South Florida Vascular Associates South Florida Vascular Associates

Tuesday, December 11, 2012


Patients Residing in South Broward County Who Suffer from Vascular Diseases Can Now be Treated at our Newest Center of Excellence for Minimally Invasive Endovascular Care
Dr. William Julien and South Florida Vascular Associates are proud to announce the opening of a new location in Plantation, Florida. Our new office is located at 201 Northwest 82nd Avenue, Suite 105, Plantation, Fl. 33324

Our physicians, William Julien, MD and Warren Swee, MD are board certified interventional radiologists who specialize in the treatment of vascular diseases using minimally invasive, endovascular procedures with imaging guidance. Minimally invasive techniques often replace the need for traditional open surgical procedures. They are generally easier for the patient because they involve no large incisions, less traumatic on the patient, less pain and shorter recovery times. Unlike vascular surgery, which treats vascular disease with open surgery, endovascular surgery is a branch of medicine that treats disease processes through the vascular system, using catheter-based image-guided techniques.

“We are pleased to offer our unique, comprehensive, endovascular services to the people of Plantation and the surrounding South Broward communities,” says Dr. Julien who is one of the first interventional radiology physicians in the country to have an office-based clinical practice. Typically, interventional radiologists see patients in the hospital at the time of surgery then after the procedure, the patients are returned to their referring physician.  Dr. Swee explains, “Our philosophy is to follow our patients from the time of diagnosis through treatment and follow-up to ensure that they receive optimal results”.  Drs. Julien and Swee perform 95% of their minimally invasive endovascular procedures in their office-based operating suites offering their patients the comfort and convenience of an office setting rather than a hospital.

“We look forward to working with our new patients and colleagues in South Broward community. We are pleased to have the opportunity to work together within the community to offer the best medical outcome for our patients”, said Dr. Warren Swee.

For more information call 954-725-4141 or visit   

About South Florida Vascular Associates
At South Florida Vascular Associates we provide expert vascular care using the most advanced technology possible. Dr. William Julien and Dr. Warren Swee place a strong emphasis on the importance of patient education offering their patients clear explanations of their diagnosis, treatment plan, and precisely what each patient should expect to experience. We provide our patients with detailed information of the plan of care and are always available to answer any questions. Our dedicated and knowledgeable staff offers the best care to each and every patient.

Our state-of-the-Art Endovascular Suites are equipped with the newest devices to assist in performing minimally invasive procedures without the inconvenience of going to a hospital.

At South Florida Vascular Associates we pride ourselves as a Center for Excellence in patient care as the premier vascular experts in the community.

For more information call 954-725-4141 or visit   

Media Contact:
Debbie Liebross
M.D. Media Connection
(954)-436-3644 (office)

Joe's Story: Critical Limb Ischemia



Joe Langer no longer takes walking for granted. “One day I was fine, the next my toes turned purple and I was in horrific pain. I developed open wounds on the bottom of my feet, gangrene set and I could barely walk. It happened very fast and the next thing I knew, I was facing amputation on both legs from the knees down.”

Every 30 seconds some one, some where in the world is undergoing an amputation, according the American Diabetes Association.

Most tragic, the majority can be prevented according to endovascular surgeon, Dr. William Julien founder of South Florida Vascular Associates, “As more people develop diabetes, amputations are becoming more common, yet 96-percent of them can be avoided. Unfortunately the vast majority of patients aren’t aware of that so they end up losing their limbs or worse yet, their lives.”
People at highest risk are diabetics, those with high cholesterol, heart disease and smokers.

The condition is known as critical limb ischemia (CLI). Simply put, plaque builds up in the arteries, seriously decreasing blood flow to extremities including the hands, feet and legs causing extreme pain and at worst, loss of limbs.

Joe, a diabetic and former smoker considers himself lucky. His podiatrist sent him to South Florida Vascular Associates where they specialize in treating CLI. Joe’s brother-in-law, also a diabetic was not so lucky. Joe says, “His podiatrist did not send him to experts like Dr. Julien and unfortunately his toes were cut off. We now know that could have been prevented.”

Endovascular surgeons at South Florida Vascular Associates take a multi-disciplinary approach to saving limbs and lives. Joe is a great example, they opened the blockages in his arteries then worked very closely with his wound care, infectious disease, and primary care doctors to make sure his wounds were properly healed”.

Using state-of-the-art ultrasound and angiogram technology, he first pinpoints blockages inside artery walls. Then an atherectomy procedure is done in which tiny rotating tools can pulverize and remove the plaque. If necessary, stents are used or angioplasty to re-open the arteries and restore blood flow to the limbs. In addition, hyperbaric oxygen therapy is sometimes prescribed to help heal wounds faster.

It’s a crime to amputate when most of the time it can be prevented. The biggest problem is getting the word out and educating the public.

Joe is trying to help do just that, “These docs performed a miracle. I was in such pain, it was killing me and now I’m back to normal and I consider myself a very lucky man.”

Dr. Julien says, “We urge patients who are told that their limbs must be amputated to get a second opinion. By spreading the word we can significantly reduce the number of amputations from wounds that just won’t heal.”

If you are diagnosed with critical limb ischemia and are told you need your limb amputated, please contact one of our our offices to schedule a consultation with our board certified endovascular surgeons. We may be able to save your limb.

Monday, November 26, 2012

Women with Diabetes Have Increased Risk for Peripheral Artery Disease (PAD)

Women with diabetes have an increased risk of developing peripheral artery disease, a thickening of the inside walls in the arteries of your legs. The excess sugar in the blood of women with diabetes damages the blood vessel walls, making them thicker and less elastic. As the arteries become progressively more damaged, it is more difficult for blood to flow through them. This can also lead to high blood pressure, another major risk factor for PAD.

Stiff and narrowed arteries reduce the flow of blood and oxygen to muscles and organs. In women with PAD in the legs, the leg muscles may not be able to get enough blood, causing leg pain that occurs when walking, but dissipates at rest. This is known as intermittent claudication, one of the major symptoms of PAD.

