Abdominal Abscess

An abscess is a pocket of puss usually caused by a bacterial infection. Abdominal abscesses are those that occur inside the abdominal cavity behind the muscles of your midsection. Abscesses can occur around organs such as the kidneys, spleen, pancreas, liver, and prostate gland. They can occur because of an injury or conditions like appendicitis, inflammatory bowel disease, and diverticular disease. Once they are diagnosed, abdominal abscesses must be drained. In the UAB Heart and Vascular Center, our specialists in vascular interventional radiology frequently drain abdominal abscesses by using state-of-the-art imaging equipment to help guide a small tube called a drainage catheter into the abscessed area. The drainage catheter allows the fluid from the abscess to exit the body. This is called percutaneous drainage and is a much less invasive way to drain abscesses inside the body than the surgical approaches that were used in the past.

Atrial Fibrillation

The human heart has four chambers. The top two are called atria and the bottom two are called ventricles. Blood is pumped through the heart via a complex, coordinated series of contractions of those chambers (what we know as heartbeats). Atrial fibrillation and atrial flutter, both considered forms of arrhythmia, are abnormally fast electrical discharge patterns that cause the atria to contract very rapidly. This causes the walls of the atria to quiver and, because the atria are not working efficiently, not all of the blood is pumped from them into the ventricles. Blood that does not empty from the atria is problematic. If it sits still too long, it can form clots. If these clots, or thrombi, become dislodged and enter the blood stream they can cause life-threatening strokes. Learn more about atrial fibrillation.

There are a number of treatments for atrial fibrillation including many drugs used to treat both the underlying cause of the arrhythmia and to help prevent clotting. At other times, our specialists in electrophysiology at the UAB Heart and Vascular Center will recommend radiofrequency ablation (RFA)  where energy of a specific frequency, delivered through a catheter, destroys the small part of the heart muscle that is firing irregularly. In some cases, all or part of the atrioventricular node (AV node) is ablated. If you think of atrial fibrillation as a situation where part of the heart is electrically misfiring, radiofrequency ablation simply neutralizes the node or “circuit” responsible for the misfiring.

Atrial Septal Defect

The human heart has four chambers. The upper chambers are called atria and the lower chambers are called ventricles. The heart is divided lengthwise into left and right sides by a wall called a septum. One side of the heart pumps oxygen-rich blood to the rest of the body. The other side of the heart pumps blood from which the oxygen has already been used back to the lungs where it becomes oxygenated again. A septal defect is sometimes called a “hole” in the heart. A septal defect between the two atria is called an atrial septal defect (ASD). If the defect is large enough, it allows oxygen-rich blood to be pumped back to the lungs, which causes inefficiency in the body’s ability to cycle oxygen.

Until relatively recently, atrial septal defects could only be closed via major surgery. These days, however, our specialists in pediatric cardiology and interventional cardiology are able to repair many of these problems using a self-expanding, double disk device known as an Amplatzer Septal Occluder, which is introduced into the heart via a catheter and implanted across the defect like a small wire web. This procedure takes place in our Heart and Vascular Center and the patient is frequently able to go home the next day.

Biliary Obstruction

Bile is a liquid produced in the liver that contains a mixture of cholesterol, bile salts, and waste products such as bilirubin. Bile salts help our bodies digest fats. Bile is transported from the liver to the gall bladder via tubes called bile ducts and is stored in the gall bladder until it is needed in the small intestine to help with the digestion of fats. A biliary obstruction is a blockage of the bile ducts and causes a buildup of bilirubin in the liver, which causes jaundice. In the UAB Heart and Vascular Center, biliary obstructions are often treated by performing a percutaneous drainage of the material blocking the duct. In performing a percutaneous drainage, our specialists in vascular and interventional radiology use imaging equipment to help guide a needle to the obstruction and relieve the blockage. This is a relatively minimally invasive means of dealing with bile duct obstructions.

