Blogs
Blogs
Discover our expert insights.
- All
- Aneurysm
- Atheroembolism
- Claudication
- Critical Limb Ischemia
- Iliac Vein Compression
- Leg & Foot Ulcers
- Pelvic Venous Incompetence
- Pelvic Venous Insufficiency
- Peripheral Arterial Disease
- Renal Vein
- Sacral Augmentation
- Varicoceles
- Venous Insufficiency
- Venous Thrombosis
Severe, Worsening Low Back Pain
Julie Campos
April 1, 2022
79-year-old female with worsening low back pain. No falls or injury. Pain worsened with standing, walking and sitting. The patient had severe enough pain that performing the tasks of active daily living were becoming more burdensome.
Read More
Percuntaneous Fem-Pop
Julie Campos
November 8, 2021
75 year old male, prior right leg bypass graft from the common femoral artery to the anterior tibial artery. Bypass graft failed due to poor outflow in the anterior tibial artery. During thrombolysis the patient had a large retroperitoneal bleed. Treatment was stopped and the patient was told there were no other options…
Read More
Renal Vein Stent Adjustment
Julie Campos
November 8, 2021
Female initially presenting with pelvic venous congestion secondary to Nutcracker Phenomena. After treatment of the PVC, the patients pelvic complaints improved but they developed worsening symptoms of Nutcracker Syndrome. The NCS was treated with renal vein stenting and the symptoms improved. However, the patient had new right sided pain with deep breathing. The renal vein…
Read More
Left Leg DVT Secondary to IVCS
Julie Campos
October 28, 2021
30-year-old female, on oral contraceptives, with severe left leg swelling after a long car ride. Ultrasound showed left iliofemoral deep venous thrombosis (DVT). The patient was started on anticoagulation. 5 days later, the patient still had severe swelling and pain. Pharmacomechanical thrombolysis using TPA and the Angiojet was performed with removal of the bulk of…
Read More
Painful Right Toe
Julie Campos
October 23, 2021
94-year-old female, worsening right toe and foot pain. Seen by primary care and diagnosed as having gout. The clinical findings of critical limb ischemia - dry scaly skin, nail changes, absent pulses and a punched out ulcer on the 2nd toe - were ignored. Popliteal artery occlusion treated with atherectomy.
Read More
Ischemic Ulceration
Julie Campos
October 23, 2021
92 year old female with left foot rest pain and worsening ulcers of typical of ischemia. CTA demonstrated severe PAD with heavy calcification in the femoral, popliteal, tibial and pedal arteries with a solid wall of calcium at the adductor canal. These types of lesions are often difficult to cross and often result in a…
Read More
Lateral Malleolus Ulcer
Julie Campos
October 23, 2021
86 year old female with a several month history of a painful non-healing ulcer over the lateral malleolus. This area is in the peroneal artery angiosome. Occlusions of the peroneal and posterior tibial artery were treated with orbital atherectomy. Ulcer healed within 1 month.
Read More
Popliteal Aneurysms and Toe Ulcers
Julie Campos
October 23, 2021
The patient was initially seen for ischemic ulceration of right foot toe ulcers and was found to have 2 left popliteal artery aneurysms. The patient declined treatment of the aneurysms at that time. 18 months later the aneurysms occluded and the patient developed ulcerations of several left toes with rest pain. Revascularizion was performed using…
Read More
Gangrene Failed BPG
Julie Campos
October 23, 2021
83-year-old male, Type I Diabetes, end stage renal disease, living independently who was told he needed a below knee amputation. The patient had a failed popliteal to dorsalis pedis artery bypass graft. An attempt at endovascular repair also failed. The patient came for a second opinion. A second at endovascular repair was successful. The patient…
Read More
Nonhealing Ulcer
Julie Campos
October 23, 2021
82-year-old male, heavy smoker, developed right heel ulcer during rehab after a femur fracture. No pulses in the foot but they could "heard" with doppler. Told to stay off their feet until the ulcer healed. CT angiography shows severe multilevel peripheral artery disease. A simple inflow endovascular procedure restored enough blood flow to achieve healing.
