Interventional Oncology

Interventional Oncology

Interventional oncology is the treatment of cancer patients with minimally invasive techniques. Most commonly patients with primary liver cancer (hepatocellular carcinoma) or secondary liver cancer (metastatic spread from colon cancer, neuroendocrine tumor, and others) are treated with these techniques.

What types of cancers can be treated?
Primary liver cancer (hepatocellular carcinoma)

Metastatic cancers with spread to liver including:

  • Colon cancer
  • Neuroendocrine tumor
  • Cholangiocarcinoma
  • Breast cancer
  • Pancreatic cancer

What types of treatments are available?
Interventional oncology treatments include:

  • Ablation
  • Chemoembolization
  • Radioembolization

How long are the procedures?
The length of the procedure varies on procedure type and patient anatomy.

How long is the hospital stay?
For most procedures, patients are discharged home the same day or the following morning.

Are the treatments compatible with chemotherapy?
In most cases, concurrent treatment with chemotherapy is recommended.

Chemoembolization

Chemoembolization is a procedure designed to treat cancers in the liver.

During the procedure, a catheter will be placed in a vessel in the upper thigh and advanced into the blood vessels of the liver under X-ray guidance.  Once the catheter is placed, small particles are injected to kill tumor cells.

Chemoembolization treats tumor by two different mechanisms.  One is by shutting down the dominant blood supply to the tumor, the tumor is deprived of oxygen and nutrients required to survive and grow.  Secondly, chemotherapeutic agents are infused directly into the tumor leading to a higher concentration of chemotherapy around the tumor and less chemotherapy elsewhere in the body.

The aim of the procedure is to increase the patient’s life expectancy and improve cancer-related symptoms. It treats primary liver cancer (Hepatocellular carcinoma) and metastatic liver disease from several organs.

Each procedure lasts for two hours or less.  More than one treatment may be necessary depending on the tumor volume.

Most patients are discharged home the morning following the procedure.  Some patients may be discharged the day of the procedure depending on their symptoms following the procedure.

Radioembolization

Radioembolization (Yttrium-90 Treatment) is a procedure designed to treat cancers in the liver.  During the procedure, a catheter will be placed in a vessel in the upper thigh.  Using X-ray, the catheter is advanced into the blood vessel in the liver.  Once the catheter is placed, small particles are injected to treat the tumor.  Attached to the particles are Yttrium-90 radiation particles.

The radiation delivered to the liver is thought to selectively target the tumoral tissue rather than normal liver.  This is based on the normal blood flow of the liver and tumor itself.

The procedure is done at two stages. The first stage is to block the arteries supplying the stomach and intestine and to determine the dose of radiation that should be given. Two weeks later the patient will come for the treatment with radiomebolization.

Similar to chemotherapy, radioembolizationis designed to increase the patient’s life expectancy and improve cancer-related symptoms.

Radioembolization treats cancers in the liver, including Primary liver cancer (Hepatocellular carcinoma) and metastatic liver cancer.

Ablative Therapies

These methods involve placing a needle into the tumor and delivering heat or cold to destroy the cancer cells. It requires no incisions and is effective for some patients who are not candidates for surgery and who have isolated tumors less than 3 cm. Ablation is also used in bones either to relieve pain or sometimes to keep metastases under control after resistance to targeted therapies.



What types of tumors are treated?

  • Primary liver cancer
  • Metastatic cancer to liver
  • Lung cancer
  • Kidney cancer

How is the procedure performed?

The procedure is performed with the patient under general anesthesia or conscious sedation.  A needle is placed through the skin and into the tumor under visualization using CT or ultrasound.  Energy is then transmitted through the needle, killing tumor tissue.

How long is the procedure?

Depending on the amount of tumor to be treated, the procedure lasts between 1-4 hours.

How long is the hospitalization?

Patients are usually discharged home the same day or next day after the procedure.

How long is the recovery?

Patients usually return to their baseline status days after the procedure.

How much pain is there after the procedure?

