Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA

Hemorrhoid Embolization

Codeholic Admin — Tue, 12 Sep 2023 08:28:26 +0000

Hemorrhoid Embolization

Hemorrhoids, swollen blood vessels in the rectal or anal area, affect millions of people worldwide. While mild cases can often be managed with lifestyle changes and conservative treatments, severe or persistent hemorrhoids may require more advanced interventions, such as hemorrhoid embolization.

Hemorrhoid Embolization: The Procedure

Hemorrhoid embolization, also known as transarterial embolization (TAE), is a minimally invasive procedure designed to treat hemorrhoids by reducing blood flow to the affected area. Here are the key steps involved in hemorrhoid embolization:

Pre-procedure Assessment: Before the procedure, patients undergo a comprehensive assessment, which may include a physical examination, medical history review, and imaging studies, such as an MRI or CT scan, to determine the extent and severity of the hemorrhoids.

Local Anesthesia: The patient receives local anesthesia to numb the area, ensuring comfort during the procedure. Twilight sedation may also be given through an IV although this procedure is not painful.

Catheter Insertion: A small IV sized catheter is inserted into the femoral artery, typically through a tiny nick in the groin area.

Guided Imaging: Using fluoroscopy or other real-time imaging techniques, Dr Allaei guides the catheter through the arterial system to the blood vessels supplying the hemorrhoidal tissue.

Embolization: Once the catheter is in position, small embolic agents, such as antibiotic beads and/or coils, are introduced into the blood vessels supplying the hemorrhoids. These embolic agents block the blood flow to the hemorrhoidal tissue, causing them to shrink and alleviate symptoms.

Post-procedure Observation: After the embolization is completed, the patient is monitored for a short time to ensure there are no immediate complications. Most patients can return home on the same day.

Hemorrhoid Embolization: The Benefits

Hemorrhoid embolization offers several benefits for individuals suffering from severe or recurring hemorrhoids:

Non-surgical: Hemorrhoid embolization is minimally invasive, involving only a small skin nick and typically performed on an outpatient basis. This means less pain, a shorter recovery period, and reduced scarring compared to traditional surgical options.

Effective Symptom Relief: Clinical studies have shown that hemorrhoid embolization can provide effective relief from symptoms such as pain, bleeding, and discomfort associated with hemorrhoids.¹

Low Risk: Hemorrhoid embolization is associated with a lower risk of complications, such as infection or wound healing problems, when compared to surgical procedures like hemorrhoidectomy.²

Preservation of Rectal Function: Unlike some surgical treatments that may alter rectal function, embolization typically preserves normal rectal function.

Hemorrhoid Embolization: The Risks

While hemorrhoid embolization is generally considered safe, there are some potential risks and complications to be aware of:

Pain or Discomfort: Patients may experience mild pain or discomfort at the catheter insertion site or in the rectal area. This can usually be managed with over-the-counter pain medications.

Infection: Although rare, there is a small risk of infection at the catheter insertion site. Patients should follow post-procedure care instructions carefully to minimize this risk.

Bleeding: In some cases, patients may experience minor rectal bleeding after the procedure. This typically resolves on its own but should be reported to the healthcare provider.

Recurrence: While hemorrhoid embolization is effective for many patients, there is a possibility of hemorrhoid recurrence in the future. Lifestyle modifications and dietary changes may be necessary to prevent recurrence.

Allergic Reaction: Some individuals may have allergic reactions to the embolic agents used during the procedure. However, this is extremely rare.

Arterial Perforation: There is a very low risk of arterial perforation, which can lead to bleeding. This is a rare complication but should be addressed promptly during the case if it occurs.

In the hands of a trained Vascular and Interventional Radiologist these risks are minimal.

Hemorrhoid Embolization: Expectation

Recovery following hemorrhoid embolization is typically faster and less painful compared to traditional surgical treatments. Here is what patients can expect after the procedure:

Immediate Relief: Many patients experience immediate relief from hemorrhoid symptoms, such as pain and bleeding, after the procedure.

Post-Procedure Care: Patients will receive instructions on how to care for the catheter insertion site and manage any discomfort. It’s essential to follow these instructions carefully to ensure a smooth recovery.

Resuming Activities: Most patients can return to normal activities, including work, within a few days to a week after the procedure. Strenuous activities and heavy lifting should be avoided for a short period. Otherwise, there is no downtime.

Dietary Changes: Patients may be advised to make dietary changes, such as increasing fiber intake and staying well-hydrated, to prevent future hemorrhoid flare-ups.

Follow-Up: A follow-up appointment with the healthcare provider may be scheduled to monitor the progress and ensure the hemorrhoids are responding to the treatment.

Hemorrhoid embolization is a minimally invasive procedure that offers several benefits, including effective symptom relief, minimal risk of complications, and preservation of rectal function. While there are potential risks and discomfort associated with the procedure, they are generally outweighed by the benefits for individuals with severe or recurrent hemorrhoids, and certainly marginal compared to surgery. Patients should consult with their healthcare provider to determine if hemorrhoid embolization is the right treatment option for their specific condition.

References:

Simillis C, Slesser A, Lacy-Colson J, et al. Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. *The British Journal of Surgery*. 2015;102(13):1603-1618. doi:10.1002/bjs.9923

Liu J, Guan Q, Li L, Li Y. Efficacy of Transcatheter Arterial Embolization for Severe Hemorrhoidal Bleeding. *Diseases of the Colon & Rectum*. 2020;63(6):769-775. doi:10.1097/DCR.0000000000001617

The above information is not all inclusive of the risks, alternatives and benefits. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion. There are complications possible with any medical procedure. Overall, minimally invasive procedures have a lower complication rate than open surgeries.

