Pain Management

pain management

What it is:

Pain is an unpleasant feeling usually occurring because of injury or disease, usually localized in some part of the body. Pain is common and often multifactorial, often the presenting symptom in many medical visits and inclusive of all patients sub populations but often ignored or undertreated.  



AVVS specializes in both acute and chronic pain, with an emphasis on diagnosis and treatment through a team approach. As a multispecialty group with expertise in imaging, vascular disease, pain management and minimally invasive intervention, we approach patients with an emphasis on accurate diagnosis and comprehensive treatment plans. 

AVVS focuses on interventional pain management including kyphoplasty and vertebroplasty for patients with osteoporotic insufficiency fractures and pathologic fractures, diagnostic, and therapeutic injections for degenerative spine disease of cervical spine through tail bone, SI joint disease as well as injuries to the hips, knees, shoulders, elbows, ankles, and feet. In addition, headache treatment is also amenable to treatment. 


Regenerative Medicine: 

Stem cell therapy

PRP (Platelet rich Plasma)

Headaches: migraine headaches, cluster headaches, occipital neuralgia

SPG blocks for Migraines


RFA of sensory nerves

Occipital nerve blocks and ablation

Back pain: cervical spine disease though low back and pelvic pain 

Compression fractures. Kyphoplasty and vertebroplasty

Epidural, facet, and SIJ blocks 

RFA nerve ablation


Trigger points

MSK pain

Osteoarthritis Knee: blocks, Synvisc and Geniculate ablation

Regenerative Medicine: PRP, Stem cell

Plantar Fasciitis: Tenex,

Tennis and golf elbow: Tenex


Nerve blocks, steroids

Pelvic and ill-defined abdominal pain.

Vascular, compressive, and neurologic workup and treatment inclusive of stenting, embolization and ablation for a variety of conditions:

Pelvic congestion syndrome,

May Thurner Syndrome

NutCracker Syndrome


Mesenteric ischemia


dialysis access & access Management

What it is:

Patients on dialysis for kidney failure can either rely on peritoneal dialysis or hemodialysis, both of which require some type of access point. Peritoneal dialysis requires a tube that goes into the abdomen that allows fluid to go in and come out.  That fluid is what cleans the patient's blood of toxins and waste products.  

Hemodialysis requires the patient to have access to clean their blood.  This can be done one of three ways. The preferred access is an arteriovenous fistula (AVF).  An AVF is a connection between a vein and an artery.  This is most commonly formed surgically, but can also be done in some patients with a simple poke hole procedure.  An arteriovenous graft is a plastic tube that hooks up an artery to a vein when a primary fistula cannot be formed.  Arteriovenous grafts (AVG) usually require more maintenance than a fistula does.  This is the second most preferred access for hemodialysis.  Sometimes patients require hemodialysis catheters.  These are usually used for short-term dialysis access until either an AVF or AVG can be used.

Symptoms of access point problems:

When arteriovenous fistulas or grafts develop narrowings, they do not function well.  Some symptoms include prolonged bleeding after dialysis of the access site.  Other times the fistula or graft does not have adequate flow during dialysis.


Most dialysis accesses can be treated with simple local procedures to make them function better.  This is often referred to as a fistula angiogram or fistulogram.  These are very simple outpatient procedures which do not require hospitalization and can often be done in the surgery center.

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cancer care

cancer care

Interventional Oncology: 

What it is:

Interventional Oncology is the subspecialty of interventional Radiology that focuses on improving the lives of patients undergoing cancer care though minimally invasive procedures. Interventional Oncologists meet and evaluate patients in clinic, assist in imaging interpretation and imaging recommendations, perform the biopsy/s for oncology treatment planning as well as insert medical devices to minimize the side effects and complications from oncology treatment. Interventional Oncology also directly treats tumors for several cancers through needles directly into tumors with imaging assistance and/or by delivery of obstructing beads, radiation, or medication directly into tumor arterial supply.  