Along with smoking, diabetes is one of the strongest risk factors for PAD. PAD is up to 4 times as common in women with diabetes compared with non-diabetic women. The longer you have had diabetes, the more likely you are to develop PAD.

Diabetes can also cause problems that make PAD symptoms more difficult to recognize. Diabetes often causes nerve problems in the legs or feet that blunt pain signals, making the symptoms of PAD harder to detect. For this reason, it is especially important that women with diabetes get regular testing with an Ankle-Brachial Index test to identify PAD early so it can be properly treated. If left untreated, PAD can lead to critical limb ischemia and amputation of a lower limb may be necessary.

Diabetes also puts you at risk for heart disease, stroke, and kidney, nerve, and eye damage. The good news is that proper treatment and lifestyle changes can drastically reduce the risk of future problems.
If you have pain in your leg while walking and it subsides at rest, you may have PAD.

We invite you to contact our office to set up a consultation with one of our board certified endovascular surgeons to determine whether you have PAD and to discuss treatment options and lifestyle changes. Being proactive about your health can save your limbs and your life.

FDA expands use of Xarelto to treat, reduce recurrence of blood clots (DVT)

November 2, 1012- The U.S. Food and Drug Administration today expanded the approved use of Xarelto (rivaroxaban) to include treating deep vein thrombosis (DVT) or pulmonary embolism (PE), and to reduce the risk of recurrent DVT and PE following initial treatment.

Blood clots occur when blood thickens and clumps together. DVT is a blood clot that forms in a vein deep in the body. Most deep vein blood clots occur in the lower leg or thigh. When a blood clot in a deep vein breaks off and travels to an artery in the lungs and blocks blood flow, it results in a potentially deadly condition called PE.

Xarelto is already FDA-approved to reduce the risk of DVTs and PEs from occurring after knee or hip replacement surgery (July 2011), and to reduce the risk of stroke in people who have a type of abnormal heart rhythm called non-valvular atrial fibrillation (November 2011).

The FDA reviewed Xarelto’s new indication under the agency’s priority review program, which provides an expedited six-month review for drugs that offer major advances in treatment or that provide treatment when no adequate therapy exists.

“Xarelto is the first oral anti-clotting drug approved to treat and reduce the recurrence of blood clots since the approval of warfarin nearly 60 years ago,” said Richard Pazdur, M.D., director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research.
Other drugs approved by FDA to treat or reduce the risk of blood clots include Lovenox (enoxaparin), generic versions of enoxaparin, Arixtra (fondaparinux), Fragmin (dalteparin), Coumadin (warfarin), and heparin.

The safety and effectiveness of Xarelto for the new indications were evaluated in three clinical studies. A total of 9,478 patients with DVT or PE were randomly assigned to receive Xarelto, a combination of enoxaparin and a vitamin K antagonist (VKA), or a placebo. The studies were designed to measure the number of patients who experienced recurrent symptoms of DVT, PE or death after receiving treatment.

Results showed Xarelto was as effective as the enoxaparin and VKA combination for treating DVT and PE. About 2.1 percent of patients treated with Xarelto compared with 1.8 percent to 3 percent of patients treated with the enoxaparin and VKA combination experienced a recurrent DVT or PE. Additionally, results from a third study showed extended Xarelto treatment reduced the risk of recurrent DVT and PE in patients. About 1.3 percent of patients treated with Xarelto compared with 7.1 percent of patients receiving placebo experienced a recurrent DVT or PE.

The major side effect observed with Xarelto is bleeding, similar to other anti-clotting drugs.
Xarelto is marketed by Raritan, N.J.-based Janssen Pharmaceuticals Inc.

Monday, November 5, 2012

November is Diabetes Awareness Month. Do you know that people with diabetes are at an increased risk for Cardiovascular Disease?

According to the American Heart Association (AHA), diabetes affects nearly 24 million Americans (7.8 percent of the population). The AHA also considers diabetes to be one of the six major controllable risk factors for cardiovascular disease.

In the U.S., a new case of diabetes is diagnosed every 30 seconds; more than 1.6 million people are diagnosed each year.
  •  Forty-one children are diagnosed with type 1 diabetes each and every day.
  •  More than $174 billion is spent annually on healthcare costs related to diabetes in the United States.
  •  Diabetes kills one American every three minutes.
Why are people with diabetes at increased risk for Cardiovascular Disease?

Heart disease and  stroke are the #1 causes of death and disability among people with type 2 diabetes. In fact, at least 65 percent of people with diabetes die from some form of heart disease or stroke.

 Adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without diabetes.

Diabetes is treatable, but even when glucose levels are under control it greatly increases the risk of heart disease and stroke. People with diabetes, particularly type 2 diabetes, often have conditions that contribute to their risk for developing cardiovascular disease.

While poor health habits aren’t good for anyone, they’re especially destructive for people with diabetes, making it harder to manage the condition and increasing your risk for dangerous complications such as peripheral artery disease, critical limb ischemia, and loss of limbs.

Common Risk Factors
High blood pressure (hypertension)
-has long been recognized as a major risk factor for cardiovascular disease. When patients have both hypertension and diabetes, which is a common combination, their risk for cardiovascular disease doubles.

Obesity- Obesity is a major risk factor for cardiovascular disease and has been strongly associated with insulin resistance. Weight loss can improve cardiovascular risk.

Lack of physical activity- Exercising and losing weight can prevent or delay the onset of type 2 diabetes and  reduce blood pressure and help reduce the risk for heart attack and stroke. Studies show that exercise lowers blood sugar and keeps it down for several hours afterward.

Smoking can increase your risk of developing serious diabetic complications: coronary heart disease, stroke, and peripheral vascular disease Smoking puts individuals, whether or not they have diabetes, at higher risk for heart disease and stroke.