Bradycardia

Simply defined, bradycardia is a heartbeat rate that is too slow for your body. Like tachycardia and fibrillation, bradycardia is a form of arrhythmia or abnormal heart rhythm. Athletes often have what could be considered bradycardia when their hearts are at rest, but this is normal for them. A slow heartbeat is considered abnormal when it causes other problems such as fatigue, dizziness, or fainting.

Bradycardia is usually not congenital; it is acquired. Most often, it is the result of disorders of nodes in the heart. Nodes, such as the atrioventricular node (AV node), are like circuits that transmit electrical signals to the muscles of the heart causing it to beat. Disorders of these nodes are frequently the cause of arrhythmias. In the case of bradycardia, the signal just isn’t always getting through. The solution, more often than not, is the installation of a permanent pacemaker. At UAB, our specialists in electrophysiology perform the relatively uncomplicated procedure in the Heart and Vascular Center, using e-ray imaging to help guide them to where the electrodes from the pacemaker contact the heart.

Congenital Heart Disease (Overview)

Congestive Heart Failure (CHF)

Often because of coronary artery disease or heart attacks, the heart muscle can become so weak that it can no longer pump effectively which leads to cardiomyopathy and congestive heart failure (CHF). Frequently, along with this weakening, the heart muscle beats irregularly, the contractions of its four chambers uncoordinated and inefficient. One treatment the specialists in electrophysiology at UAB’s Heart and Vascular Center use is cardiac resynchronization therapy or CRT. CRT devices, similar to pacemakers, consist of a small electrical pulse generator implanted under the skin. With a CRT device, however, in addition to having tiny electrodes in the right atrium and right ventricle, there is a third electrode positioned in a vein on the surface of the left ventricle. This allows the CRT device to stimulate both ventricles simultaneously, restoring a coordinated, efficient “squeezing” of the lower half of the heart, which helps the weakened heart to do its job more easily. CRT is frequently employed along with other therapies to ease the symptoms of CHF.

Coronary Artery Disease

Coronary artery disease (CAD), also called coronary heart disease (CHD), occurs when the arteries that supply blood to the heart muscle become hardened and narrow because of a buildup of plaque on the insides of the vessels. This buildup is known as atherosclerosis. As the plaque builds up, the insides of the arteries become narrower and the flow of blood is reduced. A heart attack happens when a clot forms inside one of these “hardened” or occluded coronary arteries, suddenly cutting off blood flow completely to a part of the heart muscle. CAD can also lead to forms of arrhythmia.

The least invasive treatments of CAD involve cardiac catheterization, a process that incorporates the use of using a small catheter inserted into the body through the femoral artery in the leg. This catheter can be used to perform what is known as an angioplasty or to implant a stent. When one of the specialists in interventional cardiology at UAB’s Heart and Vascular Center performs an angioplasty, he or she inserts a small hollow catheter at the end of which is a small balloon. Using X-ray imaging, the physician can see when the balloon at the end of the catheter is positioned where the artery is narrowed. The balloon is inflated which dilates the narrowed part of the artery.

Often a stent is implanted after angioplasty. Stents are small, metallic, tubular, mesh cages that help keep arteries dilated after angioplasty by providing a relatively rigid support for the artery walls. These tiny mesh cages are also implanted using a catheter inserted into the body through the femoral artery. Stents seem to work quite well, although, in some patients, scar tissue forms around the stent. When the coronary artery grows scar tissue through the openings in the mesh of the stent, the re-narrowing of the artery is known as re-stenosis.

To counter re-stenosis, interventional cardiologists are using medicated stents known as drug-eluting stents. The outside walls of drug-eluting stents are coated with a drug that helps inhibit the growth of scar tissue, dramatically reducing the occurrence of re-stenosis.

In some cases, CAD is best treated with the more invasive technique of Coronary Artery Bypass Surgery.

Coronary Atherosclerosis

Coronary atherosclerosis is the buildup of plaque on the insides of the arteries that provide blood to the heart muscle. See Coronary artery disease.