Read More
DPA Wire Fragment Retrieval
Julie Campos
October 23, 2021
82 year old male with non healing ulcer of the great toe. Severe peripheral arterial disease with long segment occlusion of the posterior tibial artery and severe disease of the distal anterior tibial artery. During crossing of the severe stenosis of the ATA the tip of the hydrophilic wire was bent and then fracture while…
Read More
Retrograde ATA Recanalization
Julie Campos
October 23, 2021
79-year-old female with non healing ulcers. Occlusion of all three arteries in the calf. Antegrade attempt at opening the anterior tibial artery failed. Retrograde crossing from the distal anterior tibial artery was successful. Treated with orbital atherectomy and angiograplasty. Ulcers healed in under 4 weeks. Entire procedure done in 75 minutes. Patients entire stay was…
Read More
Two Failed Fem-Pop BPGs
Julie Campos
October 23, 2021
71-year-old female with a non healing ulcer on the left foot. Previously had a femoral to popliteal artery vein bypass graft which had occluded and was not salvageable. In addition, the patient had end stage renal disease but was not on dialysis. The long superficial femoral artery occlusion was crossed in the subintimal space. Reentry…
Read More
2nd Toe Ulcer
Julie Campos
October 23, 2021
67 year old male, type1 diabetic, with painful ulceration at the tip of the second toe. Patient did not toe amputation. Although toe amputation sounds simple it leads to biomechanical changes in the foot which can cause progressive deterioration and further more significant amputations. Angiography showed the severe stenosis in the plantar arch. The plantar…
Read More
Failed Bypass Graft
Julie Campos
October 23, 2021
64 year old male, type 1 diabetes, with a prior femoral to politeal bypass graft and a subsequent poplileal to tibial bypass graft. The later graft failed and the patient was told there were no other options to restore blood flow. Endovascular reconstruction of the popliteal artery and tibioperoneal trunk restored blood flow and wound...
Read More
Neuro-Ischemic Ulcer
Julie Campos
October 23, 2021
61 year old male, diabetic, developed a lateral right foot ulcer after a pedicure. The posterior tibial artery pulse was palpable. No dorsalis pedis artery pulse. Monofilament testing showed decreased sensation typical of diabetic neuropathy. Angiography showed distal PTA stenosis and severe stenosis in the proximal lateral plantar artery - the blood supply to the…
Read More
Blue Toe from Ulcerated Popliteal Artery Plaque
Julie Campos
October 23, 2021
59 year old male, smoker, sudden onset of pain and discoloration of the right 3rd toe. Comprehensive workup for an embolic source demonstrated a focal plaque in the popliteal artery. Catheter angiography showed the ulcerated plaque. Directional atherectomy using a SilverHawk atherectomy device was performed. Patients symptoms resolved and at last follow up 2 years…
Read More
Neuro-Ischemic Ulceration
Julie Campos
October 23, 2021
51 year old male with Type 1 Diabetes and a lateral foot ulcer for 4 months. Patient received standard wound care with slow progression of the ulcer and was offered a below knee amputation. Skin perfusion testing showed normal perfusion. CT angiography demonstrated severe stenosis at the origin of the anterior and posterior tibial arteries…
Read More
Pedal Loop Reconstruction
Julie Campos
October 23, 2021
46 year old male, type 1 diabetes, with ulcers on several toes. Patient had palpable pulses at the ankle. Angiography shows occlusion of the distal dorsalis pedis artery and of the distal lateral plantar artery. The deep plantar artery and plantar arch were reconstructed and the wounds healed
Read More
Rest Pain in Elderly Female
Julie Campos
October 23, 2021
104 year old female, treated 3 years earlier for critical limb ischemia of the right foot. Now presents with a 2 month history of worsening left foot rest pain.