At AVV we are invested in our patients through our involvement from diagnosis through cure, or, disease control; with a primary focus on patient quality of life and supplementation of the primary oncologists’ care. We work in concert with the entire medical team, acting as the procedural Sherpas for patients, often offering much less invasive alternatives to standard surgery.  We follow our patients from biopsy and diagnosis through their treatment and are available in multiple ways to lessen the impact of therapy including expertise in oncologic pain and intervention. 


Often patients are asymptomatic with abnormal findings discovered on imaging or screening, however, symptoms can vary depending on type of tumor and location/s. Once an abnormality is identified on imaging, physical exam or history, a diagnosis will be needed. Sometimes blood tests, or simple tests are available, but grading and staging (extent and severity of cancer) of cancer is usually required. 


Treatments vary between patients and tumors and excellent treatment guidelines are provided by the various cancer societies.  AVVS offers the following services to our patients and medical referring physicians:

  • Percutaneous biopsies, 
  • long-term vascular access (chest ports, piccs, tunneled central lines), 
  • feeding tubes (Gastric and GJ tubes) 
  • Fluid management: Pleurex Pleural and peritoneal drains; nephrostomy tubes, biliary drains.
  • Pain management: Cryoablation, Cement augmentation for pathologic fractures, nerve blocks, RFA ablation, Shingles management.
  • Tumor Ablation (Lung, Liver, Bone, kidney, breast) (Cryoablation, RFA, Microwave, 
  • Tumor embolization: Bland, Chemoembolization or radioembolization Y90: Liver, Kidney, Spleen, Prostate.


prostate emolization

What it is:

BPH, also called prostate gland enlargement — Benign Prostatic Hypertrophy (BPH) is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract or kidney problems



Symptoms of BPH include urinary the standard symptoms well described in the international prostate symptoms score (IPSS).  These include 

    • Incomplete emptying 
    • Urinary frequency
    • Intermittency
    • Urgency
    • Weak stream
    • Straining, and 
    • Nocturia. 
    • A final question asking how the patient would feel if he had to live with his symptoms for the rest of his life.  Patients with moderate to severe IPSS score is a candidate for PAE.

Link to IPPS score. IF elevated contact us.


Prostate Artery Embolization (PAE) is minimally invasive outpatient procedure whereby a patient’s prostate arteries are blocked by very small particles injected into the prostate gland through the arteries in the pelvis. The patients’ radial artery (Artery in left wrist) is usually accessed allowing for a rapid discharge post procedure and minimal side effects. PAE is a noninferior alternative to TURP and other minimally invasive procedures such as urolift, for the treatment of moderate to severe lower urinary tract obstructive symptoms (LUTS) from benign prostatic hypertrophy (BPH) not alleviated by conservative management and /or intolerance to medications. 

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uterine fibroid treatments

What it is:

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.

Many women who have fibroids don't have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids.



In women who have symptoms, the most common signs and symptoms of uterine fibroids include:

    • Heavy menstrual bleeding
    • Menstrual periods lasting more than a week
    • Pelvic pressure or pain
    • Frequent urination
    • Difficulty emptying the bladder
    • Constipation
    • Backache or leg pains



Treatment options include conservative management such as hormone replacement therapy to myomectomy, hysterectomy, endometrial ablation, or Uterine Artery Embolization (UAE or UFE). Uterine Artery Embolization is a minimally invasive procedure whereby an interventional radiologist blocks the small vessels in the uterus with tiny non-allergenic beads that kill the fibroids but not the uterus.  The physician will access an artery, usually the radial artery (wrist) or femoral artery (groin) while the patient is under moderate sedation and direct very small catheters into the small vessels in the pelvis under fluoroscopic guidance.  The physician will then inject small particles to cut off the blood supply to the fibroids; essentially pruning the fruit from the tree. The procedure is an outpatient procedure with an 85-90% success rate in relieving uterine fibroid related symptoms and without the need for hysterectomy. 

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