October 4, 2022 by Dr. Akhil Monga 0 Comments

Coiling for Brain Aneurysm

Life-threatening brain tumors, aneurysms, and strokes can all be treated using a variety of advanced techniques. In comparison to more intrusive surgical treatments, coiling is less invasive, safer, and can provide patients with more immediate pain relief and quicker recovery.

What is a brain aneurysm?

A brain aneurysm is a bulge or ballooning in a blood vessel in the brain. This bulged area of the vessel wall becomes weak and can rupture. This can lead to bleeding into the brain. This condition can become life-threatening and needs immediate medical attention.

With advancements in treatment options, there are many options available for aneurysms and stroke, coiling is one of them. It is a less-invasive procedure and therefore it is safer than traditional surgical options.

What is Endovascular Coiling for an aneurysm?

As mentioned, coiling is a less invasive treatment method for aneurysms. It is performed by a neurointerventional radiologist.  Dr. Akhil Monga is one of the best neurointerventional radiologists in India. He is highly versed with super-specialized procedures like aneurysm coiling.

How is endovascular coiling performed?

In this procedure, a catheter (tiny tube) is passed through a tiny incision made in the groin area. Through this incision, the catheter is passed into the artery having an aneurysm.

Then a microcatheter is inserted through the initial catheter and the coil is attached to this microcatheter. When the microcatheter reaches the aneurysm, it is inserted into the aneurysm. Then the coil is separated from the catheter by using an electric current. This coil seals off the opening of the aneurysm.

The coil is left inside the aneurysm permanently. One or more coils can be used to seal off the aneurysm depending on the size of the aneurysm.

These coils are made of soft platinum metal and it looks like a spring. These coils are very small and thin.

Who is a Candidate?

Coiling as a choice of treatment for an aneurysm can be considered

In case of Ruptured aneurysms

When an aneurysm ruptures, it releases blood into the space between the brain and the skull. This is called a subarachnoid haemorrhage.

In these cases, the timing of treatment is very important. The earlier the patients reach the doctor, there are more chances of successful treatment.

Unruptured aneurysms

Unruptured aneurysms usually do not cause symptoms. They remain unnoticed and are typically detected during routine testing.

In such cases, endovascular coiling can be done as a preventive measure to avoid any stroke episodes in the future.

If you are looking for a trustworthy doctor for a successful endovascular coiling procedure, you can consult Dr Akhil Monga.

 

September 8, 2022 by Dr. Akhil Monga 0 Comments

Radiofrequency Ablation (RFA) Treatment for Varicose Veins

The varicose vein is a condition in which veins become swollen and enlarged due to damage to the valves of veins. This causes problems with blood flow and over time blood gets collected in your veins. This results in bulging and twisting of veins under your skin surface. These veins cause cosmetic concern along with other symptoms like aching, cramping, or swelling in your legs. 

Radiofrequency ablation (RFA) is a treatment method used to treat varicose veins. During this treatment, heat generated through radio frequency is sent into the affected vein through a thin, flexible tube called a catheter. This helps in closing the affected vein and its blood supply is shifted into a healthy vein.

How does this treatment method work?

Radiofrequency ablation (RFA) is a procedure that uses heat from radiofrequency waves for the treatment of varicose veins. In this procedure, a tiny cut is made near the knee and a catheter is threaded up in the vein from the groin area. The doctor takes the help of ultrasound for visualization and to apply radiofrequency waves with precision. The heat energy from the waves causes the affected vein to collapse. Then the blood is redirected to adjacent healthier veins and slowly the body reabsorbs the destroyed vein.

Benefits of Radio Frequency Ablation technique

Fast and safe

RFA is a non-surgical method which is performed as an outpatient procedure. It takes around 35 to 40 minutes for the procedure to get complete. Being a non-surgical procedure, it eliminates the risks that are there in surgery.

Minimally invasive

Only a tiny cut of around ¼-inch is required for RFA. 

