Overview
Drs. Loehr and Yankes will provide you the most effective treatments available, including laser/RF ablation. You will receive a personalized consultation to help you find the causes of your vein problems, and to choose the treatment that is best for you- all in a convenient and comfortable office.
Is your vein doctor a Vascular Specialist? …ASK.  It’s your right to know.

Interventional Radiology:   Nonsurgical Outpatient Procedure Treats Varicose Veins
Venous insufficiency is a very common condition resulting from pooling of blood within leg veins due to poorly functioning vein valves. Normally, one-way valves in the veins keep blood flowing toward the heart.  When standing, the valves close. With exercise, the muscles of the thigh and calf contract, forcing the blood through the valves against the force of gravity.  When the valves become incompetent, they don’t close properly.  This allows blood to flow in reverse, a condition called venous reflux. When venous reflux is present, there is increased hydrostatic pressure within the vein causing it to become dilated and varicose.
Approximately half of the U.S. population has venous disease–50 to 55% of women and 40 to 45% of men. Of these, 20 to 25% of the women and 10 to 15% of men will have visible varicose veins.Varicose veins affect 1 out of 2 people age 50 and older, and 15 to 25% of all adults.Symptoms
Symptoms caused by venous insufficiency and varicose veins include leg aching, pain, and heaviness. These symptoms tend to be worse by the end of the day and are relieved by rest and elevating the legs. With advanced venous insufficiency, open wounds may develop.  These are called venous stasis ulcers.People without visible varicose veins can still have symptoms. The symptoms can arise from spider veins as well as from varicose veins, because, in both cases, the symptoms are caused by pressure on nerves by dilated veins.
Diagnosis
An ultrasound examination can assess the valves within the leg veins.  A vein map is developed labeling the good veins from the ones with leaky valves.  Treatment is then targeted at the veins with the faulty valves.
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Vein Ablation Treatment
This minimally-invasive treatment is an outpatient procedure performed using ultrasound guidance. After numbing the vein with local anesthetic, a thin fiber is inserted within the vein using ultrasound guidance.  Laser of radiofrequency energy is delivered to the fiber which generates heat.  This heat cauterizes the vein and seals the vein closed. By sealing the vein with the leaky valves, the varicose veins, which are close to the skin, shrink and improve in appearance. Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing normal flow.
Benefits of Vein Ablation Treatment
The outpatient treatment takes less than an hour and provides immediate relief of symptoms.Minimally invasive alternative to surgical “vein stripping”Immediate return to normal activity with little or no pain. There may be minor soreness or bruising, which can be treated with over-the-counter pain relievers.No scars or stitches – because the procedure does not require a surgical incision, just a nick in the skin, about the size of a pencil tip.High success rate and low recurrence rate compared to surgery.The success rate ranges for vein ablation ranges from 93 – 95 percent.Insurance
Many insurance carriers cover the vein ablation treatment, based on medical necessity for symptom relief.
Contact us for consult at 919.677.9729 or email.
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Injection & Laser Sclerotherapy
Can also be used to treat some varicose and nearly all spider veins. An extremely fine needle is used to inject the vein with a solution which shrinks the vein.
Laser Sclerotherapy
Cosmetic laser sclerotherapy performend for spider telangiectasis and reticular veins using the Lyra Laser System. Patient evaluation and consulation services are performed at our office.
Ultrasound-guided Sclerotherapy
Involves an interventional radiologist passing a thin tube called a catheter into the vein using ultrasound guidance and injecting substance that causes the veins to scar and close – rerouting the blood to healthier veins. The affected vein forms a knot of scar tissue that is absorbed by the body over time.
Handsclerotherapy
Over the years, we lose fatty tissue and elasticity in the hands resulting in prominent veins which appear much larger. With a minimally invasive procedure the Vein Center at TIS can create a dramatic effect to the appearance of hands. Handsclerotherapy involves a series of precise injections and entails 2 to 3 sessions of sclerotherapy. Each session is virtually painless and takes less than thirty minutes. With microphlebectomy, a local anesthetic is injected over the bulging veins and very small skin nicks are made over the veins. Using special instruments the unsightly veins are gently removed. No stiches are necessary and there is minimal downtime from normal activitites. The results have been very positive for both male and female patients.
Contact us for consult at 919.677.9729 or email.
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Microphlebectomy
A minimally invasive surgical technique used to treat varicose veins that are not caused by saphenous vein reflux. The abnormal vein is removed through a tiny incision or incisions using a special set of tools. The procedure is done under local anesthesia, and typically takes under an hour. Recovery is rapid, and most patients do not need to interrupt regular activity after microphlebectomy.

