Smoking and Peripheral Artery Disease

According to the Vascular Disease Association,  smoking is not only a major cause of heart disease, cancer and lung disease, it  is also the number one cause of peripheral artery disease,( PAD). Studies show that smoking even half a pack of cigarettes per day may increase the risk of having PAD by 30 to 50 percent.
With every puff, smoking harms your blood vessels. It speeds up the buildup of plaque in the artery walls and increases the formation of leg artery blockages. Smoking constricts blood vessels and causes the blood to clot.

As a result, smoking causes PAD to get worse faster. It increases the chance of having leg pain (or claudication) even while at rest, losing a foot or a leg due to amputation, or having a heart attack or stroke. As many as one out of two people with PAD who continue to smoke will have a heart attack or stroke or die within 5 years.


Quitting smoking may be the most important life saving step people with PAD can take. And, it is not too late. 

 Research shows that people with PAD can lower the risk of heart attack, stroke or death when they quit smoking. Plus, you will enjoy these other health rewards:
•    Your blood pressure will be lower in just a few days.
•    You will reduce your risk of foot ulcers, eye problems, nerve damage and kidney disease (if you have diabetes).
•    You will lower your risk of cancer of the mouth, throat, lungs and bladder.
•    In one year after quitting, your blood flow and breathing will be improved and your coughing and shortness of breath will be reduced.
•    You will protect your children and grandchildren from second-hand smoke.
•    Best of all, you will live longer and better.

If you smoke and suffer from leg pain or foot pain we are available to answer any of your questions or you are welcome to call our office to set up a consultation with one of our physicians.

Nonsurgical Treatment for Male Infertility Caused by Varicoceles

             Highly Effective, Widely Available Treatment is Underutilized

According to the Society of Interventional Radiology , a varicocele is a varicose vein of the testicle and scrotum that may cause pain, testicular atrophy (shrinkage) or male infertility problems. Veins contain one-way valves that work to allow blood to flow from the testicles and scrotum back to the heart. When these valves fail, the blood pools and enlarges the veins around the testicle in the scrotum to cause a varicocele. Open surgical ligation, performed by a urologist, is the most common treatment for symptomatic varicoceles. Varicocele embolization, a nonsurgical treatment performed by an interventional radiologist, is as effective as surgery with less risk, less pain and less recovery time. Patients considering surgical treatment should also get a second opinion from an interventional radiologist to ensure they know all of their treatment options.

Prevalence
•    Approximately 10 percent of all men have varicoceles - among infertile couples, the incidence of varicoceles increases to 30 percent
•    Highest occurrence in men aged 15-35
•    As many as 70-80,000 men in America may undergo surgical correction of varicocele annually
Symptoms
Pain - aching pain when an individual has been standing or sitting for long periods of time and pressure builds up on the affected veins. Typically, painful varicoceles are prominent in size.
Fertility Problems - There is an association between varicoceles and infertility. The incidence of varicocele increases to 30 percent in infertile couples. Decreased sperm count, decreased motility of sperm, and an increase in the number of deformed sperm are related to varicoceles. Some experts believe that blocked and enlarged veins around the testes, called varicoceles, cause infertility by raising the temperature in the scrotum and decreasing sperm production.

Testicular Atrophy - Shrinking of the testicles is another sign of varicoceles. Often, once the testicle is repaired it will return to normal size.
Varicocele Diagnosis
Diagnosis is fairly simple through either physical or diagnostic examination.
•    Typical on left side of scrotum
•    Visual physical exam - scrotum looks like a "bag of worms"
•    Testicle can shrink in size / atrophy
•    When varicoceles are not clearly present, the abnormal blood flow can often be detected with a noninvasive imaging exam called color flow ultrasound or through a venogram - an X-ray in which a special dye is injected into the veins to "highlight" blood vessel abnormalities
 
Varicocele Treatments
Currently there are two treatment options for men with varicoceles: Catheter-directed embolization or surgical ligation