Little to no pain

Before the procedure, local anaesthesia is given in the area so you don’t feel much of anything. After the procedure, some patients might feel pain or discomfort, but it is very mild.

Minimal bruising

 Radiofrequency ablation procedures usually do not cause any post-surgical bruising as compared to other surgical and non-surgical treatment options for varicose veins. However, if there is any bruising or swelling it is usually mild and should not last more than 10 to 14 days.

Very little downtime

After the RFA procedure usually, your doctor recommends that you resume your normal activities within 24 hours. But take care to avoid strenuous exercise or heavy lifting for a week at least.

No need for general anaesthesia

There is no need for general anaesthesia while treating varicose veins with the RFA procedure. For the best Radio Frequency Ablation treatment, you can consult Dr Akhil Monga. He has vast experience in treating varicose veins with minimally invasive procedures.

August 19, 2022 by Dr. Akhil Monga 0 Comments

Carotid angioplasty and stenting

Carotid angioplasty and stenting are procedures done to open narrow or blocked arteries to restore blood flow to the brain. It is usually done as a preventive measure for stroke.

The carotid arteries are the main arteries which supply blood to the brain. They are located on each side of the neck. These arteries sometimes get clogged because of the fatty deposits also known as plaque. This slows or blocks blood flow to the brain. This condition is called carotid artery disease. It can lead to a stroke. 

In a carotid angioplasty procedure, a tiny balloon is temporarily inserted and inflated into the clogged artery. This is done to widen the artery so that blood can flow freely to your brain. 

Carotid angioplasty is usually done in combination with another procedure known as stenting. Stenting is a procedure which involves placing a small metal coil called a stent in the blocked artery. The stent helps in keeping the artery open and decreases the chance of it becoming narrow again. Carotid angioplasty and stenting are advisable when traditional carotid surgery is not possible or is too risky to be done.

Why is Carotid angioplasty and stenting done?

Carotid angioplasty and stenting are done for the treatment of stroke or it is done as a stroke-prevention option. 

It is advised by a doctor when 

  • If the carotid artery has a blockage of 70% or more
  • If the patient is having a stroke or stroke symptoms
  • If a patient’s health doesn’t allow them to undergo traditional surgery like if the patient is having severe heart or lung disease
  • If you are experiencing a new narrowing of arteries after carotid surgery.
  • If the location of the narrowing is difficult to access with surgery

You can discuss with your doctor, Dr Akhil Monga regarding the best treatment approach for you.

How are carotid artery angioplasty and stenting performed? 

  • Firstly, you will be given anaesthesia, and once you’re sedated, the doctor will make a puncture in the femoral artery in the groin area.
  • Then a small tube is placed into the artery. A catheter with a balloon tip is then threaded through the tube to the narrowed carotid artery under X-ray guidance.
  • Contrast material is then injected into the carotid artery through the catheter. It helps in providing a detailed view of the affected artery and also the blood flow through it to the brain.
  • Then the balloon tip is inflated to open up the narrowed artery and push the plaque aside to restore the normal blood flow.
  • Then a small metal mesh tube called a stent can be placed in the newly opened vessel. This helps in providing support to the expanded artery and avoids its narrowing again.
  • After the procedure is over, generally no stitches are given. A dressing is applied to the incision site.

For the best carotid angioplasty and stenting treatment, you can book your appointment at +91-9910500531

April 13, 2022 by Dr. Akhil Monga 0 Comments

Endovascular Treatment For Acute Ischemic Stroke

Acute ischemic stroke is a condition that occurs when there is a blood clot in an artery supplying the brain. This clot blocks the blood supply of the brain leading to stroke. Endovascular treatment is one of many treatment options after a stroke.

What is the endovascular treatment for stroke?

An endovascular thrombectomy is a procedure of removing a thrombus (blood clot) under image guidance. Mostly endovascular thrombectomy is performed when the blood clot is large and cannot be completely dissolved by medicines.

