interventional radiologist Archives - Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA

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.

The post Endoscopic Gallstone Removal appeared first on Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA.

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.

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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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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Vascular Malformations

Codeholic Admin — Mon, 13 Mar 2017 16:48:10 +0000

Vascular Malformations

Arteriovenous Malformation (AVM)

Normally, blood flows from the heart to the arteries of the body. The arteries branch and get smaller until they become a capillary, which is just a single cell thick. In this way blood pressure drops to very low levels that the thinner walled veins can cope with. In an AVM, usually early in life, arteries connect directly to veins. This is a high-pressure shunt or fistula. Veins are not able to handle the pressure of the blood coming directly from the arteries. The veins stretch and enlarge and create what we call a ‘nidus’. Usually, there are multiple feeding vessels in an AVM and many draining veins.

How can an AVM be treated?

Endovascular techniques are now the main route of treatment for AVMs. This involves treating the AVM through the blood vessel system.

Through a pinhole incision, a catheter is placed into an artery in the groin area and passed to the AVM using x-ray guidance. Once in the correct vessel, an embolic material such as a coil or glue is placed into the abnormal communication cutting off the blood supply, in turn shrinking and shutting down the AVM. This procedure requires no stitches, downtown or major incision and can be done under moderate IV sedation.

Venous Malformation

A venous malformation is a congenital defect of the veins. The veins are different than normal veins and contain, for example, less muscle cells. Feeding them less blood, which is actually their duty. That is why they sometimes look varicose. A venous malformation can be anywhere in the skin or in the body. Usually it is a venous malformation blue. A venous malformation feels soft and sometimes it can be empty. It is unclear why a venous malformation occurs exactly. Usually this gives cosmetic problems, sometimes pain. However, there may also be functional problems, as with a large deviation on the lip.

Important is the difference with the infantile hemangioma. Venous malformations are defects of the veins and exist from birth. Venous malformations grow along with the child and do not go away by themself (hemangiomas occur almost always after birth, then grow very fast; they can be quite large and then will go away).

Usually, the diagnosis may be made on the based on the history and look at the area. If the doctor is not sure he can order an ultrasound or a CT scan.

If treatment is required, it is typically treated with sclerotherapy. It is something sprayed in the blood vessels by an Interventional Radiologist that provides a chemical reaction which makes the walls of the blood vessels there decrease. This makes the place invisible. Correction is also possible with surgery or laser treatment. A deviation that is in the legs can also be treated with support stockings.

What is a lymphatic malformation?

A lymphatic malformation is an abnormality of the lymphatic system. The lymphatic system forms part of the immune system that identifies and fights off invaders, such as bacteria and viruses consisting of a network of vessels within the body through which lymph circulates, and many lymph nodes which filter the lymph fluid and help the body fight infection. The specific symptoms and severity of lymphatic malformations varies based upon the size and specific location of the malformation. Some lymphatic malformations can be massive. Lymphatic malformations regardless of size can potentially cause functional impairment of nearby structures or organs and disfigurement of affected areas.

How can lymphatic malformations be treated?

There are two main options for treatment: sclerotherapy and surgical removal.

Sclerotherapy

This is a procedure carried out by an interventional radiologist, who shrinks the lymphatic vessels by injecting a special substance through the skin under general anaesthetic. It may require several sclerotherapy sessions and even then, it might grow again.

Surgical removal

Sometimes, lymphatic malformations can be removed safely. Detailed scans will be needed to plan the operation. There will be a certain amount of scarring after the operation, as with all surgery.

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Non-Healing Wound/ Ischemia

Codeholic Admin — Mon, 13 Mar 2017 16:46:03 +0000

Non-Healing Wound/Ischemia

Critical Leg Ischemia

Critical leg ischemia is a lack of blood flow that endangers all or part of the leg and is usually defined as experiencing persistent and recurring pain while at rest, for more than two weeks, or ulceration or gangrene of the foot.

The pain of severe limb ischemia is felt in the toes and forefoot and is typically worse at night when cardiac output drops. Patients wake up in the early hours with severe pain, relieved by hanging the leg out of the bed allowing blood to flow down to the foot. Some patients take to sleeping in a chair. Many patients get up and walk around in the night that stimulates flow and reduces pain. During the day the patient may suffer short distance intermittent claudication. This pattern of symptoms: calf claudication by day and rest pain in the toes at night is strongly suggestive of critical limb ischemia.

