San Diego 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.

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

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.

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

Varicose Veins

Codeholic Admin — Mon, 13 Mar 2017 16:53:33 +0000

Varicose Veins

Varicose veins are gnarled, enlarged veins. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That’s because standing and walking upright increases the pressure in the veins of your lower body.

For many people, varicose veins and spider veins — a common, mild variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems.

Varicose veins may also signal a higher risk of other circulatory problems. Treatment may involve self-care measures or procedures by your doctor to close or remove veins.

Symptoms

Varicose veins often cause symptoms in the legs including swelling, itching, throbbing, restlessness, aching, burning, cramping, tiredness and varicose eczema. They can bleed, especially in the elderly, after relatively minor trauma. The increased pressure often causes skin damage and, in some patients, actual ulceration of the skin occurs which can take months to heal without appropriate treatment.

Diagnosis

The only way to accurately determine the underlying cause of your varicose and thread veins is by having a colour duplex ultrasound scan performed on your legs. Without this full and detailed scan, it is impossible to properly assess your veins or determine the exact treatment you require. This is performed by our vascular and interventional radiologist who is a board certified imaging specialist.

Treatment

There are three main reasons not to ignore varicose veins and to get the underlying problem which is causing the increased pressure treated:

Varicose veins are unattractive. Many people are seriously affected by the looks of their veins. They will not show their legs in public and indeed often even to their partner. This has an adverse effect on sport participation and enjoyment of holidays and other leisure activities. In some it can affect their careers and we have seen many actors and models (both sexes!) who “needed” their legs to look better. Most patients are delighted with the appearance of their legs after our treatments.
Varicose veins hurt. As mentioned above it isn’t actually the varicose veins that normally cause the symptoms but the increased pressure. Nevertheless, most patients with varicose veins suffer from various symptoms which can also affect lifestyle. Common symptoms are tired legs, itchiness, throbbing, restless legs, and aching. These symptoms usually resolve very quickly after EVLA and RFA.
Varicose veins can lead to serious skin damage and ulcers. Although most patients with varicose veins don’t get ulceration most leg ulcers are associated with varicose veins and caused by the same problem that causes varicose veins. Treating the varicose veins properly removes this cause and dramatically reduces the risk of leg ulcers.

The modern varicose veins treatment recommended to fix the underlying cause of varicose vein problems is either using Ablation or Foam Sclerotherapy. These are minimally invasive techniques performed under local anaesthetic on an outpatient basis that causes the abnormal veins to close.

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

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.

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

Claudication

Codeholic Admin — Mon, 13 Mar 2017 16:46:20 +0000

Claudication

Claudication is the cramp like pain that develops in the muscles of the leg when walking. The pain is the result of narrowing or blockages of the arteries in the legs. The damage to the arteries is called peripheral arterial disease (‘PAD’).

Why does it occur?

Peripheral arterial disease occurs due to damage of the arteries usually as a result of smoking, high cholesterol, diabetes or high blood pressure. The arteries narrow or block or months and years to reduce the blood supply to the legs. The cramping symptoms are worse on exercising because the narrowed arteries cannot meet the muscles demand for oxygen. When exercise stops the pain usually improves within 5 minutes.

What problems can it cause?

Most people who develop claudication will have symptoms that remain the same for many years. A few patients will improve and some will get worsening of their symptoms (especially if they continue to smoke).

Treatment Options?

Walking and living a healthy lifestyle (exercising, not smoking etc) will help reduce the risk of intermittent claudication.

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.

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

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?

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

Atherectomy

Stenting

Bypass

The post Non-Healing Wound/ Ischemia appeared first on Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA.

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.

The post Peripheral Arterial Disease appeared first on Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA.

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.

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

Prostate Artery Embolization

Codeholic Admin — Mon, 13 Mar 2017 16:43:09 +0000

Prostate Artery Embolization

What is Prostate Artery Embolization (PAE)?

Prostate artery embolization is a non-surgical alternative to TURP in treating an enlarged prostate (BPH) by blocking off the arteries that feed the gland and making it shrink. PAE was first performed in 2009.

Contact us today to see if you are candidate for PAE.

How is Prostate Artery Embolization performed?

This is a non-surgical procedure that is performed under an X-ray. You will lie on the X-ray table on your back. You will receive sedative and pain medication through an IV to make you comfortable and sleepy.

The skin and deeper tissues over the artery in the groin will be anesthetized with local anesthetic, and then a needle will be inserted into this artery. This will be the only area exposed as the rest of your body will be covered with a sterile drape. Then the needle is withdrawn allowing a fine, plastic tube, called a sheath, to be placed over the wire and into this artery.