After you suffer from a stroke your doctor may recommend endovascular treatment for it. Endovascular treatment should be performed as soon as possible after the stroke. This procedure is used to remove the clot which is responsible for causing stroke and resuming the normal blood supply in the brain.

What is the procedure for endovascular treatment?

This procedure is performed by an interventional radiologist. The doctor will insert a thin tube into the base of your skull or groin. With the help of an x-ray, he will guide this tube to the blood clot. Different techniques can be used to remove clots after that. Clots can be removed with the help of a vacuum which can suck the thrombus out. Mechanical instruments can also be used to break the clot and then remove it. The devices which are used in this technique are inserted through that thin tube into the affected artery.

Medications can be delivered directly to the brain.

With the help of the long thin tube inserted by the doctor, medicine is directly delivered to the affected artery. This medicine helps dissolve the clot. If the clot is big, medicine will dislike the clot and reduce its size so that it is easily removed.

Removing the clot with a stent retriever.

For the large clots, Doctors can use a device that is attached to a catheter. This device can directly remove the clot responsible for causing the stroke. This is typically used for large clots which cannot be dissolved by medicines. This method is often performed in combination with injected medications.

The time window is very important in the clinical outcome of the treatment. The effect of treatment is more if it is performed within 3-6 hours after the stroke. Though with newer imaging systems and advancements in equipment this time window is increasing.

What are the risks?

There can be bruising at the puncture site in the neck or groin area. The major risk includes the risk of bruising of a blood clot deep into the artery while performing the procedure. This can make the treatment more complicated. Rarely, it can cause bleeding in the skull while performing the procedure. In such situations treatment is stopped immediately. Our center offers you world-class facilities and the latest equipment for the best endovascular treatment of acute ischemic stroke.

Stroke recovery and rehabilitation

After the procedure, the doctor will closely monitor you for a few days. The important aspect of stroke care is to restore the functions so that the patient can return to normal life as soon as possible.

February 9, 2022 by Dr. Akhil Monga 0 Comments

Surgery Vs Laser Treatment for Varicose Veins

It is not something from far past when the patients used to bear the discomfort associated with painful and unsightly varicose veins only because of the fear of vein ligation and stripping. These are actually surgical procedures to eliminate tortuous veins from the legs or thighs. With this speedy advancement in the treatment of varicose veins, laser procedures have shown dominance over the typical surgical varicose vein treatments because of several patient-centric supremacies.

What are available surgical varicose Vein treatments?

Ligation and stripping are the most commonly operated surgical interventions for the treatment of varicose veins. Ligation is the process involving surgical tying off of a large vein (greater saphenous vein) in the leg while stripping is the process of removal of the same vein via incisions or tissue cuts in the groin region, thigh and leg. Both the procedures are done to diminish the blood pressure, thereby reducing the backflow of the blood into smaller superficial veins from the larger deep veins.

Complications of surgical varicose Vein treatments

Varicose vein stripping is usually carried out under general anesthesia. Although it is a very safe modality and associated with low-risk, the surgery associated side effects and discomfort are always associated with it like allergic responses to the anesthetic solution, needle prick injuries, post-surgical infections, bleeding during or after the surgery, blood clots, bruises, or scars, and possible nerve injury.

Surgical interventions typically take approximately 60-90 minutes. If the case is complicated than the usual cases, then it may last for a longer period. It is associated with comparatively longer recovery periods typically take two to four weeks. In fact, recovery actually varies from person to person depending on the number or location of the operated veins.

Laser Treatment for Varicose Veins

Endovenous (meaning: from within the vein)  treatment nowadays are preferred by patients.  One of these scientifically and technologically advanced treatments is Endovenous Laser Therapy (EVLT) and is perhaps the most common.

Endovenous Laser Therapy (EVLT)

An Ultrasound technique is used to guide an optical fiber inside the affected vein. Afterward, a highly concentrated laser beam is focussed on the walls of the veins that are to be damaged. This laser beam heats the targeted venous walls, causes their reduction, contraction, and consequent closure of the vein.