Overview
Uterine fibroids are benign tumors that develop within the muscular wall of the uterus.  They are extremely common.  Twenty to 40 percent of women over the age of 35 have uterine fibroids.  Over 50 percent of African American women have fibroids.  They are the most frequent indication for hysterectomy in premenopausal women.  Of the 600,000 hysterectomies performed annually within the United States, one third are due to symptomatic fibroids.  Now there is a proven, non-surgical alternative to hysterectomy for the treatment of symptomatic uterine fibroids, uterine fibroid embolization (UFE).
Uterine Fibroid Symptoms
Most fibroids don’t cause symptoms.  Only 10 to 20 percent of women with fibroids have symptoms that require treatment.  Symptoms may include:
Heavy menstrual bleeding that tends to be prolongedIntermittent, unusual monthly bleedingAnemia (low blood count)Pelvic pain and pressurePainful menstrual crampingFrequency in urination secondary to bladder pressureConstipationBloatingPain during sexual intercourseIncrease in waist sizeFibroid Types
Uterine fibroids are categorized by their location within the muscular wall of the uterus.
Subserosal fibroids develop under the outside lining of the uterus.  They typically don’t cause changes of menstrual flow, however may cause symptoms of pelvic or back pain, pressure, and/or bloating.  Subserosal fibroids can have stalk or stem.  These are called pedunculated subserosal fibroids.
Intramural fibroids are the most common type of uterine fibroids.  These develop within the muscular wall of the uterus and ten to grow inward.  They cause enlargement of the uterus.  Intramural fibroids can cause heavy menstrual bleeding, generalized pelvic pressure, increased waist size, frequency in urination, and or constipation.
Submucosal fibroids develop under the uterine cavity lining.  Although they are the least common type, they cause the greatest symptoms.  Even small subserosal fibroids can cause heavy menstrual bleeding with clots and gushing as well as prolonged cycles.
Diagnosis
Typically an ultrasound can determine the presence of uterine fibroids.  However, it is limited.  An MRI (magnetic resonance imaging) is far superior in determining the presence, location, and type of fibroids.  It is also a better test to diagnose other uterine and pelvic pathology that may be the cause of a patient’s symptoms.  It is necessary prior to uterine fibroid embolization (UFE).
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Nonsurgical Uterine Fibroid Embolization – A Major Advance in Women’s Health
Uterine fibroid embolization (UFE), also known as uterine artery embolization, is performed by an interventional radiologist, a physician who is trained to perform this and other types of embolization and minimally invasive procedures. It is performed while the patient is conscious, but sedated and feeling no pain. It does not require general anesthesia.
The interventional radiologist makes a tiny nick in the skin in the groin and inserts a catheter into the femoral artery. Using real-time imaging, the physician guides the catheter through the artery and then releases tiny particles, the size of grains of sand, into the uterine arteries that supply blood to the fibroid tumor. This blocks the blood flow to the fibroid tumor and causes it to shrink and die.
UFE Recovery

UFE can be performed safely in an outpatient setting.  Non steroidal medication (Motrin) and pain killers are prescribed for several days following the procedure.  This helps to control pain and cramping.  In addition, medication for nausea may be prescribed as needed. Most women resume light activities in a few days and are able to return to normal activities within ten days.  In comparison, recovery time after a hysterectomy is approximately six weeks.
UFE Facts
85-90 percent of women have significant relief of their symptomsUFE is effective on most size and types of fibroidsRecurrance of treated fibroids is rareApproximately 14,000 UFE procedures are performed annually in the U.S.Embolization of the uterine arteries has been performed by Interventional Radiologists for over 20 years.  It was and still is used to treat life-threatening bleeding after childbirth.The embolic particles are FDA approved and have been in use in people for over 20 years.UFE is covered by most major insurance companies.It is an organ sparing procedureUFE preserves fertility with numerous reports of successful pregnancy after UFERisks
UFE is a very safe method and, like other minimally invasive procedures, has significant advantages over conventional open surgery. However, there are some associated risks, as there are with any medical procedure. A small number of patients have experienced infection, which usually can be controlled by antibiotics. There also is a less than one percent chance of injury to the uterus, potentially leading to a hysterectomy. These complication rates are lower than those of hysterectomy and myomectomy.
Contact us for consult at 919.677.9729 or email.