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Endoscopic Gallstone Removal

Codeholic Admin — Mon, 20 Mar 2023 06:27:18 +0000

Percutaneous Endoscopic Gallstone Removal

Non-Surgical Endoscopic Gallstone Removal

Gallbladder stones, known as cholelithiasis, can be asymptomatic or cause abdominal pain and infection. Gold standard treatment is to remove the gallbladder.

Patients who cannot undergo surgical gallbladder removal, can end up with a tube in their gallbladder called a cholecystostomy. This is not ideal as these tubes have to be changed for life and can become a burden on the family and patient. The cholecystostomy tube cannot be removed because of the risk of recurrent pain and symptoms.

Percutaneous endoscopic gallstone removal is a non-surgical technique that preserves the gallbladder by removing the stones through the tract using different methods. There may also be stones in the bile ducts, known as choledocholithiasis, that can also be removed. This treatment is also starting to be offered to patients who can also have surgery.

The procedure is performed by a specialty trained Board Certified Interventional Radiologists, a medical doctor who is trained doing procedures with the use of X-rays and other advanced imaging to see inside the body and treat conditions without surgery. The Interventional Radiologist uses direct visualization with a small camera and X-ray guidance from a fluoroscopy machine that allows for control of the instruments used to remove the stones.

Candidates for Percutaneous Gallstone Removal

Endoscopic gallstone removal has traditionally been offered to patients who are not able to have traditional gallbladder removal surgery or who have bile duct stones that cannot be removed in the standard fashion. These patients have had symptomatic gallstones that require treatment.

Gallstones can cause pain that is usually on the right side or middle of your upper belly, may be constant or worse after a heavy meal, may sometimes feel more like fullness than pain, may be felt in your back and in the tip of your right shoulder blade. Other symptoms may include nausea, vomiting, fever, and chills. The symptoms of gallbladder problems may look like other health problems. Always see your healthcare provider to be sure.

If you have had a gallbladder drain placed for gallstones but cannot get your gallbladder surgically removed, then you are potentially a candidate for this procedure.

Recently this procedure has also started to be offered to patients who are surgical candidates but for personal, dietary or religious reasons they do not want their gallbladder removed.

Gallstone removal is a safe and effective procedure when performed by an experienced Interventional Radiologist with an understanding of the techniques to reduce complications.

Success Rate of Percutaneous Gallstone Removal

Endoscopic and fluoroscopic-guided gallstone removal is highly successful, with complete stone removal from the gallbladder or bile ducts occurring in 80% of cases. Once the stones are removed from the gallbladder and bile ducts there is no reason for removal of the gallbladder or requiring a drain. Recurrent formation of stones is possible.

Endoscopic Gallstone Removal: Procedure Details

Percutaneous endoscopy is performed through the existing gallbladder drain tract. If you don’t have a gallbladder drain, this will need to be placed.

After 4-6 weeks a tract will form around the gallbladder drain, this is required to prevent any leakage of stones or bile into the abdomen. Once it is confirmed that there is a formed tract, the endoscopic procedure can then be schedule.

Sometimes the size of the drainage catheter is increased prior to removal of the stones so that the tract is larger to accommodate the camera. This depends on the size of the stones.

On the day of the procedure, the drain is exchanged for a larger temporary access into the gallbladder that will fit the endoscopic camera. Iodinated contrast material maybe injected into the bile ducts to locate gallstones that maybe causing blockage. Small stones are removed using a basket that fits through the camera. Other stones can be washed out by irrigating the gallbladder with saline or water.

Larger stones can be fragmented under endoscopic guidance with a precisely directed holmium laser. The gallbladder is filled with sterile water prior to fragmentation as the laser beam is absorbed by water, preventing damage to the gallbladder wall.

On average, it takes two sessions to clear patients of their stones if there is a large stone burden. After the stones are removed, the tube will stay in place for a couple of weeks to ensure the gallbladder/bile system is still intact and functioning normally. Once this is confirmed, the tube is then removed. The tract heals and closes on its own and does not require any suture or surgery.

Preparing for Gallstone Removal Procedure

Prior to the Procedure

You may not eat or drink eight to 12 hours prior to the procedure.

If you are on blood-thinning medication you may be asked to stop it prior to the procedure.

During the Procedure

You will be asked to change into a gown before the procedure.

Labs will be obtained.

You will be given a sedative by the anesthesiologist, who will be present to monitor your vital signs during the examination. Typically the procedure is done with a “twilight sedation.”

After the Procedure

This is an outpatient procedure and does not require hospital stay.

You will remain in a recovery room until most of the effect of the sedative has worn off.

Because of sedation used during the procedure, you’ll need to make plans to have someone take you home.

Gallstone Removal Procedure: Risks

Discomfort at the insertion site

Infection

Nausea

Bleeding

Bile duct or gallbladder injuries like perforation

Gallstone Removal Procedure: Results

The procedure is highly successful in the right candidate. This renders patients tube and gallstone free. Risk of recurrent gallstones is unknown.

The following are x-ray images of the bile ducts, showing a gallbladder with a large stone prior to and following removal by percutaneous cholangioscopy.

This picture shows a gallbladder with a large stone. The arrow points to a smaller drainage catheter that was inserted to relieve pressure.

Following the percutaneous cholangioscopy procedure, the drainage catheter can be removed.

This image shows the gallbladder after the gallstone and drainage catheter’s removal.

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Thyroid Nodule RFA

Codeholic Admin — Wed, 28 Dec 2022 11:06:21 +0000

Thyroid Nodule RFA

Thyroid RFA

Radiofrequency ablation (RFA) is a safe and adequate technique for treating large thyroid nodules, overactive parathyroid nodules, and thyroid cancer in certain circumstance. Radiofrequency ablation (RFA) is not a new technology, rather it is one of the oldest and first applied to the treatment of tumors, eg liver cancers. RFA however is newly being applied to thyroid diseases, such as the treatment of a large thyroid nodule.