Supremacy of Endovenous Laser Therapy Over Surgical Varicose Vein Treatments

Unlike surgical treatments, endovenous laser therapy is performed under local anesthesia. So, the patient is not at the risk associated with general anesthesia. It is comparatively a safer procedure associated with low risks, lesser pain or discomfort, and a higher success rate that is around 98%.

It requires comparatively lesser time for procedureand patients is able to go back home walking on the same day. Moreover, patients requires lesser post-operative care even at home. The patient can resume his normal activities almost immediately which is much earlier than surgical interventions.

Summing Up

If you want to get rid of painful and unpleasant varicose veins in a relatively comfortable and minimally invasive painless manner then one must proceed with laser treatment for varicose veins.

Dr. Akhil Monga is among the best vascular specialist in Tricity and has rich expertise in laser treatment for varicose veins. There, you can get the best help to choose a treatment that’s perfect for your venous health.

January 17, 2022 by Dr. Akhil Monga 0 Comments

Advantages of VenaSeal Procedure for Varicose Veins

What is VenaSeal Procedure for Varicose Veins

Glue closure with VenaSeal is one of the most advanced bio-adhesive based  procedures for the treatment of varicose veins . This procedure got FDA approval in 2015 for the treatment of symptomatic varicose veins or varicose reflux disease. Unlike thermal ablation, there is no risk of tissue damage due to heat or discomfort caused by tumescent anaesthesia. Therefore, this modality is also referred to as non-thermal & non tumescent varicose vein treatment. And yes, this too is done through a pinhole!!

How does VenaSeal do vein closure?

The VenaSeal is n-butyl-2-cyanoacrylate (NBCA) based adhesive formulation which is very similar to bio-adhesives that are used to close surgical incisions, laceration or open wounds without using sutures. It is a clear free-flowing sterile liquid. When its molecules come in contact with venous blood, they begin binding with each other. Within a few minutes, a solid material closesthe target diseased vein. Gradually, a fibrous tissue is formed as our body’s natural response to the new substance which results in long lasting venous occlusion. After the diseased bulging vein is occluded, the blood flow is diverted and re-routed to healthy veins.

Who can be the right candidate for this treatment?

Most of the varicose vein patients can go for this treatment, however, our experts decide the treatment after the opd visit and doppler examination. Favourable Outcomes of VenaSeal Procedure for Varicose Veins

Improved Patient Comfort

Because of no heat, no tumescence, and minimal incisions or needle pricks, patients find this procedure more comfortable thanthermal ablations.

Ability to restart normal life immediately

Since the accomplishment of vein closure is done in a minimal invasive manner, VenaSeal procedure enables patients to resume their work or mild to moderate exercises immediately. In contrast to this, the recovery of this level requires some days when procedures  are performed. The medical-grade adhesive is infused in small increments along the vein length. This is followed by compression of the vein for a brief period. Therefore, patient suffers from very less post-procedural discomfort in comparison to other treatments

No need of compression stockings

In the VenaSeal procedure for varicose veins, the bio-adhesive seals the diseased vein within a few minutes of application. Therefore, patients usually do not need to wear compression stockings post-operatively. This also adds to the patient’s comfort and improved patient experience.

Summing Up

VenaSeal can help you get rid of varicose veins with minimal discomfort.. However, one must follow the following post-procedural instructions properly to prevent the risk of recurrence:

  • Maintain a healthy weight
  • Avoid sedentary or standing postures for longer periods
  • Following active routine

If painful and unpleasant varicose veins are bothering you and you want a relatively comfortable procedure like VenaSeal to get rid of it, then choose your vascular specialist wisely. This is because such sophisticated procedures require great skill. Dr. Akhil Monga is the best vascular specialist in tricity and has rich expertise in VenaSeal procedure for varicose veins, as well as a number of other vein closure procedures. There, you can get the best help to choose a treatment that’s perfect for your veins.