Diabetes can be well-managed if you implement a healthier lifestyle. By controlling your risk factors, diabetes patients may avoid or delay the development of heart and blood vessel disease which can ultimately save your life..

Tuesday, October 23, 2012

South Florida Vascular Associates Announces Its First In-Office Surgical Placement of the Newly Approved Flexible iDev Supera Stent for PAD

iDev Supera® Stent Is The First Flexible Artery Stent Allowing Endovascular Surgeons To  Restore Blood Flow To Parts Of The Body Never Before Possible

 Drs. Warren Swee and William Julien, board certified and fellowship trained interventional radiologists, are pleased to announce that they recently implanted their first iDev Flexible Supera Stent in their office - based catherization lab. South Florida Vascular Associates is one of the first office-based cath labs in South Florida to do this procedure. The stent was used to treat a patient who had critical stenosis, or blockage of the superficial femoral artery and the popliteal artery, which is located behind the knee and supplies blood to the knee joint and muscles in the thigh and calf.

“Until recently, stents were hard, inflexible cylinders that could only be used in certain areas of the body, but if a stent was needed in an area such as behind a knee which bends, the older hard, inflexible stents would not hold”, said Dr. Warren Swee. Prior to the development of the new titanium flexible stent, this area was very difficult to treat.

According to the American Heart Association, peripheral artery disease (PAD) of the lower extremities affects approximately 8 million -12 million people in the United States alone. People suffering from PAD have pain, or claudication while walking, often limiting their life-style activities. In order for doctors to open-up the diseased arteries and re-establish blood blow to the lower extremities, stents are often used to keep the arteries open. Stents are a less invasive alternative to surgery for some conditions, which results in a lower procedure-related complication rate and potentially have better outcomes.

“The iDev Stent is a relatively new stent that has good data accumulating about its efficacy”, said Dr. William Julien. This stent is approved for use in the billary ducts of the liver, but we often use it off-label to treat hard to reach areas in the body that require a stent with flexibility needed for areas that bend, such as behind the knee. The new stent’s unique design and composition is improving patient outcomes.

Friday, October 5, 2012

Alberto's Story: Varicoceles





 It is estimated that 15-percent of men between the ages of 25-40, at some point in their lives will suffer from varicocele. Simply put, its pain and swelling of the testicles caused by tangled blood vessels and weak defective valves in the scrotum resulting in blood pooling.  When the valves in the testis work properly, they only allow the blood to flow away from the testicle, but sometimes these one-way valves can fail and reverse the flow of blood.

“It’s often described as feeling like a bag of worms,” says Dr. William Julien, interventional radiologist and medical director of South Florida Vascular Associates. Sometimes varicocele causes no symptoms and is harmless, but sometimes it causes pain, testicular shrinkage and low sperm count resulting in fertility problems.

39-year-old Alberto Gonzalez, a grounds maintenance worker suffered with it for five excruciating months. “The pain became so severe I was unable to sit for any length of time and driving the tractor for work was excruciating for me.  Even sex was painful,”

This extremely active man, who works out regularly and takes long walks with his wife, could no longer enjoy the lifestyle he was accustomed to.

“I could barely do anything without experiencing pain.”

After many tests and seeing numerous doctors, Alberto was finally diagnosed with varicocele and underwent a procedure called Minimally Invasive Varicocele Embolization.

Dr. Julien says, “This procedure is done on an outpatient basis, requires light anesthesia known as twilight sedation, is less painful, has fewer complications and recovery is much faster.”

Performed by an interventional radiologist, first a tiny incision is made in the groin. Then using x-ray guided imaging a small catheter is inserted to close off the vein with small metal coils and sclerosant medication may be injected to shrink it. The procedure takes about 30 minutes and the patient goes home shortly afterwards with only a band aid at the puncture site.

While this procedure is the gold standard for treating varicocele, unfortunately many urological surgeons still do it the old fashioned way, making a large incision in the scrotum, requiring general anesthesia and a long, painful recovery. It’s called Varicocele Ligation Surgery.

Dr. Julien says minimally invasive varicocele embolization is underutilized and patients need to educate themselves and find an interventional radiologist who performs the procedure which is much easier on the patient.

Alberto feels lucky he found Dr. Julien. “I was back to my old active self within 10 days. My wife and I have been trying to start a family, but she hasn’t gotten pregnant. Maybe now she will.”

Wednesday, September 19, 2012

Frank's Story: Peripheral Artery Disease


Clogged leg arteries, or peripheral arterial disease (PAD) affects up to 20% of Americans 65 or older.

William Julien, M.D., medical director of South Florida Vascular Associates says, “As the population ages that number is expected to climb even higher.” Aging, smoking, high blood pressure, diabetes, and obesity are the key risk factors.

PAD often occurs in the iliac arteries, the main arteries which carry blood from the abdominal aorta to the legs and feet. Often, the first sign of iliac artery disease is leg cramps or pain when walking. In its most severe form, PAD can cause painful sores on a patient’s toes and feet. If left untreated, the blood circulation to the lower extremities will diminish causing ulcers that can become dry, gray or black, and eventually gangrenous, which can lead to amputation of a limb.

67 year-old Frank Bartilotta was forced to retire from the grocery business, in part because of PAD. His quality of life was miserable and he was unable couldn’t do anything that required walking. He even had to sit in a chair to shower.

Unloading grocery trucks for years and smoking a pack of cigarettes a day took its toll. on Bartilotta. His walking capability was only a couple of minutes at the most.

His PAD was so severe, treatment required angioplasty and iliac stenting in both legs.

 “Treating PAD with stents is not new. We’ve been doing it more than 20 years, says Dr. Julien, but the technique and the stents are more durable and better constructed these days.”
Mounting research confirms iliac stenting is safe, highly effective and life  extending.

