Every question patients ask us, answered by condition.

Not the way it sounds. A fibroid loses its supply and shrinks and softens — that is the point, and the uterus around it keeps its own blood flow. Hemorrhoid cushions shrink but stay. In a joint we use a temporary agent, so the abnormal vessels close, the inflamed lining calms down, and the joint keeps its full supply. Healthy tissue is always fed by more than one route.

Around. Your body has backup routes into every organ — collateral vessels. Block one small branch and the tissue next to it draws from another. The catheter is placed past those branches, so only the target loses its feed.

No. Coils are a few millimeters across and sit inside a vein or artery, well away from any nerve you can feel with. Microspheres are smaller than a grain of sand. Neither is something you can sense once you’ve healed.

Yes. Microspheres and dissolved agents leave nothing that matters to a scanner. Modern platinum coils are compatible with MRI too — we’ll give you a record of exactly what was placed, and you simply tell the imaging center.

No — and we’d rather be exact than vague. Embolization has been a routine hospital tool since the 1970s. Fibroid embolization has been done for thirty years. Varicocele embolization, longer. Joint embolization is the newest use, described in 2015 and now done in centers around the world — and each of our procedure pages tells you plainly how much evidence sits behind it.

No general anesthesia. Most procedures use light IV sedation with a dedicated sedation nurse — you’re comfortable, breathing on your own, and most patients say it feels like a strong margarita and wears off fast. Some vein procedures use a slightly deeper “twilight” sedation. Either way, you go home the same day.

Live X-ray is used in short pulses only while the catheter is being placed and the agent released — the same kind of imaging used for heart catheterizations every day. We keep the dose as low as we can and shield what isn’t being treated. Your physician can talk through the specifics for your procedure.

It depends on the agent — and now you know which is which. Microspheres and coils stay, permanently and inertly. The slurry we use in joints dissolves within the hour. Gelatin sponge and sclerosant foam are absorbed. The table above shows what we typically use for each procedure.

GAE is done by interventional radiologists — a different specialty with a different referral network. Nobody hid it from you; it just lives outside the surgical world you’ve been seeing. The research is published in journals surgeons and radiologists both read, and we’ll gladly share it with your doctor.

You’re awake but sedated, and most patients describe pressure more than pain. Some feel an ache like their arthritis during the procedure — interestingly, that’s often a sign the right vessels are being treated. Expect some soreness for a few days afterward.

Most responders notice improvement within the first few weeks, with the full effect by about three months.

Three ways. It’s covered by most insurance — stem-cell shots usually aren’t. It has a randomized controlled trial behind it. And we’ll tell you if you’re not a candidate.

Then you’ve lost nothing but a short recovery. Every other option — injections, a repeat GAE, or a replacement — remains fully open.

Yes. GAE doesn’t change the anatomy a surgeon works with, and in the published trials it added no difficulty to later surgery.

Possibly. About 1 in 5 knee replacement patients report dissatisfaction afterward, most often from persistent pain tied to inflammation of the joint lining — the same inflamed tissue GAE targets. The first step is making sure the implant itself is stable; that’s a question for your surgeon and imaging, and we won’t treat over an implant problem. If the implant is solid and the lining is inflamed, embolization may be an option worth discussing — early published studies in patients with pain after a knee replacement report meaningful improvement. We built a full page for exactly this situation: GAE after knee replacement.

No dinner seminar. No sales pitch. A doctor reviews your imaging and history, examines your knee, and tells you plainly which treatment — ours or someone else’s — fits your situation. Then you go home and decide. We do a complimentary benefits check before any procedure. No surprises.

No. GAE has been studied for more than a decade, including randomized sham-controlled testing — the same placebo standard used for medications — with results published in the major radiology and orthopedic journals. And it passes the test skeptics rightly apply to new procedures: it’s covered by most insurance, including Medicare. Insurers don’t cover marketing hype.

You’re under IV sedation — an anti-anxiety medicine plus pain medicine — relaxed and drowsy, breathing on your own. Not general anesthesia: it’s light, and most patients say it feels like a strong margarita and wears off fast. Most patients describe pressure rather than pain. Some feel an ache like their arthritis while the vessels are treated — often a sign the right ones are being blocked. In the British trial, patients rated their anxiety and pain during the procedure as low, and said they’d be open to having it again.

The procedure itself typically takes about 45 minutes, and you rest with us for 30 to 45 minutes afterward — purely for observation. Plan on being at our office three to four hours all told, prep included — then home, the same day. A morning, not a hospital stay.

You’ll walk the same day — we get you moving early on purpose. You can get back to your normal daily activities, to tolerance, right away — just no lifting over 50 pounds for at least 48 hours. Driving waits until the next day: the sedation means you’ll need a driver to take you home, no exceptions.

Not beads, and nothing permanent. We use a slurry of temporary microscopic crystals — a medication mixed with X-ray dye — that blocks the abnormal vessels and then dissolves into the bloodstream within 30 to 45 minutes. In the study that compared temporary crystals head-to-head against permanent beads in knees, relief at two years was just as good. The full story is on the GAE page.

Relief builds over weeks, not minutes. Improvement comes gradually over the first four to six weeks, with the full effect, in the trials, by about three months. That’s not a numbing agent wearing off — it’s inflamed tissue, cut off from its supply line, calming down.

The transparent answer: of patients who responded at one year, about seven in ten still held at least half their improvement at two years — and in the longest study, about eight in ten responders were still doing well at three. Only about 1 patient in 20 went on to a knee replacement within two years. Some patients choose a repeat treatment when appropriate. Nobody can promise your knee a number — we can promise you the real ones before you decide.

Yes — in the pooled studies about 1 patient in 12 chose a repeat within two years, and a repeat can be considered when appropriate. And if you instead choose a knee replacement later, GAE won’t have made that surgery harder — in the British trial, every later replacement went normally.

More than 700. That’s exactly the right question, by the way — patient communities researching GAE tell each other to ask it, and we’d encourage you to ask it of any doctor recommending any procedure. We’ll never be offended by it.

Yes — GAE is covered by most insurance plans, including Medicare. And we still do a complimentary benefits check before any procedure, so there are no surprises: you’ll know exactly where you stand before you decide anything.

About one patient in five still has pain after a knee replacement. A replacement resurfaces the joint — metal and plastic where cartilage used to be — but it doesn’t remove the joint’s soft lining. In some knees that lining stays inflamed after surgery, keeps its web of abnormal blood vessels and pain nerves, and keeps hurting. That inflamed lining is the tissue GAE treats.

No. X-rays are the right tool for checking the implant and the bone — and a clean X-ray is genuinely good news. But X-rays don’t show the joint’s soft lining or its blood supply. An angiogram does — and in knees like the ones pictured on our post-replacement page, it shows a dark blush of abnormal vessels feeding the inflamed lining around the implant. The pain is physical, and it has an address.

Yes — and we mean it. The replacement must be cleared first: no loosening, no infection, no alignment or wear problem. That workup belongs to your surgeon, with imaging and sometimes lab work, and we coordinate with them rather than working around them. We won’t treat over an implant problem — if your knee needs revision surgery, embolization is not a substitute for it.

The procedure doesn’t involve the implant at all. GAE happens inside the small soft-tissue arteries around the joint — the catheter never enters the joint space, the implant, or the bone it’s fixed to. The blocking agent is a slurry of temporary crystals that dissolves within 30 to 45 minutes. Nothing is implanted, and nothing permanent stays in your body.

No. GAE has been studied for more than a decade, including randomized sham-controlled trials, and is covered by most insurance — the full record is here. In patients with pain after a knee replacement, published studies report meaningful improvement, and the two patients shown on our post-replacement page are exactly why we offer it: for most people in this situation, there is no other option left short of another operation.

The same day as any GAE at ARVC: IV sedation (not general anesthesia), a pinhole in the upper thigh, about 45 minutes on the table, 30 to 45 minutes of observation, then home the same day with your driver. Plan on three to four hours all told. The step-by-step walkthrough on our post-replacement page covers the details, down to the instruction sheets you’d take home.

Then that’s what we’ll tell you — before you spend a dollar with us. GAE is not a substitute for a needed revision, and the stability workup exists precisely to catch that. And if you ever need surgery later, embolization doesn’t change the anatomy a surgeon works with — in the British trial, every knee that went to surgery after GAE had a normal operation.

GAE is covered by most insurance plans, including Medicare — and we do a complimentary benefits check before any procedure, so there are no surprises. You’ll know exactly where you stand, medically and financially, before you decide anything.

More than 700 genicular artery embolizations — including patients whose pain came after a knee replacement. The angiograms on our post-replacement page are from one of them. That’s exactly the right question to ask any doctor recommending any procedure, and we’ll never be offended by it.

Then you’ve lost nothing but a short recovery. Nothing about the embolization closes a door: every option — injections, a repeat embolization when appropriate, or revision surgery if it’s ever truly indicated — stays open. And we’ll tell you transparently before the procedure if we think you’re unlikely to benefit.

Two honest possibilities. One: the shot missed — blind injections sometimes land outside the joint space, and a gel shot that misses can’t work. Ours are confirmed by live X-ray before the gel goes in. Two: your knee may be past the point where gel helps. If that’s the case, we’ll tell you — and talk with you about treating the inflamed lining of the knee instead. Either way, you’ll leave with an answer instead of another guess.

