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coil embolization
17Dec

Ever heard of ‘dimag ki rag phat jayegi’? Or someone saying, ‘sir dard se kanpati phat rahi hai’? That’s what an aneurysm pain feels like when it ruptures. But what is an aneurysm, and how do you know if you have one?

An aneurysm is a localized, abnormal bulging of a blood vessel wall, often caused by factors such as atherosclerosis, hypertension, genetic predisposition, trauma, or infection. They are commonly found in cerebral arteries, aorta, or peripheral vessels, aneurysms can pose serious health risks, particularly when they rupture, leading to life-threatening bleeding. The bad thing about aneurysm is symptoms are often absent until a rupture occurs, causing sudden and severe headaches, nausea, and loss of consciousness.

Treatment approaches vary and may involve monitoring, medication, or surgical interventions. Endovascular coiling procedures like coil embolization, which involves placing coils in the aneurysm to promote blood clot formation, is often employed.

Coil embolization procedure

Coil embolization, also known as endovascular coiling or coil occlusion, is a medical procedure used to treat certain vascular conditions, particularly those involving abnormal blood vessels. The most common application of coil embolization is in the treatment of cerebral aneurysms, but it can also be used in other parts of the body.

Patient Evaluation:

Imaging Studies: The process usually begins with diagnostic imaging studies, such as angiography or magnetic resonance angiography (MRA), to identify the location, size, and shape of the abnormal blood vessel or aneurysm.

Preparation:

Patient Preparation: The patient is typically placed under general anesthesia or conscious sedation, depending on the specific case.

Catheterization: A catheter is threaded through the blood vessels from a small incision, often in the groin, to reach the site of the abnormality.

Navigating to the Target Site:

Guidewire Placement: A guidewire is often used to help navigate the catheter through the blood vessels to the target location.

Contrast Dye: Contrast dye may be injected to enhance the visibility of blood vessels during the procedure.

Coil Deployment:

Coil Insertion: Once the catheter is in the correct position, small platinum coils (or sometimes other materials) are threaded through the catheter and released into the abnormal blood vessel.

Formation of Blood Clot: These coils promote the formation of a blood clot, which effectively seals off the abnormal blood vessel or aneurysm.

Post-procedure Evaluation:

Imaging Confirmation: After the coils are deployed, additional imaging studies are often performed to confirm that the coils are in the desired location and that blood flow to the abnormal vessel has been successfully blocked.

Recovery:

Postoperative Care: Patients are usually monitored in a recovery area for a certain period to ensure stability before being transferred to a regular hospital room.

Follow-up:

Long-term Monitoring: Patients who undergo coil embolization are typically monitored for the long term to assess the effectiveness of the treatment and to watch for any potential complications.

Benefits of embolization of aneurysm

Endovascular coiling offers several benefits as a minimally invasive treatment for aneurysm, especially cerebral aneurysms. Some of the key benefits include:

Minimally Invasive Procedure:

Unlike traditional open surgery, endovascular coiling is performed through small incisions using catheters and imaging guidance. This minimally invasive approach generally results in shorter recovery times, reduced pain, and a lower risk of complications associated with surgical incisions.

Reduced Recovery Time:

Patients undergoing endovascular coiling often experience a quicker recovery compared to those who undergo traditional open surgery. The shorter hospital stay and faster return to normal activities can contribute to an improved overall patient experience.

Preservation of Surrounding Tissues:

Since endovascular coiling is performed through blood vessels, it minimizes the need for large incisions and reduces the impact on surrounding tissues. This can be particularly important in delicate areas, such as the brain.

Decreased Infection Risk:

The risk of infection is generally lower with endovascular coiling compared to open surgery. The procedure is conducted in a sterile environment, and the small incisions reduce the exposure of internal tissues to external contaminants.

Avoidance of Craniotomy:

In the case of cerebral aneurysms, endovascular coiling can often be an alternative to a craniotomy (open surgery involving the removal of part of the skull). This can be especially beneficial for patients who may not be suitable candidates for open surgery due to their overall health or other medical conditions.

Quicker Return to Normal Activities:

Patients undergoing endovascular coiling may be able to return to their normal activities more quickly than those undergoing traditional surgery. This can contribute to a better quality of life for the patient.

