Ground-Breaking South Florida Interventional Radiologist Achieves Excellent Patient Outcomes With Continuum of Care Model of Delivery

William Julien, MD, is a leading expert in the development of office-based clinical endovascular practices

Coconut Creek, Fl- South Florida Vascular Associates Medical Director William Julien, M.D., is one of only a few interventional radiologists in the nation to have an office-based clinical practice where he provides pre- to post-operative care to his patients suffering from vascular diseases. His practice is unique because, unlike most interventional radiologists, Dr. Julien sees his own patients and treats 95% of them in his office in a sophisticated endovascular suite, one of the first of its kind in the country. Recently, Dr. Julien opened an 8,000-sq.-ft. facility equipped with three state-of-the-art operating suites coupled with a team of the region's most highly skilled medical staff, offering patients a unique and convenient continuum of care compared to a traditional hospital setting where traditional interventional radiologists typically see and treat their patients.

South Florida Vascular Associates' medical staff treats a variety of vascular conditions, including peripheral artery disease, abdominal aortic aneurysm, varicose veins, deep vein thrombosis and carotid artery disease.

Each year the practice's physicians perform more than 1,000 image-guided endovascular procedures in their office-based setting utilizing the latest cutting-edge technology, which is implemented by specialty-trained vascular medical professionals. Office-based procedures are easier on the patient because the patients are in a relaxed environment, there is little to no wait time for surgery, the procedures are performed under IV sedation as opposed to general anesthesia, and there is a comfortable waiting area for the families. In-office endovascular procedures are also less expensive than hospital procedures for insurance carriers.

"Our endovascular practice focuses on the continuity of patient care from our first meeting until the patient is fully recovered," said Dr. Julien. "I have the opportunity to know each of my patients personally and patient outcomes are excellent with this advanced model of delivering vascular care. We emphasize the importance of patient education, offering patients clear explanations of their diagnosis and treatment plan, including providing the most comprehensive endovascular services in a fully-equipped, private, comfortable setting."

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. Endovascular procedures are minimally invasive, require less or no hospital time, have fewer complications, result in reduced cost, and faster recovery time for the patient.

Dr. Julien and his staff also provide angioplasty, stenting, atherectomy, bypass surgery, embolization and many other vascular treatments.


About South Florida Vascular Associates
William H. Julien, MD, is the medical director of South Florida Vascular Associates and is one of few interventional radiologists in the nation to offer a clinical-based practice. His philosophy is to treat the patient as a whole person and he does much of his own testing and procedures in his state-of-the-art facility equipped with three in-office operating suites, allowing patients to feel more comfortable in a non-hospital setting. His highly skilled staff provides one-on-one attention to each patient focusing on his/her needs and care. To learn more about Dr. Julien and South Florida Vascular Associates, call (954) 725-4141 or visit www.southfloridvascular.com.

NEWER ILIAC ARTERY STENTS PROVE TO BE SAFE, EFFECTIVE & LIFE PROLONGING

South Florida Interventional Radiologist Says Nearly 100% of Patients with Peripheral Artery Disease (PAD) Can Now Be Successfully Treated

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. “Life was miserable. I couldn’t do anything. I couldn’t walk any more. I even had to sit in a chair to shower. We went to Las Vegas on vacation and I couldn’t leave the hotel room because I couldn’t walk anywhere,” he says.

Unloading grocery trucks for years and smoking a pack of cigarettes a day took its toll. Bartilotta says, “My 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,” says Dr. Julien. 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. Dr. Julien says, “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!

Prevent Episodes of Deep Vein Thrombosis; Keep Moving, Especially When Travelling

One of the worst things you can do if you've had deep vein thrombosis is stay still for long periods of time. Simple exercises may help you to prevent another episode of DVT.

Deep vein thrombosis, or DVT, occurs when blood clots form in the deep veins, usually in a leg. The blood clot can partly or completely block blood flow and damage valves in blood vessels. It can also break free and travel through your blood to major organs, such as your lungs -- which can be fatal.

Doctors diagnose DVT in 600,000 Americans each year. One out of 100 of these people die. If you're at risk, there is much you can do to prevent DVT.

Being still for long periods of time, such as travelling on a long airplane flight or sitting at a desk most of your work day increases your risk of DVT. To prevent the development of DVT, it's important to keep your blood flowing by moving and exercising.

When exercise is recommended by your physician to prevent DVT, this is not necessarily talking about vigorous exercise. There are simple exercises and preventative measures you can follow to prevent blood clots from forming in your legs. By simply moving your legs by stretching them, doing leg bends, fluttering your legs while seated, and walking around every few hours to stimulate your leg muscles, you can help to prevent the development of blood clots.

The best exercises for DVT prevention are walking and swimming because these exercises keep your blood flowing.  If you're at risk for DVT, avoid exercises that involve repeated thrusting that may cause trauma to your legs.

Here are some tips to keep your blood moving when traveling:
•    Drink plenty of water before and during your trip. This will reduce your risk of dehydration, which can make your blood more likely to clot.
•    Perform simple sitting exercises every half hour or so, when on long trips.
•    Take a walk up and down the aisle during airplane flights to move around. If traveling by car, stop and get out stretching frequently.