Far less than most people fear. We freeze the skin first with a numbing cold spray — honestly, most patients say the cold spray is the most uncomfortable part. The needle stick itself is quick. Dr. Persyn has performed more than 100,000 knee injections, and that kind of practice shows up in your comfort. The live X-ray helps too: because we can see the bony landmarks, the needle goes where it should and nowhere else — which means less pain, less bruising, and less swelling than an injection placed by feel. Everyone’s different, and some soreness afterward is normal. But almost every patient tells us it was easier than they expected. And if needles genuinely terrify you, say so — we’ll take it slow.

For most people, about three to six months per course — sometimes longer. In a randomized trial, the benefit of a single series was still measurable at six months. Treatment can be repeated in six months when appropriate. We’ll tell you plainly what to expect for your knee — and if we don’t think it will help, we’ll say that instead.

Yes — gel injections for knee arthritis are covered by most insurance plans, including Medicare. We do a complimentary benefits check before any procedure, so you’ll know exactly where you stand. No surprises.

Gel treatment is a short series — one quick visit a week for a few weeks. That’s how the treatment is designed to work: the gel builds in the joint across the series, and the published research ties the full series to the strongest results. Most patients feel the difference building by about the third injection. We’ll map out the exact schedule at your consultation.

No. Gel injections are an established, insurance-covered treatment. PRP is a different thing — made from your own blood, cash-pay rather than covered, with real but mixed research behind it. We offer PRP too, when it’s genuinely worth it, and we’ve published our transparent take — including the price and when we’d say no — on its own page. The truth about PRP → Stem cells and amniotic products we’ve chosen not to sell. And unlike the clinics running seminar ads, we’ll tell you when an injection is not worth your money.

Sometimes. Early randomized research suggests the two together may work better than either alone — they do different jobs in the joint (the gel is the cushion; PRP calms the inflammation). The gel portion is covered by most insurance; the PRP portion is cash, at a price we publish. Whether the combination fits your knee is a consultation conversation. How we combine them →

Same treatment. The original gel was purified from rooster combs, which are naturally rich in hyaluronic acid. Most modern versions are made in a lab. The nickname stuck.

Usually, yes. Some gels are still made from rooster combs — a real concern if you have an allergy to eggs, feathers, or poultry. Others are made by fermentation, with nothing avian in them, and we offer those non-avian options. Tell us about any allergy at your consultation and we’ll choose accordingly.

Different jobs. Cortisone calms inflammation during a flare — it works fast, but the relief typically fades within weeks. Gel replaces the thinned fluid that’s supposed to cushion the joint — it builds more slowly and lasts months. Some knees need one, some the other, some both at different times. That’s a consultation conversation, not a menu.

Then you’re exactly the patient the rest of our practice exists for. We perform genicular artery embolization (GAE) — it treats the inflamed lining of the knee itself, and it’s not an injection into the joint at all. Injections close no doors here.

Same idea, different address. Genicular artery embolization (GAE) treats the abnormal vessels around an arthritic knee; SAE does the same for the shoulder. The knee version has the deeper research record; the shoulder version uses the identical technique and the same team. Knee Pain & Arthritis →

Depends on the tear. A complete, full-thickness tear is a structural problem — embolization won’t fix it, and the studies excluded it. Partial tears and tendon irritation (tendinopathy) are a different story: chronic inflammation is often a big part of that pain, and it’s exactly what we treat. Bring the MRI; we’ll give you a straight answer.

Guidance. An unguided shoulder injection is aimed by feel, and shoulder anatomy makes “by feel” hard to place precisely. Every ARVC injection is image-guided to the target. Same medication, very different confidence about where it went — and injections that land work better than injections that almost land.

Because it quiets the inflammation without touching what’s feeding it. The abnormal vessels are still there when the medication fades, so the loop restarts. That pattern — relief that shrinks with each shot — is often the signal that it’s time to talk about the next rung.

The studies ran from patients in their 20s to their 80s. Age matters less than what’s driving the pain. “Too young for a replacement” is precisely the situation SAE exists for — the years between “come back when it’s worse” and surgery don’t have to be endured untreated.

Injections are broadly covered. (PRP is the exception — it’s typically cash-pay, and we will tell you plainly when it’s worth considering and when it’s not.) Embolization is covered under most plans too, including Medicare and Medicaid. And the standing promise still holds: we do a complimentary benefits check before any procedure. No surprises.

It’s new to most patients — not to the research. The first shoulder-embolization study was published in 2014; since then, studies in Japan, Spain, and the U.S. — including a trial run under FDA oversight — have reported the same pattern: less pain, better motion, no major complications. What doesn’t exist yet is a large randomized trial, and we’ll be straight with you about that. The technique itself — blocking abnormal vessels through a catheter — has been used for decades elsewhere in the body, including the knee-arthritis program we run every week.

You’ll be under twilight sedation — relaxed, drowsy, and breathing on your own, with a dedicated sedation nurse monitoring you the entire time. Most patients remember little or nothing of the procedure. It’s not general anesthesia: no breathing tube, and a much quicker recovery — which is part of why you can go home the same day.

Relief builds over weeks, not minutes. In the U.S. trial, average pain scores had fallen by more than half within the first month, and kept improving through six months. In the longest-running series, night pain was the component that improved most. And because the shoulder calms down, gentle physical therapy — the kind that felt unbearable before — often becomes possible again. That’s when motion comes back.

The published series treated patients in a single session — every abnormal cluster found gets treated the same day — and reported no symptom recurrence at final follow-ups, the longest running four years. That’s encouraging, and it’s also the young part of the evidence. We won’t promise “once and done” — we’ll show you the data and let it speak.

In the 2026 meta-analysis pooling 329 treated shoulders, no severe adverse events were reported. Minor, temporary effects included small patches of skin discoloration (about 1 in 3 patients in the permanent-particle U.S. trial — gone within three months), soreness at the wrist, and a temporary deep ache in the shoulder afterward. The dissolving agent we use is the gentler analogue: one minor, passing side effect in twenty patients in the longest series. It’s still a medical procedure — catheter procedures carry rare risks we review with you in plain language before you decide anything.

At ARVC: frozen shoulder, shoulder arthritis, and chronic tendonitis. The strongest published evidence is in frozen shoulder; for arthritis and tendonitis the shoulder-specific studies are younger, and the strongest supporting evidence comes from the same procedure in the knee. Your consultation starts with which condition you actually have — our pain-management specialists work that up first, and the answer decides everything that follows.

Yes, and you deserve to know them. No randomized trial exists yet. And one small French study reported poor results — it used much larger, permanent particles in patients who had been symptomatic for years, most after failed surgery. That study is why technique details matter: the successful series used the small or dissolving agents we use, in patients treated before years of scarring set in. It’s also the honest argument against waiting: every option works worse after years of delay.

It’s new to most patients — not to the research. The first frozen-shoulder embolization study was published in 2014; since then, studies in Japan, Spain, and the U.S. — including a trial run under FDA oversight — have reported the same pattern: less pain, better motion, no major complications. What doesn’t exist yet is a large randomized trial, and we’ll be straight with you about that. The technique itself is the same one used for decades elsewhere in the body — including the knee-arthritis program we run every week.

Embolization is performed by interventional radiologists — a different specialty, a different referral network. Most orthopedic treatment plans are built from the options orthopedics itself offers. Nobody hid anything from you; the option just lives in a different building. (You found it anyway.)

The studies treated people in the painful and stuck phases — most had been symptomatic for close to a year. Night pain and inflammation are the procedure’s targets, so the pain-dominant phases are the sweet spot. Where you are in the arc is one of the first things we sort out at consultation.

Honest answer: diabetic patients in the studies improved, but less completely than non-diabetics, and some needed additional treatment later. You’ll get the candid version of what that means for your case — not a brush-off, and not a sales pitch.

In the published series, no symptom recurrence had been reported at final follow-ups — the longest ran four years. That’s encouraging, and it’s also the young part of the evidence: nobody has 15-year data yet. If anyone promises you “permanent,” be careful.

Across all 127 published patients: no major complications. Minor, temporary effects included small patches of skin discoloration (about 1 in 3 patients in the U.S. trial — gone within three months), soreness at the wrist, and a temporary deep ache in the shoulder afterward. It’s still a medical procedure — catheter procedures carry rare risks we review with you in plain language before you decide anything. One reassurance worth repeating: the embolic we use is temporary — it dissolves into the bloodstream within 30 to 45 minutes, so nothing permanent stays in your body.

Yes — we encourage it. In several studies patients resumed gentle, guided PT within days of embolization. Think of it this way: embolization quiets the pain and inflammation; therapy then restores the motion. The two work better together than either alone.

Yes — SAE is covered under most insurance plans, including Medicare and Medicaid. And we still do a complimentary benefits check before any procedure, so there are no surprises: you’ll know exactly where you stand before you decide anything.

Same idea, different address. Genicular artery embolization (GAE) treats the abnormal vessels around an arthritic knee; hip embolization does the same for the hip. The knee version has the most research behind it; the hip uses the identical technique, the same temporary blocking agent, and the same team — and in our experience the results track. Knee Pain & Arthritis →

Where it hurts, what makes it worse, and what we find when we press. Pain in the groin or the front of the hip — stiff after sitting, worse putting on socks — is usually the joint. Pain on the outside of the hip that’s tender to the touch and won’t let you lie on that side is usually trochanteric bursitis. Pain in the buttock that runs down the leg may be your back, not your hip at all. Then imaging confirms it — X-ray, and sometimes MRI or ultrasound. Often it’s some of both, which is one reason a hip that’s been “treated for bursitis” three times can still hurt.

