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Vascular and Interventional Radiology

The Division of Vascular and Interventional Radiology (VIR) performs image-guided, minimally invasive procedures ranging from basic interventions (e.g., biopsies, abscess drainage, central venous access) to more complex procedures such as pulmonary thrombectomy, Yttrium-90 radioembolization for hepatic cancers, radiofrequency ablation and cryoablation (for liver, renal, bone, and lung tumors), vertebroplasty, stent-graft repair of arterial or dialysis access aneurysms, and uterine artery embolization for the treatment of symptomatic fibroids. Imaging modalities include fluoroscopy, ultrasound, and computed tomography. The VIR staff provides consultation to physicians throughout the institution and northern New England, and manages inpatient service and the VIR outpatient clinic. We participate in multidisciplinary conferences in trauma, vascular surgery, oncology, urology, and gastroenterology—interdisciplinary collaborations that underline our commitment to provide care based on the most effective, evidence-supported therapies.

The Siemens Artis zee biplane angiography
system, used in a range of interventional
procedures (such as the embolization pictured
on the cover of this report) by the VIR and
neuroimaging teams.

Each of our attendings holds ABMS subcertification and 9 to 19 years of subspecialty VIR experience. Dr. Hoffer, division chief since 2005, offers expertise in transcatheter embolization for traumatic injury, stent graft repair of aortic trauma, and TIPS treatment for portal hypertension. Drs. Forauer, Gemery and Hoffer are full-time interventional radiologists; Drs. Silas and McNulty are part-time, with clinical responsibilities in other areas of the department. The inpatient clinical side of the service is largely coordinated by our versatile associate providers, nurse practitioner Shari Evans and physician assistant Anne Michaels. They are involved in all phases of inpatient care—from ensuring thorough pre-treatment patient evaluations to post-discharge follow-up. The associate providers also independently perform routine procedures such as paracentesis, thoracentesis, chest tubes, and central venous access. Shari and Anne hold faculty positions at DMS as clinical instructors and are integral in the education of hospital nurses and residents, and play an active role in research and quality improvement initiatives. The department maintains a nurse-staffed PICC service—only the most difficult cases require referral to VIR.

Our facilities consist principally of 4 angiographic suites, two of which utilize state-of-the-art flat panel systems. The Siemens digital flat panel biplane system, our most recently installed unit, includes powerful software for reconstructing axial images from selective contrast injections—a feature which permits precise subselective catheterization for tumor embolization procedures. Each of these suites also contains a dedicated ultrasound unit. In addition, CT-guided interventions are performed on a new Siemens widebore fluoro-CT unit.

The division plays an active role in the training of fellows, residents, and medical students. Residents typically rank VIR among the most demanding, and rewarding, of their radiology rotations—and in recent years roughly one quarter have chosen VIR fellowships. We are grateful to our institution’s vascular surgeons for their role in fellow education; the endovascular rotation provides experience in the vascular ultrasound lab and in clinical and endovascular treatment of peripheral vascular disease, including abdominal and thoracic aortic stent grafting and carotid stenting.

Research interests of the VIR staff include: endograft repair and transcatheter embolization (Dr. Hoffer); dialysis access maintenance and percutaneous therapies for renal neoplasms (Dr. Forauer); CT summation techniques in radiofrequency ablation (Dr. Gemery); chest port placement and image-guided liver biopsy (Dr. Silas); dialysis access and radiology education (Dr. McNulty). Recent national conference activities include presentations on arterial closure devices, IVC filters, and antibiotic prophylaxis. Current or considered trials include studies of regional cancer therapies, such as Yttrium-90 radioembolization of primary or metastatic liver disease, cryoablation for renal tumors; dialysis access maintenance in the elderly; evaluation of a heparin-bonded hemodialysis catheters; and transcatheter arterial chemotherapy for bladder neoplasms.

Services

  • Arterial and venous stent placement
  • Catheter-directed thrombolytic therapy
  • Chemoembolization for malignancies and vascular malformations
  • Clinic and consultation service for percutaneous diagnosis and treatment of vascular and non-vascular disease
  • Imaging-guided therapy for male and female infertility
  • Laser ablation and sclerosis of varicose veins
  • Percutaneous abscess, biliary drainage and biliary stenting
  • Percutaneous gastrostomy and gastrojejunostomy
  • Percutaneous kidney drainage, stone removal and ureteral stenting
  • Percutaneous image-guided biopsy in the chest and abdomen
  • Percutaneous transluminal angioplasty
  • Radiofrequency ablation of benign and malignant tumors
  • Transcatheter embolization of non-Neurologic Vascular Malformations
  • Transcatheter embolotherapy
  • Trans-jugular porto systemic shunts for portal hypertension
  • Uterine fibroid embolization
  • Vena-cava filter insertion
  • Venous access including percutaneous dialysis catheter insertion
  • Vertebroplasty

Diagnostic Capabilities

  • CT Angiography
  • High-resolution DSA arteriography
  • Magnetic resonance angiography (MRA)
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