Nearly 100-percent of all patients with PAD can be successfully treated. The procedure, which takes roughly up to 90 minutes and is performed with local anesthesia, is fairly simple and similar to placing stents in clogged arteries in other parts of the body. Most patients are usually up on their feet roughly two to six hours after the procedure and can immediately go back to normal activities.

In Bartilotta’s case, the iliac stents originally put in place by another doctor were too small. Bartilotta was referred to Dr. Julien who fixed the problem by doing balloon angioplasty to open up the stents wider, replacing normal blood flow to his legs. And it worked!

Bartilotta  never thought he would be back to normal, but now he is able to do whatever he wants. He can walk a good 10-to-15 minutes at a time and it’s getting better all the time. Life is pretty close to back to normal. he even went on a cruise on the biggest ship in the world and was able to walk the entire length of the ship.Barlotta now swims again, goes to the gym, takes long walks and is able to resume his fulfilling active life as he once knew it.

If you have been diagnosed or suspect that PAD is your problem, take our survey to see if you are at risk and make an appointment at our Broward or Palm Beach office with one of our physicians to discuss the best treatment option for you.

Wednesday, September 5, 2012

Are You At Risk For Peripheral Artery Disease (PAD) ?

 According to the Society of Interventional Radiologists, peripheral arterial disease (PAD) affects an estimated 8 to 10 million people in the United States. Individuals with PAD are at greater risk for heart attack, stroke and loss of limbs, yet awareness among the general public and primary care physicians regarding diagnosis, treatment and prevention of this disease is extremely low. 

The most common symptom of PAD is painful cramping in the hips, thighs, or calves when walking, climbing stairs or exercising.

Get Tested for PAD If You
•    Are over age 50
•    Have a family history of vascular disease, such as PAD, aneurysm, heart attack or stroke
•    Have high cholesterol and/or high lipid blood test
•    Have diabetes
•    Have ever smoked or smoke now
•    Have an inactive lifestyle
•    Have a personal history of high blood pressure, heart disease, or other vascular disease
•    Have trouble walking that involves cramping or tiredness in the muscle with walking or exercising, which is relieved by resting
•    Have pain in the legs or feet that awaken you at night

We invite you to answer a few yes or no questions on our questionnaire to get a baseline indication whether you are at potential risk for peripheral artery disease.  Fill out your contact information and if your score indicates that you may be at risk please contact our office for a consultation with one of our board certified interventional radiologists.

Minimally Invasive Procedure Saves Limbs and Lives for Those Suffering From Peripheral Artery Disease

Peripheral Artery Disease(PAD) is the hardening or narrowing of the arteries in the leg caused by fatty deposits or calcium which accumulate in the blood vessels of the buttocks, legs, and feet blocking normal blood flow.

Early signs of PAD can include pain to the hips, legs, and feet during normal activities such as walking. When PAD advances, it can lead to Critical Limb Ischemia (CLI) which includes leg pain at rest, wounds that are slow to heal, and gangrene. This puts a patient at risk for amputation. Depending on the severity of PAD, it can be treated through lifestyle changes, medication, or minimally invasive procedures such as an atherectomy.

An atherectomy is a minimally invasive procedure that utilizes a catheter with a sharp blade on the end to remove plaque from a blood vessel. The catheter is inserted into the artery through a small puncture in the artery and is navigated under x-ray guidance. It is designed to pulverize the plaque and sands it into tiny particles that are washed away with the patient’s blood flow. By restoring blood flow in the legs, a significant outcome can be achieved for most patients. Interventional radiologists have been using minimally invasive atherectomy procedures for the treatment of PAD for several years, however the technology continues to improve allowing doctors to treat many more people. Atherectomy has been a breakthrough in the treatment of PAD and has proven to improve a patient’s quality of life by alleviating pain, enhancing mobility, re-establishing blood flow to non-healing wounds and reducing the number of amputations.

If you have been diagnosed with PAD there are many treatments that can help you regain your quality of life. If you have any questions or would like to schedule an appointment for a consultation with Dr. William Julien or Dr. Warren Swee.

Thursday, August 30, 2012

Could Leg Pain Be a Sign Of Something Serious?

Peripheral artery disease (PAD) often goes undetected. But being aware of the warning signs can help you spot PAD early on and get prompt treatment to protect your health.

Peripheral Artery Disease is caused by a thickening of the inside walls of the arteries of your legs. This thickening, called atherosclerosis, usually occurs when a person has high levels of cholesterol, a fat-like substance in the blood. Cholesterol and fat, circulating in the blood, build up on the walls of the arteries and plaque formations can grow large enough to significantly reduce the blood's flow through an artery narrowing the space where the blood can flow and decreases the supply of oxygen and nutrients to the legs and feet. It can affect both legs, but most often symptoms begin in one leg.

Dr. William Julien explains more about PAD in the video below.

It’s important to know the signs of PAD, such as leg pain or heaviness and it is most important to discuss these symptoms with your doctor right away so that you can get be evaluated and begin treatment immediately to reduce your risk of heart attack or stroke.    
Warning Signs of PAD:   
  •    Pain that occurs when you walk and goes away when you stand still. It is important to understand that pain from PAD differs from other conditions because of how and when it occurs. Blockages in the leg can be so severe that blood is not getting to the muscles, and when muscles don't get enough blood, they get painful. This type of leg pain is called intermittent claudication and is one of the main symptoms of PAD. Leg pain can also be an indicator of back or spinal conditions. If your pain stops when you stand still after walking, chances are it’s related to PAD.
 •    Cold feet. A blockage or reduced blood flow to the lower leg muscles can make feet feel noticeably and abnormally cold. You may find that the leg with the blockage feels colder than your other leg.
 •    Discoloration in the legs or feet. Without blood flowing properly through the leg, your foot and toes may become discolored. A common PAD symptom is a foot that appears unusually pale or has a blue tint due to lack of blood flow.
 •    Persistent sores on the feet. If you have wounds on the bottom of your feet that take a long time to heal, this can also be could be a sign of PAD. When blood flow is blocked from reaching an area wounds won’t improve as quickly as they did prior to the blockage or don’t heal at all, making you more prone to foot infections. If you are experiencing any of the symptoms please take answer the questions in our survey to see if you are at risk and contact our office immediately to schedule a consultation with one of our physicians for proper diagnosis and treatment plan.

