Cardiovascular Interventional Radiology

 Patients with a variety of disease processes in the body are likely to see an interventional radiologist during their treatment. With the ability to perform minimally invasive procedures using catheters and wires under x-ray guidance, interventional radiologists have a made a large impact on how patients are cared for in today’s healthcare systems. The interventional specialists at PSHVI work with many of the specialists in the Institute and at the Hershey Medical Center to ensure that seamless, expedient world-class healthcare is received by each and every patient. Led by the Chief of Interventional Radiology, Peter Waybill, MD, the section of Interventional Radiology is the most all-encompassing interventional service in Central Pennsylvania.

 
Percutaneous Oncological Treatments
 
Penn State Heart and Vascular Institute (PSHVI) has long been the leader in the treatment of hepatic malignancies with chemotherapeutic embolization (trans-arterial chemoembolization or TACE) of hepatic lesions. With a large body of literature demonstrating improved survivals in selected patients, the use of chemoembolization has become a major weapon against the poor outcomes associated with certain tumors. Working with the oncologists and the oncological surgeons of the Penn State Hershey Medical Center, patients are offered state of the art health care using a very effective team approach.
 
More recently, ablation techniques have demonstrated promise as an adjunct to current regimens for the treatment of limited malignant disease in the liver, but also in the kidneys and the skeletal system as well. Using a small probe, under CT scan guidance, lesions are ablated using either a radiofrequency technique or a cryoablation technique, both currently offered at the PSHVI.
 
Thromboembolism Prophylaxis
 
With both a large trauma service and a large oncological practice at the Hershey Medical Center, PSHVI continues with the most experience in the evaluation and treatment of patients with thromboembolic disease.
 
Working closely with the other programs in the PSHVI, the diagnosis and percutaneous treatment of venous thrombosis including advanced techniques such as catheter directed venous thrombolysis (CDVT), are available in the PSVHI.
 
With the advent of optional IVC filters (ones that can be removed at a later date or remain as permanent filters), options for the treatment of patients at risk for pulmonary embolism have expanded. These filters are placed via a percutaneous approach either from the femoral or the jugular veins. When the patients are anti-coagulation candidates or are no longer at risk for DVT / PE, the filters can be removed from the jugular vein in an outpatient procedure. As one of the largest optional filter practices in the nation, the specialists at the PSHVI can offer solutions for almost any patient scenario.
 
Women’s Health Interventions
 
Treatment options available for women with metromenorrhagia had been relatively unchanged in the 1990’s. In the late 90’s Uterine Fibroid Embolization (UFE) was given credence as a possible treatment method for these patients. Started in 1999, the UFE service of the PSHVI, working with the Ob/Gyn department of the Penn State Hershey Medical Center, has been able to offer this successful treatment method to those patients who are hesitant to undergo a hysterectomy. It represents one possible treatment method in a whole gamut of procedures offered today in Women’s Health. Two other services offered as part of Women’s Health Interventions include Fallopian Tube Recanalization for those women unable to achieve pregnancy secondary to fallopian tube blockages. Performed as an outpatient procedure, the procedure has an excellent risk/benefit profile and has helped many women achieve pregnancy. Pelvic Congestion Syndrome, a clinical diagnosis of pelvic pain based on the anatomic finding of a distended gonadal vein represents one of the most difficult entities to diagnose. With a proper work up by the specialists in PSHVI, the possibility of treatment is offered to those patients who do not wish to have open surgery.
 

Lower Extremity Venous Disease

The varicose vein treatment arm of the CVIR section, coordinated by Dr. Scorza, offers clinical consultation at the Nyes Road facility as well as a wide spectrum of varicose vein evaluation and intervention modalities. Preliminary vascular ultrasound is performed at initial consultation and then more formal duplex ultrasound evaluation is arranged through the Vascular Laboratory. Treatment options include endovenous laser ablation, microphlebectomy, and injection sclerotherapy (including ultrasound-guided sclerotherapy for perforators when appropriate). Additional more complex procedures are offered in conjunction with the Vascular Surgery service when needed. Many procedures are done with only local anesthesia, although intravenous sedation is available.  Several hundred cases have been performed over the last two years with excellent results. 

Atherosclerotic Occlusive Disease
 
Causing arterial insufficiency in almost any organ system of the body, atherosclerotic occlusive disease can frequently be treated in a percutaneous fashion. Using advanced imaging techniques for diagnosis including CT Angiography (CTA) and MR Angiography (MRA), the specialists in the HVI can treat lesions using a combination of balloons and stents to improve blood flow to the affected system. Most procedures are performed on an outpatient basis with only a short, overnight stay. With over 500 stents placed in almost all the organ systems, the specialists in the PSHVI are able to determine which lesions would be best treated with a percutaneous method or an open method.
 
Arterial Vascular Disease Diagnosis and Treatment Services
  • Noninvasive Vascular and Cardiac Imaging
  • CT Angiography
  • MR Angiography
  • Diagnostic Arteriography
  • Peripheral Vascular Disease
  • Diagnostic Peripheral angiography
  • Arterial angioplasty and stent placement
  • Thrombolysis
  • Cerebral Vascular Disease
  • Diagnostic Carotid Angiography
  • Carotid Artery Stent Placement
  • Renovascular Disease
  • Diagnostic Renal angiography
  • Renovascular Hypertension
  • Renal Artery Angioplasty and Stent placement
Venous Vascular Disease Diagnosis and Treatment
  • Diagnostic venography
  • Treatment of Varicose veins
  • Inferior vena cava filter placement and removal
  • Treatment of Pelvic congestion syndrome
  • Treatment of Varococele
  • Treatment of ilio femoral DVT
  • Treatment of venous malformations or vascular malformations
  • Venous access (catheter) placement procedures
  • Dialysis access management
Nonvascular Disease Diagnosis and Treatment
  • Radiofrequency ablation of tumors
  • Endoscopic treatment of biliary stone disease
  • Management of benign and malignant strictures of the biliary and urinary system
  • Gastrostomy tube placement
  • Uterine artery embolization
  • Chemoembolization of tumors
  • Transjugular Intrahepatic Portosystemic shunt (TIPS)
  • Transjugular liver biopsy