Most patients have very mild pain after the procedure.  Many patients do not require pain medication afterwards.

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Treatment of Varicose Veins

Varicose veins, Bye-Bye!

Millions are suffering from some form of venous disorder. While some seek treatment for cosmetic improvement, many seek relief from pain. Help is available.

What are varicose veins?

Varicose veins are enlarged veins that are swollen and raised above the surface of the skin. They can be dark purple or blue, and look twisted and bulging. Varicose veins are commonly found on the backs of the calves or on the inside of the leg. They develop when valves in the veins that allow blood to flow toward the heart stop working properly. As a result, blood pools in the veins and causes them to get larger. Since most veins lie deep to the skin’s surface, vein disorders are not always visible to the naked eye. As a result, diagnostic ultrasound is often used to determine the cause and severity of the problem.

What are the risk factors of varicose veins?

  • Age: The risk of varicose veins increases with age.
  • Sex: Women are more likely to develop the condition. Hormonal changes during pregnancy, pre-menstruation, or menopause may be a factor.
  • Family history: If other family members had varicose veins, there is a greater chance you will too.
  • Obesity: Being overweight puts added pressure on your veins.
  • Standing or sitting for long periods of time: Your blood doesn’t flow as well if you are in the same position for long periods.

How are varicose and spider veins treated?

Ultrasound Guided Sclerotherapy

A sclerosing solution is injected into the vein that causes the vein wall to swell, stick together, and seal shut. This process stops the flow of blood, and the vein turns into scar tissue. In a few weeks, the vein should fade. The same vein may need to be treated more than once. Most patients can expect a 50-80% improvement after treatment.Sclerotherapy treatments do not eliminate diseased veins after one single treatment. Patients need to be compliant with the number of sessions that are recommended to obtain the best results.

Endovenous Ablation

Endovenous ablation shuts down a large, long vein by targeting heat energy inside the vein to seal it shut. This heat can be created with a laser, known as endovenous laser treatment (EVLT), or with radiofrequency ablation (RFA). Both are the latest technologies and replace vein stripping procedures that had been used. EVLT and RFA are minimally invasive and highly effective. They are usually performed in a comfortable office setting.

Other advantages of endovenous laser ablation and radiofrequency ablation include:

  • Treatment in less than an hour.
  • Return to normal activities immediately.
  • Up to 98 percent success rate.
  • Immediate relief of symptoms.
  • No general anesthesia or hospitalization.
  • No scars.

Varicose Veins Treatment in Qatar

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Uterine Fibroid Embolization

Uterine Fibroid treatment without surgery

Uterine fibroids are noncancerous (benign) tumors that develop in the womb (uterus), a female productive organ.

Causes, incidence, and risk factors

Uterine fibroids are common. As many as 1 in 5 women may have fibroids during their childbearing years (the time after starting menstruation for the first time and before menopause). Half of the women have fibroids by age 50.
Fibroids are rare in women under age 20. They are more common in African Americans than Caucasians. The cause of uterine fibroids is unknown. However, their growth has been linked to the hormone estrogen. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly.

Symptoms

    • Bleeding between periods.
    • Pain during intercourse.
    • Heavy menstrual bleeding (menorrhagia), sometimes with the passage of blood clots.
    • Menstrual periods that may last longer than normal
    • Need to urinate more often.
    • Pelvic cramping or pain with periods
    • The sensation of fullness or pressure in the lower abdomen.

Treatment for the symptoms of fibroids:

Surgical Treatments for Fibroids Gynecologists perform hysterectomy and myomectomy surgery. Hysterectomy is the removal of the uterus and is considered major abdominal surgery.

Myomectomy is a surgery that involves cutting out the biggest fibroid or collection of fibroids and then stitching the uterus back together. Most women have multiple fibroids and it is not physically possible to remove all of them. Fibroids may grow back several years later.