Tuesday, August 21, 2012

Margate Man Survives a Two and Half Long (DVT)Blood Clot

How is that even possible? Luck and the miracle of modern medicine!
59 year old Gerald Cunha felt pain in his leg and had a bit of swelling. He went to his internist and who put him on the blood thinner Coumadin, the standard treatment to dissolve what his doctor believed was a blood clot or deep vein thrombosis (DVT).
A couple of days later his leg blew up to three times its normal size.
The newest technology - EKOS Ultrasound which delivers clot busting drugs with an ultrasound-enhanced delivery system, could reduce the amount of drugs needed to break up dangerous blood clots in the legs and pelvis. Ultrasound catheters significantly reduce the amount of time it takes to dissolve blood clots and could help improve outcomes for victims of deep vein thrombosis, or DVT, according to new research. Blood clots are often treated through intravenous infusion of drugs, but the process of
dissolving the clot can take up to 48 hours. Longer infusion times increase the risk of life-threatening bleeding elsewhere in the body, particularly in the brain.
The EKOS Ultrasound was used to detect a massive blood clot in the patients leg which started behind his knee and went up to his belly button. A clot this size is extremely rare. The most effective way to treat it was to administer clot busting medication to dissolve the clot. Instead of taking medication, blood thinners, for several months hoping the clot will dissolve, the EKOS allows doctors to drip TPA (clot busting medicine) right into the vein, directly onto the clot dissolving it like an ice cube melting. This treatment was performed for 3 consecutive days in order to dissolve a clot so large.
The patient's vascular specialist says, had this not been done in time he would have been permanently disabled or could have died from a pulmonary embolism. In fact, the patient was so nervous prior to the clot busting meds, he put his affairs in order for fear that a piece of the clot could travel to his lungs and be fatal.

Monday, August 13, 2012

Varicocele Embolization Repair for Infertility

Varicocele Embolization Repair for Infertility
Minimally invasive, No general anesthesia, No pain, No down time

Varicoceles are fairly common, affecting 15% of men overall and 40% of men with known infertility issues. Poor circulation caused by the varicoceles results in a higher blood temperature that raises the temperature of the testes, which can serve as a barrier to sperm production and can damage or destroy sperm that is created.

Varicoceles are a tangled network of blood vessels or swelling of the veins on the testicles. It is similar to varicose veins in the legs but in this condition, a vein called the gonadal vein has weak defective valves resulting in the blood pooling in varicose veins in the scrotum. Sometimes, varicoceles cause no symptoms and are harmless. But sometimes a varicocele causes pain, testicular atrophy (shrinkage), or fertility problems.


Varicoceles can be repaired and are commonly treated by a urologist through a procedure called varicoceleligation surgery. During this procedure an incision is made is made is the skin above the scrotum, cutting down to the testicular veins and tying them off with sutures. It is usually performed under general anesthesia in a hospital setting. Although patients leave the hospital the same day, there is a two to three week recovery period.

Alternatively, at South Florida Vascular Associates, a nonsurgical minimally invasive procedure called varicocele embolization, can be done without general anesthesia by one of our  interventional radiologists to repair a varicocele.  During this procedure a small tube is inserted into the femoral vein in the groin or a vein in the neck through a small nick in the skin. 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. The vein is then intentionally closed off by plugging it with small metal coils and a special medication. This procedure takes 30 minutes and the patient goes home a few hours later with only a band aid at the puncture site. The patient can immediately resume their non external activities.

Advantages of Varicocele Ebolization
•    Performed under local anesthesia with mild sedation
•    Performed on an outpatient basis in our endovascular suite, not in the hospital
•    No surgical incision in the groin, only a tiny hole where a catheter is placed
•    If you have varicoceles on both sides, you can have them fixed at the same time through one vein   puncture site(surgery requires 2 separate open incision)
•    It is as effective as surgery,as measured by improvement in pain, semen analysis and pregnancy rates
•    Lower rate of complications compared to surgery, Infection has not been reported after embolization

If you have been diagnosed with varicoceles, call our office to learn more about varicoceles embolization and after your procedure leave our office with only a band aid at the puncture site. To make an appointment for a consultation click here.

Saturday, May 12, 2012

Do You Know That Tangerines May Protect the Body From Coronary Artery Disease?

An article on Everyday reports that tangerines are metabolic masters

A flavonoid (a type of antioxidant) in this citrus fruit may protect the body against the triad of diseases known as metabolic syndrome — coronary artery disease, stroke, and type 2 diabetes — according to research from the University of Western Ontario published in the journal Diabetes. When researchers fed mice a typical “western” diet (high in fat and refined sugar) that was supplemented with the tangerine antioxidant nobiletin, the mice experienced no increase in cholesterol, triglycerides, insulin, or blood sugar, but mice who didn’t get the nobiletin did see a rise. Other long-term animal studies have found that the compound prevents atherosclerosis, the hardening of the arteries that can lead to a heart attack or stroke. Tangerines may also help cancer-proof your body — if you eat the peel. A compound in the peel called salvestrol Q40 halts the activity of an enzyme that incites the growth of cancer cells, a British study found. Try some tangerine zest in your tea or sprinkled on a salad for a citrusy twist.

We look forward to hearing your comments.

Friday, May 11, 2012

Yankees' Rivera Says Blood Clot Caused More Complications

According to the New York Yankees Blog written by Mike Fitzpatrick, AP, Mariano Rivera has a blood clot in his right calf, the latest health problem for the longtime Yankees closer who tore a knee ligament last week while shagging fly balls during batting practice.