Without treatment, critical limb ischemia will progress, causing worsening pain and debility. Ulcers develop on the lower leg and foot, and ultimately gangrene sets in. If the problem is left too late it can become impossible to salvage the leg and amputation may become the only way to save the patient’s life.

Duplex scanning is the first method used to assess the affected limb and establish where the main blockages are that are limiting the blood flow.

Treatment Options?

All patients with claudication should have their cholesterol and blood pressure measured and should be encouraged to stop smoking. It is recommended that all people with claudication should have a variety of medications to protect their arteries form further damage.

Some people will benefit from structured exercise classes to improve how far they can walk. Others may be recommended to have endovascular treatments to improve the circulation:

Balloon Angioplasty

To open a narrowed artery, a catheter with a very small balloon on its tip is placed in the artery and is advanced to reach the narrowed or blocked artery. The doctor then inflates the balloon, pushing aside the plaque that has built up against the vessel walls. The doctor then inflates and deflates the balloon several times to open the vessel.

Atherectomy

Atherectomy is a minimally-invasive method of removing plaque to re-open arteries. Unlike angioplasty and stenting which are designed to squish plaque to the side, atherectomy involves cutting and removing the plaque from the artery, restoring normal blood flow.

Stenting

A stent is a small, metal scaffold that is placed inside an artery. Similar to balloon angioplasty, stents restore blood flow by pushing the plaque to the side but remain inside the artery forever. Stenting often follows balloon angioplasty as an additional treatment to help the vessel remain open.

Bypass

Surgical bypass treats narrowed arteries by directly creating a detour, or bypass, around a section of the artery that is blocked. During a bypass procedure, a physician creates a new pathway for blood flow using a graft. A graft can be a portion of a vein or a synthetic tube that connects above and below a blockage to allow blood to flow around it.

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Peripheral Arterial Disease

Codeholic Admin — Mon, 13 Mar 2017 16:45:41 +0000

Peripheral Arterial Disease

Peripheral Arterial Disease (PAD)

PAD refers to plaque formation in the arteries of the arms and legs. It usually happens because your arteries harden and narrow. (That’s called atherosclerosis). Smoking, high blood pressure, high cholesterol, and not being active are the main causes.

If you have diabetes, you’re more likely to get a worse case of peripheral artery disease that improves less with treatment.

Symptoms

When atherosclerosis narrows the long arteries of the legs, your leg muscles don’t get enough blood flow. As a result, you may feel muscle pain. It usually comes on with exercise and stops when you rest.

It can affect different muscle groups, including:

Calf (most common)
Buttock and hip
Thigh
Foot (less common)
Some people feel burning or numbness. Others have severe blockages with no pain at all, usually because the body grows blood vessels that go around the blockages.

Other signs and symptoms of peripheral artery disease include:

Wounds that heal poorly
Legs are cooler than the arms
Shiny skin over the legs
Loss of hair on the legs
Fainter pulse in the feet

Diagnosis

The tests you’ll take to see if you have peripheral artery disease are simple and painless.

Doctors usually start by checking your “ankle-brachial index,” which compares your blood pressure at your ankle and upper arm. Those measurements should be about the same. If your blood pressure in your ankle is a lot lower, you may have peripheral artery disease.

If your case is severe, you may take a type of X-ray called an angiogram to see exactly where the blockage is. Your doctor will inject a dye into a blood vessel to help show what’s going on.

Treatment

You can do a lot to stop peripheral artery disease in its tracks, such as:

Exercising
Controlling your cholesterol and blood pressure
Not smoking
Eating a healthy diet
The drug cilostazol eases symptoms in many people. Pentoxifylline is another that can improve symptoms in people with poor circulation. Doctors may also prescribe aspirin or other anticlotting drugs.

For severe peripheral artery disease, your doctor may recommend surgery or less invasive procedures to bypass a blocked artery and restore blood flow. See treatment options here.