The interventional radiologist then works through this sheath using small wires and catheter to get into the arteries feeding the prostate. These arteries are quite small and rather variable. A special X-ray dye, called contrast medium, is injected down the catheter into these prostate arteries, and this may give you a hot feeling in the pelvis. Once the prostate blood supply has been identified, tiny particles are injected through the catheter into these small arteries and blocks them so that the prostate is starved of its blood supply.

At the end of the procedure, all of the wires and catheter are removed.

How do I prepare for Prostate Artery Embolization?

You need to be admitted to the hospital. This can be done as a day case procedure or with an overnight stay if you are traveling or are on your own at home. You will probably be asked not to eat for six hours beforehand, though you may be told that it is alright to drink some water. You may receive a sedative to relieve anxiety. You will be asked to put on a hospital gown. As the procedure is generally carried out using the artery in the groin, you may be asked to shave the skin around this area.

If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast medium, the dye used for kidney x-rays and CT scanning, then you must also tell your doctor about this.

Does PAE hurt?

When the local anesthetic is injected, it will sting for a few seconds, but this soon passes, and the skin and deeper tissues should then feel numb.

As the dye, or contrast medium, passes around your body, you may get a warm feeling, which some people can find a little unpleasant. However, this soon passes and should not concern you.

How long does PAE take?

Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Some prostate artery embolizations do not take very long, perhaps two hours. Other embolizations may be more involved, and take rather longer, perhaps up to three hours.

What happens after a PAE procedure?

You will be taken back to the recovery are. Nurses in the recovery area will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no untoward effects. They will also look at the skin entry point to make sure there is no bleeding from it. Once any pain is controlled you will be transferred to your hospital room. You will generally stay in bed for a few hours, until you have recovered. If suitable for a day case procedure you will usually be allowed home after four to six hours. If not you will be kept in hospital over night. Once you are home, you should rest for three or four days. You will be prescribed painkillers if required and other drugs and an explanation of their usage will be given prior to your discharge.

What are the results of Prostate Artery Embolization?

Prostate artery embolization (PAE) has evolved into an encouraging minimally invasive option for patients suffering from a variety of prostatic issues, including lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), hematuria of prostatic origin, and prostate cancer.

There are two medium term studies of the results of prostate artery embolization. Over 70% of men will gain symptomatic improvement after PAE with reduction in prostate volumes and an increase in urinary flow rates, without sexual dysfunction. Difficulty in finding the small prostate arteries may lead to technical failures in around 10% of cases. In case of failure traditional TURP surgery may be offered.

PAE is a safe procedure, designed to improve your medical condition and save you having a larger operation. There are some risks and complications involved, and you do need to make certain that you have discussed all the options available with your doctors.

What are the risks of PAE versus surgical TURP?

Due to the safety, low morbidity and good long-term results, prostate artery embolization is well-accepted by patients with benign prostatic hyperplasia. Major complications are rare however there are some risks and complications that can arise, as with any medical treatment.

More serious complications are associated with non-target embolization of the particles to the bladder, rectum, and penis. Ischemia to these organs is always possible and is minimized by direct visualization under x-ray and confirmation with CT images for a more predictable embolization.

Most men don’t want traditional surgery because it involves greater risks, has possible sexual side effects, and has a recovery time that is relatively longer than PAE, which is generally performed under local anesthesia and on an outpatient basis.

There may occasionally be a small bruise, called a hematoma, around the site where the needle has been inserted, and this is quite normal. If this becomes a large bruise, then there is the risk of it getting infected, and this would then require treatment with antibiotics.

Most patients feel some pain afterwards; this is usually mild. Very occasionally a urinary catheter may need to be placed.

There are complications possible with any medical procedure and PAE is no exception. Complications include problems related to general anesthesia and cardiovascular problems such as heart attack, stroke, deep vein thrombosis and pulmonary embolus. These problems rarely occur, and the risk depends on the patient’s general fitness for surgery and previous medical problems.

Who will be performing the prostate artery embolization?

A specially trained doctor called a Vascular and Interventional Radiologist. Interventional Radiology (IR) refers to a range of techniques which rely on the use radiological image guidance (X-ray fluoroscopy, ultrasound, computed tomography [CT] or magnetic resonance imaging [MRI]) to precisely target therapy. Most IR treatments are minimally invasive alternatives to open and laparoscopic surgery and start with passing a needle through the skin to the target.

The above information about prostate artery embolization (PAE) explains what is involved and the possible risks. 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.

Research Papers:

PAE vs TURP

Prostate Artery Embolization Paper

Prostate Artery Embolization SIR Paper

Prostate Embolization Erectile Dysfunction Improvement

The post Prostate Artery Embolization appeared first on Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA.