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Interventional RadiologistsAdvancing the Boundaries of Medicine

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Interventional radiologists are

board-certified physicians who

specialize in minimally invasive, targeted

treatments. They offer the most in-depth

knowledge of the least invasive treatments

available coupled with diagnostic and clinical experience across all specialties. They use

X-rays, MRI and other imaging to advance a catheter in the body,

usually in an artery, to deliver treatment at the

source of a disease non-surgically.

Below: An inside view of our hybrid operating room.

For the past 30 years, medicine has undergone a minimally invasive revolution. Some of the physicians on the forefront of this revolution are interventional radiologists. These specialists have been responsible for much of the medical innovation and development of minimally invasive procedures we take for granted today.

Thanks to their innovation many conditions that once required surgery can be treated non-surgically. Minimally invasive procedures offer less risk, less pain and quicker recovery times compared to open surgery.

Advantages of interventional radiology procedures include: • Localized treatments, most often

performed on an outpatient basis • Usually do not require general anesthesia • Well tolerated, with most patients

resuming normal activities within a few days

• May be combined with other treatment options

• Relatively low cost

Our Interventional Radiologists

Paul Wesley Lewis, M.D.A native of Olive Hill, Ky., Dr. Lewis has been caring for patients in the Tri-State since 1999. He earned his medical degree from the University of Kentucky, Lexington, and completed residency and an interventional radiology fellowship at University of Cincinnati College of Medicine, Cincinnati.

Dr. Lewis has been involved with many new and innovative procedures at King’s Daughters, including the placement of the first carotid stent, endovenous laser ablation of varicose veins, chemo embolization and radiofrequency ablation and several new minimally invasive treatments for cancer.

Dr. Lewis is board certified in vascular and interventional radiology by the American Board of Radiology and maintains office hours in Ashland, Ky.

Pho Nguyen, M.D.Dr. Nguyen has been caring for patients in the Tri-State since 2006. He earned his medical degree from the University of Cincinnati in 2000; completed an internship at Jewish Hospital in Cincinnati in 2001; and in 2005, completed his residency in diagnostic radiology at the University of Cincinnati. His fellowship training in interventional/vascular radiology was completed in

2006 at Duke University in Durham, N.C.

Dr. Nguyen performed King’s Daughters first TIPS procedure, a life-saving procedure to improve blood flow and prevent hemorrhage in patients with severe liver dysfunction.

Dr. Nguyen is board certified by the American Board of Radiology with subspecialty certification in vascular and interventional radiology.

Office Location, Hours and Appointments

On staff at King’s Daughters Medical Center, Dr. Lewis and Dr. Nguyen are members of Tri-State Vascular Specialists, which also includes vascular/endovascular surgeons.

The office is located in Suite 140 of Medical Plaza B, 613 23rd St., Ashland. Hours are 8 a.m. to 5 p.m. Monday through Friday. Patients are seen by appointment.

Dr. Lewis

Dr. Nguyen

For more information, to refer a patient or to schedule an

appointment, please call (606) 326-1675.

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What Our Interventional Radiologists Treat

Varicose VeinsPooling of blood in the veins from weak valves resulting in enlarged, swollen vessels causing pain and cosmetic complaints.

Deep Vein Thrombosis (DVT)The formation of a blood clot in the deep leg veins that may lead to swelling, discoloration and pain. DVTs can result post-thrombotic syndrome and pulmonary embolism. Minimally invasive procedures including balloon angioplasty and stenting may be performed in the affected vein to dissolve the clot and restore normal blood flow.

Peripheral Artery Disease (PAD) Most commonly a result of atherosclerosis, occlusion of normal blood flow in the upper and lower extremities may result in pain, skin ulcers or gangrene. Stenting, angioplasty and mechanical atherectomy are available interventional treatments. Shown: The

progression from an open artery (above) to a fully occluded artery (below).

Aneurysms of Visceral Arteries Stenting, embolization, liquid occlusion and thrombin injection are the available interventional therapies.

Pulmonary Embolism A potentially life-threatening occlusion of the arteries supplying the lungs with blood clots. A catheter may be inserted into the leg, threaded up to the lung and then used to infuse clot-busting drugs into the occlusion.

IVC Filter PlacementPatients who have a history of, or are at risk for, pulmonary embolism may receive temporary or permanent inferior vena cava (IVC) filters to prevent the migration of blood clots to the lungs.

Thoracic Aortic Aneurysms (TAA) and Aortic DissectionAneurysms, or dilatations, of the thoracic (chest) aorta may be caused by a variety of conditions. Interventional treatments use stent grafts, sometimes in combination with surgery, to prevent blood flow from enlarging the diseased area or rupturing the aorta.

Acute Limb IschemiaThe sudden disruption of blood flow to an arm or a leg due to a blood clot or other debris may be treated using minimally invasive techniques.

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Acute Mesenteric IschemiaA medical emergency resulting from the interruption of the blood supply to the abdominal organs. Treatment varies based on cause, but may include thrombolysis, stenting or angioplasty.

Abdominal Aortic Aneurysms (AAA)A weakening and enlargement of the abdominal aorta wall that can result in abdominal or back pain and potentially life-threatening bleeding if it ruptures. Minimally invasive interventional

treatment uses angiography and stenting to occlude the AAA and prevent its continued growth. Left: An AAA prior to repair. Right: The aneurysm following the placement of stents.

Arteriovenous Malformations (AVMs)Aberrations in normal vascular anatomy are treatable by embolization.