Read More
Misdiagnosed Painful Toe
Julie Campos
October 23, 2021
Patient told the pain was due to an ingrown toe nail and sent home on narcotics. The patient went to podiatry and was correctly diagnosed as having critical limb ischemia.
Read More
Internal Iliac Artery Aneurysm
Julie Campos
October 23, 2021
Internal iliac artery aneurysms are rare. In most instances, they do not cause symptoms unless they rupture. Mortality after rupture is about 50%. Aneurysm under 25-30mm in size can be watched with serial imaging - typically CT. Aneurysms > 25-30mm should be treated to avoid rupture. Endovascular repair is preferred to open surgery as it...
Read More
Groin Pseudoaneurysm
Julie Campos
October 23, 2021
Advantages of an endovascular approach versus an open surgical procedure are clear - safer, faster recovery, no general anesthesia, almost no risk of infection, and no large groin incision.
Read More
Post Thrombotic IVCS in a Triathlete
Julie Campos
October 23, 2021
36-year-old female with a left lower extremity iliofemoral deep venous thrombosis (DVT) and pulmonary embolism (PE) 9 years prior. Increasing problems with left leg venous claudication with exercise. Symptoms limiting the patient's ability to be active. MR venography showed occlusion of the left iliac venous system typical of May Thurner syndrome or iliac vein compression syndrome…
Read More
Ulceration due to External Iliac Vein Compression
Julie Campos
October 23, 2021
A 65-year-old male presented with a right lower extremity venous ulcer. During workup, the patient was found to have extensive incompetence of the superficial and deep venous systems. This prompted evaluation for venous outflow obstruction. CT Venography showed compression of the proximal right external iliac vein at the right common iliac artery bifurcation between the external…
Read More
Thrombosed Popliteal Artery Aneurysm
Julie Campos
October 23, 2021
A 75-year-old male with severe PAD. Prior endovascular AAA repair. Prior right leg bypass graft times 2. Both failed. Prior right leg percutaneous bypass graft 9 months ago for CLI. Worsening left leg claudication and rest pain. The patient has a thrombosed bilobed popliteal artery aneurysms. Recanalization failed using conventional techniques even with antegrade and retrograde…
Read More
Painful Varicoceles in a High School Athlete
Julie Campos
October 23, 2021
17-year-old male with 2 years of worsening bilateral testicular pain. The pain progressively got worse as the day progressed and with any strenuous activity. In particular, the pain was interfering with high school sports. The patient wanted the procedure with the fastest recovery and best outcomes. Data from patients I have treated show that in…
Read More
Recurrent Leg DVT
Julie Campos
October 23, 2021
72-year-old male patient with 3 left lower extremity DVTs. The patient was developing severe post-thrombotic syndrome (PTS). The patient was positive for Lupus anticoagulant was being treated with oral anticoagulation. Apart from a lower extremity venous ultrasound, no investigation of the pelvic venous system was done. Imaging of the venous outflow in the abdomen and pelvis…
Read More
CFA Occlusion, Claudication and Rest Pain
Julie Campos
October 23, 2021
62-year-old female, a heavy smoker, noticed a relatively sudden worsening of chronic right calf claudication. Ultrasound and CT angiography demonstrated occlusion of the common femoral artery. The patient is overweight with a body mass index of 35. The patient was self-employed and did not want to, nor could afford the time off work to undergo…
Read More
Venous, Arterial, or Mixed Ankle Ulceration
Julie Campos
October 23, 2021
86-year-old male with left ankle ulceration. Recurrent ulceration at the left ankle over the last 6 years. The current ulcer had been present for over 5 months. Local wound care only. No investigation into the cause of the ulcer. Patient had symptoms of rest pain. Venous ultrasound showed superficial venous incompetence. Arterial testing showed severe…
Read More
AortoIliac Occlusive Disease
Julie Campos
October 23, 2021