Gastrointestinal Hemorrhage

A gastrointestinal hemorrhage is an area in the gastrointestinal (GI) tract that is bleeding. This sort of bleeding can be caused by ulcers, abnormal veins in the esophagus, known as esophageal varices, and trauma. Depending on the nature of the gastrointestinal hemorrhage, a specialist in vascular interventional radiology may choose to use a technique known as embolization. Embolization means the blocking of a blood vessel. When a physician chooses to embolize a vessel that is bleeding, it is because he or she has determined that the vein or artery is doing more harm than good.

In embolization for bleeding, the radiologist uses a catheter to deliver a material that will either permanently or temporarily block the vessel. These materials range from a gelatin sponge-like material to glue to metallic coils that slow down the blood flow and allow the blood to clot. Permanent particulate agents like polyvinyl alcohol (PVA) and gelatin-impregnated acrylic spheres are used to block vessels permanently. These types of agents are more often used to block vessels that feed tumors. Sometimes, the radiologist will choose to use liquid sclerosing agents that actually encourage the vessel to close itself off by irritating its inside walls.

Hypertrophic Obstructive Cardiomyopathy (HOCM)

In a normal heart, the cells of the heart muscle are neatly aligned. In a patient with HOCM, the cells are in disarray. This whorled alignment of the cells of the heart tissue causes a thickening of the heart muscle which prevents the heart from working efficiently. Most often, this thickening affects the septum, or wall, between the two ventricles. At UAB’s Heart and Vascular Center, our interventional cardiologists will sometimes treat this condition with a procedure known as alcohol septal ablation, where the physician introduces ethanol via a catheter to the thickened tissue. This causes it to thin, thereby reshaping the septum and allowing the heart to operate more efficiently.

Intracranial Aneurysm

Our arteries are designed to handle the pressure of blood being pumped through our bodies. Sometimes, however, the wall of an artery weakens in a spot for reasons that aren’t quite understood, and the artery wall balloons out. This “ballooned” area is called an aneurysm. When an aneurysm ruptures it can cause a potentially life-threatening loss of blood. An intracranial aneurysm is an aneurysm in an artery inside the brain. These aneurysms are particularly dangerous because a rupture can do so much permanent damage to brain tissue. Intracranial aneurysms are also problematic in that they are often difficult to treat using traditional surgical techniques. At the UAB Heart and Vascular Center, our neurointerventional radiologists can often treat intracranial aneurysms by using different embolization techniques.

Intracranial embolics take a number of different forms. In all cases, the embolic is delivered through a catheter that is introduced into the body via the femoral artery. In some cases, a liquid embolic is effective. Sometimes a permanent embolism is created by delivering a sort of “balloon” into the aneurysm. A more recent development being used by our interventional neuroradiologists are coil embolics. These metallic coils are tiny coils of wire created from an alloy that “remembers” its shape. The wire, thinner than a human hair, is fed through the catheter into the aneurysm. When it comes out the end of the catheter it returns to its original coiled shape. These coils are used to fill up the ballooned-out space of the aneurysm. This slows the flow of blood in the aneurysm and allows it to clot, which keeps the aneurysm from growing any larger and prevents the possibility of it rupturing. Some aneurysms, called wide neck aneurysms, cannot be treated in this manner and require a different approach.

Learn more about aneurysms and strokes.

Intracranial Atherosclerotic Disease

Atherosclerotic disease or atherosclerosis is the narrowing and hardening of arteries because of the buildup of plaque on their walls. In the case of intracranial atherosclerotic disease, this happens in arteries inside the brain. If those arteries become completely blocked – much like they do in coronary arteries – the affected person can suffer what is called an ischemic stroke, which means not enough blood gets to part of the brain and that part of the brain ceases to function. Atherosclerosis in the heart can be treated using a traditional steel stent fed into the artery using a catheter and expanded using an inflated balloon device. But the arteries in the brain are much more fragile than those that feed the heart. Historically, treatment of intracranial atherosclerosis was limited to the use of blood thinners or anticoagulants. Recently, however, neurointerventional radiologists at UAB’s Heart and Vascular Center have had good outcomes using what is known as a wingspan stent. This self-expanding stent, made of a softer alloy than steel, is much gentler on the arteries of the brain. Like its counterpart in the heart, it is also delivered via a catheter fed into the femoral artery. The only difference is that this stent opens itself up inside the narrowed part of the artery.