Less Disruption to Blood Flow:

Endovascular coiling allows for precise placement of coils within the abnormal blood vessel, promoting the formation of a blood clot that blocks off the aneurysm. This targeted approach can be less disruptive to normal blood flow compared to open surgical techniques.

Effective Treatment:

Endovascular coiling has been shown to be an effective treatment for certain vascular conditions, particularly cerebral aneurysms. It can help prevent the risk of rupture and related complications.

What is considered a main benefit of endovascular coiling?

Endovascular coiling is a good way to treat aneurysms in the back part of the brain. About 8-15% of aneurysms are in this area, and they’re more likely to burst compared to those in the front part. Because these aneurysms are deep and near delicate structures like the brainstem, surgery is risky and can have a lot of problems.

Life expectancy after aneurysm coiling also increases. According to a study that surveyed 1003 people, more individuals were alive and independent in the group that underwent coil treatment compared to the neurosurgery group after 10 years. Additionally, the risk of rebleeding was very low in those who underwent coil embolization.

Dr. Imtiaz Ahmed is a highly experienced endovascular surgeon and interventional radiologist, renowned for pioneering minimally invasive surgery in Pakistan. One of his areas of expertise lies in performing coil embolization procedures with precision and skill. With his years of practice he has successfully helped many patients in preventing the occurrence of aneurysm rupture.

For further information email now at info@drimtiazahmad.com. Follow us on Instagram @Profdr_imtiaz_ahmad for daily updates.

17Dec

Varicocele embolization is a minimally invasive, non-surgical procedure that can improve the quality of life for those suffering from this common condition. Approximately 15% of men will be affected by varicoceles, which are masses of swollen veins that form in the scrotum and can cause pain, discomfort, and infertility. Embolization is an effective treatment option that has been used for decades, and recent advances in technology have made it even more effective. In this article, we will discuss the benefits of varicocele embolization and how it can improve the quality of life for those affected.

varicocele embolization works by inserting a catheter into the affected area and using a special device to block the veins. This stops the blood from flowing through them and stops the swelling. The procedure is performed in an outpatient setting and requires no general anesthesia. It is also much less invasive than surgery, which can cause scarring and other complications.

The procedure has been shown to be effective in reducing the size of varicoceles and improving symptoms, such as pain and discomfort. In a study published in the journal Urology, researchers found that after embolization, varicoceles decreased in size by an average of 43%. This reduction in size was associated with a significant improvement in symptoms, such as pain and discomfort.

In addition to reducing symptoms, varicocele embolization has also been shown to improve fertility. In a study published in the journal Fertility and Sterility, researchers found that after the procedure, men had a significantly higher chance of conceiving a child. The authors concluded that embolization of varicoceles is “a safe and effective treatment for male infertility.”

The procedure is also associated with a number of other benefits, such as a faster recovery time, fewer complications, and a lower risk of recurrence. In a study published in the journal Radiology, researchers found that patients who underwent embolization recovered faster than those who underwent surgery. In addition, the authors found that the risk of recurrence was less than 10%, significantly lower than that of surgery.

Lastly, varicocele embolization has been shown to improve the quality of life for those affected by the condition. A study published in the journal Urology found that after embolization, patients reported improved quality of life, including less pain, and discomfort, and improved sexual function.

Overall, varicocele embolization is an effective treatment option that can significantly improve the quality of life for those affected by this common condition. The procedure is minimally invasive, can reduce symptoms, improve fertility, and has a low risk of recurrence. Furthermore, it can improve quality of life, leading to improved physical and mental well-being.

For those considering treatment for varicoceles, embolization is a safe and effective option that should be seriously considered. It can provide relief from symptoms and improve the overall quality of life.

References

1. Kogan, B.A., et al., Varicocele embolization: A review and update. Urology, 2017. 107: p. 11-15.

2. Christiansen, C.G., et al., Varicocele embolization increases pregnancy rates in male partners of couples with infertility. Fertility and Sterility, 2011. 95(4): p. 1389-1393.

3. Moy, F.N., et al., Varicocele embolization: A comparison of clinical outcomes with regard to recurrence and recanalization. Radiology, 2007. 243(3): p. 694-699.

