David's Story: Varicoceles in Young Men

In June of 2014, 19 year old David began feeling discomfort and heaviness in his left testicle. He had no idea what was causing the discomfort and thought that resting and icing it would help but there was no relief. When he noticed that the testicle began to swell, this gave him reason for concern.

David first consulted with a urologist about his discomfort and was sent for a testicular ultrasound that confirmed he had a varicocele in his left testicle. 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.

A varicocele is a relatively common condition (affecting approximately 10% of men) that tends to occur in young men, usually in their 20s or 30s, but can also develop in younger men and adolescents. In fact, varicoceles develop in 17% of boys between the ages of 13 – 25. Varicoceles are also known to cause infertility issues.

The urologist suggested David undergo a surgical treatment, varicocele surgical ligation. This procedure involves an open incision above the scrotum, general anesthesia, and 2 to 3 weeks of down time. David was willing to try anything to relieve himself even it if meant going under anesthesia, but he did some research on the internet and came across Dr. William Julien an expert endovascular surgeon at South Florida Vascular Associates who performs a procedure called varicocele embolization (VE). VE is a minimally invasive outpatient procedure that requires only a tiny cut in the skin, "twilight" sedation, and almost no downtime. This sounded like a much better option.

Dr. William Julien Explains Varicocele Embolization (VE)

Upon examination, Dr. Julien explained the embolization procedure in depth and also told David that the procedure only takes 30 minutes and he could go home a few hours later with only a small bandage at the puncture site. In addition, he would be able to immediately resume non-exertional activities. Of course, David opted to go with varicocele embolization.

“David had VE on June 24, 2015, and the surgery was a huge success.  “I was not in much pain after the surgery and within 10 days post-surgery, I was pain free”, said David. It took a couple of weeks before the swelling went down but for the most part he was feeling on top of the world! The embolization procedure was David’s first surgery and he was nervous but the surgery was quick and easy. David says the staff was wonderful making sure I was comfortable all the way through and Dr. Julien was awesome, he explained everything to me and eased my concerns. I was also extremely pleased with the care that I received from the time I arrived until they let me go home. David says, it’s so important to educate yourself and know your options before undergoing surgery. Until he learned of varicocele embolization he was ready to go through a painful surgery and long recovery time. I’m so happy that I pursued other options and found the right procedure for me. I feel great, says David and it was so easy!

New Study Shows Endovascular Repair of Abdominal Aortic Aneurysm is Safe, More Improved and Patients Recover Faster

Nearly 40,000 Americans undergo elective surgery per year to repair an abdominal aortic aneurysm (AAA) with the goal of preventing a life-threatening rupture. A new study from researchers at Beth Israel Deaconess Medical Center compared open surgical repair of AAA with a catheter-based procedure and found that the less invasive endovascular aortic repair (EVAR) has clear benefits for most patients, providing both a safer operation and a quicker recovery. The study was published July 22 in The New England Journal of Medicine.

An aneurysm occurs when a blood vessel becomes abnormally large or balloons outward. The abdominal aorta is a large blood vessel that supplies blood to your abdomen, the pelvis, and legs. When a weak area of the abdominal aorta grows, it is called an abdominal aortic aneurysm (AAA).  AAA can develop in anyone, but it is primarily seen in men over 60 with one or more risk factors. The larger the aneurysm, the more likely it is to rupture which can cause massive internal bleeding and can be fatal. When diagnosed early, abdominal aortic aneurysms can be treated, or even cured, with highly effective and safe treatments.

Aneurysms can be caused by inflammation in the aorta, which may cause its wall to break down. Some researchers believe that this inflammation can be associated with atherosclerosis (hardening of the arteries). Besides atherosclerosis, other factors that can increase your risk of abdominal aortic aneurysm include:      

•  Being a man older than 60 years
•  Family History of AAA
•  Having high blood pressure
•  Smoking

Many people do not feel any symptoms with an abdominal aortic aneurysm. Occasionally, patients can experience:

• A pulsing feeling in the abdomen, similar to a heartbeat
• Severe, sudden pain in your abdomen or lower back. If this is the case, your aneurysm may be about to rupture.

If your aneurysm ruptures, you may suddenly feel intense weakness, dizziness, or back pain, and you may lose consciousness. This is a life-threatening situation and you should seek medical attention immediately.