Intracranial Occlusive Disease

See intracranial atherosclerotic disease above

Intracranial Stenosis

Stenosis is the abnormal narrowing of a blood vessel and intracranial stenosis is the narrowing of blood vessels in the brain. Most often the problem is a result of intracranial atherosclerotic disease. See intracranial atherosclerotic disease

Kidney Tumors

The most common type of kidney cancer is renal cell cancer. Vascular interventional radiologists are able to treat some cases of renal cell cancer by blocking the blood vessels that feed the tumors and help them grow. This procedure is called renal artery embolization. Using a catheter inserted into the body through a peripheral blood vessel such as the femoral artery, the physician injects a small piece of special gelatin sponge or other material into the main blood vessel of the kidney blocking the flow of nutrient-rich blood to the tumor site.

Leukemias

Leukemias are cancers of the blood or bone marrow that cause an abnormally high number of blood cells, usually white blood cells or leukocytes. Leukemias are part of a wide body of diseases known as hematological neoplasms. These pernicious forms of cancer are usually treated by an aggressive chemotherapy regimen. In the Heart and Vascular Center, specialists in vascular interventional radiology are frequently required to provide vascular access so that UAB hematology oncologists can administer chemotherapy as needed.

Liver Tumors

Malignant liver tumors fall into two broad categories: those that originate in the liver or primary tumors, and those that originate elsewhere in the body, secondary or metastatic tumors. In each case, there are numerous options for treatment. In the Heart and Vascular Center, our vascular interventional radiologists are using less invasive techniques like radiofrequency ablation (RFA), in which a catheter is used to deliver electrical current directly into the tumor, killing the cancerous tissue. Also used are embolitic techniques such as chemoembolization, in which concentrated chemotherapy is delivered directly into the tumor and radioembolization, or selective internal radiation therapy (SIRT), in which tiny radioactive microspheres smaller than the diameter of a human hair, are introduced into the tumor site where they irradiate the cancerous cells, killing them. In both cases, the arteries feeding the tumors are also shut off which serves also to kill the cancerous tissue by starving it of blood.

Lung Tumors

Historically, lung cancer has been treated with an aggressive regimen of chemotherapy, radiation therapy and surgery. At the Heart and Vascular Center, however, vascular interventional radiologists are having success using several less invasive techniques in tandem with chemotherapy and radiation therapy. Radiofrequency ablation (RFA) has been shown to be very effective as has chemoembolization.

Patent Foramen Ovales (PFO)

When a human being is still in the womb, the wall or septum that separates the two upper chambers of the heart, or atria, is partially open. This opening, the foramen ovale, allows blood to flow between the two atria, bypassing the lungs. The reason for this is simple – the fetus is receiving all of the oxygen it needs from the mother through the umbilical cord. As the baby develops, a layer of tissue begins to cover the foramen ovale and soon after birth the opening closes completely. In about 25 percent of adults, the foramen ovale does not seal over completely. This is called Patent Foramen Ovale.

To close patent foramen ovales, our specialists in pediatric cardiology and interventional cardiology use what are called PFO closure devices. These devices are implanted through a catheter inserted into the body through the femoral vein, a large vein at the top of the leg. The device resembles two round, fine mesh webs that oppose each other on each side of the foramen ovale. The cardiologist guides the catheter and device to the correct position using X-ray imaging. The PFO closure device is designed so that it opens automatically when pushed out of the catheter and into the heart.

Peripheral Vascular Disease (PVD)

As is the case in coronary artery disease (CAD), the arteries throughout the human body can be afflicted with atherosclerosis. Fatty deposits in the inner linings of artery walls begin to restrict blood flow. We see this condition most often in the arteries leading to the kidneys, stomach, arms, legs, and feet. The treatment for this type of blockage is similar to the way we treat coronary artery disease. At UAB our specialists in vascular and interventional radiology use essentially the same tools – angioplasty and stent implantation to open up the narrowed arteries and reestablish strong blood flow to afflicted areas.