Rivera is on blood-thinning medication intended to dissolve the clot and said Wednesday he is OK, though he was scared when he received the diagnosis. He needs to spend at least a week or two strengthening his knee before he has surgery to repair his torn anterior cruciate ligament, but said that would have been the case regardless of the blood clot.

Strengthening the knee now will put him in a better position when he begins his rehabilitation program after the operation. He must stop taking the blood thinners 24 hours before the surgery, he said.

The 42-year-old, baseball’s career saves leader with 608, said he can guarantee he will work hard and do “whatever it takes” to return next season. But if his leg doesn’t come back strong enough, then he will take it as a sign that it’s time to retire.

“If it’s my call, I don’t want to leave the game the way it happened. ... My will and my desire is to stay,” Rivera said, adding that he was leaning toward pitching in 2013 even before the injury. “The traveling, I hate it. And the game, I love it.”

Rivera was injured last Thursday in Kansas City, tearing his ACL and damaging the meniscus in his right knee, when he stumbled and fell while chasing a fly ball during batting practice, a regular part of his pregame routine. He is expected to miss the rest of the season.

The following day he announced he was determined to get back on the mound next season and he was examined Monday by three doctors at two hospitals as he prepared to decide where to have knee surgery.

While he was being examined, Rivera mentioned to the doctor that his right calf was “sore and painful.” He was diagnosed with a blood clot and spent Monday night in the hospital, beginning treatment right away.

That was the complication Yankees general manager Brian Cashman and Rivera’s agent, Fernando Cuza, referred to this week when discussing Rivera’s schedule and prognosis. Cashman would not elaborate Tuesday at Yankee Stadium.

“I was more concerned with the blood clot than the knee. For a minute I was like, what else is going to happen?” Rivera said. “I was scared because I never hear good things about blood clots. ... I take it like, OK, what do we have to do?”

In the worst cases, blood clots can be life-threatening if they travel to the lungs. Rivera said he’s not sure what caused the clot, and he didn’t even ask.

“I know that I’ve got to deal with it,” he said. “They don’t know if it happened before or after the trauma of the injury.”

Rivera said he planned to speak to his doctor later Wednesday and he will soon go back for a check-up. He hasn’t decided on a doctor to perform the knee surgery yet, but the clot will not affect the date of the operation.

“I really believe if Mo wants to continue to play, he’ll play,” manager Joe Girardi said. “I mean, obviously he’s got to go through a process of rehab here, but I don’t see any reason why that’s not going to happen and he’s not going to get through that, so I look forward to seeing him back in a Yankee uniform.”

Rivera appeared in good spirits at a 25-minute news conference Wednesday before the Yankees played the Tampa Bay Rays. Wearing a long-sleeve shirt and jeans, he hobbled up to the podium on a set of crutches he’s already grown tired of.

“I just feel old. Walking with these crutches is not fun at all,” he said.

Later, he joked that would begin running again in 5 or 10 minutes.

Rivera said he’ll be at the ballpark as much as possible to help his teammates however he can this season, but for the first time in his life he thinks he needs to be a bit “selfish” and focus on his rehab. He said he watched nervously from his couch at home as fill-in closer David Robertson loaded the bases Tuesday night before saving New York’s 5-3 victory over the Rays.

“It’s still tough, though, mentally. These games don’t help me. He did a good job,” Rivera said. “I was sweating and screaming. It was difficult, but I was screaming at Robby on the TV.”

And when he returns, Rivera said he’ll resume shagging flies during batting practice.

“Oh, no doubt about it,” he said. “I don’t know what the Yankees will do. They might need to tie me up,” he said.

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Tuesday, May 8, 2012

Witnessing someone experiencing a stroke can be very frightening. Staying calm might just save a life.

If you have the unfortunate experience of witnessing someone having a stroke, act quickly! The sooner a person suffering a stroke gets to the emergency room, the better their chances are that doctors will have the ability to intervene quickly to restore blood flow to the affected area saving brain cells and creating better chances for a good recovery.

Many strokes are caused by blockage in an artery. These arteries, called the carotid arteries, supply your brain with blood. Approximately 25 percent of strokes are caused by carotid artery disease from atherosclerosis, a buildup of plaque in the arteries that carry blood to the brain. Some strokes are even caused by bleeding from an artery that burst

According to the American Stroke Association, learn the many warning signs of a stroke.
Act FAST and CALL 9-1-1 IMMEDIATELY at any sign of a stroke.

Use FAST to remember the warning signs:

   F     FACE:
Ask the person to smile. Does one side of the face droop?
   A    ARMS:
Ask the person to raise both arms.Does one arm drift downward?
   S    SPEECH:
Ask the person to repeat a simple phrase. Is their speech slurred or strange?
   T    TIME: If you observe any of these signs, call 9-1-1 immediately.

Factors that put people at greater risk for carotid artery disease include:

    High blood pressure;
    Diabetes mellitus
    Family history of atherosclerosis (build-up of plaque in the arteries)

If you experience any of the symptoms referred to in this blog or you suspect someone else is experiencing these symptoms call 911 immediately! If you have any questions or comments about carotid artery disease or stroke please comment on our blog and we will be happy to answer you questions.

Thursday, May 3, 2012

May is Stroke Awareness Month: Know The Facts It Can Happen to You

Do you know?

  • Stroke is an emergency and a brain attack, cutting off vital blood flow and oxygen to the brain.
  •  In the United States, stroke is the fourth leading cause of death, killing over 133,000 people each year, and a leading cause of serious, long-term adult disability. 
  • There are an estimated 7,000,000 stroke survivors in the U.S. over age 20.Approximately 795,000 strokes will occur this year, one occurring every 40 seconds, and taking a life approximately every four minutes. 
  • Stroke can happen to anyone at any time, regardless of race, sex or age. 
  • From 1998 to 2008, the annual stroke death rate fell approximately 35 percent, and the actual number of deaths fell by 19 percent.
  • Approximately 55,000 more women than men have a stroke each year.
  • African Americans have almost twice the risk of first-ever stroke compared
    with whites. 
Types of Stroke:

 Ischemic stroke occurs when arteries are blocked by blood clots or by the gradual build-up of plaque and other fatty deposits. About 87 percent of all strokes are ischemic.