This treatment has significant impact on shrinking the nodule size and relieving symptoms. Interventional radiologists have used thermal ablation in cancers of kidney, liver and lung and these studies have not only shown decrease in size of the tumor but regression of the cancers.

Traditionally, only surgery or removal of the thyroid gland was the only option for symptomatic or cosmetic thyroid nodules. Surgery however has a higher rate of surgical complications, mortality rate, and morbidity of thyroid surgery, especially in older individuals. This can also leave behind an unflattering scar on the neck.¹

Thyroid Nodules

Thyroid nodules are lumps that may appear in front of your throat. Nodules may be single or numerous, rigid or soft. Thyroid nodules are mostly benign, but you may have signs of thyrotoxicosis (excess thyroid hormone). Some nodules can act autonomously, thus producing excess thyroid hormone. A biopsy is recommended because it is necessary to exclude thyroid cancer.³

Thyroid Nodules – Clinical Signs

Thyroid nodules can be benign or cancerous, a biopsy is required to determine what type of cells they contain. Sometimes repeat biopsies are required.

Most thyroid nodules are asymptomatic. However, some thyroid nodules can be active or “hot” and cause symptoms such as palpitation, heat intolerance, weight loss, etc due to excessive hormone production. Inactive nodules are generally asymptomatic until they grow large.

Here are some signs that large nodules can cause due to the size:

Voice changes – pressure on the vocal nerves
Shortness of breath or difficulty with breathing – pressure on the trachea
Pain or discomfort when swallowing – pressure on the esaphagus
Chronic cough – pressure on nerves or airways
Foreign body sensation in the throat
Cosmetic changes, bulging in the neck

Thyroid RFA Versus Surgery

Surgery has been the primary treatment offered for thyroid nodules until recently. The removal of the thyroid gland (partial or complete thyroidectomy) is an invasive treatment with numerous disadvantages, including lifelong hormone replacement, weight gain etc. RFA is a non-surgical treatment alternative that has been used for cancers in other organs for over 20 years and is now being offered for benign nodules of the thyroid.

Studies have proven recovery is faster and easier, and cosmetically appealing. RFA treatment can significantly reduce thyroid nodules volume and symptoms without the risks of surgery, surgical recovery, or surgical drains. RFA also has a higher likelihood of preserving the thyroid function without the need for hormone replacement.⁵

Cost of surgery can be higher for thyroid removal than RFA as there are hospital, general anesthesia and potential hospital stay fees. RFA is well tolerating as an outpatient in-office procedure with a one day downtime.⁶

Thyroid RFA Results

Before the RFA procedure, our doctor will make your expectation clear by informing you of the realistic outcomes. This procedure does not shrink thyroid nodule instantly, it can take several months before there is noticeable difference. Similar to ablation in other organs, it takes some time for the body to resorb the ablated thyroid tissues.

Radiofrequency ablation (RFA) has shown significant result in restoration of thyroid function, normalization serum TSH (thyroid- stimulating hormone), and thyroid nodule volume reduction.⁸

Just like every other therapeutic procedures, RFA has a few risks and complications.

Thyroid RFA Risks

RFA has a lower risk of complications compared to surgical removal.

Lower risks of damage to the surrounding tissues: trachea, lymphatic vessels, laryngeal nerve, blood vessels, and parathyroid glands.
Lower risks of scaring, surgery has a visible large scar. RFA does not require any incision and leaves minimal to no visible scar.⁵
Lower risk of voice change
Low risk of skin burn, bleeding, recurrence, and nodule rupture.⁷

RFA is an accepted effective non-surgical treatment for benign thyroid nodules such as non-functioning nodules and AFTN (Autonomously Functioning Thyroid Nodules). You may consider RFA as possibly the first-line treatment for benign thyroid nodules.

Why Dr Allaei?

Dr Allaei is one of only a few RFA specialists specifically trained in ultrasound-guided procedures performing over 2,000 procedures yearly of different parts of the body. As a double-board certified imaging specialist, he has received 6 years of post-graduate training with specialization in ultrasound guided procedures and ablations, which requires a 3D spatial understanding while viewing a 2D image. In comparison, most other RFA specialist trained by taking a weekend course and only perform 20-100 ultrasound guided procedures yearly. Our specialist performs ablation of not only the thyroid but more complex organs such as cancers of the kidney, liver and lung. These more complex organs require a higher level of skill and understanding of the ablative technology to prevent damage to nerves, bowel and nearby organs.