That pattern is the signal. Cortisone quiets the inflammation without touching what’s feeding it — the abnormal vessels are still there when the medication fades, so the loop restarts, usually a little sooner each time. For bursitis that’s severe and keeps returning, hip embolization goes after the supply line itself — and patients exactly like that are who the published bursitis series were built on. Bring your history; we’ll tell you if you’re there.

Because the hip joint sits deep, under muscle, and there is no reliable way to reach it by feel. Guidance means the medication lands in the joint — or precisely at the bursa and tendon — instead of somewhere near it. It also tells us something: if numbing the joint takes the pain away, the joint was the source. If it doesn’t, we keep looking rather than treating the wrong thing.

Maybe — and if that’s the honest answer, you’ll hear it from us. Total hip replacement is one of the most successful operations in medicine. If your arthritis is advanced, you’re a good surgical candidate, and you’re ready, that’s usually the right road. What we treat is everyone who isn’t there yet: not advanced enough, not safe for surgery right now, or not ready — and everyone whose problem is bursitis, which a replacement was never going to fix. And embolization doesn’t burn the bridge: in the published series, the few patients who didn’t respond went on to have a replacement afterward.

The published hip studies were mostly patients in their 60s and 70s — and one was built entirely on patients over 60 whose health ruled surgery out. Age matters less than what’s driving the pain. “Too young for a replacement” is precisely the situation this procedure exists for — the years between “come back when it’s worse” and surgery don’t have to be endured untreated.

Sometimes. Step one is always the implant: it has to be confirmed sound — not loose, not infected, not out of position — before we would consider treating inflammation around it. That’s your surgeon’s call and it comes first. If the implant is fine and the pain is inflammatory, it’s something we evaluate. We do the same for knees →

Injections are broadly covered. (PRP is the exception — it’s typically cash-pay, and we will tell you plainly when it’s worth considering and when it’s not.) Hip embolization is covered by most plans too, including Medicare. And the standing promise still holds: we do a complimentary benefits check before any procedure. No surprises.

It’s newer, and it’s real. Five published series — all patients with hip arthritis or bursitis that had failed conservative care — saw average pain fall from about 7 or 8 out of 10 to about 4, with relief that held for as long as they were followed and no serious complications. The technique — blocking abnormal vessels through a catheter — has been used for decades elsewhere in the body, and it’s the same one our doctors use every week for knees and shoulders. The hip research is newer and smaller than the knee’s; the early studies show it’s safe and effective, and we’ll always tell you that.

You’ll be under twilight sedation — relaxed, drowsy, breathing on your own, with a nurse watching you the entire time. It’s not general anesthesia: no breathing tube, and a much quicker recovery. The pinhole in the groin is numbed first, and a brief pinch is the only thing you should feel — blood vessels themselves have no pain nerves. Most people describe pressure rather than pain, and go home the same day with mild bruising in the groin.

Weeks, not days. Relief builds as the inflammation settles, and a brief flare in the first few days is normal. In the published series, improvement was measured as early as six weeks and continued through three, six and twelve months. If you’re expecting to wake up fixed, this isn’t that — and we’d rather say so now.

Across the published hip series, no serious complications have been reported. The side effects were groin bruises, a temporary patch of thigh numbness, and a brief patch of skin discoloration — all cleared on their own. It’s a safe, well-tolerated procedure. Every catheter procedure carries a small risk of bruising or bleeding at the pinhole and of a reaction to contrast dye. One thing careful people ask about the hip specifically: the ball of the hip joint has its own delicate blood supply, which is one reason a temporary agent matters — in the largest hip-arthritis series, there was no damage to it. If you have significant artery disease in the leg or a serious contrast allergy, this may not be for you — and we review the rare risks with you in plain language before you decide anything.

Both-hip cases were treated in the published series. Whether to do them together or one at a time is something we’d decide with you.

Then you’re where you were, minus a day — nothing was cut, nothing permanent was left behind, and every other option is still on the table, including a replacement. In the published series, the few patients who didn’t respond went on to have one afterward. That’s the honest answer, and it’s a real part of the decision.

Almost certainly not. In the study that followed 174 patients for up to 15 years, having a spur made no difference to who got better. Plenty of people with a spur have no pain at all. The spur is a bystander; the attachment is the problem.

One injection: very unlikely. Across the randomized trials, no ruptures occurred. The risk that shows up in clinic reviews attaches to repeated injections. It’s a reason to be careful about the third and fourth shot — not to refuse the first.

The trials don’t show custom beating off-the-shelf at any point out to a year. Try a store-bought insert first. If a $60 version helps, a $600 version is unlikely to help more — and if you’ve already spent the money and felt let down, the research agrees with you.

The pinhole is numbed; most people describe pressure rather than pain, and go home the same day with mild bruising. Then: weeks, not days. In the published series, improvement was measured at one month and kept improving through three and six. We’ll give you a date to check in and a plan for what happens if it’s not working.

Then you’re where you were, minus a day — nothing has been cut, nothing permanent was left behind, and surgery is still on the table. Occasionally a second session is what’s needed, and we’d talk that through with you.

Because it’s a catheter procedure, and most foot specialists don’t do those. Embolization is what interventional radiologists do — blocking abnormal blood vessels that feed inflamed tissue — and it’s only in the last few years that it’s been applied to the heel. The studies are recent, the results are consistent, and the people who tend to hear about it are the ones who’ve run out of other things to try. That’s exactly who it’s for.

Bilateral cases are treated in the published series. We’d discuss timing with you — and both feet get their own ultrasound, because both have to show the target.

Hands-on therapy and cortisone usually are, and embolization is typically covered by insurance. PRP isn’t — $900 per injection, cash, at our published price. Either way we don’t guess: we do a complimentary benefits check before any procedure, usually the same day as your consultation, so you know your number before you decide anything. If we don’t think a treatment is worth your money, we’ll tell you that in the room.

It’s newer, and it’s real. Four published series — roughly 120 patients in four countries, all with heel pain that had failed conservative care — saw pain fall from 7 or 8 out of 10 to about 1 to 3, with relief that held and no serious complications. The technique — blocking abnormal vessels through a catheter — has been used for decades elsewhere in the body, and it’s the same one our doctors use every week for knees and shoulders. The heel research is newer than the knee’s; the early studies show it’s safe and effective, and a US study is under way.

You’ll be under twilight sedation — relaxed, drowsy, breathing on your own, with a nurse watching you the entire time. It’s not general anesthesia: no breathing tube, and a much quicker recovery. The pinhole is numbed first. Most people describe pressure rather than pain, and go home the same day with mild bruising at the top of the thigh.

Weeks, not days. In the published series, improvement was measured at one month and continued through three and six. Relief builds as the inflammation settles. If you’re expecting to wake up fixed, this isn’t that — and we’d rather say so now.

Across everything published, no serious complications have been reported — no tissue death, no ulcers, no ruptured fascia. It’s a safe, well-tolerated procedure. Every catheter procedure carries a small risk of bruising or bleeding at the pinhole and of a reaction to contrast dye. If you have peripheral artery disease, poor circulation in the foot, or an iodine contrast allergy, this is likely not for you — and we review the rare risks with you in plain language before you decide anything.

The picture on our plantar fascia embolization page is from one of our own cases. The artery runs down the inside of the ankle to the heel, and the dark, tangled blush around the heel is the abnormal blood supply feeding the inflamed attachment. That’s the target. Once the temporary agent goes in, that blush fades while the normal arteries to your foot keep flowing. The outcome we care about afterward isn’t the picture, though — it’s whether you can walk the dog. That’s what we’ll ask you about.

Almost certainly not. In that same ten-year study, having a spur made no difference to who got better. Plenty of people with a spur have no pain at all. It isn’t what this procedure treats, and it isn’t why your heel hurts.

One image-guided injection to break a bad patch is a defensible thing to accept — across the randomized trials, no fascia ruptures occurred after a steroid shot; the risk that shows up in clinic reviews goes with repeated injections. A fourth shot into tissue that hasn’t responded to three is a different conversation, and it’s one we’ll have honestly.

Yes — platelet-rich plasma (PRP): your own blood, concentrated and injected into the damaged tissue under ultrasound guidance. For some people it’s the right step before any catheter procedure, and we’ll say so. It isn’t covered by insurance — $900 per injection, and we’d rather print the price than surprise you with it. Which tool fits your foot, if either, is an exam conversation, not a menu item.

Both-feet cases were treated in the published series. Whether to do them together or one at a time is something we’d decide with you.

No. PRP is not covered by insurance, but we will tell you plainly when it’s worth considering and when it’s not. We’re an insurance-based practice — most of what we do is covered — so PRP has to earn its recommendation against covered options, not against a sales quota.

$900 per injection. If your plan calls for more than one, each additional injection is discounted — and you’ll know the exact total before anything is scheduled. No packages, no pressure.

Because the research, while real, is mixed — trials used different preparations, doses, and techniques, so results vary from study to study. Insurers wait for that to settle. It’s a fair standard, and it’s also why we’ll tell you honestly whether the research fits a joint like yours before you pay anything.

No — and the difference matters. PRP is concentrated platelets from your own blood, drawn the same day. Nothing else is offered here: no stem cells, no amniotic products. Those categories carry weaker evidence and heavier marketing, and we’ve chosen not to sell them.