Here are some exercises that are useful for DVT prevention:
•    Tighten your calves. Flex your feet and raise your toes 15 times per set. This will tighten your calf muscles and promote proper blood flow through your legs.
•    Turn your ankles. With your feet off the floor, move one foot clockwise, the other, counterclockwise. Repeat, only switch directions.

•    Lift your feet. With your heels on the floor, raise your toes up; then lower them to the ground. Then do the opposite — heels up, balls of your feet on the floor.
Risk Factors for DVT
•    Being over age 40
•    Obesity
•    Cancer
•    Personal or family history of DVT
•    Immobilization
•    Pregnancy
•    Oral contraception (birth control) or hormone therapy use
•    Recent surgery or hospitalization
•    Smoking

Regardless of your risk factors in order to prevent DVT, remember to keep moving, especially when sitting for long periods of time while traveling, at work, or even relaxing at home.

NON-INVASIVE TREATMENT FOR VARICOSE VEINS OFFERS IMMEDIATE RELIEF

Endovenous Laser Treatment (EVLT) Enables Patient Suffering from Painful Varicose Veins to Return to Labor Intensive Work Day after Treatment

COCONUT CREEK, FL (November 16, 2011) - 39 year old Gabriel Quiroga is an air conditioner contractor. Each day he drives from house- to -house or business- to -business, pulls out his ladder and climbs up on top of roofs, into attics, and other hard to reach areas. Quiroga is totally dependent upon the use of his legs for his livelihood and a good quality of life.

Several months ago, Quiroga was experiencing pain in his left leg and swelling at the ankle, especially while standing and climbing up ladders. “I was in constant discomfort and was concerned that I might have to change careers. I could barely stand for any length of time without feeling severe pain”, said Quiroga.

Quiroga was referred to William Julien , M.D.,  a board certified, fellowship trained interventional radiologist who is the medical director of South Florida Vascular Associates (www.southfloridavascular.com) Upon testing and examination, Dr. Julien determined that Quiroga had a large varicose vein in his left leg which was causing venous insufficiency, a common condition resulting from decreased blood flow from the leg veins up to the heart. “When valves become weak and don't close properly, they force blood to flow backward, a condition called reflux”, said Dr. Julien. In normal veins, valves in the vein keep blood moving forward toward the heart. With varicose veins, the valves do not function properly, allowing blood to remain or pool, in the vein. Pooling of blood in a vein causes it to enlarge, which creates pain, especially when a person is standing and placing pressure on the leg.

A non-invasive technique has been developed to treat venous insufficiencies such as varicose veins called Endovenous Laser Treatment (EVLT).  EVLT is an alternative to traditional open surgery called vein stripping, and it requires minimal access to the vein. Light emission (heat) from a laser fiber beam is used to cauterize, or seal off, the inside of the varicose vein wall. This method closes the unhealthy, refluxing vein.

 During this procedure, a local anesthetic is applied to the vein and the physician inserts a tiny catheter into the problematic vein using ultrasound to guide its entry. The energy from the laser then works to close the unhealthy refluxing vein and thus reduce the tension on the surface skin veins. With the problematic vein permanently closed, the body then reroutes the blood to healthier veins returning the blood back to the heart. EVLT is a reliable and simple way to treat varicose veins without surgery.

In the past, if a patient was suffering from bulging, painful varicose veins, a patient would need to undergo an open surgical procedure called vein stripping to seal off the vein. Vein stripping is a very painful and arduous experience for the patient.

Vein stripping is done using general anesthesia and the procedure usually takes up to 1 1/2 hours. During this procedure a vascular surgeon makes two small surgical cuts in your leg. The cuts will be near the top and bottom of your damaged vein. The surgeon will then thread a thin, flexible plastic wire into the vein through your groin and guide the wire through the vein toward the other cut farther down your leg. The wire is then tied to the vein and pulled out through the lower cut, which pulls the vein out with it.

The vascular surgeon will close the cuts with sutures. After surgery you will have bandages and compression stockings on your leg and your leg may need to be wrapped to control swelling and bleeding for 3 - 5 days after surgery. You may need to keep them wrapped for several weeks.

The advantages of EVLT treatment include: treatment typically takes less than one hour, provides immediate relief, general anesthesia is not needed, recovery period is minimized and a patient can immediately return to normal activities, no scarring or stitches, lower rate of complication,  and a higher success rate and durability of the procedure relative to surgery.

“I can’t believe how simple this procedure was”, said Quiroga. “I postponed the procedure for so long thinking I would be out of work for several weeks and the day after the procedure, I was able to climb my ladder, something I thought I might never be able to do again”. Aside for wearing a compression stocking for a few weeks, Quiroga did not experience any discomfort and was immediately able to return to his job. “This procedure is amazing, said Quiroga, I can’t believe how easy and painless it was”.

If you suffer from unsightly and painful varicose veins, call our office for a consultation. www.southfloridavascular.com or call 954-573-2929

High Tech Treatment helps to Effectively Eliminate Plaque Build-up from Atherosclerosis

If you suffer from atherosclerosis, our endovascular surgeons offer a very safe and effective procedure called an atherectomy to eliminate the build-up of plaque in your arteries.

You may need this procedure if your arteries become too narrowed or blocked from plaque inside the artery walls. When arteries are blocked, blood cannot get through to nourish the tissues, causing the muscles of the lower extremities to cramp and lose strength.