REFERENCES

Popoveniuc, G., & Jonklaas, J. (2012). Thyroid nodules. The Medical clinics of North America, 96(2), 329–349. https://doi.org/10.1016/j.mcna.2012.02.002
Hegedüs, L. (2001). THYROID ULTRASOUND. Endocrinology and Metabolism Clinics of North America, 30(2), 339–360. doi:10.1016/S0889-8529(05)70190-0
Spiezia, S., Garberoglio, R., Milone, F., Ramundo, V., Caiazzo, C., Assanti, A. P., … & Faggiano, A. (2009). Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid, 19(3), 219-225.
Bernardi, S., Dobrinja, C., Fabris, B., Bazzocchi, G., Sabato, N., Ulcigrai, V., Giacca, M., Barro, E., De Manzini, N., & Stacul, F. (2014). Radiofrequency ablation compared to surgery for the treatment of benign thyroid nodules. International journal of endocrinology, 2014, 934595. https://doi.org/10.1155/2014/934595
Che, Y., Jin, S., Shi, C., Wang, L., Zhang, X., Li, Y., & Baek, J. H. (2015). Treatment of Benign Thyroid Nodules: Comparison of Surgery with Radiofrequency Ablation. American journal of neuroradiology, 36(7), 1321–1325. https://doi.org/10.3174/ajnr.A4276
Stan, M. N., Papaleontiou, M., Schmitz, J. J., & Castro, M. R. (2022). Nonsurgical Management of Thyroid Nodules: The Role of Ablative Therapies. The Journal of Clinical Endocrinology & Metabolism, 107(5), 1417-1430.
Na, D. G., Lee, J. H., Jung, S. L., Kim, J. H., Sung, J. Y., Shin, J. H., Kim, E. K., Lee, J. H., Kim, D. W., Park, J. S., Kim, K. S., Baek, S. M., Lee, Y., Chong, S., Sim, J. S., Huh, J. Y., Bae, J. I., Kim, K. T., Han, S. Y., Bae, M. Y., … Korean Society of Radiology (2012). Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations. Korean journal of radiology, 13(2), 117–125. https://doi.org/10.3348/kjr.2012.13.2.117
Vu, D. L., Pham, M. T., & Van Bang Nguyen, T. M. L. (2022). Efficacy and Safety of Radiofrequency Ablation for the Treatment of Autonomously Functioning Thyroid Nodules: A Long-Term Prospective Study. Therapeutics and Clinical Risk Management, 18, 11.

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Geniculate Embolization

Codeholic Admin — Mon, 30 May 2022 07:32:49 +0000

Geniculate Embolization

Geniculate Artery Embolization

Patient with knee pain or bloody joint effusions are often informed that surgery or medicine are their only options. Non-surgical treatment called geniculate artery embolization, on the other hand, maybe an effective alternative option for osteoarthritis and hemarthrosis.

Osteoarthritis

Connective tissue called cartilage acts as a lubricant in joints, making it possible to move freely. Over time these can wear down and the joints can become inflamed causing what is called osteoarthritis (OA). 32.5 million Americans are affected with OA each year. The knee, hands, elbows, and spine are the most common locations.^1,2

Hemarthrosis

Hemarthrosis is when there is bleeding into the knee joint cavity. Pain, tenderness, redness, swelling, warmth, and stiffness in the affected joint are some of the symptoms. Bruising may be visible in the area around the joint.

Postoperative hemarthrosis most commonly occurs after arthroscopic surgery, such as a total knee replacement. Recurrent hemarthrosis occurs in about 0.3% of people who have had a total knee replacement. Repetitive trauma and inflamed hypervascular synovial tissue causes bleeding in the joint. Typically, these joints are aspirated yielding bloody fluid. Some patients however do not respond well to conservative measures and experience continued bleeding into the joint. Hemarthrosis embolization is an option for those who need a more permanent solution.

Blood thinners, osteoarthrosis, hemophilia, and malignancies in the joint are also other potential causes of hemarthrosis.

Why Treat Hemarthrosis

After knee replacement surgery, if hemarthrosis develops and the patient does not receive treatment, the joint can be further damaged causing stiffness and loss of range of motion. This can lead to muscular weakening as well. Infection of the joint can occur as well.

Current Treatments for Hemarthrosis

Ice and rest of the joint, elevation of the leg, and pain medication are typically first line treatments. This may be all that is required for patients in some cases.

Aspiration, surgical excision of the synovial tissue, or embolization can also be used to treat recurrent hemarthrosis. If a patient fails conservative management and aspiration, embolization procedure may be explored as a minimally invasive option.

Why Treat Osteoarthritis

Osteoarthritis is a chronic process that worsens over time causes discomfort, swelling and reduced range of motion in the joint. Progressive symptoms would not be ideal in an active patient or someone who does not want to be on pain medication long term.

Current Treatments for Osteoarthritis

Treatment regimens include a variety of medications that aim to slow or stop its progression. Symptomatic care with ice packs to reduce swelling, heating pads to ease pain, and NSAIDs like ibuprofen to alleviate discomfort.^2,4

Osteoarthritis that is both painful and accompanied by mobility impairment necessitates surgical intervention. Surgical options include arthroscopy, cartilage repair, osteotomy, and joint replacement.⁴

However, there is a period in this disease process where conservative measures are not working or ideal, and the joint is still too healthy and functional for surgery. In this period, embolization can provide symptom relief until there is enough joint disease warranting joint replacement surgery.

Embolization

During an embolization, the blood supply to a specific location is cut off. Geniculate artery embolization specifically cuts off the blood supply to the inflamed tissues of the knee joint.

The geniculate arteries extend into the knee joint and can cause sporadic bleeding or pain if inflamed and are frequently the source of the problem.

Geniculate Artery Embolization: Procedure

Embolization is an outpatient non-surgical procedure with a short recovery. The patient is given a mild sedative and a local topical anesthetic to help numb the skin. A tiny catheter is inserted and guided to the knee using an x-ray system that provides moving photographs in “real time.”

Embolism of the geniculate artery is completed by injecting sand-sized particles into the catheter. The blood arteries become blocked with the particles, resulting in a lack of blood flow to the abnormal tissues of the joint reducing inflammation and pain.^8,9

Patients are discharged one to two hours after the treatment, and pain relief typically begins within two weeks. As the procedure is minimally invasive, the incidence of any complications is very low. Patients might experience bruising or pain at the injection site. Some rare complications for GAE include allergic reactions, infection, bleeding/bruising, skin irritation.