Portal Hypertension

Portal hypertension is increased blood pressure in the portal vein typically caused by liver disease. Liver disease is characterized by the presence of fibrosis (scar tissue), which, if left unchecked, ultimately leads to cirrhosis of the liver, a condition where healthy cells are replaced by scar tissue.

Prostate Cancer

After skin cancer, prostate cancer is the most common cancer among men. Specialists in vascular interventional radiology in the Heart and Vascular Center use several minimally invasive approaches to treat prostate cancer. One such treatment, cryoablation, involves using ultra-thin needles to freeze the cancerous tissue. This method is often used in cases where the cancer has resisted both external and interstitial radiation therapy.

Pulmonary Embolism

A pulmonary embolism is the potentially life-threatening blockage of a pulmonary artery by a blood clot (thrombus) or pieces of one, fat, tumor tissue, or air. Pulmonary embolisms caused by blood clots – thromboembolisms – are often a dangerous side-effect of some surgical techniques. One method for preventing pulmonary thromboembolisms is put in place vena cava filters. At the Heart and Vascular Center, specialists in vascular interventional radiology use a catheter to place a small mesh filter inside the heart to keep clots from finding their way into the pulmonary arteries.

Renal Artery Stenosis

Renal artery stenosis is the stenosis or narrowing of the renal artery because of atherosclerosis or fibromuscular dysplasia (a fibrous thickening of the walls of the renal artery occurring in women between 14 and 50 years of age). Renal artery stenosis is treated in the Heart and Vascular Center using angioplasty and stent implantation.

Renal-induced Systemic Hypertension

Sometimes renal artery stenosis causes blood pressure to rise – hypertension. The mechanisms that cause this to happen are still being studied. Treatment of the stenosis itself is one part of treating the problem. The high blood pressure is treated using several different medications.

Thromboembolysis resulting from Atrial Fibrillation

Atrial fibrillation is a form of arrhythmia in which the atria, the upper chambers of the heart, contract too rapidly. When this happens, the upper chambers don’t fully empty of blood and the blood that stays behind can sometimes form clots. If dislodged, these clots can cause the blockage or embolysis of blood vessels in the brain and cause strokes.

Clots that form because of atrial fibrillation often form in the same part of the heart, the left atrial appendage or LAA. The LAA is a small pouch-like area about the size of your thumb that opens off of the left atrium. One way of preventing dangerous blood clots from dislodging and entering the brain (thromboembolysis) is to block off the area where they form. To accomplish this, specialists in adult Diagnostic and Interventional Cardiology use a device called a left atrial appendage occlusion device. This device, implanted into the heart using a catheter, works much like an umbrella to open out and block off the entrance to the LAA. In this manner, any clots that do happen to form because of atrial fibrillation are kept in the LAA and not allowed to enter the bloodstream.

Urinary Obstruction

The kidneys remove impurities from the body. Those impurities are passed through the urinary tract as urine. The urinary tract consists of the ureters which pass the urine from the kidneys to the bladder and the urethra which passes the urine from the bladder out of the body. There are several points along the urinary tract that can become blocked or obstructed. The obstruction can be caused by cancers, kidney stones, inflammation of the tract itself, or inflammation of tissue around the passage. Obstruction of the urinary tract is dangerous. If urine is allowed to back up in the body, it becomes infected and it can be very difficult to rid the body of the resulting infection. Urinary tract obstructions are treated in the Heart and Vascular Center by vascular interventional radiologists [VIR-home] who employ different types of stents using a urinary catheter.

Uterine Fibroids

Uterine fibroids are tumors or growths made up of muscle cells and other tissues. Although fibroids are benign, they can still cause women problems such as pain, excessive menstrual bleeding or frequent urination. Until recently, the preferred treatment for fibroids was a hysterectomy. Nowadays however, a specialist in vascular interventional radiology is able to treat uterine fibroids without performing a hysterectomy. Using a catheter, the physician is able to inject small particles of polyvinyl alcohol into blood vessels that feed the tumors, sealing them off and causing them to shrink. For a more detailed explanation of uterine fibroids and their treatment click here.