62-year-old male, heavy smoker, with a long history of leg pain with walking. Lumar spine fusion was done with no improvement in symptoms. Exercise ABI's demonstrated severe peripheral arterial disease. CT angiography showed occlusion of the infrarenal abdominal aorta, bilateral common iliac arteries, left external iliac artery, and severe right external iliac artery disease. Recanalization…
Read More
Chronic Pelvic and Low Back Pain
Julie Campos
October 23, 2021
A 51-year-old female with chronic pelvic complaints undiagnosed for many years. She was referred after her doctor saw a presentation I gave about pelvic venous disease in females. Workup of her pelvic pain using trans-vaginal and trans-abdominal ultrasound demonstrated an incompetent left internal iliac vein. CT venography was obtained, confirming severe compression of the left…
Read More
30 Years of Pelvic Pain
Julie Campos
October 23, 2021
62-year-old female correctly diagnosed over 15 years ago with pelvic congestion syndrome (PCS). The patient was offered a hysterectomy which is not the first line of treatment for this condition. She declined. The patient was identified by her chiropractor as have PCS and was referred for treatment. In this patient, the primary cause of PCS…
Read More
Debilitating Leg Pain
Julie Campos
October 23, 2021
A 59-year-old male with short distance exercise-induced left leg pain. The pain was severe and was interfering with the patients actively living. He was seen and treated for neurogenic claudication for several months without any improvement. The patient had palpable pulses in the left foot, which was mistaken as indicating he had good blood flow…
Read More
Non-Healing Ulcer After Skin Biopsy
Julie Campos
October 23, 2021
A 55-year-old female with ulceration after a skin lesion was removed from the posterior calf. Lesion turned out to be a basal carcinoma. Seven weeks after the surgery, the patient had a large area of ulceration with copious drainage of fluid. The patient returned to the physician that did the procedure was told to continue…
Read More
Right Flank Pain With Exertion
Julie Campos
October 23, 2021
A 50-year-old female has right flank pain that occurs when walking. Extensive workup for nonvascular causes was done, and severe stenosis in the abdominal aorta was found. During further workup, the patient had typical symptoms of leg claudication. However, it was their flank pain that was causing the most concern. Flank pain due to claudication…
Read More
Endovascular Treatment of EIA and CFA Occlusions
Julie Campos
October 23, 2021
56-year-old male, a lifelong smoker, presents with severe bilateral lower extremity claudication. At the initial visit, medical management and risk factors were addressed. Trial of management with Pletal failed at 1 month due to side effects. The patient's employment was at risk due to limitations in walking. CT angiography showed left external iliac, common femoral…
Read More
Post Aorto-Bifemoral Graft Placement
Julie Campos
October 23, 2021
60 year old female, smoker, underwent aorto-bifemoral bypass graft placement for severe iliac artery occlusive disease and short distance claudication. Patient had symptomatic improvement but quickly deteriorated on the right with worse symptoms than prior to surgery. Exercise ABI's showed severe PAD with claudication at 125 yards. Patient was at risk of losing employment…
Read More
Dyspareunia and Dysuria
Julie Campos
October 23, 2021
A 36-year-old female with typical symptoms of pelvic venous insufficiency. Primary complaints of pelvic heaviness, painful intercourse, and urinary frequency. Transvaginal ultrasound demonstrated left ovarian vein incompetence with extensive pelvic varicosities. Large varicose veins were found around the base of the bladder consistent with the patient's symptoms of urinary frequency. Treatment with foam sclerotherapy and…
Read More
Prostate Cancer with Left Leg Swelling
Julie Campos
October 23, 2021
65-year-old male, T3a prostate cancer. Prior robotic lymph node dissection for staging. Post-operative lymphocele developed along the left external iliac vein. Percutaneous drainage decompressed the fluid collection and improved the leg swelling. Collection re-occurred, and the leg swelling worsened with severe pain. Venography and intravascular ultrasound (IVUS) showed severe narrowing of the external iliac vein…