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Varicocele

Codeholic Admin — Mon, 13 Mar 2017 16:44:16 +0000

Varicocele

A varicocele is the swelling in the scrotum caused by a collection of abnormally large bloods vessels (veins) in the scrotum. This is due to dilatation of the testicular vein which drains the scrotum and testicle and is a form of varicose vein. They are often described as feeling like “a bag of worms”.

A varicocele occurs in approximately 1 in 8 men and it is usually first noticed between the ages of 12 to 28. The incidence is noted to be higher in infertile couples, often up to 30%.

They usually occur on the left hand side but can occur on both sides of the scrotum. They occur more frequently on the left side as a result of the differing anatomy of the veins from which varicoceles result on the left hand side of the body compared to the right.

Symptoms

Pain:

This is often described as a discomfort or aching sensation particularly by the end of the day when the person has been standing or sitting for a long period of time. This is thought to be due to increasing pressure in the varicocele due to increased blood pooling.

Infertility:

There is an association between infertility and varicoceles. Most men with varicoceles are not infertile. However, if one has a varicocele,then there an increased chance of infertility. Among infertile couples, the incidence of a varicocele is about 30%. It is thought that the increased blood flow around the scrotum is responsible for raising the temperature in the testicles and results in defective sperm formation.

Varicoceles may cause decreased sperm count, decreased motility of sperm, or an increase in the number of deformed sperm.

Testicular atrophy:

Another symptom of varicoceles is the shrinkage of the testicles, also known as atrophy. This may recover following treatment.

Varicocele embolization

This is a non-surgical, day case procedure which is performed by an interventional radiologist. By this procedure, the vein is blocked internally, therefore accomplishing what a urologist does surgically, but without the need for surgery in the scrotum.

Surgical treatment

This is performed by a urologist, usually under general anesthesia or sedation. Then an incision is made into the skin above the scrotum. The offending veins are identified and tied off with sutures. Recovery time is often two to three weeks. A keyhole operation is also possible using a laparoscope as is used for other common operations like gallbladder removal.

Advantages of embolization over surgery

No surgical incision or sutures.
As effective as surgery.
Day case procedure with no overnight stay.
Short recovery period of one to two days.
Hardly any complications. Infection has not been reported.
If a patient has varicoceles on both sides, both can be treated at the same time.

How effective is varicocele embolization?

Varicocele embolization is as effective as surgery for the treatment of varicoceles as measured by improvement in pain, semen analysis and pregnancy rates. In one study pregnancy rates were as high as 60 percent. Another study showed that sperm parameters improved in 83 percent compared to 63 percent for surgery. Patients who have had both procedures express a preference for embolization.

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Ovarian Vein Embolization/Pelvic Venous Congestion

Codeholic Admin — Mon, 13 Mar 2017 16:39:21 +0000

Ovarian Vein Embolization / Pelvic Venous Congestion

Pelvic Congestion Syndrome

Pelvic congestion syndrome is a condition that is caused by what are basically ‘pelvic varicose veins’. Due to differences in anatomy of the pelvis, it usually affects females more than males. As with varicose veins in the legs, if the valves fail in the pelvic veins, blood that should be pumped out of the pelvis and back to the heart stays inside dilated varicose veins within the pelvis. This both stops the normal blood circulation to the pelvic organs and also causes these large varicose veins to push on the pelvic organs – the bladder, bowel, vagina and also the pelvic floor.

The symptoms of pelvic congestion syndrome predominantly come from the weight of the blood pushing on these structures.

‘Pelvic’ – means that it relates to a condition of the pelvis
‘Congestion’ – meaning too much blood in the veins and hence the venous circulation is “congested”
‘Syndrome’ – means a collection of different symptoms and signs

Who gets symptoms from Pelvic Congestion Syndrome?

Pelvic congestion syndrome affects women in their childbearing years. It is uncommon for girls to get pelvic congestion syndrome before puberty, as the pelvic organs and blood supply have not increased due to the effect of female hormones. Similarly, it is uncommon to get pelvic congestion syndrome after the menopause, as when the female sex hormones reduce sufficiently, the blood supply to the pelvis also reduces. However it is possible to get pelvic congestion syndrome postmenopausally if the veins have been very dilated.

What are the symptoms of Pelvic Congestion Syndrome?