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Ovarian Vein Embolization
Pelvic congestion syndrome, also known as chronic pelvic pain syndrome, is caused by
Pelvic Congestion Syndrome – Chronic Pelvic Pain in Women
It is estimated that one-third of all women will experience chronic pelvic pain in their lifetime. Many of these women are told the problem is “all in their head” but recent advancements now show the pain may be due to hard to detect varicose veins in the pelvis, known as pelvic congestion syndrome.
The causes of chronic pelvic pain are varied, but are often associated with the presence of ovarian and pelvic varicose veins. Pelvic congestion syndrome is similar to varicose veins in the legs. In both cases, the valves in the veins that help return blood to the heart against gravity become weakened and don’t close properly, this allows blood to flow backwards and pool in the vein causing pressure and bulging veins. In the pelvis, varicose veins can cause pain and affect the uterus, ovaries and vulva. Up to 15 percent of women, generally between the ages of 20 and 50, have varicose veins in the pelvis, although not all experience symptoms.
The diagnosis if often missed because women lie down for a pelvic exam, relieving pressure from the ovarian veins, so that the veins no longer bulge with blood as they do while a woman is standing.
Many women with pelvic congestion syndrome, spend many years trying to get an answer to why they have this chronic pelvic pain. Living with chronic pelvic pain is difficult and affects not only the woman directly, but also her interactions with her family, friends, and her general outlook on life. Because the cause of the pelvic pain is not diagnosed, no therapy is provided even though there is therapy available.
If you have pelvic pain that worsens throughout the day when standing, or any of the other symptoms mentioned below, you may want to seek a second opinion with Dr. Makris.  He will work with your gynecologists to determine the best treatment option for your pain.
Prevalence
Women with pelvic congestion syndrome are typically less than 45 years old and in their child bearing years.Ovarian veins increase in size related to previous pregnancies. Pelvic congestion syndrome is unusual in women who have not been pregnant.Chronic pelvic pain accounts for 15% of outpatient gynecologic visits.Studies show 30% of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a sole cause of their pain and an additional 15% have PCS along with another pelvic pathology.Risk Factors
Two or more pregnancies and hormonal increasesFullness of leg veinsPolycystic ovariesHormonal dysfunctionSymptoms
The chronic pain that is associated with this disease is usually dull and aching. The pain is usually felt in the lower abdomen and lower back. The pain often increases during the following times:
Following intercourseMenstrual periodsWhen tired or when standing (worse at end of day)PregnancyOther symptoms include:
Irritable bladderAbnormal menstrual bleedingVaginal dischargeVaricose veins on vulva, buttocks or thigh.Diagnosis and Assessment
Once other abnormalities or inflammation has been ruled out by a thorough pelvic exam, pelvic congestion syndrome can be diagnosed through several minimally invasive methods. An interventional radiologist, a doctor specially trained in performing minimally invasive treatments using imaging for guidance, will use the following imaging techniques to confirm pelvic varicose veins that could be causing chronic pain.
Pelvic venography: Thought to be the most accurate method for diagnosis, a venogram is performed by injecting contract dye in the veins of the pelvic organs to make them visible during an X-ray. To help accuracy of diagnosis, interventional radiologists examine patients on an incline, because the veins decrease in size when a woman is lying flat.
MRI: May be the best non-invasive way of diagnosing pelvic congestion syndrome. The exam needs to be done in a way that is specifically adapted for looking at the pelvic blood vessels. A standard MRI may not show the abnormality.
Pelvic ultrasound: Usually not very helpful in diagnosing pelvic congestion syndrome unless done is a very specific manner with the patient standing while the study is being done. Ultrasound may be used to exclude other problems that might be causing pelvic pain.
Transvaginal ultrasound: This technique is used to see better inside the pelvic cavity. As with a pelvic ultrasound it is not very good at visualizing the pelvic veins unless the woman is standing. However it may be used to exclude other problems.
Treatment Options
Once a diagnosis is made, if the patient is symptomatic, an embolization should be done. Embolization is a minimally invasive procedure performed by interventional radiologists using imaging for guidance. During the outpatient procedure, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the femoral vein in the groin and guides it to the affected vein using X-ray guidance. To seal the faulty, enlarged vein and relieve painful pressure, an interventional radiologist inserts tiny coils often with a sclerosing agent (the same type of material used to treat varicose veins) to close the vein. After treatment, patients can return to normal activities immediately.