They’re different shapes of relief. Cortisone is fast and temporary — it calms a flare in days and typically fades in weeks. PRP builds over weeks and, in published trials, lasts months; in a pooled analysis of eight randomized trials, PRP showed superiority over cortisone at six and nine months. Cortisone is covered by insurance; PRP isn’t. If you need to get through your daughter’s wedding next month, cortisone might be the right call — and we’ll say so. If you’re tired of re-buying the same three weeks of relief, that’s the patient PRP was studied for.

A straight answer: it depends on where the injection goes. Into a joint — a knee or a shoulder — it’s more comfortable: most patients feel pressure more than pain, because the joint has space to receive the fluid. Into a tendon — tennis elbow, for example — it can genuinely ache. A tendon has no open space to receive fluid, so the tendon feels the volume as it goes in, and for those moments the ache can be significant.

We’ll numb the area before the injection, and we’d rather tell you about the uncomfortable part up front than have it surprise you. Soreness for a day or two afterward is part of how the treatment works.

PRP builds gradually — it’s signaling your body, not numbing the joint, so most patients notice change over weeks, not days. In published trials, relief typically lasts six months to a year. Treatment can be repeated when appropriate.

Sometimes — early randomized research suggests the combination may work better than either alone, because they do different jobs in the joint. The gel is typically covered by insurance; the PRP portion isn’t. We’ll lay out both parts of that math at your consultation.

We’ll be straight with you: probably not. The research consistently shows PRP does least for the most worn joints. If that’s your knee, we’d rather talk about genicular artery embolization — a covered procedure that treats the inflamed lining of the knee, and doesn’t depend on how much cartilage is left.

Ask both of us the same three questions. What’s in the syringe? What does the published research show for a joint like mine? And when would you tell me not to do this? We’ll answer all three in plain language, with the studies on the table. A transparent “no” costs us an injection fee. It’s also the reason our “yes” means something.

Typically, yes — steroid and numbing-medicine injections into joints, tendons, bursae and trigger points are routine, covered care under most plans, including Medicare. Zilretta is covered by most plans too; a few don’t cover it, and where a plan wants prior authorization first, we handle it. Either way, our complimentary benefits check tells you where you stand before anything is scheduled. PRP is the exception among the injections we offer — it is not covered by insurance, and we say so plainly.

No. You can call us directly — no referral or prior authorization is needed for your initial consultation. If you already have X-rays, an MRI or notes from another doctor, bring them; if not, we’ll get what we need.

A straight answer: it depends on where the injection goes. We freeze the skin first with a numbing cold spray, and for most joint injections the stick is quick — pressure more than pain. Tendon injections, like tennis elbow, genuinely ache for a few moments, because a tendon has no open space to receive fluid. We’d rather tell you that now than have it surprise you. Dr. Persyn has performed more than 100,000 knee injections, and that kind of practice shows up in your comfort. If needles genuinely scare you, say so — we’ll take it slow.

Because small is the point. In a review of injection accuracy across the major joints, the biggest improvement from image guidance was in the small joints of the hand and foot — the ones a needle placed by feel most often misses. A big knee is forgiving; a thumb joint, an AC joint or a wrist tunnel is not. Imaging turns “probably in” into “confirmed in” before the medicine goes anywhere. (The one exception is trigger points, which are found and treated by feel — that’s the correct technique for a muscle knot.)

We space them out — commonly no more often than every few months in the same spot, and for Zilretta we prefer about once every six months — because repeated steroid isn’t kind to tendon or joint tissue over time. If you find yourself needing the same shot again and again, that’s useful information: it means it’s time to talk about the next option rather than re-buying the same few weeks of relief.

Zilretta is the same steroid as a regular cortisone shot, packaged in slow-dissolving microspheres so it stays in the knee and releases over months instead of days. It’s FDA-approved for arthritis pain of the knee. In its main trial it clearly beat placebo, but on the primary head-to-head measure against ordinary cortisone the difference wasn’t statistically significant — we won’t oversell that. We’ve used it here for about seven years, and in our experience it is simply the better steroid option for an arthritic knee: it doses the joint slowly, and the relief typically runs three to six months instead of a couple of weeks. The full discussion is on our joint injections page.

Usually, with a plan. A standard steroid injection raises blood sugar for a few days, so we’ll ask about your control and suggest checking more often afterward. For the knee, Zilretta is the steroid we recommend for diabetic patients — it was designed to keep the steroid in the joint and out of the bloodstream, and in a randomized study of diabetic patients it raised average blood sugar much less than a standard cortisone shot. Tell us you’re diabetic at your consultation and we’ll choose accordingly.

No. Trigger point injections treat muscle knots, not the spine, and we don’t perform epidurals or other spinal injections. We do treat SI joint pain with image-guided injections and radiofrequency ablation, and spinal compression fractures with kyphoplasty — those have pages of their own.

Then you’ve learned something, and so have we. Sometimes it means the pain has another source, and the exam and imaging point us there. Sometimes it means the joint or tendon has moved past what a steroid can do — and that’s exactly where the rest of this practice comes in: PRP for stubborn tendons, gel injections, Zilretta and GAE for arthritic knees, and embolization for shoulders, hips and heels. Injections close no doors here.

Yes. These are office injections with a numbing spray — no sedation, no driver needed. Plan on a quiet day or two, and you’re otherwise free to get on with things.

Close cousins. Both put medical cement into a broken vertebra through a needle. Vertebroplasty injects the cement directly. Kyphoplasty first inflates a small balloon inside the collapsed bone to open a space, then fills that space — which lets the cement go in gently, under lower pressure. Head to head, the two relieve pain about equally; in a 2,838-patient comparison, kyphoplasty had fewer cement leaks and corrected the wedge angle better. We perform balloon kyphoplasty.

We’ve seen that number too, and we won’t repeat it. In the best blinded trial, 44% of treated patients reached mild pain at two weeks, versus 21% after a placebo procedure. That’s more than twice as likely — and it is not 90%. Kyphoplasty is a real option with real evidence for the right patient. It is not a guarantee, and anyone who tells you otherwise is selling.

Sooner than most people are told — and there’s a physical reason, not just a statistical one. A broken vertebra starts healing and scarring right away; within about six weeks it has begun to harden into its collapsed shape, and the balloon can no longer re-open it. Past that point kyphoplasty is unlikely to change the shape of the bone, and the pain is usually easing on its own anyway. The trials line up with that: VAPOUR enrolled only fractures under six weeks old, and a 2025 meta-analysis found better pain relief when kyphoplasty was done within four weeks. That doesn’t mean panic. It means: don’t let a fresh, severe fracture drift for months on a “come back in six weeks” plan without at least asking. If your pain is already improving week to week, waiting is reasonable. If it isn’t, call — this week, not next month.

Studies have not found a higher risk. A 2024 analysis of 23 randomized trials found no difference in next-level fractures after kyphoplasty compared with letting the fracture heal on its own. What is true is that people who fracture once tend to fracture again — because of the osteoporosis, not the cement. That’s why treating the bone is part of every plan we make, procedure or not.

It can — if it’s done early. While the crushed bone is still soft, the balloon re-opens the collapsed vertebra, and the cement holds it there: in the FREE trial, kyphoplasty patients regained 27% of the vertebra’s front height and 3.3 degrees of the wedge angle, and were still holding it two years later. In VAPOUR, treated patients kept 30% more height than untreated ones — nearly half of whom lost more height over the following six months. Once the bone has hardened, usually by about six weeks, that chance is largely gone. What that means for how you stand depends on how many levels are involved and how early we treat, so we won’t promise you a number in the mirror — but restoring the broken bone’s shape, not just numbing it, is part of the point.

Yes. Compression fractures caused by cancer weakening the bone — myeloma, or a tumor that has spread to the spine — can also be stabilized with kyphoplasty; the multi-society position statement on vertebral augmentation covers both osteoporotic and cancer-related fractures. We coordinate with your oncology team, and the goal is the same: pain relief and getting you moving. Bring your reports.

Every procedure carries risk, and we’ll go through yours specifically. Across the randomized trials, major complications occurred in fewer than 1% of patients, with no procedure-related deaths. The most-discussed risk is cement leaking outside the bone; small leaks are common on a CT scan and almost never cause symptoms, and kyphoplasty’s balloon lets the cement go in at lower pressure, which means fewer leaks than the older technique. Infection and bleeding are uncommon. Location does matter — some levels are technically harder to reach — which is exactly what the imaging review is for. If a level isn’t safe to treat, we’ll say so rather than treat it. And rest isn’t risk-free either: weeks in bed at this age cost bone, muscle and lung function.

Age by itself isn’t the deciding factor — the trials that tested this were done in older adults with osteoporosis, because that’s who gets these fractures. What matters is whether the fracture is fresh, whether the pain is severe, and whether her health allows moderate sedation. If anything, for someone frail the case for getting her upright and moving sooner is stronger, not weaker: weeks in bed at 84 carry their own risks. And yes — you can call on her behalf. We’ll talk with both of you.

Yes. Cement stabilizes one bone; it does nothing for the rest of them. A DEXA scan, a T-score and a bone medicine that fits you belong in the plan whether or not you have kyphoplasty. If nobody has raised it, we will — and we co-manage your osteoporosis with a rheumatologist or your primary care physician, so it actually gets treated.