4. El-Nashar, S.A., et al., Varicocele embolization and its effect on quality of life. Urology, 2010. 76(2): p. 260-264.

varicocele treatment without surgery
17Dec

A torturous mass above the testicles is a common finding in men. Many people, with little to no knowledge about genitalia, mistakenly believe this is a normal finding until the disease begins to manifest consequences.
Varicocele is a condition characterized by the enlargement of the veins within the scrotum, which is the pouch of skin containing the testicles. These veins are called the pampiniform plexus. Varicoceles are similar to varicose veins that occur in the legs. This pathology results from the malfunction of the valves within the veins that regulate blood flow to the testes. It affects about 10-15% of men.

Causes:

The exact cause of varicocele remains unclear but many factors can contribute:

Faulty Valves:

The veins in the spermatic cord, which carry blood to and from the testicles, have one-way valves that help regulate blood flow. If these valves become weak or fail to function properly, blood can pool in the veins, leading to their enlargement and the formation of a varicocele.

Anatomy:

The anatomy of the blood vessels in the spermatic cord may contribute to its development. The left testicular vein is longer and connects to the left renal vein at a right angle, making it more prone to increased pressure and backflow of blood.

Genetic Factors:

There may be a genetic component to the development of varicoceles.

Increased Intra-Abdominal Pressure:

Conditions that lead to increased pressure within the abdomen, such as chronic constipation, heavy lifting, or prolonged standing, may contribute to the development or worsening of varicoceles.

Unknown Causes:

In some cases, the exact cause of varicoceles remains unknown.

Symptoms:

Varicoceles often develop without causing noticeable symptoms, and some individuals may be unaware that they have this condition. When symptoms do occur, they can vary in intensity.

Pain or Discomfort:

A dull, aching pain or discomfort in the scrotum is a common symptom of varicoceles, more pronounced after standing for long periods.

Visible Enlargement:

The veins within the scrotum may become visibly enlarged or swollen, giving the appearance of a “bag of worms.” This is often more noticeable when standing.

Testicular Atrophy (Rare):

In some cases, particularly if the varicocele develops during adolescence, there may be a discrepancy in the size of the testicles. The affected testicle may be smaller than the other due to reduced blood flow and potential impact on testicular growth.

Infertility:

Varicoceles are a common cause of male infertility, and they may impact sperm production, motility, and quality. In cases where fertility is a concern, a healthcare professional may recommend further evaluation and, if necessary, treatment.

Varicocele grade:

Varicoceles are often graded based on their size and severity. The most commonly used is the clinical grading system, which classifies varicoceles into three grades:

Grade I (Subclinical or Small):

Grade I varicoceles are typically not visible or palpable (felt) without the Valsalva maneuver, which involves bearing down or taking a deep breath to increase abdominal pressure. They may only be detected using techniques like ultrasound. These are considered mild or subclinical and may not cause noticeable symptoms.

Grade II (Palpable):

Grade II varicoceles are palpable (can be felt) without the need for the Valsalva maneuver. The veins are easily felt when the person is standing. This grade indicates a moderate-sized varicocele.

Grade III (Visible):

Grade III varicoceles are not only palpable but also visible. The enlarged veins are easily seen when the person is standing. These are considered large and may be associated with more significant symptoms.

Sarteschi/Liguori is another classification that depends on swollen veins, where they are, and their behavior when standing or lying down.

  • Grade 1: Swollen veins in the groin when standing.
  • Grade 2: Swollen veins reach the upper part of the testis when standing.
  • Grade 3: Swollen veins around the testis when standing.
  • Grade 4: Swollen veins when lying down and standing, getting bigger when a person strains. Varicocele grade 4 symptoms include dull aching pain, visible veins and testicular shrinkage may happen.
  • Grade 5: Enlarged veins when lying down and standing. Testicular shrinkage is common. Reflux doesn’t increase when you strain.

Diagnosis:

The diagnosis of a varicocele typically involves a combination of a physical examination, medical history review, and sometimes imaging studies like ultrasound.

A common test used by physicians to check for varicoceles is valsalva maneuver. This involves taking a deep breath and bearing down, which increases abdominal pressure. The doctor will then check for changes in the size of the veins in the scrotum during this maneuver.

How Are Varicoceles Treated?

The treatment of varicocele depends on the staging of the disease. For some watchful waiting is best while others having severe issue medical intervention is needed.

