot. This same technique can be used to treat uterine fibroids by interrupting their blood supply, allowing theses muscular tumors to shrink in size.

Compression fractures in the spine caused by osteoporosis often result in the collapse of a vertebral body, causing pain from nerves being pinched. This has been a difficult problem to treat until the advent of vertibroplasty. A balloon is placed inside the collapsed vertebral segment; the balloon is then inflated, resulting in a re-enlargement to the previous vertebral size. The vertebrae are then filled with bone cement, which helps to maintain its normal shape. Often this procedure results in pain relief and return of regular functioning.

It is amazing to watch medicine evolve right before our eyes. Having a front row seat at one of the nation’s best vascular centers allows the physicians at the Executive Health Evaluation program pick and choose the right tests for the right reasons and deliver high tech health for our patient clients. Investment is necessary to maintain a technologic advantage, investment in ones health and wellness is as important as maximizing your retirement income. Invest in your health; maximize your wellness at the Executive Health Evaluation Program at CJW’s Levinson Heart Hospital.

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