Endovascular aortic repair (EVAR) has become widely used to treat AAA as compared to traditional open surgery. During the study, researchers found that EVAR was superior to open surgical repair and that this minimally invasive procedure has been increasing and improving over time. Findings also suggest that even as sicker patients have undergone EVAR, the short- and long-term outcomes have continued to improve with favorable outcomes.

Endovascular treatments have many benefits including: patients typically leave the hospital sooner and recover more quickly, have less pain and a lower risk of complications and lower mortality than traditional surgery because the incisions are smaller. Sometimes traditional surgery is required if the shape or the location of the aneurysm is not favorable for an endovascular treatment.

According to the lead author of the study Marc Schermerhorn, MD, AAA rupture is still a common cause of death. “Because there are typically no warning signs, heightened awareness among patients and physicians is needed. AAA can be diagnosed with a simple ultrasound and can now often be treated with an effective, durable, minimally invasive approach”, said Schermerhorn.

Do you Suffer from Unsightly, Painful and Embarrassing Varicose Veins?

People who live in warm climates such as South Florida, often enjoy wearing bathing suits, shorts and skirts, but if you are a person who suffers from unsightly varicose veins, revealing your legs can be embarrassing.

Varicose veins are swollen, twisted, and enlarged veins that can be seen under the skin. They are often red or blue in color usually appearing in the legs, but can occur in other parts of the body. These veins are common and affect more women than men and they don't cause problems for most people. However, in some people, especially if left untreated, varicose veins can lead to serious conditions, such as leg swelling and pain, blood clots, and skin changes.

Risk Factors for Varicose Veins

• Family history of varicose veins
• Age (more common as you age)
• Gender (more common in women)
• Obesity or overweight
• Pregnancy
• History of blood clots in your legs
• Standing or sitting for long periods of time

Symptoms of Varicose Veins

• Aching or cramping leg pain
• Leg fatigue
• Feeling of heaviness or throbbing in the leg that worsens as the day progresses

 The good news is you don’t have to suffer from these unsightly, painful varicose veins anymore. At South Florida Vascular Associates we offer an in-office, minimally invasive procedure called Endovenous Laser Ablation (EVLT). EVLT is a reliable and simple way to treat varicose veins without painful surgery.
                                                 
                                                              Watch our Video on EVLT 

In the past, a patient would undergo a procedure called vein stripping, a very painful surgery with weeks of downtime. EVLT is a procedure that uses heat from a laser fiber beam to cauterize the inside of the of the vein wall. The energy from the laser then works to close the unhealthy vein and reduces the tension in the veins that appear on the surface of the skin. Once the problematic vein is permanently closed, the body then reroutes the blood to healthier veins returning the blood back to the heart.

Advantages of Endovenous Laser Ablation:

•  Treatment typically takes less than one hour
• Provides immediate relief
• Avoidance of general anesthesia
• Minimized recovery period and immediate return to normal activities
• No scarring or stitches
• Lower rate of complication
• Higher success rate and durability of the procedure relative to surgery

If you are one of the many people who agonize over the discomfort of varicose veins we invite you to visit our office to consult with one of our board certified, endovascular surgeons. Dr. William Julien and Dr. Curtis Anderson have treated thousands of patients who have had life-altering experiences after having EVLT. It’s painless, easy to tolerate and it’s performed in the comfort of our office. Contact us today at 954-725-4141.

Gentlemen: Are You Having Difficulty with Infertility or Experiencing Pain in Your Scrotum?

If you and your partner have been trying to conceive a baby and are having difficulty, you could be suffering from varicoceles. Varicoceles are enlarged varicose veins that occur in the scrotum. They are fairly common, affecting approximately 10% of men, usually in their 20’s and 30’s. Very often, varicoceles occur in the left testicle. Sometimes, varicoceles cause no symptoms and are harmless, but sometimes a varicocele causes pain, testicular atrophy (shrinkage), or fertility problems.

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 the varicose veins in the scrotum.

Varicoceles can cause fertility problems because they are thought to raise the temperature of the testicles or cause blood to back up in the veins supplying the testicles. Although the exact cause of why varicoceles affect fertility is poorly understood, varicoceles seem to help damage or kill off the sperm. Varicocele repair is typically recommended to improve the fertility of men who have both a varicocele and impaired sperm.