Yes — kyphoplasty is covered by insurance. Plans generally want to see a fracture confirmed on imaging and significant pain that hasn’t settled with conservative care; we handle that paperwork. And here’s the standing promise: we do a complimentary benefits check before any procedure. No surprises. How insurance and costs work here →

For many people, that’s the right call — and if your pain is improving week to week, we’ll tell you so. The evidence for kyphoplasty is weakest for older fractures that are already healing. What we don’t want is the other version: severe pain, not moving, losing ground for months, and then asking about it after the window has narrowed. If it’s fresh and it’s bad, have the conversation now.

You’re given moderate sedation through an IV — relaxed and comfortable, breathing on your own, no general anesthesia — and the skin over the fracture is numbed before anything else happens. You lie face down, covered, for the procedure. Most people remember very little of it. Afterward, some soreness where the needles went in is normal for a day or two; the fracture pain itself is what most people notice easing first.

The procedure itself usually takes about 60 to 90 minutes. Afterward you spend about an hour in recovery, you walk before you leave, and someone drives you home. Plan on a few hours with us all told — prep, procedure and recovery — then home the same day. It’s done in our own IR suite, in our office; there is no hospital stay.

Often quickly. The fracture stops moving the moment the cement sets, and many people notice a difference within the first day or two. In one randomized trial, every treated patient was up and walking within 24 hours, against 2% of those managed with rest and medication. The trials measured the improvement formally at two weeks and at one month — in VAPOUR, 44% of treated patients had reached mild pain at two weeks, against 21% after a placebo procedure — and the advantage held at six months. Not everyone gets there, and we’ll be honest about that at the consultation.

Medical bone cement — PMMA, an acrylic cement that has been used to anchor hip and knee replacements for decades. It goes in as a thick paste and hardens within minutes; in the trials the average amount was about a teaspoon and a half per vertebra. Yes, it stays. It sets inside the bone and holds the fracture the way a cast holds a wrist — from the inside, permanently. Unlike our embolization procedures, nothing here dissolves; that’s the point.

It’s the most-discussed risk, so here is the honest version. Small leaks of cement outside the bone are common when you go looking for them on a CT scan and almost never cause symptoms. Across the randomized trials, a leak needing surgery happened in one patient, and major complications of any kind occurred in fewer than 1% of patients, with no procedure-related deaths. Kyphoplasty’s balloon opens a space first, so the cement goes in at lower pressure — which is why kyphoplasty has fewer leaks than the older technique. Location matters too: some levels are technically harder to reach, which is exactly what the imaging review is for. If a level isn’t safe to treat, we’ll say so rather than treat it.

Often, yes. The trials enrolled people with one to three fresh fractures — VAPOUR one or two, FREE up to three. Whether yours are treated in one session or more than one depends on how many levels are involved, where they are, and how you’re doing — a decision we make with you from the MRI, not a rule.

Because the MRI was probably of your lumbar spine, and the SI joint sits next door. Even when the SI joint is imaged, a worn joint can look ordinary, and a normal-looking joint can hurt. That is why the joint is diagnosed by numbing it, not by looking at it. Bring the scan anyway; it helps us rule other things out.

It could, and you would be in familiar company. One of the most common patients in any SI joint clinic is the person whose spine has already been treated, sometimes very well, and who still hurts low and to one side. Sometimes the SI joint was the problem all along; sometimes it was the second problem, unmasked once the first was fixed. Either way, a diagnostic block will tell us.

The same day. The numbing medicine takes effect within minutes and wears off over a few hours, and that window is the test: we ask you to do the things that always hurt — get in and out of the car, roll over, sit and stand — and pay attention. If the pain drops most of the way and then returns as the numbing fades, that is a clear answer. The steroid that goes in with it works more slowly, over days, and that is the part that gives longer relief. We call you the next day to hear how it went.

We won’t promise that, because the research doesn’t. Steroid injections into the SI joint give many people real relief for weeks to months, and they can be repeated when appropriate. But in head-to-head comparisons, injections rank behind radiofrequency ablation and fusion for how long the relief lasts. So we use them for what they are best at: confirming the joint and buying real, temporary relief. If the joint is confirmed and injections don’t hold, ablation is the next rung, not another round of the same shot.

In the published studies, relief from SI joint ablation lasts months, and for many patients up to about a year; nobody has good evidence past twelve months, so we don’t claim it. The nerves treated are tiny sensory branches that carry pain from the joint, not the nerves that move your legs. They slowly grow back, which is why the effect fades and why the procedure can be repeated.

Less than most people expect. The skin is numbed first, the needle is thin, and the live X-ray means it goes exactly where it should the first time. Most people describe pressure, then a few seconds of sting as the medication goes in. The whole thing is measured in minutes, not hours.

Then we have learned something important: the SI joint is probably not your pain source, and you have not spent months treating the wrong thing. That is the point of testing before treating. We will tell you what we think is next — the hip, the spine, or something else — and where to go for it, even when the answer is not us.

It can be. When part of the lower spine is fused, the joints below it carry more of the load, and the SI joint is the next joint down. New pain that sits lower and more to one side than the pain your fusion fixed is worth testing. We will need your surgical history and, ideally, your imaging.

No. An epidural puts medication in the space around the spinal nerves, and we don’t do those here — no epidurals, no spinal injections. An SI joint injection goes into the joint itself, well below and to the side of the spine, and it answers a different question: is this joint the source? If your pain turns out to be coming from the spine, we will say so and point you to the right place for it.

Image-guided SI joint injections are an established, broadly covered procedure. Radiofrequency ablation is usually covered too, once diagnostic injections have confirmed the joint; many insurers in fact require those blocks first, which happens to match how we work anyway. As always: we do a complimentary benefits check before any procedure. No surprises.

Fair question — most women ask it. The fibroid doesn’t rot or float loose. Your body does what it does with any tissue it no longer feeds: it breaks it down and scars it in, the way a bruise resolves. In some cases, small fibroid fragments pass naturally. Your doctor will tell you what to expect for your specific fibroids — location matters, and we don’t sugarcoat it.

They’re smaller than a grain of sand — soft, biocompatible medical spheres, FDA-cleared specifically for uterine fibroid embolization since 2002, delivered sterile, and they stay put in the treated vessels. They’ve been used in millions of procedures worldwide.

No. The technique was pioneered in Paris in the 1970s to stop life-threatening bleeding after childbirth, and first used for fibroids in the early 1990s, with results published in The Lancet in 1995. The microspheres have been FDA-cleared since 2000 — for uterine fibroids specifically since 2002. It has been tested against both hysterectomy and myomectomy in randomized trials published in the New England Journal of Medicine, with ten-year follow-up data — and ACOG, the OB/GYNs’ own college, recommends it at its highest evidence level for women who want to keep their uterus.

Most plans cover UFE, including Medicare and Medicaid, and we’re in-network with most insurance plans. We do a complimentary benefits check before any procedure. No surprises.

Different specialty, different referral world — not bad intent. We’re glad to coordinate with your OB/GYN, and many stay involved in your care afterward.

Ablation treats the uterine lining to reduce bleeding; it doesn’t shrink fibroids. UFE treats the fibroids themselves — the bleeding and the bulk, pressure, and bloating.

When the bleeding stops, iron levels recover. Many patients see their energy return over the months after treatment as their blood counts rebuild.

Bleeding usually improves within the first cycles. Most women notice significant change in the first four to six weeks — if you could feel the fibroid before, you’ll often feel it soften and shrink. The most substantial shrinking happens between six and twelve months.

Not for your initial consultation — call us directly. We do a complimentary benefits check before any procedure, and if your plan requires a referral or prior authorization for treatment itself, we’ll help you get it.

You’re under IV sedation — relaxed and drowsy, breathing on your own. Not general anesthesia. The procedure itself doesn’t hurt — discomfort during it is rare. The honest pain conversation is about the first night afterward, and it’s covered in plain view on our UFE page — along with the plan we send you home with.

UFE is an outpatient procedure in our own IR suite — not a hospital. Plan on being at our office three to four hours all told, prep included. After the procedure you recover with us for about an hour, and every patient goes home the same day. Bring a driver: the sedation means no driving until the next day, no exceptions.

We use the groin. Both are genuine routes to the same arteries, and some centers prefer the wrist — so if you’ve read about wrist access, that’s why. Either way it’s a pinhole: no incision, no stitches.

You won’t be guessing alone at 2 a.m. You go home with the on-call doctor’s cell number, real pain medication, and a plan we built with you before the procedure — and we call you the next morning. In our practice, nine out of ten women are off narcotic pain medication by that call.

In our experience, most of our patients are back to normal life in one to two weeks — many sooner. The first night is the hard part; after that it’s typically period-like cramps and fatigue that taper off. We’ll give you an honest read for your situation at your consultation.

Regrowth risk is strongly age-dependent, and for many patients it’s low — a number we personalize at consultation. In the 2,112-woman registry, fewer than 1 in 10 women had gone on to a hysterectomy three years after the procedure, and fewer than 1 in 50 chose a repeat embolization. If regrowth does happen, a repeat UFE — or another path, if it genuinely fits better — is a conversation we’ll have with real numbers on the table.

No — but tell us first, because it changes the conversation. The honest, number-by-number fertility discussion — including what the largest analysis to date shows by age — lives on our uterine fibroids page, and we’ll have it with you in person, with your imaging in front of us.