Atherectomy has been very effective in the treatment of peripheral artery disease (PAD) below the knee and it helps to reduce pain caused by walking to heal non-healing wounds by improving circulation. It also has been an effective treatment for limb salvage of the lower extremities. Atherectomy is especially helpful for treating blockages in arteries that occur around branches or in vessels that are not easily treated with stents.

The procedure is done in our office, as opposed to a hospital setting, in one of our state-of-the art endovascular suites. Local anesthesia is used with a mild sedative if needed. During the procedure a catheter is inserted into the artery through a small puncture in the groin. The catheter has a tiny sharp blade on the end which spins around at a very fast speed and sands away the plaque from the blood vessel to open the vessel and re-establish better blood flow. The plaque is scraped away and collected in a chamber in the tip of the catheter for removal. If you have a significant amount of plaque, the catheter can be passed multiple times in order to remove large amounts of plaque.

Depending on the amount of plaque build-up a patient has, the procedure usually takes about two hours. Atherectomy most often results in immediate relief of the symptoms of atherosclerosis.  There are typically no side effects and patients can usually begin normal activities several days after the procedure.

This procedure is not ideal for everyone. Each patient is evaluated, and treatment will be individualized for the patient's circumstances.

To find out if you are a candidate for this procedure contact our office for a consultation.

Do you Suffer from Varicose Veins?

At South Florida Vascular Associates we use the latest, state-of-the-art techniques for the treatment of varicose veins and venous insufficiencies
 Venous insufficiency involves one or more veins. Valves in the veins usually push the flow of blood toward the heart. When these valves are damaged, the blood leaks and pools in the legs and feet. This condition may also be caused by a blockage in a vein from a clot (deep vein thrombosis).

Chronic venous insufficiency is a long-term condition. It occurs because of partial vein blockage or blood leakage around the valves of the veins.
Risk factors for venous insufficiency include:
•    History of deep vein thrombosis in the legs
•    Age
•    Being female (related to levels of the hormone progesterone)
•    Being tall
•    Genetic factors
•    Obesity
•    Pregnancy
•    Prolonged sitting or standing 
Symptoms
•    Dull aching, heaviness, or cramping in legs
•    Itching and tingling
•    Pain that gets worse when standing
•    Pain that gets better when legs are raised
•    Swelling of the legs
•    The tortuous blue vein disease seen running down the leg
•    Areas of small red/blue blood vessels in the skin known as spider veins
Treatments
    Use compression stockings to decrease chronic swelling.
    Avoid long periods of sitting or standing. Even moving your legs slightly will help the blood in your veins return to your heart.
•    Aggressive wound care should be taken if any skin breakdown or infection occurs
Endovenous Laser Ablation (EVLT)
 EVLT is a minimally invasive procedure where light emission (heat) from a laser fiber beam is used to cauterize, or seal,  the inside of the varicose vein wall. This method closes the unhealthy, refluxing vein. EVLT is an alternative to both traditional surgery such as vein stripping. EVLT requires minimal access to the vein.


If you suffer from any of the symptoms above, contact our office for more information on how we can help you to alleviate painful, unsightly varicose veins.

SOUTH FLORIDA VASCULAR ASSOCIATES WELCOMES WARREN SWEE, MD, MPH FELLOWSHIP TRAINED INTERVENTIONAL RADIOLOGIST TO THE PRACTICE

Dr. Swee’s Specialized Endovascular Surgical Skills Enhances Treatment Options for Patients Suffering from Complex Vascular Diseases

COCONUT CREEK, FL (October 12, 2011 ) – South Florida Vascular Associates (www.southfloridavascular.com), an office-based clinical practice specializing in image-guided, minimally invasive endovascular surgeries, today announced that Warren Swee, MD, MPH, a fellowship trained and board certified Vascular and Interventional Radiologist has joined the practice.

Dr. Swee will work with William Julien, MD, Medical Director of South Florida Vascular Associates, to offer cutting-edge endovascular surgical techniques to treat patients who suffer from a wide array of vascular diseases including Peripheral Artery Disease (PAD), a condition in which plaque build-up causes a narrowing of the arteries which diminishes normal blood flow to the lower extremities.
People with vascular diseases are typically treated in a hospital setting. South Florida Vascular Associates (SFVA) is one of few office-based, endovascular practices in the region that can treat patients outside of the hospital. “I am very privileged to have the opportunity to work with Dr. Julien and to provide high quality care in a well-developed office based practice”, said Dr. Swee. SFVA is equipped with 3 in-office endovascular surgical suites where our physicians perform over 1,000 image-guided endovascular surgeries a year. This is done in the comfort of a state-of-the-art facility using the latest technology to treat vascular conditions. “We are pleased that Dr. Swee has joined our practice”, said Dr. Julien. “The addition of Dr. Swee’s specialized training in the treatment of advanced limb threatening peripheral artery disease adds to our vision of offering the most comprehensive endovascular services in a fully-equipped, private, comfortable setting to our patients”, said Dr. Julien.
Dr. Swee earned his medical degree and Master’s of Public Health degree from the George Washington School of Medicine and Public Health. He completed his residency through the Vascular and Interventional Radiology Clinical Pathway at the University of Virginia in Charlottesville, VA., where he was awarded Clinical Resident of the Year. Dr. Swee then completed a fellowship in Vascular & Interventional Radiology from the University of Virginia Health System, where he later served as Assistant Professor of Radiology.