Catheter directed embolization is a non-surgical, outpatient treatment performed by an interventional radiologist using imaging to guide catheters or other instruments inside the body. Through mild IV sedation and local anesthesia, patients are relaxed and pain-free during the approximately two-hour procedure.
For the procedure, Dr. William Julien or Dr. Warren Swee makes a tiny nick in the skin at the groin using local anesthesia, through which a thin catheter (much like a piece of spaghetti) is passed into the femoral vein, directly to the testicular vein. The physician then injects contrast dye to provide direct visualization of the veins so s/he can map out exactly where the problem is and where to embolize, or block, the vein. By using coils, balloons, or particles, the interventional radiologist blocks the blood flow in the vein which reduces pressure on the varicocele. By embolizing the vein, blood flow is re-directed to other healthy pathways. Essentially, the incompetent vein is "shut off" internally by preventing blood flow, accomplishing what the urologist does, but without surgery.

Efficacy of Embolization for Varicoceles
Embolization is equally effective in improving male infertility and costs about the same as surgical ligation. Pregnancy rates and recurrence rates are comparable to those following surgical varicocelectomy. In one study, sixty percent conceived who were treated for infertility.
In another study, sperm concentration improved in 83 percent of patients undergoing embolization compared to 63 percent of those surgically ligated. Patients who underwent both procedures expressed a strong preference for embolization.

Recovery Time
•    Average of one to two days for complete recovery for embolization, compared to two to three weeks for surgery
•    24 percent of surgical ligation patients required overnight hospital stay, compared to none for embolization
Benefits of Interventional Radiology Procedure
•    No surgical incision in the scrotal area
•    Effective as surgery, as measured by improvement in semen analysis and pregnancy rates
•    Less recovery time-patients are able to return to normal daily activities immediately and without hospital admittance
•    A patient with varicoceles on both sides can have them fixed simultaneously through one vein puncture site, compared to surgery, which requires two separate open incisions
•    No general anesthesia
•    No sutures
•    No infections
•    Cost-effective

Surgical Treatment of Varicocele
After the patient receives anesthesia, an incision is made in the skin above the scrotum, cutting down to the testicular veins, and tying them off with sutures. Although patients leave the hospital the same day, there is a two- to three-week recovery period.

Clot-busting technology saves man from 2 1/2-foot blood clot

Read more: http://www.foxnews.com/health/2012/06/18/new-clot-busting-technology-used-to-treat-2-and-half-foot-blood-clot/#ixzz208orDaK7



When 59-year-old Gerald Cunha was diagnosed with a 2 1/2-foot blood clot that stretched from his knee to his abdomen, doctors prepared him for the worst. 

But thanks to a new clot-busting technology, Cunha survived and was able to tell his story to FoxNewsHealth.com.

Cunha’s ordeal began with what he thought was just sciatica causing pain in his legs.

“I started getting some swelling,” Cunha said. “[I] made an appointment with my primary, and the swelling got worse.  So [I] went to the emergency room.”

“My leg had swollen up to about twice the size,” he added.”

Doctors found Cunha was suffering from deep vein thrombosis (DVT), which occurs when a blood clot forms in a vein deep inside the body.

Dr. Warren Swee, an interventional radiologist at South Florida Vascular Associates, discovered Cunha's DVT stretched all the way up his leg to his pelvis.

“When people develop a DVT and experience pain and swelling of the knee or leg, they often think they might have a pulled muscle from exercising too much or from wearing the wrong shoes,” said Swee. “This  misconception prevents people from seeking medical attention immediately, which is key.”

In Cunha's case, he had been suffering from pain and swelling for about 10 days before going to the emergency room.

Cunha also had many classic risk factors for DVT; he was overweight, lead a sedentary lifestyle and was a smoker.

“He was referred to our office because he had a poor response to the primary therapy for a DVT – blood thinner,” Swee said. “Blood thinners alone will allow you to prevent the clot from breaking off and going to the lungs – which can be life-threatening and is called a pulmonary embolism.”

But for Cunha, blood thinners didn't cut it, and Swee soon found he would need to be creative in his approach to treatment.