Uterine Fibroid Embolization

Uterine fibroid embolization (UFE) is a minimally invasive treatment for fibroid tumors of the uterus. The procedure is also sometimes referred to as Uterine Artery Embolization (UAE). In a UFE procedure, physicians use an x-ray camera called a fluoroscope to guide the delivery of small particles to the uterus and fibroids. The small particles are injected through a thin, flexible tube called a catheter. These block the arteries that provide blood flow, causing the fibroids to shrink. Nearly 90 percent of women with fibroids experience relief of their symptoms.

Advantages

Uterine fibroids embolization is much less invasive than surgery.
No surgical incision is needed.
Patients ordinarily can resume their usual activities weeks earlier than if they had a hysterectomy.
Follow-up studies have shown that 90% of women who underwent fibroids embolization experienced either significant or complete resolution of their fibroid-related symptoms.

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Address: Aman Hospital, Doha, Qatar

Prostate
Artery
Embolization

Benign Prostatic Hyperplasia (BPH)

Benign prostate hyperplasia (BPH) is a disease characterized by smooth muscle proliferation in the prostate that can lead to lower urinary tract symptoms (LUTS), including urinary frequency, urgency, and incontinence which can have a significant impact on quality of life.

Management of BPH has historically involved medications, lifestyle modifications, and regulating dietary and fluid intake and output. Those patients who are refractory to these treatments have been referred for transurethral resection of the prostate (TURP). This procedure does come with significant risks including bleeding and nerve damage potentially leading to impotence.

Prostate Artery Embolization (PAE)

PAE is an FDA-approved minimally invasive technique that can be used as an alternative to TURP with fewer adverse effects and increased patient comfort. A tiny catheter is navigated into the arteries feeding the prostate gland from a pinhole in the groin or upper arm artery and small gelatin particles are injected into these small arteries to decrease blood flow to the enlarged prostate gland. Patients can go home the same day with very little discomfort. This innovative therapy involves new technologies, such as 3D navigation, microcatheters, and state-of-the-art x-ray imaging devices.

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Address: Aman Hospital, Doha, Qatar

Pain Management

WHAT IS BACK PAIN?

We use a variety of interventional procedures to treat pain. Guidance from X-ray or ultrasound imaging helps us deliver the therapy to the exact source of your pain. We strive to give you the most pain relief possible. The interventional treatment options include the following.

Epidural steroid injections help us treat irritated spinal nerve roots that cause pain in your neck, shoulders, arms, upper and lower back, buttocks, or legs. Many conditions can cause this type of pain, such as herniated disc, degenerative disc disease, and arthritis.  X-ray guidance helps us inject low doses of long-lasting corticosteroids (potent anti-inflammatory pain medications) directly into the source of the pain. This approach decreases inflammation and helps you feel better. these procedures take about five minutes under local anesthesia.

Medial branch blocks/facet joint injections are injections, which we perform using X-ray guidance, that help us diagnose and treat pain that comes from the small joints of the spine (facet joints). Disease in these joints, including arthritis, can cause pain in the head, neck, upper and lower back, and buttocks. These procedures take about five minutes.

Major joint injections help relieve pain from many causes, including osteoarthritis. We inject medications such as corticosteroids, local anesthetics, or hyaluronic acid directly into the source of the pain. To find the precise right location, we use either X-rays or ultrasounds. This procedure takes two minutes.

Kyphoplasty (balloon kyphoplasty)

Compression fractures usually begin with tiny breaks in the vertebrae that can occur as bones get softer and weaker over time. These fractures can result in changes in the shape of your spine affecting your posture and making it more difficult to breathe while also causing pain and potentially, immobility.

A spinal X-ray is done to confirm your diagnosis. Next, a CT scan or MRI may be performed to reveal more detail about the bone, surrounding nerves, and the condition of other discs.

We thread a small balloon through an incision in the back to the site of the injury. Then we inflate it to gently push any damaged bone back into place. Finally, we insert cement into the site to hold the bone in proper position. This procedure is performed under local anesthesia and sedation.