Read More
50 Yard Claudication
Julie Campos
October 23, 2021
64-year-old female with a 2-year history of worsening left calf claudication. Pain has become severe enough the patient is having a hard time working and staying employed. CT angiography showed a heavily calcified common femoral artery plaque causing near occlusion of the artery. Retrograde superficial femoral access with directional atherectomy was attempted but limited due…
Read More
Chronic Iliofemoral DVT in a Young Male
Julie Campos
October 23, 2021
22 year old with severe post thrombotic syndrome 6 months after left leg deep venous thrombosis (DVT). Initial attempt at catheter directed thrombolysis without iliac vein stenting resulted in re-thrombosis. The patient had severe restriction in activity due to venous claudication and he wanted to see if anything could be done. He underwent stenting and…
Read More
Orbital Atherectomy
Julie Campos
October 23, 2021
87-year-old male, living independently in a long-term facility. He could not walk from his room to the dining hall without stopping twice for severe left leg pain. Would 15 minutes to walk one block. Treated with atherectomy and angioplasty. He was able to walk out from the procedure to his car with no leg pain…
Read More
Post Thrombotic Ulcer
Julie Campos
October 23, 2021
A 38-year-old female with deep venous thrombosis 14 years ago while on birth control pills. Second DVT shortly after discontinuing anticoagulation. Hematologic workup showed the patient to have Protein S deficiency. The patient suffered from severe post-thrombotic syndrome, eventually resulting in venous ulceration 8 years ago. The patient suffered from a chronic ulcer that eventually…
Read More
Recurrent Varicocele After Incomplete Embolization
Julie Campos
October 23, 2021
22 year old with a 10 year history of left groin and testicular pain. Prior embolization about 4 years ago with a temporary improvement of symptoms. Only the proximal left testicular vein was embolized. The patient had asymptomatic compression of the left renal vein (Nutcracker Phenomena) leading to the develop of renal vein collaterals to…
Read More
Claudication for 4 Months
Julie Campos
October 23, 2021
63-year-old male with a sudden onset of left leg claudication. Symptoms started after a day of gardening. CT Angiography demonstrated a thrombosed right popliteal artery aneurysm. The aneurysm was treated with stent grafting and resolution of symptoms.
Read More
Pelvic Venous Congestion: Symptoms
Julie Campos
October 16, 2021
Pelvic congestion syndrome (PCS) is a condition that causes significant pain and discomfort for women.
Read More
Venous Claudication
Julie Campos
October 16, 2021
Venous claudication occurs when venous drainage from the left is impaired, Diagnosis and treatment are often delayed.
Read More
Venous Valves on Ultrasound
Julie Campos
October 16, 2021
Valves are one of the key components of normal venous function. There are valves throughout the veins in the body.
Read More
Clinical Evaluation of the Foot for Peripheral Arterial Disease
Julie Campos
October 15, 2021
Peripheral arterial disease (PAD) and its more severe variant critical limb ischemia (CLI) can be notoriously difficult to diagnose.
Read More
Reperfusion Syndrome and Critical Limb Ischemia
Julie Campos
October 15, 2021
Reperfusion syndrome and inury can occur after revascularization in patients with critical limb ischemia but the entity is poorly understood.
Read More
Varicocele Embolization Outcomes – Skill Matters
Julie Campos
October 15, 2021
Varicoceles are a collection of dilated veins around the testicle. They are common and occur in about 1 of 10 men, usually 20-40 years of age.
Read More
Vascular Evaluation in Patients with Lower Extremity Ulceration
Julie Campos
August 4, 2021
Lower extremity wounds are complex and challenging for patients, families, and healthcare providers. Most lower extremity ulcers are secondary to either or both arterial and venous problems. A comprehensive history and physical assessment followed by appropriate imaging are essential to identify, diagnose and develop care plans. Dedicated vascular specialists should be involved in the care…
Read More