Women’s Health

Uterine Fibroids These are non-cancerous growths of the muscular portion of the uterus that may cause pain and heavy bleeding. Interventional radiologists may perform a uterine fibroid embolization (UFE), using real-time imaging. The interventional radiologist makes a tiny nick in the skin in the groin and inserts a catheter into the femoral artery. The physician guides the catheter into the uterine arteries that supply blood to the fibroid and then releases tiny particles to occlude the blood supply to the tumor, causing it to shrink and die. On average, 85-90 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and/or bulk-related symptoms. Recurrence of fibroids treated by UFE is very rare.

Pelvic Congestion Syndrome A condition caused by pooling of blood in the pelvic veins, possibly resulting in pelvic pain and lower extremity varicose veins. Interventional vein embolization is possible in some cases, eliminating the need for surgical removal of the ovaries and/or uterus.

Infertility One cause of female infertility is the blockage or narrowing of the fallopian tubes through which eggs pass from the ovary to the uterus. This cause of infertility may be diagnosed using selective salpingography and treated by opening the narrowing using a minimally invasive device such as a balloon.

What is an Arteriovenous

Fistula?It is a surgically

created connection between an artery

and a vein. An AVF is created to make

it easier, more comfortable and safer for patients on hemodialysis

to receive their treatments.

An AVF helps to reduce

complications, infections and

delays in dialysis treatment arising

from clots and malfunctioning

access ports. Should an AVF fail or become occluded, our interventional

radiologists are well trained to

treat the problem.

Kidney

Renal Artery Stenosis A narrowing of the arterial supply of the kidneys which may result in high blood pressure (hypertension) or renal insufficiency. Stenosis may be treated by balloon angioplasty or stenting.

Renal Failure/Dialysis Catheter PlacementPatients in renal failure may require the placement of a hemodialysis catheter prior to initiating hemodialysis for renal failure.

Nephrostomy Tube PlacementIn conditions where a blockage exists between the kidney and the urethra, such as with kidney stones, a tube may be placed into the kidney under imaging guidance to allow the drainage of urine and to prevent kidney damage.

Dialysis Fistula/Arteriovenous Graft Clot Dialysis fistulae and grafts may become occluded by blood clots, requiring an interventional declot procedure.

Dialysis Fistula/Arteriovenous Graft FailureDialysis fistulae and grafts may fail to mature, resulting in the need to image the fistula and potentially relieve any blockages using angioplasty.

Hepatobiliary (Liver, Gall Bladder and Bile Ducts)

Portal HypertensionA condition in which the normal flow of blood through the liver is slowed or blocked by scarring (cirrhosis) or other damage. Patients are at risk of internal bleeding or other life-threatening complications. Transjugular intrahepatic portosystemic shunt (TIPS) formation is the minimally invasive treatment to alleviate this impaired blood flow.

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Bile Duct Obstruction Patients with liver cancer, bile duct cancer, cholecystitis, cholangitis, or other hepatobiliary pathology may experience obstruction of bile ducts. Interventional radiologists commonly perform procedures to image these obstructions and may treat them using percutaneous transhepatic biliary drainage (PTBD).

Oncologic

Various interventional therapies exist to treat cancers. Tumor type, size, extent of disease and involvement of anatomical structures all factor into deciding which therapy is most appropriate. Some therapies, such as transarterial chemoembolization, block the blood supply to tumors. Other techniques — radiofrequency ablation (RFA), microwave ablation, cryoablation, irreversible electroporation (IRE) and high-intensity focused ultrasound (HIFU) — directly damage the cancerous tissue. All of these treatments are delivered locally, minimizing damage to nearby tissue and avoiding the systemic side-effects of chemotherapy.

IR treatments are available for cancers of the liver, lung, kidney, bone, breast and prostate.

Neurologic

StrokeInterventional radiologists play a critical role in determining the type of stroke (ischemic or hemorrhagic) using CT imaging or MRI and then treating the stroke using minimally invasive techniques, if possible. Treatments include intra-arterial

thrombolysis, mechanical thrombectomy and embolization, most commonly using tiny metal coils. Left: An MRI of the brain.

Carotid Artery Stenosis A narrowing of the carotid artery supplying the brain, which can lead to stroke and disability. Carotid artery stenting is an alternative to surgical carotid endarterectomy, which may be performed in patients who have symptoms but are poor candidates for open surgery.

Multiple Sclerosis Stenting of the cerebral veins is currently being studied as a potential interventional treatment for MS.

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Other

Spinal FracturesVertebroplasty and kyphoplasty, the percutaneous injection of biocompatible cement into fractured vertebrae, are two available treatments for vertebral fractures.

Gastric VaricesA condition in which blood flow through the vessels around the stomach is slowed or stopped, potentially resulting in bleeding. Interventional treatments include embolization and balloon-retrograde transverse obliteration (BRTO).

Varicoceles and Male InfertilityA dilatation in the veins of the scrotum that can result in pain, swelling and infertility. It may be treated interventionally using embolization and sclerotherapy.

Line Placement Vascular access and management of specialized kinds of intravenous devices (IVs) (e.g. PICC lines, Hickman lines, subcutaneous ports, translumbar and transhepatic venous lines).

Percutaneous DrainsDrainage of fluid from various body compartments using catheters and drains placed through the skin (e.g., abscess drains to remove pus, pleural drains).

Gastrostomy Tube PlacementIn instances where patients are unable to take food by mouth, a feeding tube may be placed through the skin and into the stomach using imaging guidance.

BiopsiesSamples of tissue may be required to identify the cause of certain diseases. Using imaging guidance, interventional radiologists may reach underlying tissue using a small needle to pierce the skin and retrieve tissue samples from the target organ. This procedure is minimally invasive.

Tri-State Vascular Specialists613 23rd St., Suite 140

Ashland, KY 41101 Phone: (606) 326-1675

Fax: (606) 326-1436 | (606) 408-6930