March is Deep Vein Thrombosis (DVT) Awareness Month

Did you know?
•    According to the Vascular Disease Foundation, blood clots affect over 600,000 Americans each year and cause more deaths each year than the more well-publicized conditions of breast cancer, AIDS, and motor vehicle accidents.
•    Blood clots are a leading cause of preventable hospital deaths in the United States.
•    Blood clots are the leading cause of maternal death in the United States.
•    One-half of clot patients will have long-term complications and one-third will have a recurrence within 10 years.
•    An estimated $10 billion in medical costs in the US each year can be attributed to DVT and Pulmonary Embolism (PE).
 
What is DVT?

This patient has a DVT in his left leg.

 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 pulmonary embolism (PE).  DVT’s can cause permanent damage to the leg veins that result in long-term pain, swelling, change in skin color and skin ulcers.

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 also be similar to those of other conditions, like 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.

What Causes Blood Clots (DVT and PE)?
Blood clots may form when either the flow of blood in a vein slows, damage to a vein occurs, or the blood is more clotable. Many factors can increase a person’s risk for developing a blood clot in a vein.

Common risk factors for developing a blood clot include:
Immobility:
• Hospitalization
• Being paralyzed
• Prolonged sitting

Surgery and Trauma:
• Major surgery (especially of the pelvis, abdomen, hip, knee)
• Bone fracture or cast
• Catheter in a big vein (PICC line, central venous catheter, or port)

Increased estrogens:
• Birth control pills, patches, rings
• Pregnancy, including up to 6 weeks after giving birth
• Estrogen and progestin hormone therapy

Medical conditions:
• Cancer and chemotherapy
• Heart failure
• Inflammatory disorders (lupus, rheumatoid arthritis, inflammatory bowel disease)
• The kidney disorder called nephrotic syndrome

Other risk factors:
• Previous blood clot
• Family history of clots
• Clotting disorder (inherited or acquired)
• Obesity
• Older age
• Cigarette smoking
• Varicose veins

Tips for Preventing Blood Clots (DVT and PE)

•    Stay active.  Immobility increases the risk of developing clots. If you've been sitting for a long period of time (such as long-distance travel)   stop and take a break to stretch your legs.
•    Maintain an ideal body weight. 
•    Know your risk factors for developing a clot and discuss these with your doctor.
•    Know your family medical history.  Make sure your doctor knows about any history of blood clots.



If you or someone you know has been diagnosed or is experiencing symptoms of DVT, please contact our office to set up an appointment with one of our board certified endovascular surgeons to discuss which treatment option works best for you.  We have 3 convenient offices located thoughout Broward and Palm Beach Counties.

Do You Have Wounds on Your Feet that Won’t Heal? Seek Medical Attention Immediately

If you have wounds on your feet that won't heal, you may have critical limb ischemia which can lead to the loss of a limb.

Critical limb ischemia (CLI) is the most advanced stage of peripheral artery disease (PAD) and is the leading cause of amputation worldwide. Critical limb ischemia results from a progressive thickening of the lining of an artery caused by a buildup of plaque known as atherosclerosis, which narrows or blocks blood flow reducing circulation of blood to the legs and feet.  If PAD is left untreated, CLI can develop because the leg vessels may become so severe that almost no blood can make it through the vessels to your feet causing the tissue in your feet and leg to become starved of oxygen.  You may feel severe foot pain even at rest, and form ulcers on your legs and feet. In severe cases, tissue can die due to poor circulation, causing gangrene and this can ultimately lead to loss of a limb.  If you have advanced diabetes or kidney disease, you are at particularly high risk of developing CLI.

CLI needs to be treated promptly because the symptoms can progress very quickly.
The goal of treatment is to relieve your pain and allow ulcerations and wounds to heal.  In the case of gangrene, the goal is to remove the dead tissue with subsequent healing of the underlying tissue. Treatment requires aggressive revascularization of blocked arteries as with PAD.  However, because blockages are so advanced in CLI, more advanced techniques are often required.

 

What can you do to protect yourself?
Stop smoking. Smoking doesn't only increase your risk of cardiovascular disease but it increases your risk of PAD and CLI as well. Women who smoke are at the greatest risk.

Pay attention to the condition of your legs and feet. Are your feet often in pain or numb, especially when elevated? Are your toes slightly blue? Signs of CLI also include shiny, dry skin and thickening toenails.

CLI is closely associated with advanced age, men over 60 and women after menopause. It is also associated with diabetes and kidney disease.

Be aware of symptoms. Ischemic rest pain is a common symptom where legs ache and cramp during exercise or movement. Other symptoms include skin ulcers, lesions and a slow pulse in legs and feet.

CLI is a serious, complex disease that requires a multidisciplinary approach.  At South Florida Vascular Associates we work closely with your primary care physician, wound care physician, and other specialty physicians to provide the comprehensive care needed to treat CLI effectively and preserve the limb.

If you suspect or if you have been diagnosed with CLI, please call our office to schedule an appointment with one of our board certified endovascular surgeons to evaluate your condition and discuss the best treatment plan for you. For your convenience, we have 3 office locations throughout Broward and Palm Beach counties, Coconut Creek, Plantation and Boynton Beach.

SOUTH FLORIDA VASCULAR ASSOCIATES OPENS NEW LOCATION IN PLANTATION, FLORIDA

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 www.southfloridavascular.com   

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 www.southfloridavascular.com   

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

Joe's Story: Critical Limb Ischemia

DO YOUR LEGS HURT WHILE WALKING OR EVEN SITTING STILL?

             
IF SO, TAKE IT SERIOUSLY OR YOU COULD END UP LOSING A LIMB!
                     
MILLIONS OF PEOPLE ARE AT RISK AND DON’T KNOW IT.
                        
WHAT YOU NEED TO KNOW BEFORE IT'S TOO LATE.

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.

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.

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..