“We decided to use a secondary form of therapy which incorporated clot busters and not just blood thinners,” Swee said. “We put him on his stomach and prepped his leg. Through a small hole we inserted a catheter directly into the clot, which drips clot busting medication right into the clot and melts it away.”

Using a new device called the EKOS Ultrasound Catheter, Cuhna’s health improved quickly.

Attacking a Monster Clot! -- In Depth Interview with Dr. Warren Swee

   
Warren Swee, MD, MPH, a Vascular and Interventional Radiologist at South Florida Vascular Associates, in Coconut Creek, FL, talks about a state-of-the-art device that melted away a potential killer.

What is DVT?

Dr. Swee: DVT or a deep vein thrombosis is essentially a clot that forms in the deep veins of the leg. Initially it will present as pain and swelling in the leg, which can increase over several days. It’s usually identified with a simple test in which an ultrasound probe is placed over the veins of the leg. DVT is a tremendous public health problem in the United States with almost six thousand cases diagnosed every year. Although the initial problem with the pain and swelling can resolve it, it also places patients at significant risk of a pulmonary embolism, which is when a part of that clot breaks off and travels to the lungs and that can be life threatening. It’s estimated that up to a hundred thousand patients every year will die of pulmonary embolism.
What does a pulmonary embolism do?
Dr. Swee: It breaks off from the legs and travels up the pelvis through the abdomen, through the heart and into the pulmonary artery, which is the main vessel that supplies oxygen to the lungs for transport. Without blood going to your lungs it can be fatal.
How often do you see DVT patients coming in here?
Dr. Swee: We see DVT patients quite frequently. Typically they’re relatively simple DVT’s with an isolated clot behind the knee or in a portion of the vessel along the thigh. In rarer cases the clot can travel up across the thigh in to the pelvis and even in to the abdomen. Those are much more severe cases.
What is the size of a normal clot?
Dr. Swee: Typically anywhere from an inch to six inches or so is-- would be a typical clot size.
The clot basically cuts off the circulation to the rest of the vein?
Dr. Swee: Correct. It prevents drainage of the blood from the leg from going up through that vessel. Usually that’s what causes the swelling because you’re unable to drain blood from the leg, but over time if a patient is placed on the proper anticoagulation, some of the clot will melt away on its own. The body will form collateral or side channels around the blocked segments.
How do you take care of the clot?
Dr. Swee: Most cases of deep vein thrombosis are treated with just blood thinners. The pain and swelling usually will resolve within a week or so.
As long as you catch it early enough the danger might be minimized?
Dr. Swee: The blood thinners is twofold. One is to prevent the clot from becoming bigger and second to help stabilize the clot so that pieces don’t break off and go to the lungs.
What is the biggest one you’ve seen?
Dr. Swee: Mr. Cunha has a very large clot. His is about a two and a half foot clot that starts below the level of the knee and extends all the way up his thigh into his pelvis and into the lower abdomen. Those clots don’t respond as well to blood thinners because they’re so massive.
How often do you see that?
Dr. Swee: We probably see that maybe once every few months, if that.
How do you survive when you have a clot that big?
Dr. Swee: The blood is no longer liquid. It’s solidified into almost a jelly like substance, and plugs up the vessels instead of allowing flow. It causes immediate swelling but the body does have a lot of capacity to somehow move blood around the actual blockage through their side channels.
So when you get to a point where it’s two and a half feet long what’s the next attack?
Dr Swee: Those patients are in particular at risk of throwing clots to their lungs. If they are treated only with conservative measures, they tend to have debilitating pain and swelling in their legs often for the rest of their lives. They can develop something called post thrombotic syndrome, in which the clot damages valves within the veins. With damage to the valves, it causes you to have this horrendous pain and swelling. What we can do now is use a catheter called the EKOS catheter, which has really revolutionized the way we as interventional treat large blood clots. A small catheter is essentially inserted through the skin into the clotted vessel and positioned there. Within a coaxial system, there is a wire, which is an ultrasound wire, and together this allows simultaneous deliver of ultrasound energy and clot busting medications to allow breaking up the clot much more quickly and safely compared to standard techniques.