 Hemorrhagic stroke occurs when a blood vessel in the brain breaks leaking blood into the brain. Hemorrhagic strokes account for thirteen percent of all strokes, yet are responsible for more than thirty percent of all stroke deaths.

Two million brain cells die every minute during stroke, increasing risk of permanent brain damage, disability or death. Recognizing symptoms and acting FAST to get medical attention can save a life and limit disabilities.

The prevalence of transient ischemic attacks (TIA – “mini strokes”) increases with age. Up to 40 percent of all people who suffer a TIA will go on to experience a stroke.

Women are twice as likely to die from stroke than breast cancer annually.

Monday, April 23, 2012

Gerry's Story: Deep Vein Thrombosis

State-of-the-Art Technology and Quick Intervention Saves Limbs and Lives

59-year-old Margate, Florida resident Gerry recently became a deep vein thrombosis (DVT) statistic and is lucky to be alive. Gerry developed a two and half foot long blood clot that started below his knee, ran all the way up his leg, wrapped into his abdomen and up to the level of his belly button.

“They basically told me to go home and put my affairs in order. It was very frightening.”
Gerry is a classic case of DVT waiting to happen.  When his right leg began swelling, his primary care doctor diagnosed a blood clot behind the knee and prescribed an oral blood thinner to prevent the clot from getting bigger and potentially going into his lungs. It didn’t work. Within days his leg blew up three times its normal size and the pain was excruciating.

 Interventional Radiologists at South Florida Vascular Associates discovered that the clot had extended all the way up the leg and into the pelvis,  measuring almost 2 ½ feet long.

This type of DVT is rare and it is usually seen once every few months, if that. If left untreated, or treatment is unsuccessful, it could result in post thrombotic syndrome (PTS) in which the valves in the legs are damaged from the clot causing permanent disability.There is also risk of a piece of the clot breaking off and traveling to the lungs that can cause a pulmonary embolism, which can be life-threatening,

“I put my affairs in order and wrote a farewell letter to my wife just in case something went wrong. It was surreal, said Gerry..

Since the blood clot was so massive, and previous oral blood thinner medications failed, the best way to dissolve the clot and save Gerry's leg was to use a device called the EKOS Ultrasound Catheter.
Here’s how this state-of-the-art, minimally invasive device works.

Performed in a hospital Endovascular Lab, the EKOS catheter is inserted behind the knee and threaded through the clot. It uses ultrasonic energy to deliver clot busting drugs like TPA directly to the clot, causing it to break-up and dissolve like a melting ice cube, restoring blood flow much more quickly. In many cases, if the clot is less than 2 weeks old, it takes only 12-14 hours to dissolve, but in Gerry's case, the clot was 5 weeks old and so massive that it took 2 days.  Remarkably, soon after treatment, Gerry's debilitating leg pain and swelling resolved allowing him walk normally and finally return back to work.

Unfortunately, many people are not aware of this technology and should because it saves limbs and lives.  EKOS state-of-the art technology offers significant benefits over other methods for DVT treatment. It’s faster, reduces the risk of post thrombotic syndrome, and requires less clot busting medication greatly reducing the risk of bleeding complications such as brain bleeds.

Based on U.S. statistics, up to 600,000 people develop DVT each year with an estimate of over 100,000 pulmonary embolism deaths each year in the U.S.

The number of DVT cases is concerning. There’s a vital need to make people aware of the risk factors and how to prevent it and recognize early warning signs. This is the only way we can reduce these staggering statistics.

Obesity, lack of exercise, smoking, sitting too long at our desks or during long commutes; birth control pills and being over age 40 are the biggest risk factors.

As a restaurant supply sales person, Gerry spends long hours behind the wheel of his car, is overweight and was a smoker.

This experience was a real wake-up call and a great learning experience for Gerry. He quit smoking, is exercising, eating healthy and even gets out of his car when he’s been sitting too long to stretch his legs and walk around.“I’ve got a second chance at life and I’m doing it right this time!” he says. 

Thursday, April 12, 2012

U.S Adds More on Blood Clot Risk to Some Birth Control Pills

In a recent article published by Reuters, US regulators are adding information to the labels on a popular class of birth control pills that includes Bayer AG's, Yaz, and Yasmin to show that they may raise the risk of blood clots.
All common birth control pills increase a woman's chances of getting potentially fatal blood clots.
But the U.S. Food and Drug Administration said  that some studies showed the danger may be even higher for more recent pills that contain the compound drospirenone, a synthetic hormone.

According to the Wall Street Journal, the FDA said that women should talk to their health-care professional about their risk for blood clots before deciding which birth-control method to use and that doctors should consider a woman's risk for developing a blood clot before prescribing the drugs.

Most birth-control pills contain two types of hormones, estrogen and progestin. All types of pills increase the risk of blood clots, and product labels warn of such risk.

While the risk of blood clots is low among women who take birth-control pills, the FDA said it is higher than the risk among women who aren't taking the pills. However, the risk of blood clots from pregnancy and during the postpartum period is higher than that of women taking all types of birth-control pills.

Blood clots form inside a vein and are known as deep vein thrombosis. The clots usually form in the lower leg or thigh, but can break loose and travel to other areas of the body such as the

The FDA's own study found that 10 in 10,000 women taking pills with drospirenone would get a blood clot per year, compared with about six in 10,000 women taking older contraceptives.

A clot in blood vessels can prove fatal if it breaks loose and travels to the lungs, heart or brain.

To put the risk into perspective, the FDA added that the risk of blood clots from pregnancy is even higher than any risk from birth control pills.