More than 300. That’s exactly the right question, by the way — we’d encourage you to ask it of any doctor recommending any procedure. We’ll never be offended by it.

Yes — most plans cover UFE, including Medicare and Medicaid, and we’re in-network with most insurance plans. We do a complimentary benefits check before any procedure. No surprises.

Same reason as with fibroids: UAE is performed by interventional radiologists — a different specialty from your OB/GYN, with a different referral network. Most women find it by refusing the first answer and looking for themselves.

UAE for adenomyosis has years of published follow-up — including a four-plus-year study described on our adenomyosis page — and uses the same FDA-cleared technique and materials as fibroid embolization, which ACOG recommends at its highest evidence level for fibroids. And in 2025, the European QUESTA study published its one-year results comparing the two paths directly: among 101 women who chose either UAE or hysterectomy, quality of life improved significantly after both, with comparable one-year scores — and 44 of the 50 women who chose UAE kept their uterus through the first year. The authors’ conclusion: UAE is a valid, less-invasive alternative that preserves the uterus. The trade, plainly: women who chose hysterectomy reported more pain relief and higher satisfaction — removing the disease outright does that. That’s exactly the choice we’ll walk through with you.

In the longest follow-up study, UAE did not appear to bring menopause forward.

If future pregnancy matters to you, tell us first — it changes the conversation. Fertility evidence for embolization in adenomyosis specifically is thinner than for fibroids, so this is a genuinely individual discussion: your age, your imaging, and your timeline. What we can say from the fibroid data: age — not the procedure — is the biggest predictor of fertility afterward. We’ll give you the transparent version for your specific case.

Yes — insurance typically covers embolization for adenomyosis the same way it covers it for fibroids: most plans, including Medicare and Medicaid, and we’re in-network with most plans. We do a complimentary benefits check before any procedure. No surprises.

Same procedure, different target. When embolization treats fibroids, it’s called UFE — uterine fibroid embolization. When it treats adenomyosis, you’ll see it called UAE. The arteries, the materials, and the doctors are the same. Many women have both conditions at once — and that’s actually where results are strongest. Our uterine fibroids page covers the fibroid side.

No. The technique has a half-century history, the spheres have been FDA-cleared for uterine fibroid embolization since 2002, and ACOG — the OB/GYNs’ own college — recommends the procedure at its highest evidence level for fibroids in women who want to keep their uterus. For adenomyosis specifically, there’s more than four years of published follow-up and a European study comparing it directly against hysterectomy. And it passes the test skeptics rightly apply: insurance covers it. Insurers don’t cover hype.

Microscopic, biocompatible spheres — smaller than a grain of sand, FDA-cleared, and used in uterine embolization for more than two decades. They’re the very same spheres we use for fibroid embolization — just smaller, sized for the finer vessels that feed adenomyosis tissue inside the muscle wall. They stay where they’re placed, sealed inside the small arteries they closed — vessels that were feeding the diseased tissue. A transparent answer to a fair question — and if you’d like the details down to the product name, ask at your consultation and we’ll gladly walk you through it.

The procedure itself doesn’t — you’re sedated and comfortable. The transparent answer is about the first night: as the treated tissue reacts, the cramping is very real for about the first 18 hours. We counsel every woman about this before the procedure, you go home with real pain medication and a plan, and most patients are off the narcotic by the next day. Then we call you in the morning.

Most women take three to five days off. Five is the comfortable version; returning at three is definitely doable for most patients, depending on how physical your job is. Recovery follows the same pattern as our fibroid embolization patients’ — the first night is the hard part, and it gets steadily easier from there.

Some do come back — adenomyosis is estrogen-driven, and in our experience about 15% of patients see symptoms return over ten years, with the risk falling the closer you are to menopause. If it happens, re-treatment can be considered when appropriate. And UAE closes no doors: every other option, including a hysterectomy if you ever choose one, stays fully open.

Embolization is performed by interventional radiologists — a different specialty from your OB/GYN, with a different referral network. Nobody hid it from you; it lives outside the world of the doctors you’ve been seeing. We’re glad to coordinate with your OB/GYN before and after — and to share the published studies with them.

More than 300 uterine embolization procedures. That’s exactly the right question, by the way — we’d encourage you to ask it of any doctor recommending any procedure. We’ll never be offended by it.

Insurance typically covers embolization for adenomyosis the same way it covers it for fibroids: most plans, including Medicare and Medicaid, and we’re in-network with most plans. We do a complimentary benefits check before any procedure — no surprises. And no referral is needed for your initial consultation; if your plan requires a referral or prior authorization for treatment itself, we’ll identify that during the complimentary benefits check and help you get it.

No. Bring everything — reports, discs, the list of who you’ve seen. We’ll read it before we repeat it. Most women who reach us have done more research than anyone gave them credit for; the consultation starts from where you are, not from zero.

Yes — same problem, newer name. Doctors have moved toward “venous-origin chronic pelvic pain” and “pelvic venous disorder” because “congestion” was never very precise. We use the name most women search for, and both names in our records.

Yes. Standard pelvic imaging is done lying down, which is the position where these veins drain and flatten — so a “normal” scan doesn’t rule this out. Reports written to look for cysts and fibroids also don’t always comment on veins. We look at the images themselves, and if the story fits we go further.

They can look alike and can even coexist. The most useful distinguishing sign is timing: with endometriosis there are usually pain-free stretches between cycles; with a venous cause the ache tends to be present through most of the month and simply worsens around your period. The other tell is gravity — venous pain builds with standing and eases lying down. If you’ve had a full endometriosis workup that came back clear, that’s a reason to look at the veins, not a reason to stop looking.

Typically, yes. We do a complimentary benefits check before any procedure, usually ready the same day as your consultation, so you’ll know exactly where your plan stands before you decide anything — and any out-of-pocket cost is discussed with you before any procedure is performed. If your plan requires a referral or prior authorization for treatment, we’ll identify that during the benefits check and help you get it.

Once pelvic congestion is confirmed, embolization is the treatment. The alternatives are thin: medication that suppresses the cycle tends to help only while you take it, and surgery — tying off the veins, or a hysterectomy — is a much bigger operation for a problem that isn’t in the uterus, and it doesn’t reliably fix vein pain. Embolization treats the veins themselves, through a pinhole, home the same day. And the evidence behind it is real: a randomized trial in which the comparison group had the same catheter procedure without treatment, and the treated women did significantly better at one year with no major complications; systematic reviews pooling more than a thousand women, with 7 to 9 in 10 reporting lasting relief; and formal practice guidance from the Society of Interventional Radiology in 2026. That’s why, for the right woman after a proper workup, it’s what we recommend.

We use both: a medicated foam that seals the tangle of smaller pelvic veins, and tiny coils — made of the same materials used in vascular procedures for decades — that close the main trunk. The foam does its work and is absorbed; the coils stay, permanently closing the vein while blood reroutes through healthy ones. You won’t feel them. Some women notice a few days of ache and low-grade fever afterward as the vein closes; that settles. Rarely, a coil can move out of position, which is one reason technique and vein selection matter — and one of the things we’ll go over with you before you decide.

It can — in roughly 1 in 10 to 4 in 10 women over time, in the published series. Sometimes a treated vein reopens; sometimes a different vein takes over the job. If it happens, we look again with a venogram, and re-treatment is possible. We’d rather you hear that now than be surprised later. We won’t call this a cure.

It can be. May-Thurner is compression of the main left pelvic vein by the artery that crosses it. When that vein is squeezed, blood backs up into the pelvic veins and can drive the same symptoms — so a good workup looks for it, and treatment is different when it’s the cause. Read about May-Thurner syndrome →

The procedure itself, no — you’re sedated and comfortable, the pinhole at the groin is numbed, and most women describe pressure rather than pain. The first few days afterward are the hard part. As the treated veins close, expect a deep pelvic ache and sometimes a low-grade fever for a few days — the body’s normal reaction to a closed vein, and in the published experience generally milder than the cramping after fibroid embolization. You go home with a plan and real pain medication, we call you the next morning, and you have the on-call doctor’s cell number if it isn’t behaving.

You get twilight or moderate sedation through an IV — relaxed and drowsy, breathing on your own. Not general anesthesia. No breathing tube, no operating room. It is still sedation, so you’ll need a driver to take you home — no exceptions.

Yes — when it confirms. The venogram is the reference standard for this diagnosis: the doctor watches, in real time, how blood actually moves through your pelvic veins, measures the ovarian veins, and looks for backward flow. If what we see matches what you feel, we treat right then, through the same pinhole. If it doesn’t confirm, nothing is closed — the catheter comes out and you go home with a real answer and your images, which we’re glad to share with your other doctors. That outcome isn’t a failure. It’s the point of confirming first.

The foam does its work and is absorbed. The coils stay: small, soft, and permanent, made of the same materials used in vascular procedures for decades, sitting inside a vein high in your abdomen. You won’t feel them. Rarely, a coil can move out of position, which is one reason technique and vein selection matter — and one of the things we’ll go over with you before you decide. Airport scanners: no. MRI: the coils are MRI-compatible, but always tell the technologist what’s in you.

Across the published reviews, complications run about 2–3%, and most of that is the post-procedure ache and low-grade fever described above, which settles in a few days. In the randomized trial there were no major complications. The rare serious ones — a coil moving out of position, a clot travelling to the lung — are recognized, uncommon, and exactly what your physician will go through with you at the consultation. Occasionally a vein goes into spasm and can’t be fully treated in one sitting; that happened to about 1 woman in 50 in the trial.