He is board certified in Vascular and Interventional Radiology by the ABR (American Board of Radiology) and board certified in Endovascular Medicine by the ABVM (American Board of Vascular Medicine). He is also a member of the American Medical Association, the Society of Interventional Radiology , the Society of Vascular Medicine, , and the American College of Radiology.

For more information visit us at www.southfloridavascular.com or 954-573-2929.

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

Varicoceles Can be Treated with a Minimally Invasive, Painless Procedure

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 a gonadal vein has weak defective valves resulting in the blood pooling in varicose veins in the scrotum. It is a relatively common condition affecting approximately 10% of men usually in their 20's or 30's. Sometimes, varicoceles do not cause any symptoms and are not harmless, but sometimea they can cause pain, testicular atrophy (shrinkage) or fertility problems.

Very often varicoceles are treated through open surgery in which an incision is made in the skin above the scrotum, cutting down to the testicular veins and tying them off with sutures. This open procedure is done as an outpatient procedure in a hospital, under general anesthesia, with a 2-3 week recovery period.

South Florida Vascular Associates offers a minimally invasive varicocele embolization procedure that is performed under twilight anesthesia. A small tube is inserted through a small nick in the groin and a small catheter is painlessly guided into the abdomen and into the varicocele vein under the guidance of x-ray imaging. The vein is sealed off by plugging it with small metal coils and a special medication is used to dissolve the excess veins. This painless minimally invasive procedure takes only 30 minutes and the patient goes home several hours later with a band aid at the puncture site.The patient can resume normal non-exertion activities immediately. Obviously, this procedure is much easier on the patient.

If you have a varicocele and would like more information call our office to schedule a consultation or send a comment through our blog.

Standard Risk Carotid Artery Surgical Patients Now Have Option for Minimally Invasive Procedure

In May 2011, The Food and Drug Administration approved carotid artery stenting for use in standard risk patients. Previously, only patients at high risk for surgery were approved for the procedure. High risk patients are typically older, sicker or have abnormalities of their neck that make it difficult for a surgeon to operate. Dr. William Julien was one of the first endovascular surgeons in the region to perform this procedure.

More than 60% of United States patients are standard risk. Now patients who need carotid revascularization have the option of choosing a minimally invasive endovascular procedure rather than traditional open surgery known as an endarterectomy, which is a major surgical procedure performed under general anesthesia.

During carotid stenting, a tiny incision the size of a pencil head is made in the patient’s groin and the doctor inserts a specially designed guide wire with a filter that is placed beyond the site of the narrowing or blockage in the carotid artery. Once the filter is in place, a small balloon catheter is guided to the area of the blockage. When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened to increase blood flow. The balloon is removed and a stent is placed inside the artery to widen the opening and support the artery wall. The final step is to remove the filter device along with any particles that may have been trapped during the procedure. The patient typically spends one night in the hospital and is able to resume their normal activities immediately.

FDA Approves Carotid Artery Stenting for Standard Risk Patients

South Florida Interventional Radiologist One of First in the Region to Perform Procedure

COCONUT CREEK (August 19, 2001)-Carotid Artery Disease occurs when the major arteries in the neck become narrowed or blocked. “These arteries are the main supplier of blood to the brain; when blocked, they often cause strokes or in some cases, be fatal,” explained William Julien, MD, medical director of South Florida Vascular Associates. Carotid Artery Stenting is a minimally invasive procedure used to re-open the carotid arteries, restoring blood flow and preventing stroke.

    In May 2011, The Food and Drug Administration approved Carotid Artery Stenting for use in standard risk patients. Previously, only patients at high risk for surgery were approved for the procedure.  High risk patients are typically older, sicker or have abnormalities of their neck that make it difficult for a surgeon to operate.

     More than 60% of United States patients are standard risk. Now patients who need carotid revascularization have the option of choosing a minimally invasive procedure rather than traditional open surgery known as an endarterectomy, which is a major surgical procedure performed under general anesthesia. During carotid stenting, a tiny incision the size of a pencil head is made in the patient’s groin and the doctor inserts a specially designed guide wire with a filter that is placed beyond the site of the narrowing or blockage in the carotid artery. Once the filter is in place, a small balloon catheter is guided to the area of the blockage. When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened to increase blood flow. The balloon is removed and a stent is placed inside the artery to widen the opening and support the artery wall. The final step is to remove the filter device along with any particles that may have been trapped during the procedure. The patient typically spends one night in the hospital and is able to resume their normal activities immediately. 

    With traditional endarterectomy surgery the patient experiences more pain and must remain in the hospital for several days. The incision also leaves unsightly post operative scars on the neck.  The recent FDA approval for carotid stenting is likely to have a significant impact on how many patients are now able to be treated for carotid artery disease.

    75-year-old Dent Lackey experienced a 4-hour dizzy spell in April 2011. The Tamarac resident, who plays the bass fiddle for local bands, was encouraged by his family to go to the emergency room. “I felt fine except for the dizziness,” said Lackey.  “I had no other symptoms and was not dizzy any other time. If it weren’t for my children, I would not have gone to the hospital.” But he’s sure glad he did. A number of tests revealed he had severe stenosis or plaque build-up in his left carotid artery.