Geniculate Artery Embolization: Results

Current data shows promising results in relieving osteoarthritis. There was a 61% and 67% drop in WOMAC and VAS pain levels, respectively, throughout a 12-month period in research.⁵ Clinical investigations have revealed that after GAE, pain is significantly reduced. The demand for medications such as analgesics was also reduced. There were also no major adverse effects or complications during or following the treatment, according to the research.⁷

For hemarthrosis, embolization has a technical success rate over 90%. After 26.8 months of follow-up, the clinical success rate is 89%, which means that 89% of patients are symptom-free.

References

Lombardi M, Cardenas AC. Hemarthrosis. [Updated 2020 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525999/
Medical News Today. All you need to know about hemarthrosis by Tom Seymour. Date: December 27, 2017. https://www.medicalnewstoday.com/articles/320443#
Hemarthrosis by Jacquelyn Cafasso, medically reviewed by Graham Rogers, M.D. Updated on June 14, 2017. https://www.healthline.com/health/hemarthrosis
The Hemophilia, von Willebrand Disease & Platelet Disorders Handbook. Joint Bleeds. https://www.hog.org/handbook/article/3/33/joint-bleeds
Yoo JH, Oh HC, Park SH, Lee S, Lee Y, Kim SH. Treatment of Recurrent Hemarthrosis after Total Knee Arthroplasty. Knee Surg Relat Res. 2018;30(2):147-152. doi:10.5792/ksrr.17.059. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990227
National Cancer Institute. Arterial embolization.https://www.cancer.gov/publications/dictionaries/cancer-terms/def/arterial-embolization
Maheshwari R, Kelley SP, Langkamer VG, Loveday E. Spontaneous recurrent haemarthrosis following unicompartmental knee arthroplasty and its successful treatment by coil embolisation. Knee. 2004;11:413-5.
van Baardewijk LJ, Hoogeveen YL, van der Geest ICM, Schultze Kool LJ. Embolization of the Geniculate Arteries Is an Effective Treatment of Recurrent Hemarthrosis Following Total Knee Arthroplasty That Can Be Safely Repeated. J Arthroplasty. 2018 Apr;33(4):1177-1180.e1. doi: 10.1016/j.arth.2017.11.002. Epub 2017 Nov 24. PMID: 29224993. https://pubmed.ncbi.nlm.nih.gov/29224993
Osteoarthritis – Symptoms and causes – Mayo Clinic. Accessed March 2, 2022. https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925
Osteoarthritis (OA) | Arthritis | CDC. Accessed March 2, 2022. https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
Osteoarthritis | National Institute on Aging. Accessed March 2, 2022. https://www.nia.nih.gov/health/osteoarthritis
Rönn K, Reischl N, Gautier E, Jacobi M. Current surgical treatment of knee osteoarthritis. Arthritis. 2011;2011:1-9. doi:10.1155/2011/454873
Padia SA, Genshaft S, Blumstein G, et al. Genicular Artery Embolization for the Treatment of Symptomatic Knee Osteoarthritis. JB & JS open access. 2021;6(4). doi:10.2106/JBJS.OA.21.00085
Heller DB, Beggin AE, Lam AH, Kohi MP, Heller MB. Geniculate Artery Embolization: Role in Knee Hemarthrosis and Osteoarthritis. Radiographics. 2022;42(1):289-301. doi:10.1148/RG.210159/ASSET/IMAGES/LARGE/RG.210159.VA.JPEG
Torkian P, Golzarian J, Chalian M, et al. Osteoarthritis-Related Knee Pain Treated With Genicular Artery Embolization: A Systematic Review and Meta-analysis. Orthopaedic journal of sports medicine. 2021;9(7):23259671211021356. doi:10.1177/23259671211021356
van Zadelhoff TA, Moelker A, Bierma-Zeinstra SMA, Bos PK, Krestin GP, Oei EHG. Genicular artery embolization as a novel treatment for mild to moderate knee osteoarthritis: protocol design of a randomized sham-controlled clinical trial. Trials. 2022;23(1):1-8. doi:10.1186/S13063-021-05942-X/TABLES/1
Society of Interventional Radiology – SIR 2021 knee pain. Accessed March 2, 2022. https://www.sirweb.org/media-and-pubs/media/news-release-archive/sir-2021-knee-pain-031621/
Geniculate Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis NCT number NCT02850068. Published online 2017.

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Non-Surgical Gallstone Removal Cholangioscopy

Codeholic Admin — Sat, 08 Aug 2020 09:01:46 +0000

Non-Surgical Gallstone Removal

Gallstones

Non-Surgical Gallstone Removal

Percutaneous endoscopic procedure is a technique that can be used to treat patient that have gallstones, known as cholelithiasis, but cannot undergo surgery for gallbladder removal due to other medical issues. Often times these patients end up with a gallbladder drain, a cholecystostomy tube, that cannot be removed because of the risk of recurrent pain and symptoms.

There may also be stones in the bile ducts, known as choledocholithiasis.

This procedure is performed by our trained interventional radiologists, a doctor who uses X-rays and other advanced imaging to see inside the body and treat conditions without surgery. Our interventional radiologist using direct visualization with a camera and X-ray guidance from a fluoroscopy machine that allows for control of the instruments used to remove the stones.

Non-Surgical Gallstone Removal and Choledoscopy Candidate

Endoscopic gallstone removal is typically for patients who are too old or high risk to have traditional gallbladder surgery or who have bile duct stones that cannot be removed in the standard fashion. Sometimes this treatment can be offered to patient who have strong medical, religious or personal reasons for not wanting their gallbladder removed.

If you have had a gallbladder drain placed for gallstones but cannot get your gallbladder surgically removed, then you are potentially a candidate for this procedure.

Our specialist has treated a number of patients who are over 80 years old and too sick to undergo surgery. The lower risk profile makes this an ideal procedure for older patients or those with a number of medical issues to undergo surgery. Since this procedure can be performed with twilight sedation, this also eliminates the risks of general anesthesia and intubation. This is a safe and effective procedure when performed by our experienced interventional radiologist with an understanding of the techniques needed to reduce complications.

Non-Surgical Gallstone Removal Procedure

Percutaneous endoscopy is performed through the existing gallbladder drain tract. If you don’t have a gallbladder drain, this will need to be placed.

Sometimes the size of the drainage catheter is increased prior to removal of the stones so that the tract is larger to accommodate the camera. This depends on the size of the stones.

How to Prepare for Non-Surgical Gallstone Removal Procedure

Prior to the Procedure

You may not eat or drink eight hours prior to the procedure.

If you are on blood-thinning medication, ask your provider if you need to stop it prior to the procedure.

During the Procedure

You will be asked to change into a gown before the procedure.

Labs maybe obtained.

You will be given a sedative by the anesthesia nurse, who will be present to monitor your vital signs during the examination. Typically the procedure is done with a “twilight sedation.”

After the Procedure

This is an outpatient procedure and does not require hospital stay.

You will remain in a recovery room until most of the effect of the sedative has worn off.

Because of sedation used during the procedure, you’ll need to make plans to have someone take you home.

What are the Risks?

Discomfort at the insertion site

Infection

Nausea

Bleeding

Bile duct or gallbladder injuries like perforation

Results:

We have successfully treated many patients with complete removal of the gallstones. This has rendered them tube free, which is a huge relief for patients and their family.

Gallstones

Non-Surgical Gallstone Removal

There may also be stones in the bile ducts, known as choledocholithiasis.

Non-Surgical Gallstone Removal and Choledoscopy Candidate

If you have had a gallbladder drain placed for gallstones but cannot get your gallbladder surgically removed, then you are potentially a candidate for this procedure.

Success Rate of Non-Surgical Gallstone Removal Cholangioscopy

Endoscopic and fluoroscopic-guided gallstone removal is highly successful, with complete stone removal from the gallbladder or bile ducts occurring in 80% of cases. This has a significant impact on patients and their family who are left to care for the drainage catheter, which would be otherwise for the rest of the patient’s life. After the procedure, the catheter can be removed allowing the patient to have a better quality of life.

Non-Surgical Gallstone Removal Procedure

Percutaneous endoscopy is performed through the existing gallbladder drain tract. If you don’t have a gallbladder drain, this will need to be placed.

Sometimes the size of the drainage catheter is increased prior to removal of the stones so that the tract is larger to accommodate the camera. This depends on the size of the stones.

On the day of the procedure, the drain is exchanged for a larger temporary access into the gallbladder that will fit the endoscopic camera. Iodinated contrast material maybe injected into the bile d

ucts to locate gallstones that maybe causing blockage. Small stones are

removed using a basket that fits through the camera. Other stones can be washed out by irrigating the gallbladder with saline or water.

How to Prepare for Non-Surgical Gallstone Removal Procedure

Prior to the Procedure

You may not eat or drink eight hours prior to the procedure.

If you are on blood-thinning medication, ask your provider if you need to stop it prior to the procedure.

During the Procedure

You will be asked to change into a gown before the procedure.

Labs maybe obtained.

You will be given a sedative by the anesthesia nurse, who will be present to monitor your vital signs during the examination. Typically the procedure is done with a “twilight sedation.”

After the Procedure

This is an outpatient procedure and does not require hospital stay.

You will remain in a recovery room until most of the effect of the sedative has worn off.

Because of sedation used during the procedure, you’ll need to make plans to have someone take you home.

What are the Risks?

Discomfort at the insertion site

Infection

Nausea

Bleeding

Bile duct or gallbladder injuries like perforation

Results:

We have successfully treated many patients with complete removal of the gallstones. This has rendered them tube free, which is a huge relief for patients and their family.

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Back Pain/Compression Fracture

Codeholic Admin — Mon, 13 Mar 2017 16:56:33 +0000

Back Pain/Spinal Fracture

Kyphoplasty

Kyphoplasty is a new minimally invasive technique in vertebral compression fractures. It is primarily performed for patients who suffer vertebral fracture due to diminished bone strength.

Patients who benefit the most from kyphoplasty include those with osteoporosis or age related bone loss. In addition, steroids also weaken the bones of young people, who then face the risk of compression fractures.

Purpose of Kyphoplasty

stop the pain associated with the fracture

stabilize the vertebra

restore vertebral body height

Kyphoplasty is one of the latest breakthroughs in the field of minimally invasive techniques. Since the technique was adopted in 1998, more than 200,000 kyphoplasties have been performed worldwide.

By achieving fracture stabilization and correction of spinal deformity, patients experience significant reduction in pain and improvement in mobility, thus leading to an overall improvement in the quality of life.

Kyphoplasty Procedure

Kyphoplasty uses a two-step process, inclusive of inserting a special balloon device and injection of the bone cement.

It involves an introduction of a cannula into the vertebral body followed by the insertion of an inflatable balloon. The balloon is inserted through tiny incisions along the spine and then inflated to expand the broken bone.

Once done, the bone cement is then injected into the fracture. This restores height and stabilizes the compressed vertebra. After the balloon is removed, there is an empty space within the vertebral body that allows for the low-pressure injection of the cement-like material polymethylmethacrylate into the cavity created by the balloon.

The procedure might be performed under intravenous sedation and the patient might be administered a local or general anesthetic.

Results

Kyphoplasty is considered most successful in restoring bone height and correcting deformity if done on relatively recent fractures, diagnosed within two to three months. Patients are able to return home the same day and resume their daily activities almost immediately after the surgery.

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Phlebectomy

Codeholic Admin — Mon, 13 Mar 2017 16:55:32 +0000

Phlebectomy

What is Phlebectomy of Varicose Veins?

Phlebectomy is a minimally invasive procedure used to remove varicose veins on the surface of the leg. This is usually done in a physician’s office using local anesthesia.

How should I prepare?

You will receive specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule.

You should wear comfortable, loose-fitting clothing to your exam. You may be given a gown to wear during the procedure.

What does the equipment look like?

A small scalpel or needle is used to make very small incisions. A phlebectomy hook is used to remove the veins. The hook is similar to a tiny crochet hook with a blunt tip and a straight shaft.

How does the procedure work?

Phlebectomy involves making tiny punctures or incisions in the skin near the varicose vein. Veins are very collapsible and even large veins can be removed through the tiny incisions used in this technique.

How is the procedure performed?

This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Please consult with your physician as to whether or not you will be admitted.

Your physician will numb the area with a local anesthetic.

Because the area is numbed, you are typically awake during the procedure.

A very small skin incision is made at the site.

After cleansing and anesthetizing the skin, a series of incisions no larger than a pencil eraser are made in the skin next to the enlarged vein. A phlebectomy hook is inserted under the surface of the skin to remove the varicose vein through the tiny incision. This procedure is usually completed between 30 minutes and one hour.

What will I experience during and after the procedure?

Patients rarely report any pain during this procedure because the area being worked on is under a local anesthetic.

The incisions made during the procedure are so small that no stitches are required.

When the procedure is complete, your leg will be wrapped in a comfortable but snug compression wrap.

You will need to wear graduated compression stockings for approximately two to three weeks following the procedure. As long as the stockings are worn, almost all activities can be done beginning the day after the surgery.

You should be able to resume daily activities within 24 hours. Strenuous activities will be limited for approximately two weeks.

Who interprets the results and how do I get them?
The interventional radiologist can advise you as to whether the procedure was a technical success when it is completed.

Your interventional radiologist may recommend a follow-up visit after your procedure or treatment is complete.

The visit may include a physical check-up, imaging procedure(s) and blood or other lab tests. During your follow-up visit, you may discuss with your doctor any changes or side effects you have experienced since your procedure or treatment.

What are the benefits vs. risks?

Benefits

No surgical incision is needed—only a small nick in the skin that does not have to be stitched.

Risks

Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
Skin pigmentation at the site of the treated varicose vein may occur but is usually temporary.

What are the limitations of Phlebectomy of Varicose Veins?

Long-term success in greater than 90 percent of patients has been observed. The long-term results of phlebectomy are excellent when the procedure is performed in patients who are good candidates.

Often, phlebectomy is used with a more comprehensive treatment plan, including additional procedures such as endovenous catheter ablation that use radiofrequency or laser energy.

Patients should discuss their individualized treatment plan with their interventional radiologist.

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SVC Obstruction

Codeholic Admin — Mon, 13 Mar 2017 16:55:08 +0000

SVC Obstruction

SVC obstruction is a narrowing or blockage of the superior vena cava, which is the second largest vein in the human body. The superior vena cava moves blood from the upper half of the body to the heart.

Causes

Superior vena cava (SVC) obstruction is a relatively rare condition.

It is most often caused by cancer or a tumor in the mediastinum (the area of the chest under the breastbone and between the lungs).

The types of cancer that can lead to this condition include:

Breast cancer
Lymphoma
Metastatic lung cancer (lung cancer that spreads)
Testicular cancer
Thyroid cancer
Thymus tumor

Superior vena cava obstruction can also be caused by noncancerous conditions that cause scarring. These conditions include:

Histoplasmosis (a type of fungal infection)
Inflammation of a vein (thrombophlebitis)
Lung infections (such as tuberculosis)

Other causes of superior vena cava obstruction include:

Aortic aneurysm (a widening of the artery that leaves the heart)
Blood clots in the superior vena cava
Constrictive pericarditis (tightening of the thin lining of the heart)
Effects of radiation therapy for certain medical conditions
Enlargement of the thyroid gland (goiter)
Catheters placed in the large veins of the upper arm and neck may cause blood clots in the superior vena cava.

Symptoms

Symptoms occur when something blocks the blood flowing back to the heart. They may begin suddenly or gradually, and may worsen when you bend over or lie down.

Early signs include:

Swelling around the eye
Swelling of the face
Swelling of the whites of the eyes
The swelling will most likely be worse in the early morning hours and go away by mid-morning.

The most common symptoms are shortness of breath (dyspnea) and swelling of the face, neck, trunk, and arms.

Other possible symptoms include:

Decreased alertness
Dizziness
Fainting
Headache
Reddish face or cheeks
Reddish palms
Reddish mucus membranes (inside the nose, mouth, and other places)
Redness changing to blueness later
Sensation of head or ear “fullness”
Vision changes

Exams and Tests

An examination may show enlarged veins of the face, neck, and upper chest. Blood pressure is often high in the arms and low in the legs.

A bronchoscopy (a lighted tube placed through the mouth into the windpipe and lungs) may be performed if lung cancer is suspected.

Blockage of the SVC may be visible on:

Chest x-ray
CT scan of the chest or MRI of chest
Coronary angiography (a heart blood vessel study)
Doppler ultrasound (sound wave test of the blood vessels)
Radionuclide ventriculography (nuclear study of heart motion)

This disease may also affect the results of the following tests:

Abdominal MRI or CT scan
Liver scan

Treatment

The goal of treatment is to relieve the blockage.

Diuretics (water pills) or steroids may be used to temporarily relieve swelling.

Other treatment options may include radiation or chemotherapy to shrink the tumor, or surgery to remove the tumors. A minimally invasive option is placement of a stent to open up the SVC. This is performed by a vascular and interventional radiologist. Surgery to bypass the obstruction is rarely performed.