Discography

Discography focuses on your physical response to pressure on specific spinal discs. This procedure injects a dye into your disc which causes pressure and will result in a response that will determine if your back pain is disc-related and what areas of your back need attention.

As one of the most reliable diagnostic tools for this type of pain, we recommend discography if you have undergone extensive tests and treatments, but still suffer from severe groin, hip, leg, or lower back pain.

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Address: Aman Hospital, Doha, Qatar

Back Fracture

Bariatric Embolization (Left Gastric Artery Embolization)

Bariatric embolisation

Obesity leads to many comorbid conditions such as cardiovascular disease, diabetes mellitus, sleep apnea, and stroke; therefore, there is a critical need to find solutions to this widespread problem. Treatment can entail diet, exercise, medication, and surgery.

Bariatric embolization is a new promising minimally invasive procedure that can reduce the sensation of hunger for treating patients with morbid obesity. It targets ghrelin, the hunger hormone, and patients will become less hungry.

The procedure is done under local anesthesia where a tiny catheter is navigated into the arteries feeding the fundus of the stomach from a pinhole in the groin. Small gelatin particles are injected into these small arteries to decrease blood flow to the fundus where ghrelin is produced.

The procedure can be done with one-night hospital admission and patients can go home the next day with very little discomfort. This innovative therapy involves new technologies, such as 3D navigation, microcatheters, and state of the art x-ray imaging devices

Patients have shown promising weight loss in the first month after the procedure and an average excess weight loss of roughly 10 percent at 3 months.

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Address: Aman Hospital, Doha, Qatar

Varicocele Embolization

Varicocele without surgery

A varicocele is an enlargement of the veins within the scrotum, the loose bag of skin that holds your testicles. A varicocele is similar to a varicose vein that can occur in your leg. It is present in approximately 10% of young men.

Treatment

Surgical ligation: performed under general anesthesia either traditional, laparoscopic or microscopic surgery.Varicocele embolization is a minimally invasive, image-guided procedure that uses a catheter to place a tiny coil and/or embolic fluid in a blood vessel to divert blood flow away from a varicocele. It is performed without general anesthesia or surgical wound.

Varicocele embolization Procedure

Varicocele embolization is an outpatient procedure that is performed without general anesthesia using twilight sedation. In this procedure, a small tube is inserted into the arm vein (just like having an IV line). The skin is numbed for this procedure and it is not painful. Next, a small catheter, or tube, is painlessly guided into the abdomen and into the varicocele vein under the guidance of x-ray imaging (see Figure). The vein is then intentionally closed off by plugging it with small metals coils and a special medication (the same sclerosant medication injected into leg varicose veins). The procedure takes 30 minutes and the patient goes home immediately after with only a band-aid at the puncture site. Patients can drive or travel immediately. They can immediately resume their non-exertional activities.

Advantages of Varicocele embolization include:

  • Performed under local anesthesia with mild sedation (general anesthesia used for surgical varicocele ligation). No surgical incision in the groin.
  • Lower rate of complications compared to surgery. Infection has not been reported after embolization.
  • Performed on an outpatient basis.
  • Can resume normal intercourse a day after (after surgery, patient need weeks).
  • It is as effective as surgery, as measured by improvement in pain, semen analysis and pregnancy rates.
  • Varicocele embolization safely relieves that pain and swelling and may improve sperm quality for infertile couples.

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Tel: +974 6611 2349

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Address: Aman Hospital, Doha, Qatar

Peripheral
Vascular
Disease

Peripheral Vascular Disease Angioplasty and Stenting

Peripheral vascular disease (PVD) is a condition in which the blood vessels become blocked or narrowed, which can affect the way that blood flows through the body. It can affect the blood vessels of the legs and arms, as well as organs of the abdomen, like the stomach and kidneys.

The objective of angioplasty and stenting is to restore proper blood flow through arteries or veins that have become blocked or narrowed, and are therefore experiencing a decrease in blood flow with symptoms such a pain, fatigue.