Observation:

Not all varicoceles cause symptoms or fertility issues. In some cases, the condition may be asymptomatic and not require treatment. Regular monitoring may be recommended to assess any changes in symptoms or the varicocele itself.

Supportive Measures:

Scrotal Support: Wearing supportive underwear or a scrotal support (like a jockstrap) can help relieve discomfort associated with varicoceles by reducing pressure on the veins.

Lifestyle Changes:

Diet and Exercise: Maintaining a healthy lifestyle, including regular exercise and a balanced diet, can contribute to overall vascular health.

Medication:

There is no specific medication approved for the treatment of varicoceles, but some medications may be prescribed to manage symptoms such as pain or discomfort. Non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended for pain relief.

3-D Precision Guided Varicocele Embolization:

This is varicocele treatment without surgery. Transcatheter embolization is a minimally invasive procedure in which a catheter is threaded through the blood vessels to the varicocele. A substance is then injected to block the blood flow in the affected veins, causing them to shrink. This procedure is typically performed by an interventional radiologist.

Dr. Imtiaz Ahmed is an expert endovascular surgeon and interventional radiologist with extensive experience in embolization techniques. He is the founder of 3-D precision guided varicocele embolization of varicocele.He has successfully treated all grades of varicocele without surgery. His areas of expertise include non-surgical treatment for varicocele, male infertility, and venous leak. Additionally, he addresses female infertility issues.

For further assistance email now at info@drimtiazahmad.com. Follow us on Instagram @Profdr_imtiaz_ahmad for daily updates.

17Dec

Erectile Dysfunction (ED) is a condition in which men have difficulty maintaining an erection. Many people believe that arterial insufficiency is the only vascular cause of ED, but what they don’t know is that vascular causes can be broadly divided into arterial and venous causes.

Can venous insufficiency cause erectile dysfunction?

Venous insufficiency literally means the pooling of blood. Normally, blood enters the penis through arteries and leaves via veins. During arousal, blood flow is blocked by veins, allowing it to remain in the penile vessels for a longer period, which helps in achieving an erection.

A venous leak occurs when the veins responsible for trapping blood within the penis during an erection are unable to maintain the necessary pressure. When this happens, blood leaks out of the penile tissues, leading to an insufficient or weak erection.

It’s essential to recognize that venous leak is not as widely discussed as other causes of ED, such as hormonal imbalances, nerve damage, and psychological factors. This lack of awareness may prevent many men from realizing that venous leak could be the root of their erectile problems.

Factors contributing to venous leak:

Sometimes the issue of venous leak can be present from birth, while in other cases, several factors can contribute to its development.

Age:

As men age, the elasticity of their blood vessels may decrease, making them more susceptible to venous leak.

Health condition:

Certain medical conditions, such as diabetes, hypertension, or cardiovascular diseases, can affect blood vessel health and contribute to venous leak.

Trauma

Injury to the penile area, surgery, or pelvic fractures can damage the veins responsible for maintaining proper blood flow.

Lifestyle factors:

Unhealthy habits like smoking, excessive alcohol consumption, or a sedentary lifestyle can increase the risk of developing venous leak.

Venous leak cure:

The good news is that venous leak-related ED is treatable, and there are several approaches that individuals can explore:

Lifestyle changes:

Adopting a healthier lifestyle by quitting smoking, reducing alcohol intake, maintaining a healthy weight, and engaging in regular physical activity can positively impact overall vascular health, potentially reducing the severity of venous leak.

Boron for erectile dysfuction has been shown to produce very effective results in improving sexual health in men.

Medications:

Some medications, such as PDE5 inhibitors (commonly known as Viagra), work by enhancing the body’s ability to maintain an erection. These can be effective for some individuals with venous leak, but they may not address the underlying issue directly. PDE5 inhibitors are also effective for nerve damage in erectile dysfunction treatment.

Penile injections:

Injectable medications can be directly administered into the penis to stimulate blood flow, often producing an erection.

Vaccum erection devices:

These devices create a vacuum around the penis, drawing blood into the area, and then using a constriction band to maintain the erection.

Surgery:

In severe cases, surgical procedures like penile venous ligation or arterialization may be considered to address the specific venous leak issue. However, these options have a very high failure rate and potential complications, leading to minimal usage of surgery for treating venous leak.