December 13, 2021 by Dr. Akhil Monga 0 Comments

How to treat varicocele without surgery?

If you are looking for options to manage varicocele, many treatment options are available, excluding surgery.

Varicocele is a condition where veins in the scrotum become abnormally enlarged. This condition is similar to varicose veins in your leg. The veins in the scrotum become twisted and swollen, just like varicose veins in the leg. It is believed that varicocele forms during puberty, and they grow larger and develop over time.

Like other body parts, the blood from the testicles flows out via veins (testicular veins). The blood flows from the heart to the testicles in one direction. The blood flow is unidirectional because of the veins’ valves that prevent the blood from moving backward. However, in varicocele veins, they fail to perform their normal function (cause may be unknown), which causes pooling of the blood in and around the testicles and causes varicocele veins.

Varicocele may affect 10-15 males out of 100, and it is more common on the left side of the scrotum. However, it can also occur on both sides simultaneously.

If you or your friend or a relative has varicocele veins and are looking for treatment options that do not involve surgery, please keep reading.

What are the treatment options for varicocele, and why varicocele embolization?

Varicocele is usually harmless and does not cause problems, and most patients do not need treatment. However, it may cause pain in the scrotum, low sperm production, and poor sperm quality. All this may cause infertility or abnormal development of testicles. For such cases, treatment may be indicated.

The various treatment options for varicocele are:
1. Surgery: There are three types of surgical treatment options available which are:

  • Microsurgery
  • Open surgery
  • Laparoscopic surgery

2. Varicocele embolization or Catheter-directed embolization

Varicocele embolization is a non-surgical procedure that interventional radiologist does. It is highly effective and widely used to treat varicocele. The advantages of varicocele are as follows:

  • Faster recovery time as compared to surgical procedures
  • No need for General anesthesia
  • No incisions
  • No hospitalization required
  • Lower risk and complications as compared to surgical procedures
  • Less downtime for physical activity
  • Cost-effective
  • No sutures
  • No infections
  • As effective as surgical procedures

What is Varicocele embolization?

As mentioned above, it is a non-surgical procedure performed by an interventional radiologist. The procedure involves using catheters and other instruments to close off the blood flow of the nonfunctional vein. The procedure does not cause any pain, and the patient is relaxed. The interventional radiologist makes a tiny cut (incision) in the groin region using localized anesthesia. After which, a thin catheter is threaded into the vein (femoral vein) directly to the testicular vein. Later, a contrast dye is injected to help identify where the varicocele is and perform the varicocele embolization or blocking of the vein. Using coils or sclerosants, the physician blocks the abnormal veins, thus decreasing the pressure on the varicocele. Varicocele embolization causes blood flow to redirect to other pathways and stops the blood flow internally without undergoing a surgical procedure which does the same.

What to expect before and after the varicocele embolization procedure?

Before the procedure, your urologist or interventional radiologist (IR) will take your medical history and ask you to for an ultrasound of the scrotal region.

A brief physical examination is conducted to determine if the procedure can be conducted on you or not. An interventional radiologist will explain the procedure that needs to be followed before the procedure. The following instructions need to be followed:

  • Any allergies or known interactions with contrast dye should be disclosed to your physician
  • You will be advised not to eat or drink 8-12 hours before the procedure
  • If you are a smoker, you should stop smoking
  • You may be placed on antibiotics treatment to avoid the risk of infection
  • Pre-anesthetic checkup for determination of fitness for anesthesia
  • Additional instructions provided by the doctor or healthcare team needs to be followed

Once the procedure is completed, you will be kept under observation for an hour or two. The healthcare team will provide a set of instructions that need to be followed (for instance, what to eat, when to eat, what to drink, and when to drink).

In the majority of the cases, you will be advised to go home. However, you should take it easy and rest for a day. You can resume daily activities within 24 hours (driving). However, activities that involve physical exertion should be avoided for a few days. Sexual activity should also be avoided for some weeks.

You should inform your doctor immediately if you experience any complications and visit for timely follow-up.

