Image Archives - 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 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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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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Infertility / Fallopian Tube Recanalization

Codeholic Admin — Mon, 13 Mar 2017 16:39:02 +0000

Infertility / Fallopian Tube Recanalization

Fallopian Tube Recanalization

Fallopian tube blockage (tubal factor infertility) is one of the most common causes of female infertility. The fallopian tubes are very fine tube-like structures that connect the ovaries to the uterus. The eggs from the ovary normally travel through the fallopian tubes, where they can be met and fertilized by sperm. Sometimes the tubes can become blocked or narrowed, preventing pregnancy. This can happen in one or both fallopian tubes.

How is fallopian tube recanalization performed?

We can diagnose and treat blocked fallopian tubes with a nonsurgical procedure known as selective salpingography. Similar to a pelvic exam at your OBGYN you lay on your back and a speculum is placed into the vagina. Then a small catheter is inserted through the cervix and a contrast agent, or dye, is injected into the uterus so an X-ray image of the uterine cavity can be obtained. When a fallopian tube blockage is identified, another smaller catheter and wire is threaded into the fallopian tube to open the blockage. You will be given moderate sedation through an IV to make you comfortable for the procedure.

https://allaeimd.com/wp-content/uploads/2017/03/Video-Showing-Recanalization-of-a-blocked-fallopian-tube-performed-by-Dr.-Allaei.mp4

What Causes Tubal Blockage?

The most common cause of tubal factor infertility is pelvic inflammatory disease (PID). PID is a general term used to describe inflammation of the uterus, fallopian tubes and sometimes the ovaries. It is generally caused by repeated sexually transmitted infections (STIs) such as chlamydia or gonorrhea (although this is not always the case). If left untreated, scar tissue can build up, leading to the blockage of one or both fallopian tubes and infertility. If only one tube is blocked, you may still be able to conceive naturally depending on the health of the ovary on that side.

Other causes of tubal factor infertility include endometriosis, previous ectopic pregnancy, previous abdominal surgery, history of infection caused by miscarriage or abortion, and previous or current infection with gonorrhea or chlamydia. Although tuberculosis is relatively rare in the Western world, it can also cause infection in the fallopian tubes, as can a ruptured appendix. All of these can cause scar tissue, mucus and debris to build up in the fallopian tubes, which can lead to blockage.

What is the success rate?

If the blockage is due to debris within the tube, there is a high chance of success. If the tube however is scarred down from prior infection or inflammation, there is a lower success rate of opening the blockage. A clogged pipe is fixed much simpler than a broken pipe.

https://allaeimd.com/wp-content/uploads/2017/03/IMB_ubELDn.mp4

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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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Tunneled Drainage Catheter

Codeholic Admin — Mon, 13 Mar 2017 16:36:33 +0000

Tunneled Drainage Catheter

A tunneled drainage catheter is used when patients have a recurrent accumulation of fluid surrounding the lungs called pleural fluid. A tunneled drainage catheter may also be used to drain fluid in the abdomen, called ascites. This minimally invasive procedure allows patients to drain fluid while at home.

The tunneled drainage catheter system includes a drainage catheter and drainage bottles that collect fluid. The catheter is inserted, typically as a simple outpatient procedure, in the chest for draining pleural effusions (pleural catheter) or in the abdomen for malignant ascites (peritoneal catheter). The end of the catheter stays outside of the body, hidden under a bandage when not in use.

What is the catheter recommended for?

Candidates for tunneled drainage catheter placement often include patients with various types of cancer and diseases, including:

Advanced Heart failure
Cancer
Chylothorax
Liver disease

Patients with these conditions often experience an accumulation of excess pleural fluid around one or both lungs. As a result, the lungs are unable to expand all the way, making it difficult to breathe. Other symptoms may include:

Chest pain
Cough
Inability to lie flat

In addition, cancer patients may experience ascites, or fluid accumulation in the abdomen. In these cases, a tunneled drainage catheter may be used to relieve pain, breathing challenges, and a feeling of fullness in the abdomen.

How does the peritoneal catheter work?

This system lets you drain fluid at home and on your own schedule, so you can manage fluid buildup before it becomes even more uncomfortable. For most patients, drainage takes approximately five to 15 minutes. You drain fluid on your schedule, without needing to visit the doctor when your fluid builds up. The drainage system is a safe, proven option that has provided relief to over 300,000 patients since 1997.