The first few days are ache. Then, over the following weeks, the heaviness eases as the pooled blood clears and the swollen veins shrink back down. Across the published series, 7 to 9 in 10 women get meaningful, lasting relief — and pain returns in roughly 1 in 10 to 4 in 10 over time. We print both numbers because you deserve both. If it does come back, we look again with a venogram, and re-treatment is possible.

Possibly — because the veins that cause this aren’t in the uterus. That’s why, in the published surgical series, about 1 in 3 women had pain that persisted after hysterectomy and 1 in 5 had it return. If your workup shows the ovarian or pelvic veins are still there and still leaking, they can be closed the same way. If it shows something else, you’ll leave knowing what.

Part of the venogram is looking for them. Sometimes the pooling in the pelvis is being driven from above — a squeezed left kidney vein (“nutcracker”) or a squeezed left pelvic vein (May-Thurner) backing blood up into the pelvic veins. The current professional guidance specifically recommends checking for kidney-vein compression before the ovarian vein is closed, and treatment is different when compression is the cause. If we find it, we’ll tell you, and we’ll explain what it changes — the May-Thurner treatment page covers that route.

It isn’t experimental. There’s a randomized trial in which the comparison group had the same catheter procedure without the treatment, and the treated women did significantly better at one year with no major complications; and in 2026 the Society of Interventional Radiology published formal practice guidance for it. The reason it may never have come up is that it isn’t performed by gynecologists. Your gynecologist looks for gynecologic causes — that’s their job, and they’re good at it. Veins are a vascular problem, treated by interventional radiologists: a different specialty, with a different referral network. Nobody’s fault; a gap in the map. What we won’t do is tell you anyone was wrong.

Because of where the vessels cross. The artery to your right leg passes over the vein from your left leg, low in the pelvis, right in front of the spine — so it’s the left vein that gets pinched. It can happen on the right, but it’s rare. If your left leg has been the problem for years, that’s not a coincidence.

Not necessarily. Some compression at that crossing is so common — more than a third of people with no symptoms have a lot of it — that many doctors call the finding “May-Thurner anatomy” and save “syndrome” for when it’s actually causing trouble. CT can also exaggerate the narrowing if you were dehydrated. A report like that means it’s worth a proper evaluation. It doesn’t mean you need a stent, and it isn’t a diagnosis on its own.

Probably not — and we won’t pretend otherwise to win you over. A stent is a permanent implant, and doctors are right to be careful about placing one in a young, otherwise healthy person. What you were owed was the rest of the conversation: what they found, how narrow it really is, whether your symptoms match, and what to do in the meantime. Come in and we’ll have it. Sometimes the answer is still “not a stent — here’s the plan.” Sometimes it’s “yes, and here’s why.”

We wish. The narrowing in May-Thurner is scar-like and springs back after a balloon alone, so a lasting fix means a stent. If you’d rather not have permanent hardware, that’s a completely legitimate choice — and compression stockings and blood thinners (if you’ve clotted) remain real options. We’ll help you weigh it, not push it.

Venous stenting has been done for decades, and the durability record is strong: in the largest review, stents placed for compression without a clot were still open in more than 98% of people at two years. In 2026, the New England Journal of Medicine published the first large randomized trial — 225 patients, run by the NIH — and stenting improved symptoms and quality of life at six months compared with standard care alone. Read the fine print with us, though: those patients all had a prior clot with lasting damage. The trial didn’t study compression without a clot, and guideline groups haven’t yet made stenting a routine recommendation. That’s the honest state of the evidence, and it’s why we’re so careful about who we treat.

The common ones: new low-back pain (up to two in three, usually mild and temporary), and bleeding (about 12% vs 4% in the trial’s stented arm, almost all minor). The less common ones: the stent clotting or collapsing (each in a small minority, often treatable), a clot in the same or the other leg, and the ordinary rare risks of any catheter procedure. Across the pooled studies, no lung clots (pulmonary embolism) were reported after stenting. We go through your specific numbers in plain language before you decide anything.

It can. When the left iliac vein is pinched, blood can back up into the pelvic veins and cause the aching, pressure, and varicose veins of pelvic congestion syndrome. It’s one reason we check for compression before treating pelvic congestion — treating the pelvic veins without fixing an outflow blockage upstream misses the cause. If you have both a heavy left leg and chronic pelvic pain, say so. They may be one problem.

Then you belong in a hospital, not on this page — sudden swelling, pain, or shortness of breath is an emergency-room visit. An active clot is treated there, urgently, and we don’t treat May-Thurner while a clot is active. Once the DVT has been treated and things are stable, the question of why it happened comes next — and that’s where we come in. If the pinch caused the clot, it’s still there when the clot is gone. That’s the point at which we evaluate for the compression and decide on treatment.

Yes — most plans, including Medicare and Medicaid, and we’re in-network with most plans. We do a complimentary benefits check before any procedure is scheduled — usually on the day of your consultation. No surprises.

The procedure itself, no — you’re sedated and comfortable, the pinhole in the groin is numbed, and you won’t feel the catheter, the balloon, or the stent going in. The honest pain conversation is about afterward: many people get a low-back ache in the first days as the vein and the tissue around the stent adjust. It’s usually mild and settles on its own. We’d rather you hear that from us now than discover it at home.

You won’t feel it once the first days pass — it sits inside a large vein deep in the pelvis, and your own vein lining grows over it. Venous stents are built to push outward against exactly this kind of compression. In the pooled studies, stent collapse or clotting happened in a small minority, and both can often be treated; that’s the reason for the follow-up ultrasounds, and one of the reasons we choose candidates carefully.

We stop. The venogram at the start of the procedure is there to confirm what your scan showed — and if it doesn’t, no balloon and no stent. That’s a good outcome, not a wasted trip: it means you don’t carry a permanent implant you didn’t need. The imaging review beforehand is what earns you a procedure date in the first place — but we’d rather you know the stop is possible before the day than be surprised by it.

Those are real questions, and they’re yours specifically — the answers depend on whether you’ve had a clot, your bleeding risk, your other conditions, and your plans. We don’t publish a one-size answer because there isn’t one. We go through it with you, in person, before you decide anything — and we’re glad to coordinate with your hematologist or OB.

No. It won’t become cancer and it isn’t life-threatening. It can cause pain, and it can affect fertility and the size of the testicle on that side. Those are good enough reasons to treat it if it’s affecting you — and they’re also why nobody should rush you.

Because it’s pooled blood. Every hour you’re upright, gravity fills the failed veins a little more; lie down and they drain. That’s why the ache builds through the day, is worse after standing, walking, or lifting, and eases overnight — and it’s the same reason a varicocele can be missed by an exam or a scan done lying down.

No. Nothing shrinks a varicocele except a repair. Scrotal support and anti-inflammatories genuinely help a lot of men and are the right place to start — but they manage the ache; they don’t change the veins. If you’ve given them a fair run and you’re still aching, that’s the point at which the treatment conversation is worth having.

Maybe not. Epididymitis — an infection of the tube behind the testicle — causes scrotal pain and is a reasonable first guess in a short appointment; antibiotics are the right treatment for it. They do nothing whatsoever to a varicocele, because a varicocele isn’t an infection. Repeated courses that didn’t help aren’t a failure of the medicine. They’re a sign the diagnosis hasn’t landed yet — say it out loud at your next appointment, and ask to be examined standing.

Yes — it’s the whole test. A varicocele fills when you stand and drains when you lie down; examined or scanned flat, a real, symptomatic varicocele can simply not be there when someone looks. The physical examination, standing, is the reference standard for finding one. At ARVC we examine you standing and have you scanned standing. If you’ve had an ultrasound before and aren’t sure how it was done, it’s a fair question to ask, and the answer explains a great deal.

It can. Varicoceles are found in about 40% of men evaluated for infertility; the leading theory is heat — pooled blood warms the testicle, and sperm production is sensitive to temperature. Treating one can improve semen quality. It does not guarantee a pregnancy. If conceiving is your goal, start with a urologist or reproductive urologist and a semen analysis — and know that for men in that position, the American guidelines name surgical repair, not embolization. We’ll tell you the same thing in person.

You’ll find that claim online. There’s a real signal in the research, but it comes almost entirely from studies that looked backward rather than forward, and all of it is from surgery. We don’t print it as a benefit of anything we do. If your testosterone is genuinely low and you have a varicocele you can feel, it’s a fair thing to raise at your consultation — as a conversation, not a promise.

It depends on the question. For men trying to conceive who have a varicocele that can be felt, infertility, and abnormal semen results, the American Urological Association and the American Society for Reproductive Medicine advise considering surgical varicocelectomy. For pain — the reason most men are actually treated — the guidelines say much less, and both surgery and embolization are reasonable; the trade is recovery and risk against a marginally lower recurrence rate with microsurgery. The one thing the guidelines are emphatic about: don’t treat a varicocele that can’t be felt and shows only on a scan. We follow that.

Worth mentioning specifically. About 85% of varicoceles are on the left, for reasons of plumbing. One that appears only on the right — especially suddenly, in an older man, or one that doesn’t drain when you lie down — is unusual enough that doctors look further up for a cause. It usually turns out to be nothing sinister, but it’s the kind of detail that should change how carefully you’re looked at, so say it early.