3-D Precision Guided Venous leak EndovascularTreatment:

It is a minimally invasive procedure that aims to address venous leak. The process typically begins with advanced diagnostic imaging, such as dynamic cavernosography or Doppler ultrasound. These imaging techniques help identify the specific veins causing the venous leak.

During the procedure, a skilled endovascular surgeon or an interventional radiologist uses image guidance to navigate catheters through the blood vessels to the site of the venous leak in 3-D imaging.. Once the problematic veins are located, the radiologist will use FDA-approved embolic agents to block or seal off these veins.

The benefits of this procedure are its minimally invasive nature, meaning there will be no cuts, sutures, or related complications. Recovery is quick, and the patient is usually discharged home on the same day or the following morning.

While many men can face problems maintaining an erection, not everyone can be labeled as having erectile dysfunction. So the question arises, how long does temporary erectile dysfunction last? Usually, a person should experience symptoms of ED consistently for more than 6 months before being diagnosed as having ED. It is also very important to consult an expert for the correct diagnosis of venous leak as a cause of ED.

Dr. Imtiaz Ahmed, an interventional radiologist and endovascular surgeon, is the best doctor to visit for venous leak issues. He has been practicing for years in his field and is an expert in diagnosing and treating venous leak. He also specializes in other causes of erectile dysfunction.

For more information email us at info@drimtiazahmad.com. Follow us on Instagram @Varicocele_and_venous_leak for more information and daily updates.

Varicocele in Young Adults
9Dec

Understanding varicocele in young adults is crucial for protecting long-term reproductive and hormonal health. Early adulthood is a key period for hormonal balance and fertility potential, and for young men facing challenges like azoospermia (zero sperm count) or oligospermia (low sperm count), identifying and treating varicocele can be life-changing.

What Is a Varicocele?

A varicocele occurs when the veins around the testicle become enlarged and fail to regulate blood flow properly. Normally, these veins help keep the testicles cool, allowing for optimal sperm and hormone production. When the valves in these veins fail, blood pools, temperatures rise, and both testosterone levels and sperm quality can be affected.

In fact, meta-analyses show that a varicocele can involve as many as 18 to 21 veins. The complexity of varicocele in young adults is why traditional surgery, which may only address a few major veins, can sometimes fail to resolve the problem completely. Blood often finds alternative pathways, leading to recurrence if not treated comprehensively.

Why Early Diagnosis Matters

Diagnosing a varicocele is incredibly quick; it often takes just seconds during a physical exam. A doctor can feel for enlarged veins while the patient is standing, and additional maneuvers like the Valsalva maneuver or an ultrasound can confirm the diagnosis. Identifying varicocele early is essential because it is one of the few truly treatable causes of male infertility related to low or zero sperm count.

Treatment Options and Why Minimally Invasive Procedures Are Preferred

For varicocele in young adults, especially those with fertility concerns, minimally invasive treatments like embolization are often the best option. Unlike traditional surgery, which may miss some of the smaller veins and lead to recurrence, embolization precisely targets all the faulty veins using real-time imaging. This approach not only has a shorter recovery time but also offers a higher success rate in restoring normal sperm production and improving testosterone levels.

Long-Term Benefits and Final Thoughts

Early treatment of varicocele in young adults can lead to significant improvements in hormone levels, sperm count, and overall fertility outcomes. For young men, especially those dealing with infertility or hormonal symptoms, addressing varicocele can restore confidence and improve quality of life.

How Dr. Imtiaz Can Help

For young adults navigating the uncertainty of varicocele, having the right specialist makes all the difference. Dr. Imtiaz combines advanced, image-guided techniques with a patient-focused approach to ensure every vein contributing to the condition is accurately identified and treated. With extensive training across leading U.S. academic centers and faculty roles at New York Medical College and the University of Louisville, he applies image-guided techniques that focus on complete venous occlusion while preserving testicular function.

This approach aligns especially well with the needs of young men, where sperm production, hormonal balance, and long-term reproductive potential must be protected. By tailoring each treatment plan to the individual’s reproductive goals and diagnostic findings, he helps patients regain confidence in their long-term fertility, hormonal balance, and overall health.