What to Expect During Peripheral Vascular Disease Angioplasty and Stenting

Before the procedure begins we use ultrasound imaging to locate the blockage or narrowed part of the blood vessel. Then a tiny incision is made over the area and a thin, flexible tube called a catheter is inserted into the affected blood vessel and carefully guided to the blocked area. The catheter will have a small balloon attached to the end, which will be inflated to open the blockage.

The balloon will be kept inflated for few minutes and if the blood vessel continues to collapse, a stent will be placed into the blood vessel that will keep it permanently open.

Benefits of Peripheral Vascular Disease Angioplasty and Stenting

Minimally invasive angioplasty and stenting for peripheral vascular disease offer patients numerous benefits, including:

  • Smaller incisions
  • Faster recovery time
  • Lower risk of complications
  • Local anesthesia instead of general anesthesia, so patients can go home the same day.

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Address: Aman Hospital, Doha, Qatar

Hemorrhoid Embolization

What is a hemorrhoidal disease and what are the symptoms

Hemorrhoidal disease is the most frequent proctologic pathology. It is a dense anastomotic arteriovenous network that contributes to anal canal incontinence. Chronic bleeding is the main symptom of internal hemorrhoids located at the anorectal junction and may or may not be associated with hemorrhoidal prolapse. External hemorrhoids, located at the anal margin, manifest as painful inflammatory crises that are sometimes associated with thrombosis.

Hemorrhoidal disease treatment usually involves hygiene and dietary measures and other non-surgical procedures. However, 10% of patients still require surgical treatment with long, painful postoperative courses with a significant complication rate

What is hemorrhoidal artery embolization?

Hemorrhoidal artery embolization is a minimally invasive procedure designed to treat patients with moderate to advanced symptoms of hemorrhoidal disease. The procedure consists of a placement of a small catheter through a vessel in the upper thigh.  Under X-ray guidance, the catheter is advanced into the vessels supplying blood flow to distal branches of the superior rectal artery.  Embolization is performed by small particles infused through the catheter for the purposes of eliminating blood flow.

What is the procedure time?

Most cases will be performed in less than 2 hours. Depending on patient anatomy, the procedure may last for up to 4 hours.

What is the recovery time?

Currently, patients are admitted overnight for observation and discharged the following morning.

How effective is the procedure?

Patients can expect to have symptomatic improvement as early as 1 week after the procedure.  The symptomatic improvement is similar to that expected for surgery. Patients were found to have improved symptom scores and quality of life.

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Address: Aman Hospital, Doha, Qatar

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Pelvic Congestion Syndrome

Women with pelvic congestion syndrome are typically less than 45 years old and in their childbearing years. Ovarian veins increase in size related to previous pregnancies. Pelvic congestion syndrome is unusual in women who have not been pregnant.

Chronic pelvic pain accounts for 15% of outpatient gynecologic visits. Studies show 30% of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a sole cause of their pain and an additional 15% have PCS along with another pelvic pathology.

Symptoms

The chronic pain that is associated with this disease is usually dull and aching. The pain is usually felt in the lower abdomen and lower back. The pain often increases during the following times:

    • Following intercourse.
    • Menstrual periods.
    • When tired or when standing (worse at end of the day).
    • Pregnancy

Other symptoms include:

  • Irritable bladder.
  • Abnormal menstrual bleeding.
  • Vaginal discharge.
  • Varicose veins on vulva, buttocks, or thigh.

Procedure

Once a diagnosis is made, if the patient is symptomatic, an embolization should be done. Embolization is a minimally invasive procedure performed by interventional radiologists using imaging for guidance. During the outpatient procedure, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the femoral vein in the groin and guides it to the affected vein using X-ray guidance. To seal the faulty, enlarged vein and relieve painful pressure, an interventional radiologist inserts tiny coils often with a sclerosing agent (the same type of material used to treat varicose veins) to close the vein. After treatment, patients can return to normal activities immediately.

Patient Feedback

Pelvic Congestion Syndrome

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