The announcement comes after an advisory committee of outside experts to the FDA voted in December for a label revision for pills with drospirenone, calling for clearer information about their risks and benefits.

The experts stopped short of agreeing that these pills' risks outweighed their benefits, since some studies found the pills did not increase blood clot risks.

During a December panel meeting, some women's advocacy groups called for the pills to be taken off the market, as the studies that viewed pills favorably were industry-funded.

The consumer groups and patients shared tearful stories about sudden deaths or life-changing disabilities they or their loved ones suffered from blood clots, which they believed were caused by Yaz or Yasmin.

Most common contraceptive pills combine the hormones estrogen and progestin to help block ovulation and sperm. But they also increase the chance of a woman getting blood clots compared to not taking pills, particularly as she ages.

If you or a loved one are taking Yaz, we encourage you to check with your family physician to be sure that this is the right contraceptive medication for you.

Thursday, March 22, 2012

Cancer Patients at Higher Risk of Developing Deep Vein Thrombosis (DVT)

It is well known within the medical community that cancer patients have an increased risk of developing deep-vein thrombosis -- blood clots that develop in deep veins in the lower extremities. Did you know that more than 90 percent of patients with cancer may be at risk for DVT?  According to the Coalition to Prevent DVT, a majority of cancer patients were not aware of the increased risk for DVT and its potentially fatal complication, pulmonary embolism. In fact, complications from deep vein thrombosis are the second leading cause of death among cancer patients.
 If you or a loved one have cancer, it is most important to discuss your potential risk of deep vein thrombosis with your healthcare provider because blood clots can be prevented.
Cancer may put you at an increased risk for blood clots because:
•    Surgery or chemotherapy may injure blood vessel walls, causing the blood to clot
•    Certain types of cancer treatments may reduce the body’s ability to produce blood clotting agents called anticoagulants
Complications from DVT blood clots kill up to 600,000 people in the U.S. each year — more than AIDS and breast cancer combined.
If you have pain and swelling in your lower extremities, be sure to seek medical attention as soon as possible

Travel & Deep Vein Thrombisis (DVT)

While there is no direct link between travel and deep vein thrombosis, sitting for long periods of time could put you at higher risk especially if you have additional risk factors such as cancer, congested heart failure, are over the age of 40, are obese or are a smoker.
Whether you are traveling by plane, train or car, it is important to speak with your doctor about the potential risk of DVT and other health issues before you leave for your trip.
According to the Centers for Disease Control and Prevention (CDC), when traveling for more than four hours you should
•    Get up and move around every two to three hours
•    Keep hydrated and drink plenty of water
•    Reduce alcohol or caffeine consumption
•    Avoid crossing legs for long periods of time

Tuesday, March 6, 2012

Why is March Deep Vein Thrombosis Month?

March is Deep Vein Thrombosis (DVT) Awareness Month. It's no coincidence, according to The Vascular Disease Foundation, that the month selected to raise awareness about this potentially fatal disease is the only month named with an action verb. Consumers need to take action to prevent deep vein thrombosis.
Deep vein thrombosis is a blood clot in the deep veins in the legs. These clots can break loose and travel to the lungs, causing a potentially fatal deep vein thrombosis, Dr. William Julien, DVT, pulmonary embolism (PE). They can also cause permanent damage to the leg veins that result in long-term pain, swelling, change in skin color and skin ulcers.
The Vascular Disease Foundation says that DVT and pulmonary embolism affect more than 600,000 people every year. Some people experience swelling and varying levels of discomfort in the affected area, while others don't feel anything at all. The symptoms of DVT can be similar to a pulled muscle. Because some people with DVT don't have any symptoms, and because the symptoms can masquerade as a more benign ailment, there's often a delay in diagnosis. That's when DVT can be fatal. DVT/PE is the fourth leading cause of death in western society, with more fatalities than breast cancer, AIDS and traffic accidents combined.
Anyone can develop DVT. The more risk factors you have, the greater your risk. Risk factors include:
• Hospitalization
• Recent major surgery or injury
• Personal or family history of a clotting disorder or DVT
• Cancer and cancer treatments
• Immobility
• Prolonged sitting when traveling
• Obesity
• Smoking
When diagnosed and treated early enough, DVT isn't always life-threatening. Risk can be reduced by:
• Knowing your risk factors
• Exercising regularly
• Maintaining a healthy weight
• Not smoking

South Florida Vascular Associates Opens New Location in Boynton Beach, florida

Patients Residing in Palm Beach Communities Who Suffer from Vascular Diseases Can Now be Treated at our Newest Center of Excellence for Minimally Invasive Endovascular Care

Dr. William Julien and South Florida Vascular Associates are proud to announce the opening of a new location in Palm Beach County. Our new office is located at 10151 Enterprise Center Blvd. Suite 204, Boynton Beach, FL.

Dr. Julien is a board certified interventional radiologist who specializes in the treatment of vascular diseases using minimally invasive, endovascular procedures with imaging guidance. Minimally invasive techniques often replace the need for traditional open surgical procedures. They are generally easier for the patient because they involve no large incisions, less traumatic on the patient, less pain and shorter recovery times.

“We are pleased to offer our unique, comprehensive, endovascular services to the people of Boynton Beach and the surrounding Palm Beach communities,” says Dr. Julien who is one of the first interventional radiology physicians in the country to have an office-based clinical practice. His 8,000 square foot office in Coconut Creek, FL. is equipped with 3 in-office endovascular suites where he performs minimally invasive endovascular procedures that are traditionally done in the hospital. Unlike vascular surgery, which treats vascular disease with open surgery, endovascular surgery is a branch of medicine that treats disease processes through the vascular system, using catheter-based image-guided techniques.

“We look forward to working with our new patients and colleagues in Palm Beach County and welcome the opportunity to work together offering the community the best medical outcome,” said Dr. Warren Swee.

For more information call 561-752-5195 or visit