    Lackey was referred to Dr. William Julien, an interventional radiologist in Coconut Creek. He was one of the first doctors in South Florida to perform carotid artery stenting in 2004 when it was first approved by the FDA for high-risk patients. Dr. Julien discovered Lackey had 85% blockage of the left carotid artery. This could have led to a severe stroke or been fatal if it was ignored.

     Lackey was given the choice of endarterectomy or stenting. Some patients are not candidates for stenting because of anatomical issues such as extreme calcification or unusually curvy vessels. Fortunately for Lackey he was a candidate. During the procedure, Dr. Julien was able to re-establish blood flow to the arteries. “He is currently asymptomatic with no signs or symptoms of stroke. He is doing well on Plavix and aspirin daily,” added Dr. Julien.

    Resistant at first to going to the doctor, Lackey is now singing a different tune. “I am so grateful that I was referred to Dr. Julien and that I learned about other options than surgery.  I am lucky to be alive.”  Just this month, he felt so good Lackey traveled to Ireland for a family vacation and will be able to continue playing his bass fiddle which is his passion and his livelihood.
About South Florida Vascular Associates

    Dr.William Julien is the medical director of South Florida Vascular Associates and is one of few interventional radiologists in the nation to offer a clinical-based practice. His philosophy is to treat the patient as a whole person and does much of his own testing and procedures in his new state-of-the-art facility equipped with 3-in-office operating suites. This allows patients to feel more comfortable in a non-hospital setting. His highly-skilled staff provides one-on-one attention to each patient focusing on his/her needs and care.

To find out more about Dr. Julien and South Florida Vascular Associates call 954-725-4141 or visit www.southfloridvascular.com

Carotid Artery Stenting

The Boynton Times

Local Surgeon Implants New Minimally Invasive Carotid Stent Device and Saves One Man's Life
Boynton Beach, FL. By the time Joseph Camiso was 73, he already had a six-vessel coronary bypass surgery. He had also undergone carotid artery surgery, called endartectomy, which is performed for patients whose carotid arteries have narrowed because of cholesterol buildup. The threat of stroke caused by clogged carotid arteries is not uncommon.

The endartectomy created a large scar on the left side of his neck, but more concerning was that the nerve supplying the left vocal cord was damaged leaving that side of his throat paralyzed.

“I sounded like a character from ‘The Godfather,’” said Mr. Comiso.

Unfortunately, his carotid artery on the right side was also dangerously narrowed and needed to be opened to prevent a stroke. Mr. Comiso and his wife, Marie, then visited an ear, nose, and throat specialist to discuss having an endartectomy for the right carotid artery, but the specialist told them that it was too dangerous. If the nerve supplying the right vocal cord was damaged from the incision, he would be unable to speak or breathe and an emergency tracheotomy tube would be needed.

“My doctor thought that I was too high risk to have another surgery because of the vocal cord paralysis,” he said.

Traditional carotid artery surgery can pose complications in healthier patients as well, including strokes and heart attacks. For Mr. Comiso, the traditional surgery would have been dangerous and likely impossible.

The Comisos then visited their neurologist who referred them to Dr. William Julien, a Board Certified Interventional Radiologist who practices full time endovascular surgery in Margate, FL.
“We were buying against time,” said Mrs. Comiso.


Dr. Julien enrolled Mr. Comiso into an FDA-approved carotid stent research trial for patients who are considered high risk for traditional carotid endartectomy surgery. The procedure offers a life-saving alternative for these patients and was sponsored by Boston Scientific Corporation. Only 780 people were enrolled, and Mr. Comiso was one of them. Since his left vocal cord was already paralyzed, his physicians determined that traditional surgery was too high a risk. Losing control of both sides of his vocal cords could have led to an emergency tracheotomy.

Carotid stenting is a minimally invasive procedure performed by inserting a catheter in the femoral artery passing it through the blood system and up into the carotid artery using X-ray guidance to navigate through the bloodstream. A novel filter device which looks like a tiny butterfly net is first inserted and positioned in the carotid artery downstream from the narrowing. The filter captures any particles that are inadvertently dislodged during the procedure while maintaing blood flow to the brain. An angioplasty balloon then expands the carotid narrowing followed by placement a tubular metal mesh called a stent. This stent acts as a scaffolding to hold the artery open. The final step is removing the filter along with any debris that was trapped during the procedure.

"I feel great. My voice is much better," said Mr. Comiso. "Dr. Julien was wonderful. This procedure not only saved my life but gave me my voice back. I am happy to share my story with others because it may save more lives. Patients and doctors need to know that this is available."

"Mr. Comiso was a delight to work with, and it was gratifying to use this new technology for his serious situation. Since the carotid stent procedure avoids any neck incisions, there is zero risk of vocal cord paralysis," said Dr. Julien. "My practice philosophy is to offer each patient the latest and best technologies, procedures, and medications currently available. Clearly, we were able to accomplish that here."

Dr. Julien emphasizes the importance of patient education and clear explanations on the details of a diagnosis, including short and long-term treatment plans, alternative treatment, and precisely what each patient should expect to experience. His practice has been highlighted as a model for the next generation of Interventional Radiology Practices.