Treatment for varicoceles may be done surgically, but minimally invasive procedures should be considered before deciding what to do. Traditional surgery can mean painful, open surgery with general anesthesia and 2 to 3 weeks of down time, but that can be reduced significantly with alternative methods that reduce pain and swelling.

Our board certified interventional radiologists, Dr. William Julien and Dr. Curtis Anderson, recommend varicocele embolization, the least invasive treatment option for men. The procedure is fast and painless and you can usually return to normal activities right away. Varicocele embolization (VE) is a 30 minute, minimally invasive, outpatient procedure performed at our in-office operating suite. VE requires only a tiny cut in the skin, "twilight" sedation, and almost no downtime. Our endovascular physicians are experts when it comes to treating varicoceles without surgery.

View our video about Varicocles Embolization

 

The advantages of varicocele embolization include:

• It is performed under local anesthesia with mild sedation (general anesthesia is used for varicocele surgery).
• It is performed on an outpatient basis in our office endovascular suite, not in a hospital.
• There is no surgical incision in the groin, only a tiny hole in the skin where a catheter is placed.
• A patient with varicoceles on both sides can have both fixed at the same time through one vein puncture site (surgery requires two separate open incisions).
• It is as effective as surgery, as measured by improvement in pain, semen analysis, and pregnancy rates.
• There is a lower rate of complications compared to surgery; infection has not been reported after embolization.

To find out more about minimally invasive varicocele treatment, we invite you to contact South Florida Vascular Associates to schedule a consultation at one of our 3 convenient locations in Coconut Creek, Boynton Beach, or Plantation, Florida. Call us today: (954) 725-4141.

Do You Know That Drinking Coffee Can Reduce the Risk of Clogged Arteries?

If you love your cup or cups of java, you will be happy to learn about the results of a recent study. The study, which was published in the journal Heart, shows those who drink an average of 3-5 cups of coffee per day could have a significant decreased risk of atherosclerosis, plaque build-up in the arteries and lower risk of heart attacks.

Coffee contains more than 1,000 chemicals, including antioxidants that may be contributing to health benefits. Part of the benefit seems to stem from coffee’s ability to improve insulin sensitivity and blood sugar control which, in turn, reduces the risk of type 2 diabetes, a strong risk factor for clogged arteries.

The research examined more than 25,000 Korean men and women average age of 41 with no symptoms of heart disease and were categorized as people who drank none, less than one cup a day, three to five cups per day and five or more per day.

During a yearly health exam, the participants were asked about what they ate and drank. They all had CT scans to determine how much calcium had built up in their heart arteries. The researchers then compared the calcium build-up with how much coffee participants drank.

Researchers determined that the presence of coronary artery calcium (CAC) - an early indicator of hardening of the arteries, (atherosclerosis) and heart disease- was lowest among the group that drank between three and five cups.  It was also determined that people do not have to drink large amounts of coffee to see positive results. Those who drank 1-3 cups per day had less calcium present compared to their non-coffee drinking counterparts. Researchers also found that as coffee consumption rose, the amount of calcium build-up declined especially in those who drank three to five cups a day having the least amount of calcium build-up.

Although the study was done on people in South Korea, Dr. Eliseo Guallar, professor and co-author of the study from the department of epidemiology and medicine at Johns Hopkins Bloomberg School of Public Health in Baltimore, expects the findings would be similar for American coffee drinkers. While the study cannot show a direct cause-and-effect relationship between coffee and reduced calcium in the arteries, the association between these factors is very strong.

If you are not a coffee drinker, researchers say that there is no reason to start since the greatest findings are in those who drink 3-5 cups per day. Also remember what you put in your coffee may not be advantageous to your health such as creamers, whipped cream and lots of sugar.

Bottom line: enjoy your "joe", it may better for you than you thought!

Congratulations to Dr. William Julien: Newly Elected President of Outpatient Endovascular and Interventional Society

We are proud to announce that our Medical Director, Dr. William Julien

Dr. William Julien

has been elected as President of the Outpatient Endovascular and Interventional Society (OEIS).