November 23, 2021 by Dr. Akhil Monga 0 Comments

Uterine Fibroid Embolization

Fibroids are benign tumors of the uterus (womb).  They do not possess cancerous tendencies, so they are not life threatening. Fibroids are highly common and around half of the women in this world get affected with them at some stage of their lives. It is seen that in most of the women with fibroids, symptoms do not even appear at all. They may stay unaware of the presence of fibroids in their body.But some may face huge suffering because of them.Fibroids are made of muscle and are highly vascular i.e. well supplied with blood. Although the causes of fibroid are unknown, the hormones play a huge role in their growth. It is seen that during a woman’s mid life when the estrogen levels are at peak, they grow faster. They usually affect the women in the 30-35 years age group and are rarely seen in teenage girls. After the menopause, the fibroids tend to shrink.

What symptoms can it cause?

  • Increased bleeding / passage of clots during menstrual periods.
  • Increased bleeding resulting in anemia.
  • Chronic lower abdominal pain.
  • Increased pain during menstruation.
  • Painful intercourse.
  • Frequent urination.
  • Difficulty in emptying urinary bladder.
  • Constipation
  • Reproductive problems and/or complications during pregnancy or labor

What are the types of fibroids?

Fibroids can be of four types depending on their location.

  • sub-serosal (outside of the womb under the mucosa)
  • intra-mural (within the uterus wall)
  • sub-mucosal (inside of the uterus under the mucosa)
  • cervical (arising from the cervix (the neck of the womb) itself)

Infertility and Problems with Pregnancy?

In most of the cases, fibroids do not interfere with the pregnancy or ability to carry pregnancy. But some of them may lead to an uncomfortable pregnancy. They can even result in difficulty in conceiving or miscarrige in some cases. This is logical as an abnormal lump in the uterus can easily be imagined blocking the fallopian tube preventing the egg travelling from the ovary to the uterus.  Pregnancy loss or interference with embryo growth may occur due to the fibroids within the womb lining. Occasionally, few fibroids may become non-vital because of lost blood supply during pregnancy resulting in severe pain, misscarriage or premature delivery.

Large fibroids may obstruct a baby’s passage to move out during birth leading to difficult delivery. In such cases, a caesarean section surgery may become necessary. Fibroids may increase the risk of heavy bleeding after birth which may later require some kind of intervention to stop.

What are the available treatment options for uterine fibroids?

  1. Hormonal drugs (cannot be taken for long duration since it has its own side effects)
  2. Surgical –
    1. hysterectomy – removing uterus.
    2. Myomectomy – surgical removal of the fibroids.
  3. Non-surgical – Uterine fibroid embolization (UFE)

What is Uterine fibroid embolization (UFE) and how is it done?

Fibroids have a rich blood supply from the uterine arteries. If these arteries which are supplying the fibroids are blocked, eventually fibroids shrink and symptoms will disappear.

After giving local anesthesia in the hand or leg, through a small pin hole sized access in the artery of the wrist or in the groin, small angiographic catheters are inserted and uterine arteries are entered. Through this small particle called PVA particles are injected which results in shrinkage of the fibroids. This procedure is done inside a cath lab by an interventional radiologist and will only take an average of 45 min – 1 hour depending on the anatomy and is particularly effective for fibroids less than 12 cm size.

What are the advantages of UFE when compared to surgical methods?

  1. Uterus is preserved.
  2. No scars in the uterus (scars in uterus can lead to complications in subsequent delivery).
  3. No need for general anesthesia.
  4. Can leave the hospital in 24 hours.
  5. Can return to normal activities as soon as they go home.
  6. No need for prolonged bed stays.
  7. Does not interfere with hormonal functions, since ovarian function is not impaired
  8. Less rate of complications as compared to surgery .
  9. Normal periods will be preserved in menstruating ladies.
  10. Avoids the possibilities of developing obesity, high blood pressure, depression and early ovarian atrophy after hysterectomy.