Post Tunneled Drainage Catheter

Most patients can return home the same day of their procedure. Before being released, your medical team will provide instructions on how to care for the tunneled drainage catheter, including how to empty the drainage bottle. Your doctor will also give you information on identifying signs of complications, such as difficulty breathing or discomfort.

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Metastatic Tumor Ablation

Codeholic Admin — Mon, 13 Mar 2017 16:10:58 +0000

Metastatic Tumor Ablation

What is percutaneous ablation?

Our high resolution imaging technology enables visualization of the tumor and accurate placement of the ablation probes without the need for surgical incision. There are different methods of ablation including cryo, microwave and radiofrequency ablation.

What is cryoablation?

Cryoablation uses extremely cold temperatures to kill cancer cells. Doctors started using it to treat small kidney cancer tumors as early as 1999, and the results have been extremely impressive. To treat a patient with cryoablation, doctors create ice using specially designed probes, through which compressed gas is circulated. The ice is very precisely shaped and positioned by the doctor to freeze the tumor and destroy all of the cancerous tissue within the kidney, while healthy tissue and surrounding organs are protected.

What is microwave ablation?

A new technology, microwave ablation (MWA), destroys liver tumors using heat generated by microwave energy. With microwave ablation, the interventional radiologist inserts a small needle through the skin and into the tumor using CT or ultrasonic guidance to pinpoint the exact location of the tumor. Unlike the procedure done by a surgeon, this does not require an open incision to access the tumor. The probe produces intense heat that ablates (destroys) tumor tissue, often within 10 minutes.

What types of tumors can be ablated?

Any type of tumor can be ablated. However, large tumors or tumors next to vital structures may not be a candidate for this type of treatment.

What are the benefits of percutaneous ablation over surgery or open ablation?

Minimally invasive – less invasive than standard or laparoscopic ablation
A treatment that demonstrated 95%effectiveness in targeted tumors
Tissue-sparing treatment (targets mostly tumor tissue)
Clinical data supports safety and effectiveness
Decreased blood loss versus surgery (including laparoscopic surgery)
Performed on an outpatient basis or requiring just one overnight stay
Shorter recovery time
Can be used when other treatments, such as prior surgery, have failed
May be suitable for patients who cannot tolerate general anesthesia
Lower morbidity (side effects)
Can be repeated, should the cancer returns
Multiple tumors can be treated in one session

How long does the procedure take?

The procedure length will vary according to the size and location of the tumor, but usually lasts about one hour.

How long will I need to stay in the hospital?

Some cases are done on an outpatient basis, meaning you do not need to stay in the hospital overnight. Other doctors prefer their patients to stay in overnight (depending on other associated conditions). Your doctor will want to make sure that you are eating, drinking and comfortable before you leave the hospital.

How long before I can return to work and other activities?

Your doctor will advise you on when it is sensible for you to return to work and resume other activities since this will depend on your general health and the work you do. Usually, patients are back to their normal day-to-day activities within two weeks of the procedure – often sooner.

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Lung Cancer Ablation

Codeholic Admin — Mon, 13 Mar 2017 16:08:28 +0000

Lung Cancer Ablation

What is tumour ablation?

Tumour ablation involves treatments that destroy cancer cells using:

heat (radiofrequency or microwave ablation)
cold (cryoablaton)

Doctors sometimes use these to treat small, very early-stage lung cancers.

Who is a candidate for percutaneous lung cancer ablation?

It is usually only used in people with small, early-stage lung cancers if:

surgery is not suitable
they choose not to have surgery.
Some people have it at the same time as radiotherapy or chemotherapy.

Before having an ablation procedure, you may have a local anaesthetic and sedative to make you sleepy. Some people have a general anaesthetic. You may need to stay in the hospital overnight to have the treatment.

You might have one or more treatment session.

How is lung cancer ablation done?

The doctor puts a needle into the tumour, usually using a CT scan to make sure it is in the right place. Depending on the specialized needle, the needles then either heat up or cool down. The needles then reach a temperature that destroys (ablates) the tumor cells.

It is common to have some pain or discomfort after having ablation. You will be given painkillers to control this. You may also feel tired afterwards.

Results?

Pulmonary ablation is now an accepted treatment for lung metastases and some lung primary tumors. There is growing evidence of its efficacy, particularly in those patients with oligometastatic disease and survival in patients with metastatic colorectal cancer treated with ablation seems better than when patients are treated with chemotherapy alone. The key to successful treatment depends upon patient selection.

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