Outlook (Prognosis)

The outcome varies, depending on the cause and the amount of blockage.

SVC syndrome caused by a tumor is a sign that the tumor has spread, and it indicates a poorer long-term outlook.

Possible Complications
The throat could become blocked, which can block the airways.

Increased pressure may develop in the brain, leading to changed levels of consciousness, nausea, vomiting, or vision changes.

When to Contact a Medical Professional
Call your health care provider if you develop symptoms of SVC obstruction. Complications are serious and can sometimes be fatal.

Prevention

Prompt treatment of other medical disorders may reduce the risk of developing SVC obstruction.

Alternative Names
Superior vena cava obstruction; Superior vena cava syndrome

References

Rice TW, Rodriguez MR, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore). 2006;85;1:37-42. PMID: 16523051 www.ncbi.nlm.nih.gov/pubmed/16523051.

Ugras-Rey SS. Selected oncologic emergencies. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 123.

Wilson LD, Detterbeck FC, Yahalom J. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356:1862-9. PMID: 17476012 www.ncbi.nlm.nih.gov/pubmed/17476012.

Review Date 1/13/2015
Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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May-Thurner Syndrome

Codeholic Admin — Mon, 13 Mar 2017 16:54:49 +0000

May-Thurner Syndrome

May-Thurner syndrome is a rare vascular condition that affects a vein in the pelvis.

It occurs when a nearby artery compresses the left iliac vein. This vein brings blood from your pelvis and legs back up to your heart.

The compression prevents blood from flowing properly, leading to narrowing and scarring.

In some cases, an artery can compress the right iliac vein, or both veins.

Complications

Some people with May-Thurner syndrome have no symptoms, but over time, this condition can lead to:

Leg swelling.

Chronic venous insufficiency, in which blood pools in your veins. This causes swelling, pressure, skin changes, and venous ulcers or sores that don’t heal.

Deep vein thrombosis (DVT), a blood clot in a vein deep below your skin. If a blood clot breaks free and travels to your lungs, heart, or brain, it can lead to serious, even life-threatening issues like: Pulmonary embolism, a blood clot in your lung, Heart attack or Stroke.

Symptoms

Swelling, heaviness, or fullness in your leg or foot.
Venous ulcers or sores that do not heal on your leg.
Varicose veins in your leg.
In some cases, May-Thurner syndrome has no symptoms and patients go undiagnosed until they develop deep vein thrombosis (DVT).

Symptoms of DVT can include:

Leg swelling.
Leg pain and tenderness.
Redness or other changes in skin color.
Skin that feels warm.

Diagnosis

To diagnose May-Thurner syndrome, your doctor will:

Perform a physical exam.
Ask about your medical history and symptoms.
Use an imaging test — like an ultrasound, MRI, or venogram — to confirm your diagnosis.

Treatment

If symptoms are severe, this would warrant placement of a stent in the affected vein which would displace the pressure that caused the narrowing. This is performed by a vascular & interventional radiologist.

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Non-Healing Venous Ulcer

Codeholic Admin — Mon, 13 Mar 2017 16:54:24 +0000

Non-Healing Venous Ulcer

Non-Healing Ulcer

Venous ulcers, also referred to as stasis, insufficiency or varicose ulcers, are the result of malfunctioning venous valves causing pressure in the veins to increase. These typically occur along the medial or lateral distal (lower) leg. The resulting venous hypertension causes blood pooling when it is not as efficiently pumped back towards the heart, otherwise known as venous insufficiency. In addition, the increase in pressure stretches the vein walls, allowing proteins in the blood and blood cells to leach resulting in swelling.

The above along with poor oxygenation in turn lead to necrosis and ulceration.

Risk Factors

Diabetes mellitus
Congestive heart failure
Peripheral vascular disease
Deep vein thrombosis
Pregnancy
Obesity

Complications

One of the most typical complications associated with venous insufficiency ulcers is infection of the affected tissue.

Treatment

In addition to treating the superficial wound and edema, the secondary goal in treating venous ulcers is to alleviate the underlying condition. One of the most common treatments is compression therapy , which serves to decrease blood vessel diameter and pressure, increasing effectiveness and in turn preventing venous reflux. The second therapy would be to treat the underlying abnormal veins. This requires an experienced interventional radiologist. Our physician uses ultrasound guided to find and treat the veins with the abnormal veins by means of sclerotherapy or ablation. These methods use heat or medication to close the abnormal veins down.

References

Cleveland Clinic. Leg and Foot Ulcers. Cleveland Clinic. http://my.clevelandclinic.org/heart/disorders/vascular/legfootulcer.aspx. Accessed July 12, 2017.

Gabriel A. Vascular Ulcers. Medscape Reference. http://emedicine.medscape.com/article/1298345-overview. Updated Mar 16, 2016. Accessed July 12, 2017.

Healthwise, Inc. Venous Skin Ulcer – Topic Overview. WebMD. http://www.webmd.com/skin-problems-and-treatments/tc/venous-skin-ulcer-t…. Updated August 21, 2015. Accessed July 12, 2017.

London Health Sciences Centre. Venous Stasis & Arterial Ulcer Comparison. London Health Sciences Centre. http://www.lhsc.on.ca/Health_Professionals/Wound_Care/venous.htm. Updated February 1, 2009. Accessed July 12, 2017.

Ngan V. Leg ulcers. DermNet NZ. http://dermnetnz.org/site-age-specific/leg-ulcers.html. Accessed July 12, 2017.

Takahashi P. Chronic Ischemic, Venous, and Neuropathic Ulcers in Long-Term Care. Annals of Long-Term Care. http://www.annalsoflongtermcare.com/article/5980. Published September 5, 2008. Accessed July 12, 2017.

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