The Guidant Corporation received the first FDA approval for a carotid stent platform on August 31, 2004 and Dr. Julien was the first South Florida physician to implant the newly approved device. The Boston Scientific device that Mr. Comiso had implanted as part of the research trial is expected to be FDA approved third quarter 2005. Dr. Julien's practice will serve as one of a few physician training sites. One of the innovative techniques used during the training will be the use of a sophisticated simulator that allows surgeons to practice on a dummy rather than a real patient.

“We think simulator training will become an important tool in training surgeons performing technically demanding and risky procedures such as carotid stenting,” said Dr. Julien.

For more information, visit www.southfloridavascular.com.

Arteriosclerosis

The Boynton Times

There is a light

I always talk about modern technology and the miracles performed daily. I recently received a story telling about a miracle and a light at the end of the tunnel.

This is a story about a medical breakthrough procedure called CryoPlasty, a frozen balloon angioplasty, which is benefiting many people with bad circulation and immobility.

The living proof of this story is about an 87-year old woman who is now living a normal life because of this procedure.

Jeanette Shorr was an extremely active 87-year old woman. One of her favorite activities as to walk the malls and shop as part of her daily routine. She walked for hours on end with a group of friends while they socialized; they also exercised at the same time.

Two months ago while engaging in her activity, Jeanette noticed she was unable to walk for any length without having to stop to catch her breath. She also experienced extreme pain in her left leg when this happened. After resting for a few minutes, she resumed walking. This was coming a very common occurrence and was getting worse. She noticed her quality of life was diminishing.

One day while engaging in her routine, her knee buckled and gave out completely. She knew that this was a problem needing medical advice immediately.

She asked around and was told there was a new procedure being done by Dr. William Julien, an Interventional Radiologist in Margate, Florida. He is the first physician in Broward County to perform the procedure. She sought him out and became his patient.

She was diagnosed with arteriosclerosis, namely a build-up of plaque in the arteries. With the new medical breakthrough, CryoPlasty, (a frozen balloon angioplasty,) her life was given back.

It is the only procedure to treat this type of problem. The build-up of plaque in the arteries is extremely treacherous, especially in the knee. Conventional angioplasty would not have worked in this part of the body.

The result of not using this procedure could have been the cause of a life threatening complication. Without it this lady would have to alter her lifestyle dramatically and would have been debilitated in movement and quality of life. She had to have the surgery.

Shortly after being operated, she returned to her busy, active lifestyle with her friends once more. She no longer had worries of falling or becoming incapacitated. She is very grateful to her doctor and for being about to live a much more complete life.

"Mr. Comiso was a delight to work with, and it was gratifying to use this new technology for his serious situation. Since the carotid stent procedure avoids any neck incisions, there is zero risk of vocal cord paralysis," said Dr. Julien. "My practice philosophy is to offer each patient the latest and best technologies, procedures, and medications currently available. Clearly, we were able to accomplish that here."

We never stop to think what our lives would be like if we were not able to be mobile. Jeanette was helped because of this breakthrough and procedure.

Her mind is now at ease and she is living a pain free, happy life enjoying what she likes doing best.

Stories like this are very enlightening and when I am sent something I feel can give my readers hope; I enjoy putting it in to the paper. Thank you for sharing your story with us and I hope it is an inspiration to others suffering from the same problem.

Modern medicine never stops finding new possibilities in so many areas thus creating a success story, as the one above.

A short while ago, I wrote on Hope, and the above is exactly what I was talking about. We must never feel that anything is so fatal that the result seems hopeless, you never know!

Uterine Fibroid Embolization

The South Florida Sun Sentinel

Non-invasive Treatment Helps New Mom In Trouble. Doctor Uses Rare Procedure to stop Bleeding, Save Uterus

Venus Tenerife couldn't wait to thank Dr. William Julien for her first Mother's Day with her husband and new baby. She almost didn't make it.

"I really didn't get a chance to talk to him the first time I saw him and thank him for all he did for me," said Tenerife, 34. "I definitely owe him a lot."

After 11 hours in labor on Easter Sunday, the Coconut Creek woman delivered a healthy 71/2-pound son, Justin Thomas, at Northwest Regional Medical Center in Margate.

But then she had complications -- life-threatening bleeding from her uterus.

"I was really scared when they told me what was happening," she said. "I could see all the commotion that was happening around me. I realized it could be serious and I could lose my uterus."

As time passed and the bleeding didn't stop, her obstetrician Dr. Tara Solomon was faced with two choices, begin a hysterectomy to remove the damaged uterus or call for a rare procedure that could stop the bleeding and save the uterus without Tenerife having to go through surgery.

The minimally invasive procedure, called uterine artery embolization, seals off the blood flow with a jellylike substance thinned to a slurry that's delivered into the bleeding artery inside the uterus by a tiny catheter. The substance eventually disappears.

Solomon called in Dr. Julien, an interventional radiologist, who alerted his team and rushed to the hospital. He has an endovascular surgery practice, the South Florida Vascular Associates, with offices adjacent to Northwest Medical Center.

"The procedure is rare. We probably only get one or two calls like this a year," Julien said. "When the call comes, you have to arrive with your game face on and ready to go. It's an emergency situation, like a fire drill, where the patient is in danger of dying.

