View Issues Subscribe for FREE
Back in the Flow
The board-certified physicians of Main Line Vascular Institute offer minimally invasive solutions to circulatory conditions of every sort, from the simple to the complex.

by Bill Donahue

Within the intricate mosaic known as the human body, the circulatory system may be among the most complex—a highway of blood vessels that snakes through the body, from head to toe. Like any highway, the system sometimes experiences problems and disruptions to the traffic flow—in this case, the flow of blood throughout the body.

In the Greater Philadelphia Area, individuals have an invaluable resource in the form of Main Line Vascular Institute, a state-of-the-art outpatient facility based in King of Prussia. There, a team of board-certified physicians offers a number of solutions to conditions related to the circulatory system, from the simple to the complex, and from cosmetic issues to potential threats to life and limb.
“There’s really no vein abnormality we can’t address,” says Aaron Shiloh, M.D., FSIR, a Main Line Vascular Institute physician who is double board certified in radiology and interventional radiology. “We specialize in minimally invasive techniques, essentially using a needle to introduce catheters or other devices to deliver treatment, and it’s all done under local anesthesia. In most cases, it’s no worse than a dental visit.”
Dr. Shiloh focuses much of his practice on treating conditions that negatively affect women’s health, including uterine fibroids. These noncancerous tumors form on the walls of the uterus, typically appearing in women between the age 40 and menopause. Although usually benign, uterine fibroids have the potential to hamper a woman’s quality of life.
“The primary symptoms include heavy bleeding [during menstruation], bloating, increased urinary frequency, painful intercourse, and back pain,” says Dr. Shiloh. “The No. 1 symptom is heavy bleeding, and you sometimes hear horror stories about women who are afraid to leave the house because of the risk of having an incident in public. They can also become anemic as a result, so it affects their overall wellbeing.
“We call women who have uterine fibroids ‘silent sufferers,’” he continues. “It’s a big deal, but because the fibroids are slow-growing and usually benign, it’s not treated aggressively. The standard of care has been hysterectomy, but there’s a minimally invasive alternative.”
It’s called uterine fibroid embolization, and Dr. Shiloh can perform the procedure through a pinhole-sized incision in the patient’s wrist. He uses specialized X-ray equipment to guide a catheter toward the location of the fibroid tumor. Once reached, he injects embolic material through the catheter and into the vessels that feed the fibroid. As a result, the fibroids are deprived of oxygenated blood, causing them to shrink over time.
“The patient comes in by 8 a.m. or 9 a.m., and leaves by noon,” Dr. Shiloh adds. “The procedure itself takes only 30 minutes, and it’s performed using IV sedative, so they don’t have to go to sleep. Oftentimes, a woman will notice a significant difference within a month of treatment, but it takes a little time for the fibroids to shrink; I like to use the analogy of turning a grape into a raisin, which usually takes two to three months. The recovery tends to be significant, and the procedure is completely covered by insurance.” 
Curing patients of varicose veins is another area of focus for Dr. Shiloh. Varicose veins are commonly seen in pregnant women and those who spend a lot of time on their feet. Dr. Shiloh says people often assume these gnarled, enlarged, and dark-colored veins are a purely cosmetic concern, but many with varicose veins also experience aches, pains, heaviness, and restlessness in the legs.
“In order to solve the problem, we have to remove the vein from circulation,” he adds. “Historically, this was done by vein stripping, which is about as traumatic and painful as it sounds. Now we have other, less invasive ways to accomplish the same end result.”
These include ClosureFast RF, a device that uses radiofrequency ablation to deliver uniform heat that essentially collapses the target vein; VenaSeal, a proprietary adhesive that seals the vein shut; and Varithena, an injectable microfoam that fills and treats the desired section of the target vein.      
A Positive Influence
Peripheral arterial disease, or PAD, is another common circulatory problem treated by Main Line Vascular Institute. PAD results from arteries that have been narrowed or blocked by the buildup of plaque, which reduces blood flow to the limbs, thereby causing significant pain and affecting mobility. While genetics may predispose an individual to PAD, factors such as heart disease, diabetes, a sedentary lifestyle, and smoking may increase someone’s risk of developing the condition. If PAD worsens to advanced stages, potentially life-threatening health problems may follow.
“It’s called critical limb ischemia, where the patient has such low blood flow that the tissue on the feet and the toes will start to die,” says Edward K. Pavillard, D.O., a board-certified vascular surgeon with Main Line Vascular Institute who specializes in minimally invasive procedures for the treatment of arterial and venous disease. “In the earlier stages, it can result in non-healing wounds, which may prevent people from walking. The more advanced it becomes, people can’t do much of anything, and that sets off a cascade of other issues.”
Main Line Vascular Institute offers a number of treatments to help patients with PAD, including angioplasty and stenting to maintain the opening of the blood vessels, and plaque-shaving devices to increase blood flow to the affected areas. Once patients are treated for the condition, Dr. Pavillard says they “almost immediately” feel better.
Dr. Pavillard has a particular interest in utilizing cutting-edge technology to advance the treatment of PAD. He is a proponent of Optical Coherence Tomography (OCT), a noninvasive imaging technology that enables him to have an intra-lumen (inside the vessel) view without resorting to X-rays, which promote radiation, or contrast dyes, to which some patients have an allergy. In addition, he is personally involved with the development of endovascular devices designed to expand the treatments available for the condition.
For example, Dr. Pavillard is involved with clinical trials of the Shockwave Medical lithotripsy system, which has been used to treat calcified plaque in PAD patients. In addition, he is the primary investigator for two active trials in the United States that are being performed by high-volume OCT users to extend the indications for the use of intra-lumen imaging. Dr. Pavillard says Main Line Vascular Institute will be the only outpatient facility in the Northeast to offer such revolutionary treatments. 
“Our facility is truly state of the art,” adds Dr. Shiloh. “We have every advanced imaging and interventional type of equipment to treat conditions associated with the circulatory system. Most of the procedures we offer are covered by insurance, and most of what we’re doing here is done using a minimally invasive approach. So if something is affecting your quality of life, there’s no reason to wait or to not get it taken care of.”

Main Line Vascular Institute
700 S. Henderson Ave., Suite 225
King of Prussia, Pa.


Photography by Jody Robinson
Suburban Life Magazine