How does the EKOS work?
Dr. Swee: The catheter itself has hundreds of holes in it which allow the clot buster to be delivered directly in to the clot. At the same time the ultrasound core wire delivers ultrasound energy, which causes a vibration, which allows the clot busting medication to better penetrate the clot.
In Mr. Cunha's case, if this wasn’t around what would be the other option?
Dr. Swee: The standard technique is to put a catheter in with a lot of side holes, which is can also deliver clot busting medication but without the ultrasound energy. That can work also, but it can take almost double the time. Time counts when we’re treating clot because we’re delivering a very powerful clot busting medication that has a lot of side effects. There could be bleeding from other parts of your body and the worse scenario would be bleeding into your brain, which can be fatal.
How often have you been able to use this now?
Dr. Swee: I’ve used this catheter in about a half a dozen cases, including clot in the leg vessels, and also clot up in the pulmonary arteries. When a clot breaks off and becomes a pulmonary embolism, the catheter can actually be advanced all the way up through the heart from the groin and positioned inside the pulmonary artery.
What is the clot busting drug that you use?
Dr. Swee: There are several different ones that can be used. The one that we typically use is called TPA or tissue plasma activator.
Once Mr. Cunha was diagnosed with his huge blood clot, what was the step after that?
Dr. Swee: Once we reviewed some more imaging we found out that the clot was not just in his leg but it actually went up in to his pelvis and abdomen. We performed the procedure in a hospital endovascular suite under an x-ray machine. He essentially was positioned on his stomach to allow access to his vein right behind his knee. Using ultrasound guidance we advanced the needle into that vein and then through that hole threaded the catheter into the clot. We positioned it under x-ray guidance and then started dripping the clot busting medication into the clot to dissolve it. In Mr.Cunha’s case because this clot was almost five weeks old, it took longer than most cases. It took two days to finally melt the clot away. But he had a fantastic result and dramatic improvement in his leg swelling and pain.
What was his recovery like?
Dr. Swee: The patient is transported to the ICU where they’re monitored carefully for any complications from the clot busting medication. If they do well then they’re brought down the next morning and then we do a check by injecting x-ray dye in to the vessel to see how much clot is still there. If there’s still clot then we’ll send the patient back up to ICU and continue the drip and the ultrasound energy and then bring them back the next day.
Between the ICU and the actual procedure how long are you busting the clot?
Dr. Swee: The actual procedure to get the catheter in is actually pretty quick. It takes about twenty minutes or so to get the catheter where it needs to be. The catheter stays inside the body until the clot is dissolved totally.
What added benefit does the ultrasound give you?
De. Swee: The ultrasound allows the clot busting medication that’s being dripped through the catheter to better penetrate the clot and allows for more surface area between the clot busting medication and the clot. That essentially allows for much quicker dissolving of the clot and decreases the overall amount of clot busting medication that we need to use.
What are the risks?
Dr. Swee: This actually allows us to use this sort of treatment on patients that previously were not candidates, because they couldn’t tolerate several days of clot busting medication. By using this device we can decrease the time it takes to do the procedure and also the amount of clot busting medication.
It’s pretty amazing that Mr. Cunha was left with no disability.
Dr. Swee: Over five weeks he was basically hobbling around and just in constant pain. But about a day or two after the clot was dissolved he was almost back to normal.
What was his recovery time?
Dr. Swee: Following the procedure he stayed in the hospital for an additional week in order to thin his blood to an appropriate level and then after that he was sent home and walking quite comfortably.
Has he had to take anything since?
Dr. Swee: He’s going to be on lifelong blood thinners.
Once you’ve had a clot that big, are you at risk for another?
Dr. Swee: The biggest risk for him is re-developing a clot in the same place.
What has it done to the vein now? Having such a massive clot how stable is it?
Dr. Swee: The vein now that the clot has been melted away is very resilient. In his case his veins should essentially come back to their normal configuration. He may have some mild damage to the valves, but certainly not anywhere near the damage that would have been caused if the clot was not removed.