Additional treatments are available depending on the severity of the woman’s symptoms. Analgesics may be prescribed to reduce the pain. Hormones such birth control pills decrease a woman’s hormone level causing menstruation to stop may be helpful in controlling her symptoms. Surgical options include a hysterectomy with removal of ovaries, and tying off or removing the veins.
Efficacy
In addition to being less expensive to surgery and much less invasive, embolization offers a safe, effective, minimally invasive treatment option that restores patients to normal. The procedure is very commonly successful in blocking the abnormal blood flow. It is successfully performed in 95-100 percent of cases. A large percentage of women have improvement in their symptoms, between 85-95 percent of women are improved after the procedure. Although women are usually improved, the veins are never normal and in some cases other pelvic veins are also affected which may require further treatment.
Contact us for consult at 919.677.9729 or email.

PAD is a common circulation problem in which the arteries that carry blood to the legs or arms become narrowed or clogged. This interferes with the normal flow of blood, sometimes causing pain, but often causing no symptoms at all. The most common cause of PAD is atherosclerosis, often called “hardening of the arteries.” Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called “plaque” that clogs the blood vessels. In some cases, PAD may be caused by blood clots that lodge in the arteries and restrict blood flow. Left untreated, this insufficient blood flow will lead to limb amputation in some patients.
In atherosclerosis, the blood flow channel narrows from the buildup of plaque, preventing blood from passing through as needed, restricting oxygen and other nutrients from getting to normal tissue. The arteries also become rigid and less elastic, and are less able to react to tissue demands for changes in blood flow. Many of the risk factors-high cholesterol, high blood pressure, smoking and diabetes-may also damage the blood vessel wall, making the blood vessel prone to diffuse plaque deposits.
PAD Symptoms
The most common symptom of PAD is called claudication, which is leg pain that occurs when walking or exercising and disappears when the person stops the activity.Other symptoms of PAD include: numbness and tingling in the lower legs and feet, coldness in the lower legs and feet, and ulcers or sores on the legs or feet that don’t heal.Many people simply live with their pain, assuming it is a normal part of aging, rather than reporting it to their doctor.
Prevalence
PAD is a disease of the arteries that affects 10 million Americans.PAD can happen to anyone, regardless of age, but it is most common in men and women over age 50.PAD affects 12-20 percent of Americans age 65 and older.PAD Treatments
ClaudicationMore information coming soon.
Lifestyle Often PAD can be treated with lifestyle changes. Smoking cessation and a structured exercise program are often all that is needed to alleviate symptoms and prevent further progression of the disease.
Angioplasty and stenting Interventional radiologists pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease. Using imaging for guidance, the interventional radiologist threads a catheter through the femoral artery in the groin to the blocked artery in the legs. Then he or she inflates a balloon to open the blood vessel where it is narrowed or blocked. In some cases this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip.
Get Tested for PAD If You
Are over age 50Have a family history of vascular disease, such as PAD, aneurysm, heart attack or strokeHave high cholesterol and/or high lipid blood testHave diabetesHave ever smoked or smoke nowHave an inactive lifestyleHave a personal history of high blood pressure, heart disease, or other vascular diseaseHave trouble walking that involves cramping or tiredness in the muscle with walking or exercising, which is relieved by restingHave pain in the legs or feet that awaken you at nightContact us for consult at 630.954.8346 or email.
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Central Venous Access
Dialysis Access Procedures – thrombectomy, fistulagrams, fistula maturation and steal syndromeCentral line placents (powerports, PICCS, groshongs, dialysis/pheresis cathetersVenograms, Venous angioplasty/stentsMore information coming soon.
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Oncologic
Venous AcccessBiopsy (thyroid, liver, soft tissue, bone)Paracentesis, thoracentesisMore information coming soon.

A powerful combination of highly specialized care has arrived…
Welcome to Triangle Interventional Services.
Whether you are a patient or a referring physician, you need to be able to depend on care that is current, safe, effective and tailored to the individual needs of the patient.
At Triangle Interventional Services we provide that kind of care. With board certified and fellowship trained interventional radiologists, we are able to offer a complete range of minimally invasive image-guided vascular and non-vascular procedures.
We are one of the first medical groups in the area to offer interventional radiology procedures located in the outpatient setting. This unique opportunity allows us to keep up-to-date with technological advancements and remain at the forefront of our field. As a result, we offer patients state-of-the -art treatments for the best possible outcomes in a timely and efficient manner. Please read on to learn more about us.
To schedule a consultation, call Triangle Interventional Services at 919.677.9729.