"This is a case where you have got to get moving faster than almost any other situation. You are worried about the patient, the mother of a brand-new baby who potentially may not be around. It's pretty scary for a baby not having its mother."

By the time Julien arrived, Tenerife was in trouble.

"Her blood pressure had dropped, they were giving her transfusions, and they were thinking they might have to start the hysterectomy."

In a specially equipped operating room in the hospital, Julien used imaging equipment to steer the catheter through a tiny incision where the material was injected, and the bleeding was stopped.

For Tenerife, a physical therapist at Woodlake Nursing Rehabilitation Home in West Palm Beach, all Mother's Days from now on will be special.

"I feel very grateful. I am so lucky to have another chance to have a baby," Tenerife said. "I feel so great and thankful for everything they did to save me."

The next day, when Julien made his rounds and saw Tenerife and baby Justin, he said he was nervous until he saw for himself that the procedure was effective.

"It's always a scary period until you see the results. It's most gratifying to see a mom caressing her baby as she was, " he said."I can't express the words right now," Tenerife said, "but telling the doctor is really something that is easy and I have to do."

Dr. Julien Honored as a Top Physician in South Florida

South Florida Hospital News

Dr. William Julien is a board certified interventional radiologist with a full time endovascular practice. Dr. Julien places a strong emphasis on the importance of patient education offering his patients clear explanations on the details of a diagnosis, treatment plans, alternative treatment, and precisely what each patient should expect to experience. His practice is unique in that, unlike most interventional radiologists, Dr. Julien sees his own patients and treats many of them right in his office in a sophisticated endovascular surgery suite – one of the first of its kind in the country. His practice has been highlighted as a model for the next generation of Interventional Radiology Practices.

Currently, Dr. Julien is the President of South Florida Vascular Associates. He is also on staff at Northwest Medical Center. Some of Dr. Julien's past and present achievements are that he has been Director of Interventional Radiology at Florida United Radiology, as well as Chief of Interventional Radiology at a 3 hospital system here in South Florida. Dr. Julien has been principal investigator for several device trials for medical break-through procedures including carotid artery stenting. Because his skills are so specialized, Dr. Julien has frequently been asked to speak at national endovascular meetings and has also had the privilege of training many physicians on cutting-edge minimally invasive procedures. Dr. Julien is on the advisory boards of Boston Scientific and Medcomp.

He is a fellow of the Society of Cardiovascular and Interventional Radiology as well as Council for Cardiovascular Radiology at the American Heart Association.

Dr. Julien was one of the original researchers of Carotid Artery Stenting and was the first South Florida physician to implant the newly approved filter device upon its post-market approval.

Recently, Dr. Julien became the first doctor in South Florida to use a new FDA approved vessel closure system, StarClose™ This device closes the artery securely in a matter of seconds following diagnostic catheterization procedures such as those used to diagnose coronary artery disease. StarClose™ has the potential to change the current standard of vessel closure, which is manual compression. It is in the patient's and physician's best interest to close the femoral artery as securely, quickly and cleanly as possible to reduce complications, as well as allow patients to get up and walk around sooner.

Dr. Julien has also recently become one of the first doctors to implant a new wireless device during an endograft procedure for tracking aneurysm pressure called EndoSure™. This is the first time doctors can implant something in a patient that can send information without the use of batteries or a power source.
Because it is inside the body, the sensor gives doctors information they have never had before.

Minimally Invasive Procedures

By Gail M. Lassner - The Parklander

Painless new medical procedures make traditional surgery a thing of the past

A new and exciting trend in medicine offering minimally invasive surgical procedures has given local resident Franey Way the opportunity to ring in the New Year with a renewed sense of optimism.

It’s difficult to imagine her frustration when Way was told that she was considered too high-risk to undergo necessary surgery after being diagnosed with severe carotid artery stenosis. This disease is characterized as a build-up of plaque in the carotid artery which is the artery that supplies blood to the brain and when left untreated often results in a stroke.

Her frustration was soon replaced with an overwhelming sense of hope, as well as relief when she was introduced to Parkland resident Dr. William Julien, a Board-Certified Interventional Radiologist who practices full-time endovascular surgery in Margate. Dr. Julien told Way that she was a candidate for a new FDA approved minimally invasive life-saving procedure called Carotid Stenting. This procedure involves puncturing the femoral artery in the groin. Under x-ray guidance, a catheter device is then threaded through the blood stream into the carotid artery and then an angioplasty balloon and stent are inserted to hold the artery open.

Also employed is a novel technology involving the insertion of a filter device which stays in place during the procedure that catches particles which are often inadvertently dislodged during angioplasty, thereby minimizing the possibility of any complications which could occur during the surgery. Following her surgery, like so many others treated by Dr. Julien, Way is fully recovered after having undergone the hour long painless procedure. “Now I can enjoy my life,” she said gratefully.

Julien, on staff at Northwest Medical Center, was one of the original researchers of Carotid Stenting and was the first South Florida physician to implant the newly approved filter device. Presently, medicare coverage for this procedure is limited to patients like Way, who are considered too high-risk for traditional carotid endartectomy surgery. Dr. Julien sees this changing in the future. “I think ten years from now pretty much everyone will have carotid stenting procedures and very few people will have open surgery,” he said.