Sudden, severe testicular pain is an emergency-room visit — it can mean a twisted testicle, and hours matter. So is pain with fever, redness, or swelling of the testicle itself. A varicocele doesn’t do any of those things; it aches. And separately, regardless of any varicocele: a lump on the testicle itself, as opposed to the soft veins above it, should be seen promptly.

Varicocele embolization is covered by most insurance plans, and we’re in-network with most plans. You don’t need a referral for your initial consultation — call us directly. If your plan requires a referral or prior authorization for treatment itself, we identify that during the complimentary benefits check and help you get it. And we’re glad to coordinate with your urologist before and after; many stay involved.

The procedure itself, no — you’re sedated and comfortable, the pinhole — at the groin or the neck — is numbed, and most men describe pressure rather than pain. Afterward, expect some soreness at the pinhole and a dull ache or pulling on the treated side for a few days as the veins seal. You go home with a plan for it, and with the on-call doctor’s cell number if it isn’t behaving.

You get IV sedation — relaxed and drowsy, breathing on your own. Not general anesthesia. No breathing tube, no operating room. It is still sedation, so you’ll need a driver to take you home — no exceptions.

The coils are small, soft, and permanent, and they sit inside a vein high in your abdomen — not in your scrotum, not against the testicle. They’re sized to the vein and anchor as it seals around them; migration is a recognized but uncommon complication your physician will go through with you. Some men online report feeling them; most feel nothing at all — and we’re not going to tell you nobody ever has. Airport scanners: no. MRI: the coils are MRI-compatible, but always tell the technologist what’s in you.

Nothing is done to the testicle, to the nerves that control erection, or to the structures involved in ejaculation. The whole procedure happens inside a vein in your abdomen, well above the scrotum.

Yes — one session, one pinhole. Surgery generally means a second incision, or a laparoscopic approach under general anesthesia. Treating both sides in one sitting is one of the places embolization is at its most useful.

Sometimes. In the 15-year series, about 6 in 100 varicoceles were confirmed back on ultrasound, at an average of just under three years. Here’s the more interesting number: among men whose varicocele was found again on ultrasound, only about 1 in 6 had their pain come back. The picture and the symptom come apart. If it does come back and it bothers you, it can usually be treated again.

It happens — in about 4% of cases in one large series and about 12% in another. The vein is attempted, it can’t be catheterized safely, and the procedure is stopped without anything being closed. You should know before you consent that this is possible. If it happens to you, nothing has been lost: surgery remains fully open to you, and we’ll help arrange it.

It isn’t experimental — doctors have been closing testicular veins this way since the late 1970s, and there are published series following patients for 15 years. The reason you may not have heard of it is that it isn’t performed by urologists. It’s performed by interventional radiologists — a different specialty, with a different referral network. Your urologist trained in an operating room, and when a man walks in with a varicocele, the treatment that comes to mind is the one that specialty performs. That’s not dishonesty; it’s how medicine is organized. And for a man trying to conceive, the American guidelines name surgery — your urologist would be following them.

Then that’s what you should have, and we’ll help you get there — we refer for it routinely. If you’re trying to conceive, it may well be the better choice. One thing worth asking any surgeon: will it be done with an operating microscope? Microsurgical repair has the lowest recurrence rate of the surgical routes.

Varicocele embolization is covered by most insurance plans, and we’re in-network with most plans. We do a complimentary benefits check before any procedure is scheduled — usually on the day of your consultation. No surprises. If cost is the obstacle, say so: we offer Affirm, CareCredit, and in-house payment arrangements.

Not for your initial consultation — call us directly. If your plan requires a referral or prior authorization for treatment itself, we’ll identify that during the complimentary benefits check and help you get it. And we’re glad to coordinate with your urologist before and after; many stay involved in your care.

Banding treats hemorrhoids one at a time, from inside the anal canal, and larger (grade 3) hemorrhoids often aren’t good candidates. HAE works from inside the blood vessels — nothing enters the anal canal — and treats the supply feeding the whole hemorrhoidal cushion at once. If banding didn’t hold for you, or you couldn’t face a second round, that doesn’t mean this won’t work.

No — HAE wasn’t designed for external hemorrhoids, which have a different blood supply. That’s one more reason the exam matters: many patients have both kinds, treatments differ between them, and we need to know which ones are actually causing your symptoms.

If external hemorrhoids are your only concern — no significant rectal bleeding, and no prolapse with bowel movements or activity — they’re often managed with over-the-counter ointments and lifestyle changes: more fluids, more fiber, not sitting on the toilet too long, and sitz baths. For an external hemorrhoid that’s extremely painful, recurrent, causing hygiene concerns, or resistant to those measures, surgical removal (hemorrhoidectomy) is the more drastic option — and if that’s your situation, we’ll say so and point you the right way.

You’re sedated and comfortable — IV sedation plus local numbing, per our standard protocol. The access point is a pinhole in the upper thigh. Most patients describe pressure, not pain, and go home the same day.

Afterward, many patients feel a pressure sensation — doctors call it tenesmus — that feels like needing to use the restroom even when you don’t. It eases with time, can linger for two or three days, and is typically managed with over-the-counter medication like ibuprofen and Tylenol.

No. Plan on light activity for the first 48 hours — then back to your normal routine. Published reviews describe return to daily routine as soon as the day after the procedure. Symptom improvement builds over four to six weeks, and bleeding typically settles within one to two.

Yes — hemorrhoid artery embolization is a covered benefit under most insurance plans, and we’re in-network with most plans. We still do a complimentary benefits check before any procedure, so there are no surprises: you’ll know exactly where you stand before you decide anything.

Possibly — if you haven’t had one recently, or your symptoms have changed dramatically since your last one. Rectal bleeding has more than one possible cause, and hemorrhoids are only the most common. Before treating, we make sure the serious causes — including colorectal cancer — have been ruled out. It protects you, and it means that when we do treat your hemorrhoids, we’re treating the right problem.

Then we’ll tell you, and we’ll point you to the treatment that actually fits — including a surgical referral when that’s genuinely the right answer. We turn away patients who aren’t candidates for what we do.

No. Hemorrhoid embolization has been performed and published since 2014, with results from roughly 250 patients across a dozen studies reviewed in the radiology literature by 2022 — and no serious complications reported in any of them. What is transparently true: the trials so far are smaller and younger than the ones behind, say, knee embolization, and there is not yet a head-to-head trial against banding or surgery. We say so plainly on our HAE page. And it passes the test skeptics rightly apply to newer procedures: it’s a covered benefit under most insurance plans.

No. That is the single biggest difference between HAE and every other hemorrhoid procedure. Nothing enters the anal canal at all — no scope, no band, no instrument. The entire treatment happens inside the arteries, reached through a pinhole in your upper thigh. The only time anyone examines you is at the consultation, briefly and privately, to confirm which hemorrhoids are causing the trouble.

You’re under IV sedation — an anti-anxiety medicine plus pain medicine — relaxed and drowsy, breathing on your own. Not general anesthesia. The access point in your thigh is numbed first. Afterward, many patients feel a pressure sensation — doctors call it tenesmus — that feels like needing to use the restroom even when you don’t. In the published series it showed up in roughly a third to most patients, eased over a few days, and needed nothing more than ibuprofen and Tylenol. We’ll tell you to expect it so it doesn’t worry you.

The procedure itself takes about an hour. Afterward you rest with us — most of the time about an hour under observation while we watch you and give you fluids, occasionally a bit longer — then you go home. Plan on three to four hours at our office all told, then home the same day. An afternoon, not a hospital stay.

Light activity for the first 48 hours — then your normal routine. Published reviews describe patients returning to daily life the day after the procedure. Bleeding typically settles within one to two weeks, and the full improvement builds over four to six weeks as the hemorrhoids shrink. Driving waits until the next day: the sedation means you’ll need a driver to take you home, no exceptions.

Tiny coils and microscopic particles — we typically use both, placed only in the small artery branches feeding the hemorrhoids. Yes, they stay; that’s the point. The coils are a few millimeters long, made of the same platinum-alloy that has been used inside blood vessels for decades, and they never touch the anal canal. Nothing is removed from your body and nothing is left where you sit.

It isn’t designed to, and this is where HAE most clearly differs from surgery. Nothing is done at the anus itself, so the sphincter muscle — the muscle that gives you control — is never cut, stretched, or touched. The published reviews describe HAE as preserving anal tone precisely because there is no direct anorectal trauma.

Surgery removes the hemorrhoidal tissue, which leaves a wound in a place that has to keep working every day — that’s where the recovery stories come from. HAE removes nothing. It turns down the blood supply that keeps the tissue swollen and bleeding, and the tissue stays where it is and shrinks. No wound, no packing, no first bowel movement to dread. The transparent other half: for grade 4 hemorrhoids that stay prolapsed, surgery is still the right treatment, and we’ll refer you for it.

Yes. Re-bleeding is the main way HAE falls short, and in the published series about 1 patient in 7 had a second embolization session for it — often to treat a small feeding branch that wasn’t reached the first time. A repeat is done the same way, through the same pinhole. And HAE doesn’t burn any bridges: banding and surgery remain available afterward if they’re ever needed.

HAE is done by interventional radiologists — a different specialty with a different referral network. Nobody hid it from you; it just lives outside the world of scopes and operating rooms you’ve been seeing. The research is published in journals every specialty can read, and we’ll gladly share it with your doctor.