Valvular Heart Disease (Overview)

Venous Thrombosis

A venous thrombosis is the blockage of a blood vessel by a blood clot. When the clots are in veins deep in your body, most often in your legs, it’s called deep vein thrombosis or DVT. Treatment of venous thrombosis often involves the use of anticoagulants like heparin that dissolve the clot. Another treatment for venous thrombosis involves using a device inserted into the vein via a catheter to break up the clot mechanically. This procedure is normally performed by a specialist in vascular interventional radiology.

Also see Prevention of DVT During Air Travel

Ventricular Fibrillation (VF or V Fib)

When the heart is beating normally, the two lower chambers of the heart – the ventricles – beat together. Ventricular fibrillation is a form of arrhythmia in which an electrical signal is sent from the ventricles at a very fast and erratic rate. As a result, the ventricles contract in a rapid unsynchronized manner best described as a “flutter.” When this happens, the heart pumps little or no blood causing a very low blood pressure and symptoms such as weakness, dizziness, and fainting or loss of consciousness. In the Heart and Vascular Center, specialists in electrophysiology are able to treat ventricular fibrillation by implanting an implantable cardioverter-defibrillator (ICD). An ICD is a device that senses the irregular rhythm of ventricular fibrillation and jolts the heart back into a normal rhythm by shocking the two ventricles simultaneously.

Ventricular Tachycardia (VT)

Ventricular tachycardia, much like ventricular fibrillation, is a form of arrhythmia wherein the ventricles contract abnormally. In the case of VT, however, an electrical signal is sent from the ventricles at a very fast but even rate. If the heart rate is sustained at a high rate, symptoms such as weakness, fatigue, dizziness, fainting, or palpitations may be experienced. As with ventricular fibrillation, electrophysiologists at the UAB Heart and Vascular Center are able to treat ventricular tachycardia by implanting an implantable cardioverter-defibrillator (ICD).

Wide-neck Aneurysm

Our arteries are designed to handle the pressure of blood being pumped through our bodies. Sometimes, however, the wall of an artery weakens in a spot for reasons that aren’t quite understood, and the artery wall balloons out. This “ballooned” area is called an aneurysm. When an aneurysm ruptures it can cause a potentially life-threatening loss of blood. An intracranial aneurysm is an aneurysm in an artery inside the brain. These aneurysms are particularly dangerous because a rupture can do so much permanent damage to brain tissue. Intracranial aneurysms are also problematic in that they are often difficult to treat using traditional surgical techniques. At the UAB Heart and Vascular Center, our neurointerventional radiologists can often treat intracranial aneurysms by using different embolization techniques.

Intracranial embolics take a number of different forms. In all cases, the embolic is delivered through a catheter that is introduced into the body via the femoral artery. In some cases, a liquid embolic is effective. Sometimes a permanent embolism is created by delivering a sort of “balloon” into the aneurysm. A more recent development being used by our neurointerventional radiologists are coil embolics. These metallic coils are tiny coils of wire created from an alloy that “remembers” its shape. The wire is fed through the catheter into the aneurysm. When it comes out the end of the catheter, it returns to its original coiled shape. These coils are used to fill up the ballooned-out space of the aneurysm, slowing the flow of blood in the aneurysm and allowing it to clot, which keeps the aneurysm from growing any larger and prevents the possibility of it rupturing.

Wide-neck aneurysms, are particularly difficult to treat because the opening of the aneurysm is so wide that the coils cannot stay in place and fall out into the main artery. To solve this problem, our neurointerventional radiologists employ the use of a Neuroform® stent. The Neuroform stent is a lightweight alloy stent that forms a mesh cage or scaffolding to support the wall of the artery. Coil embolics are then inserted through the mesh of the stent into the aneurysm. The stent prevents the coils from falling out and allows them to do their job, slowing down the blood flow through the aneurysm and neutralizing it.