OEIS is a multispecialty/multidisciplinary society that was established in 2013 for Vascular Surgery, Interventional Cardiology and Interventional Radiologists to establish the highest standards of safety, successful surgical outcomes, top-notch care for patients, cost effectiveness, types of equipment needed, and research to demonstrate that in-office based operating facilities are a good place to perform interventional procedures.

Dr. Julien’s experience as one of the first interventional radiologists to implement an in-office, outpatient facility provides him with the knowledge of what it takes to successfully lead the OEIS Society as President.  He has always understood the need for quality patient care and has developed his practice model as one in which he sees his own patients and treats many of them in his fully-equipped, sophisticated, endovascular surgery suite. Dr. Julien runs a well-credentialed operating suite and has always placed a strong emphasis on the importance of patient education, proper diagnosis, and optimal treatment plan for each patient. His practice has been highlighted as a model for the next generation of interventional radiology practices.

Dr. Julien brings many years of hands-on experience at South Florida Vascular Associates in Coconut Creek, Florida to the Society and as President of OEIS, Dr. Julien plans to increase membership, help develop practice guidelines, offer research programs, and provide educational meetings, to name a few. We congratulate Dr. Julien on his newly elected position.

Uterine Fibroids; What You Need to Know -Women's Health Awareness

Earlier this month we honored National Women’s Health Week, an observance led by the U.S. Department of Health and Human Services Office on Women’s Health. The goal is to empower women to make their health a priority and to help women understand what steps they can take to improve their health.

In honor of Women’s Health Awareness Week, we would like to educate you about a common health problem that many woman face; uterine fibroids.

What You Need To Know

Fibroids are muscular tumors that grow in the wall of the uterus and are almost always benign (not cancerous). They can grow as a single tumor, or there can be many of them in the uterus. They can be as small as an apple seed or as big as a grapefruit. In unusual cases, they can become very large.
About 20 percent to 80 percent of women develop fibroids by the time they reach age 50 and are most common in women in their 30’s and early 40’s. Not all women with fibroids have symptoms, however women who do have symptoms often find fibroids hard to live with. Some women experience pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder causing frequent urination, or the rectum, causing rectal pressure. If fibroids grow to become very large, they can cause the abdomen to enlarge, distending their belly.

Some fibroids do not cause any symptoms, but many women with fibroids can experience:

• Heavy bleeding or painful periods
• Feeling of fullness in the pelvic area
• Enlargement of the lower abdomen
• Frequent urination
• Pain during sex
• Lower back pain
• Complications during pregnancy and labor, including a six-time greater risk of cesarean section
• Reproductive problems, such as infertility

 Factors that can increase a woman's risk of developing fibroids:

• Age. Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.
• Family history. Having a family member with fibroids increases your risk. If a woman's mother had fibroids, her risk of having them is about three times higher than average.
• Ethnic origin. African-American women are more likely to develop fibroids than white women.
• Obesity. Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
• Eating habits. Eating a lot of red meat and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.

No one knows for sure what causes fibroids. Researchers think that more than one factor could play a role. These factors could be:

• Hormonal (affected by estrogen and progesterone levels)
• Genetic (runs in families)

 Fibroids may need to be treated to reduce symptoms and pain. In the past, treatment usually involved surgery – removing the uterus through a hysterectomy, or removing the fibroids from the uterus through a myomectomy.

While these options are generally effective, they require general anesthesia and lengthy recovery times and they carry the risk of surgical complications. Many women are not candidates for a myomectomy because of the size, number, or location of their fibroids. Fibroids commonly recur after myomectomy.

Doctors at South Florida Vascular Associates offer a procedure called uterine fibroid embolization (UFE), or uterine artery embolization which is used to treat fibroids. It is a minimally invasive procedure in which the blood flow of the uterus is intentionally reduced, causing the fibroid tumors to shrink. It alleviates or improves fibroid symptoms 90% of the time.

Our board certified, interventional radiologists perform uterine fibroid embolization in our beautiful, state-of-the art outpatient facility without the need for hospitalization.  No general anesthesia, shorter recovery times and many women resume light activities in just a few days with the majority of women able to return to normal activities within seven to ten days.

If you have uterine fibroids and have been told you need to have them removed, you may be a candidate for fibroid embolization. To learn more, contact us today. Call (954) 725-4141 or request an appointment online now.