What is Virginia Interventional and Vascular Associates (VIVA)?
Virginia Interventional and Vascular Associates (VIVA) is a group of interventional radiologists and vascular surgeons located in Fredericksburg, Virginia. VIVA is one of only four outpatient interventional radiology facilities in all of Virginia. We can perform same-day procedures in our office, without requiring a hospital stay. All of our doctors are experienced and board-certified in their specialty. They are supported by caring staff who are committed to the comfort and well being of our patients.
What are Interventional Radiologists (IRs)?
Interventional radiologists are doctors who use their skills in reading medical images to guide treatments exactly where they are needed, inside the body. IRs invented the use of angioplasty and stents to open blocked arteries. But they also specialize in many other treatments. IRs specialize in “minimally invasive, targeted treatments.” This means that their procedures can often be performed without open surgery.
How do they treat medical conditions?
The doctor makes a small nick in the skin. He uses X-rays, ultrasound, and other medical images to help guide tiny instruments into the body. This is how IRs target treatments exactly where they are needed. IRs also implant catheters in patients who need pathways for receiving nutrients and medications while being treated for cancer, kidney disease, and other illnesses. This eliminates the need for repeated needle injections.
What are the most common procedures?
IRs are trained and board-certified to perform important procedures for patients with peripheral vascular disease, compression fractures from osteoporosis, cancer uterine fibroids, varicose veins, kidney disease/failure and many other diseases.
Will I be awake?
Yes. Most patients only need a sedative to help them relax, and a local anesthetic to numb the site of the procedure. Our goal is to make you as comfortable as possible before, during and after the procedure.
Will I go home the same day?
Most patients go home the same day of their procedure. Some procedures require an overnight hospital stay. If your procedure requires sedation, make sure a friend or relative comes with you, can drive you home, and is prepared to help you afterward.Make sure to follow your doctor’s instructions after you go home, and return for any follow-up appointments.
Separate lists of exam-specific questions can be found in the exam sections for the procedures listed below:
Carotid Intima Media Thickness Screening Examination::
Does the test involve radiation?
No, this test is performed with ultrasound, there is no radiation involved.
Is there any special preparation for the test?
No, you may eat and drink before the test. There are no restrictions about having a pacemaker, applying lotion, deodorant or perfume.
When will I get the results of the test?
A Board Certified Interventional Radiologist will review the images from your exam and talk to you the after test is performed.
Will the test hurt?
No, a small amount of ultrasound gel will be placed on your neck to measure the IMT layers. In addition EKG leads placed on your chest during the exam.
Who will get the results of this test?
The physician who referred you for the study and your primary care physician will get the results of this exam.
Will I need to see a specialist?
Depending on the results of the test, a visit to a cardiologist or vascular surgeon may be recommended. It is important to see your primary care doctor on a regular basis.
How long have they been performing this type of test?
These exams have been researched for 20 years and have approved for clinical use since 2002.
Who performs the test?
A technologist who is registered with the American Registry for Diagnostic Medical Sonographers in Vascular Technology will perform the exam.
What will this test tell me?
The measurement of the intima and media are a good indicator of risk for a cardiovascular event such as a stroke or heart attack to occur within the next 10 years.
Will my insurance pay for this test?
Medicare and some select insurance companies do not cover the cost for the CIMT screening. We recommend you contact your insurance company for coverage details.
How long will the test take?
The test will take 10 to 15 minutes to perform. At the conclusion of the test, the technologist will leave the room and make a report for the radiologist to review. The radiologist will come in and talk to you about the results of your exam. Please allow 30 minutes for the exam and talk with the physicians.
Why should I have my screening performed at VIVA?
VIVA is a dedicated vascular laboratory that has experienced, Board Certified Registered Vascular Technologists performing the exams as well as Board Certified Interventional Radiologists interpreting the exam.
Who should participate in this screening?
If you have a strong family history of heart disease, have diabetes, use tobacco, or have high cholesterol, you should participate in this screening.
Kyphoplasty and Vertebroplasty for Osteoporosis::
How will I feel after the procedure?
- Some patients experience immediate pain relief after Vertebroplasty/Kyphoplasty. Most report that their pain is gone or significantly better within 48 hours. Many people can resume their normal daily activities immediately.
- You may note some soreness or bruising at the needle access site for a few days after the procedure. You may use an icepack to help with discomfort. Taking Tylenol or non-steroidal anti-inflammatory medication such as Ibuprofen is usually sufficient in relieving the discomfort. If you develop recurrence of pain after a pain-free post procedure interval you should call our office.
What are signs of complication?
If you develop chest pain, fever or numbness or tingling to your hands or feet please call VIVA at 540-654-9118.
When should I follow up?
2 weeks after your procedure.
Uterine Fibroid Embolization::
Will this procedure require hospitilization?
This procedure typically requires an overnight stay in the hospital for pain control.
Will I have pain following the procedure?
Pelvic discomfort can be severe the day of and night of procedure. You will have a way
to give yourself pain medication on demand as needed. Most patients can control their
pain with oral medications by mid-morning the day following the procedure. Our goal is
to discharge you by noon the day after procedure.
