Varicocele Glue Embolization
Similar to varicose veins in legs, varicocele is the medical condition comprising a group of veins within the scrotum becoming unusually enlarged. Varicocele Glue Embolization is the latest specialized pin-hole technique used to treat varicocele by way of injecting a liquid substance in the diseased blood vessel to divert the blood flow to healthier vessels.
This is performed under image guidance (usually X-ray) generally using local anesthetics. A catheter is inserted through the upper thigh region and positioned into the diseased Gonadal vein. After confirmation of the correct positioning, the glue is released in the vein which closes the vein diverting the blood flow to the healthy veins. This relieves the pressure off the varicocele and re-establishes the proper blood flow.
The main advantage of this technique is that no cut or suture is required as the catheter is passed into the vein through a pin-hole. Also, very little to no pain is experienced throughout the procedure. The recovery time for this procedure is very short as the patient can be sent home on the same day and can resume his normal routine from same day itself.
Uterine Fibroid Embolization
Uterine Fibroid Embolization, also called Uterine Artery Embolization, is a non-surgical and minimally invasive specialized procedure to treat uterine fibroids. It is regarded as the safest and most effective treatment for uterine fibroids (non-cancerous growths in the uterus). The objective of the procedure is to block the blood vessels supplying blood to the fibroids, thereby causing them to regress and eventually shrink.
This procedure is performed under real-time X-ray called fluoroscopy by a Specialist Interventional Radiologist. The catheter is inserted through a pinhole-sized incision into the groin and under fluoroscopy guidance advanced into the vessels supplying blood to the fibroid. Once the catheter is properly positioned, embolic agents are injected that block the blood supply to the fibroid which then gradually softens and shrinks down.
The recovery period is generally short as most women are usually discharged on the day of the procedure with pain medication and the pain generally subsides within a day or two.
Radiofrequency Ablation (RFA) for Osteoid Osteoma
Radiofrequency Ablation of Osteoid Osteoma is a minimally-invasive pin-hole procedure that carries a high success rate of close to 100% and is considered the Method of Choice for the treatment of Osteoid Osteoma. Radiofrequency Ablation for Osteoid Osteoma aims at destroying the Osteoma (benign bone growth) through the heat generated by Radiofrequency energy (waves). It causes no damage to the vital structures and does not cause any significant structural (bony) weakness. It takes approximately 60-90 minutes for an expert Interventional Radiologist to perform this procedure and it is usually performed with the patient under general anesthesia.
After confirming the location of the Osteoid Osteoma under CT Guidance, a cannula (a very thin hollow tube) is advanced to the lesion under fluoroscopy. After verifying correct positioning of the cannula, Radiofrequency probe (electrode) is then placed into the tumour through the cannula. The Radiofrequency probe is then heated to 85-90 ℃ to destroy the bone tumour. Upon completion of the procedure, the Radiofrequency probe and cannula are removed and a sterile dressing is applied to the skin entry site incision (small cut).
The patient is usually able to go home the same day and the pain relief is generally felt within 2-3 days. The patient can resume normal daily activities within the first week.
Genicular Artery Embolization
Most people are only aware of two types of treatments for Knee Osteoarthritis pain that is either conservative in the form of rest, medication and physiotherapy or surgery known as total knee replacement. Conservative methods give you temporary relief till you follow the schedule and pain recurs the moment you stop the medication or exercise. Knee replacement, which is currently thought to be the only long-term solution, is too big a challenge to undertake.
Genicular Artery Embolization is a newly developed and highly effective pinhole procedure which is performed by Interventional Radiologists that provides a long-term relief from knee osteoarthritis pain. Genicular Arteries are the branches of the femoral and popliteal arteries and these supply blood in the region of the knee.
Genicular Artery Embolization involves slowing down (embolizing) the blood flow in the specific branches of the artery that are inflamed thereby reducing the inflammation and as a result reducing the knee pain.
This procedure is performed under local anesthesia and it takes an expert Interventional Radiologist approximately 1 hour to perform this procedure. Through a pinhole in groin area, a small catheter is advanced into the blood supply of knee and an angiogram is then performed by injecting contrast dye to locate the culprit inflamed branch. Once identification is done, small particles of embolic agent are injected to decrease the blood flow and as a result decreasing the inflammation which in turn relieves the pain in the knee.
In most cases, patient can go home the same day and usually start to see the relief in 1-2 weeks.
Arteriovenous Malformation Embolization (AVM Embolization)
AVM can occur anywhere in body but the most common types are: Brain AVM, Spinal AVM, Uterine AVM or peripheral AVM. Embolization is the process to block the abnormal blood vessels (large-sized blood vessels that would connect arteries directly to veins, also known as shunts) in the nidus (central point) of the AVM. These shunts do not supply anything (blood, oxygen, nutrients) to the normal tissue and are simply a conduit (pipe or connection) between the artery and the vein and therefore shutting or blocking these does not have any effect on the patient.
This is a non-surgical procedure and is performed through pinhole technique using a catheter by an expert Interventional Radiologist. Depending on the situation, the patient can be given general anesthesia or conscious sedation (patient awake but made comfortable with anesthesia). Under angiogram monitoring (X-ray with contrast to look at blood vessels), a catheter is introduced through thigh/groin area and advanced up to target area and particularly into the arteries that are shunts of the AVM. After confirmation of the correct placement, an embolic agent such as NBCA Glue or Onyx is injected into the blood vessels to block the blood flow to the AVM, which results in gradual shrinking of the AVM.
After the procedure, the patient would be kept under observation for 24 hours and can be discharged next day. The recovery period after AVM embolization is usually very short and generally the patient can resume normal activities right after discharge.
Pre-surgical Embolization procedures are performed before surgical procedures for vascular masses to reduce the blood supply, mainly to improve visualization during such surgical procedures as well as to reduce blood loss and operation time, thereby improving the overall outcome/result of the surgery. Pre-surgical Embolization procedures greatly help in reduction of intra-operative risks in operations/removal of tumours involving brain, head and neck, bones, etc.
Usually performed a day before the actual procedure/operation, Pre-surgical Embolization involves injecting embolic material called Polyvinyl Alcohol (PVA) or Gel foam into the blood vessels supplying the tumour/area to be operated, through a catheter placed using pin-hole technique. This material blocks off the blood supply to the area (embolization), thereby reducing the blood loss and improving visualization during the operation and subsequently reducing the intra-operative risks.