Vascular Interventional Radiology

Montefiore Medical Center
111 East 210th Street
Bronx, NY 10467
Tel:  (718) 920-4857

Jacob Cynamon MD, Division Head

The goal of interventional radiology is to offer minimally invasive treatment to their patients and achieve successful outcomes. The radiologists perform numerous procedures using catheter techniques to diagnose and treat vascular disease. Using percutaneous techniques, these physicians can usually avoid subjecting their patient to major surgery. The percutaneous procedures are simpler, thereby minimizing concomitant physical and emotional trauma.

At Montefiore, interventional radiologists diagnose and treat over 1,400 patients each year. There are only a few thousand radiologists performing these vital procedures in the United States and fewer still  limit their practice to these specific procedures.

Internists and surgeons refer patients to interventional radiologists because the radiologist's techniques and procedures are applicable to a wide range of conditions. These conditions include diagnosis and management of peripheral vascular disease and acute and chronic venous thrombosis, biliary drainage, percutaneous nephrostomies, abscess drainage, renal angioplasty, venous access including PICCS, hemocatheters and ports, hemodialysis graft maintenance and declotting, TIPS, IVC filters, embolizations including embolization of fibroid uterus, and foreign body retrievals.

Key Strengths
Generally, a patient is referred to Montefiore's Vascular Center because of severe claudication, foot ulcers, or gangrene. When vascular disease is likely, the patient is evaluated with noninvasive studies. If radiological or surgical intervention is needed, the interventional radiologist will perform an angiogram. An angiogram provides a road map of the blood vessels which is crucial to understanding the extent of the patient's disease and determining the best method of treatment.

Angiograms identify vascular abnormalities or lesions. These lesions can often be repaired with either angioplasty or stents. Once a blockage is identified and if it is amenable to treatment with angioplasty, the angioplasty can be performed immediately at the time of the diagnostic angiogram. Stents are metallic tubes that are placed in the patient's artery following arterial dilatation. With these stents, which mechanically prevent restenosis, longer lesions can be treated and the long-term patency of angioplasty has been improved. Angioplasty and stenting procedures are advantageous to patients because there is minimal pain and bleeding involved, only local anesthesia is necessary, and the patient can usually return home a day or two after the procedure.

Interventional radiologists' technique also allows them to deliver clot dissolving agents directly into the affected arteries and veins. Urokinase is the primary thrombolytic drug used by radiologists. Following clot dissolution, lesions causing thrombosis are often identified and can then be treated by either angioplasty or stents. This technique for dissolving clots is less invasive than standard surgery. It is also some patients' only chance for a cure because not all thromboses are manageable by current surgical methods.

Programs and Services

• Biliary drainage
• Percutaneous nephrostomies
• Abscess drainage
• Renal angioplasty
• Venous access
• Hemodialysis graft maintenance and declotting
• TIPS
• IVC filters
• Embolizations
• GI bleeds
• Tumor ablations
• Fibroid uterus embolizations
• Foreign body retrievals
• Peripheral angiography
• Angioplasty
• Stent placement
• Thrombolysis for arterial and graft occlusions
• Aneurysm evaluation and management
• Venous disease evaluation and management with venous angioplasty and stents
• Venous thrombolysis
   

Faculty
Jacob Cynamon, M.D.
Marcy Jagust, M.D.