What do I have to do to be discharged from the hospital?
- You must pass urine after your urinary catheter is removed.
- You must be able to eat and drink without vomiting.
- Your pain must be under control with oral medications before discharge. We do not expect you to be pain free at the time of discharge. We expect you to take up to 10 days to be totally pain free.
Will I still have a period?
- The first menses after procedure can come early, on time, or may be delayed. It may be
just as heavy or heavier than your usual. It is common for our patients to need two to
three one with fewer bleeding days, a lighter flow and less clots.
- You will likely have clear, tan, or pink discharge for up to a month following the procedure. As long as there isn’t a foul odor you do not need to worry about this. If a foul odor occurs, please call VIVA to report this.
What happens to my fibroids after the procedure?
The fibroids will slowly shrink after the procedure. In the 6 months following the
procedure they will become ½ of the original size. Some patients will pass small pieces
of fibroid tissue after the procedure as the fibroids waste away.
Do I have any activity restriction after the procedure?
- You should limit heavy lifting (over 25 pounds) for about 5 days due to the small incision in your hip area.
- We request nothing be placed in your vagina for 7 days after procedure. This includes tampons, douche and intercourse.
- You should not drive while you are on narcotics.
What medications will I have to take after I go home?
- Pain Medication- The primary pain medication when you go home should be ibuprofen (Advil, Motrin). You should take this 3 times daily with food as prescribed. If you have pain while taking the ibuprofen you may take the narcotic provided as prescribed. You should continue the ibuprofen for 1 ½ to 2 weeks to treat the inflammation caused by the procedure.
- Antibiotic-to prevent infection
- Stool Softener-to help with changes your bowels as a result of the pain medications you received during and after the procedure.
- Nausea medication-as needed.
What are the most common signs of complication?
- Severe abdominal pain that doesn’t go away with medications.
- Fever over 101.5
- Vaginal discharge with a foul odor.
When should I return to the clinic?
6-8 weeks following the procedure or sooner if any questions or concerns arise.
Varicose Vein Therapy::
Do I have to wear compression stockings?
- Prior to your procedure: Most insurance companies will require that you complete a 3 month trial using compression stockings before they will authorize any procedures to be done to see if they improve your symptoms. The compression stockings will help to return the blood back towards your heart.
- Following a procedure: We require you to wear compression stockings following the procedures improve the outcome.
When should I wear my compression stockings?
- When you are out of bed. You do not need to wear your stockings while you are sleeping.
- Do not wear your stockings for 2 days before your first mapping ultrasound.
How long do these procedures take?
Procedures vary in length depending on what is being done. They typically last between 45 minutes and 90 minutes.
Can I drive myself to and from procedure?
- Most patients drive themselves to and from their procedure.
- If you receive a medication to relax you during your procedure you will need to have someone drive you home.
When can I resume my normal activities?
- You may return to your normal activities immediately with few exceptions. You may be sore so we recommend that you take an over the counter pain medication like Tylenol or Motrin and resume your normal routine. Some of those exceptions include but are not limited to.
- Driving: If you received a medication to relax you during your procedure you may not drive following your procedure. You may resume driving the day after your procedure.
- You should not lift anything over 25 pounds for 2 weeks after the procedure.
- You should not swim or soak in a bath tub until your incisions have healed.
- You should limit your abdominal workouts for 2 weeks after your procedure. Increased core pressure can cause veins to reopen.
Do I have to wear compression stockings following the treatments?
You should follow your discharge instruction sheet for details of when to wear them.
What should I expect right after the procedure?
You will experience soreness at the site of treatment. This is typically relieved with Tylenol or Motrin. We will give you instructions on how to take these medications following your procedure. There may be some unpleasant temporary cosmetic changes such as bruising which could take several weeks to resolve. There may be hardening in the area of the treated vein. This may take several weeks to completely resolve however the tenderness can be relieved with Motrin and Tylenol.
Are there any side effects to this procedure?
- There are risks with this procedure like there are with any invasive procedure.
- Infection- We rarely see this in our practice. You should watch for the symptoms of infection such as redness, tenderness, swelling or drainage from the treated area. We are able to treat these infections if they do occur with antibiotics.
- Bleeding-You should stop your blood thinners prior to our procedure to decrease the risk of bleeding. The incisions very small and bleeding complications are rare.
- Deep vein thrombosis (DVT)- This is a very rare side effect. You will have an ultrasound 2 weeks following your procedure to assess if all of the treated veins are closed and this would also show us if there are any blood clots. We would treat the blood clots with blood thinners. Symptoms of a DVT could include severe redness, tenderness, and swelling in the treated extremity. If these occur, you should call our office immediately.
How many procedures will I require?
- A treatment plan will be customized for you and discussed with you in detail.
- We only treat one leg at a time so depending on how complex your veins are you may require multiple treatment sessions.
The symptoms you came to us with that are related to your varicose veins, such as leg heaviness, tiredness, swelling, and cramping should be improved. There may not be a 100% improvement in the cosmetic appearance of your leg but this may be addressed once the cause of the varicose veins is treated if desired.