The symptoms of pelvic congestion syndrome are mainly those caused by the pressure of the venous blood in the dilated pelvic varicose veins pressing on the pelvic organs. As such they can include:

aching or dragging feeling in the pelvis, particularly on standing. This is due to the weight of blood in the pelvic varicose veins weighing heavily on the pelvic floor which is made of muscle. It is usually worse around the time of the period
irritable bladder sometimes giving stress incontinence, due to the weight of the pelvic varicose veins on the bladder
irritable bowel due to the weight of the pelvic varicose veins on the rectum
discomfort on sexual intercourse medically referred to as ‘deep dyspareunia’

How do I know if I have pelvic congestion syndrome?

Unfortunately many of the symptoms of pelvic congestion syndrome are variable and also can occur with other conditions. Usually patients have already seen their doctors and gynaecologists and have been told that there is nothing wrong with them.

One easy test to diagnose varicose veins of the pelvis is by a transvaginal duplex ultrasound. MRI or CT can also identify these abnormal veins.

What is Ovarian Vein Embolization?

Unlike the veins of the leg, which are surrounded by subcutaneous fat, the pelvic veins have got very sensitive organs and vital structures around them. As such, we cannot use the heat producing method such as laser, which might end up burning the ovaries, uterus, vagina, bowel, bladder or indeed the ureters, nerves or arteries. Therefore to be able to treat these veins successfully, we need to be able to close them without using heat.

Open surgery or laparoscopic surgery is not particularly useful to treat pelvic veins. Firstly, the pain and complications from open surgery is not needed. Secondly, it is exceptionally difficult to get to the very small veins involved deep in the pelvis by using open surgery or laparoscopy.

By using x-ray guided venography, we are able to place very thin catheters directly into the veins that need treatment. Once the catheter is in place, a combination of foam sclerotherapy and insertion of a specialist inert metal coil can be placed into the vein, closing it and stopping the pelvic vein reflux.

Although some patients are concerned about having coils placed into their pelvic veins, the actual metal involved is less than the clips used in many surgical procedures such as laparoscopic hernia repair or laparoscopic gallbladder removal and far far less than the metal used in a hip replacement or other joint replacement procedure.

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Gastric Varices (CARTO/BRTO/PARTO)

Codeholic Admin — Mon, 13 Mar 2017 16:37:15 +0000

Gastric Varices (CARTO/BRTO/PARTO)

Gastric Varices

Varices are dilated vessels which may rupture, causing variceal bleeding. Gastric variceal bleeding describes the bleeding that occurs when dilated vessels in the stomach rupture, and is associated with high morbidity and mortality rates. One of the major possible complications of portal hypertension is gastric variceal bleeding; portal hypertension refers to high blood pressure in the liver. BRTO/CARTO/PARTO are minimally invasive techniques used to treat gastric variceal bleeding.

Balloon-occluded retrograde transvenous obliteration (BRTO)

Coil-assisted retrograde transvenous obliteration (CARTO)

Plug-assisted retrograde transvenous obliteration (PARTO)

What is retrograde transvenous obliteration?

The procedure involves blocking the dilated vessels, reducing the risk of rupture. It can be used in addition to or as an alternative to TIPS, which is the primary treatment for gastric varices. TIPS aims to relieve the pressure on the dilated vessels by creating new connections between blood vessels in the liver using a shunt.

How does the procedure work?

The interventional radiologist will insert a catheter (a thin, flexible tube with a tiny balloon at one end) through a vein in your thigh or neck and guide the catheter to the liver using fluoroscopyfor guidance. The catheter is then directed to the gastrorenal or gastrocaval shunt and the blood flow is blocked.

The interventional radiologist will then perform a venography, which is a type of imaging technique in which X-rays are used to see the vessels clearly. This will allow the interventional radiologist to confirm exactly which vessels need to be treated and if there are any other abnormal or dilated vessels which have not previously been identified. A medication will then be injected into the dilated vessels through the catheter, until they are completely filled.

Another venography will then be performed, to confirm that the blood flow in the shunt has stopped.

Why perform it?

You may be advised to undergo this procedure if you are at risk of or already have gastric variceal bleeding and hepatic encephalopathy as well as a gastrorenal shunt. Hepatic encephalopathy refers to the worsening of brain function that is caused by a damaged liver.

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