His practice is unique in that, unlike most interventional radiologists, Dr. Julien sees his own patients and treats many of them right in his office in a sophisticated endovascular surgery suite – one of the first of its kind in the country. He now performs minimally invasive varicose vein surgeries right in his office using local anesthesia. Traditionally, patients would have undergone surgery in the hospital under general anesthesia. The new procedure involves the use of an endoluminal laser guided by ultrasound which enters through the blood stream to close the abnormal vein. Patient's can immediately resume their non exertional activities.

Another new trend as we approach the New Year is a relief for the approximately 13 million American women who suffer from uterine fibroids. A new minimally invasive treatment option called Uterine Fibroid Embolization offers an alternative to having a hysterectomy. The procedure is performed with local anesthesia, again using interventional radiology catheter techniques rather than traditional surgery to destroy the blood supply to the fibroid tumors. As more women become aware of the availability of this procedure, Dr. Julien is confident that more will seek this new treatment option.

There are many benefits to minimally invasive endovascular surgery, according to Dr. Julien. Two-thirds of the surgeries are done right in his office, and procedures performed in the hospital are usually outpatient or sometimes a one night stay Also, because patients undergo local anesthesia, the surgeries are not painful and the risks associated with general anesthesia are eliminated. Additionally, these types of surgeries offer a significant savings to the health care system, especially since there is such a quick recovery time. Dr. Julien stresses that consumer awareness is critical. “Whoever performs endovascular surgery must be well trained and have a lot of experience,” he said. “Consumers should ask a lot of questions.” For more information visit www.southfloridavascular.com.

Carotid Artery Stenting

Boca Raton News

Local Resident Able to Enjoy Life After New Medical Procedure

Franey Way wasn’t able to garden and tend her flowers outside her Boca Raton home any more.
In fact, she wasn’t able to do much of any of the things she used to enjoy like cooking her favorite meals or making a trip to the local grocery store, after having a series of alarming episodes where her right hand and foot would become numb.

“I discovered it was very difficult to walk and at times I became uncoordinated,” said Way.

After urging from her daughter, the local resident went to the hospital to get checked out.
“I went to the Boca Raton Community Hospital. They admitted me right away, observed me and took tests. After a few days, they diagnosed me with severe carotid artery disease in my neck. It affects the blood supply to you brain, which is why I was having little episodes, which were actually tiny strokes called TIA’s. They told me surgery was too risky for me because of my medical history and that my blockage wasn’t severe enough to take that risk.

So, they sent me home with medication treatment,” said Way.
But the numbness and difficulty to walk started to become worse and more frequent for the 79-year-old resident.

“It was a feeling of clumsiness and lack of coordination. It was getting worse and more frequent,” said Way, who then decided to go to her family doctor, Matthew Pinto.

Since Way was at too-high risk for surgery Dr. Pinto referred her to Dr. William Julien, a Board Certified Interventional Radiologist who practices full-time endovascular surgery in Margate.

“The first time I walked into the examination room, I didn’t feel intimidated by him. He was like an old friend walking into the room,” said Way.

Julien checked out his new patient and thought she would be a perfect candidate for an FDA approved carotid stent research procedure since she was considered too-high risk for traditional carotid endartectomy surgery. The procedure offers a life-saving alternative for these types of patients, according to Julien.

Carotid Stenting is a minimally invasive procedure performed by inserting a catheter in the femoral artery passing it through the blood system and up into the carotid artery using X-ray guidance to navigate through the bloodstream. Then, a novel filter device which looks like a tiny butterfly net is first inserted and positioned in the carotid artery downstream from the narrowing. The filter captures any particles that are inadvertently dislodged during the procedure while maintaining blood flow to the brain.

Next, an angioplasty balloon expands the carotid narrowing followed by placement of a tubular metal mesh called a stent, which acts as a scaffolding to hold the artery open. The final step is removing the filter along with any debris that was trapped during the procedure.

“Franey’s a high risk patient, too-high risk for surgery and gets relegated to a category where no one wants to touch her. Her right carotid artery was closed off because of radiation damage because of that, blood flow to the brain was coming from the left artery and supplying both. The stroked would have been more devastating,” said Dr. Julien, an endovascular surgeon at North West Medical Center, who was involved in the national research trials for the procedure and was the first South Florida physician to implant the newly approved filter device.

Julien’s practice will serve as one of a few training sites, for other physicians who would like to learn how to administer the procedure where patients do not have to be put under anesthiea.

Way said the procedure was painless and took only about an hour and she has fully recovered. Way said now she can enjoy her life.

“Before I didn’t go shopping or I couldn’t have been gardening or out there watching my butterflies. Most of the time I was sure I was gong to fall,” said Way. “Now, all the symptoms are gone. I do my laundry. I do my cooking and I manage the house. I have no more episodes of numbness.”

Way said she encourages others diagnosed with same illness never to give up hope.

“Never give up. Keep looking for a solution and be open to change. Medicine is always changing. What we’ve done for years isn’t always what we should keep on doing,” said Way. For more Information, www.southfloridavascular.com.

Advances in Radiology and Imaging Lead to Medical Breakthroughs in the Field

By Julie Laviolette - South Florida Hospital News

New advances in radiology and imaging have led to a medical breakthrough in the way doctors are now able to locate and treat veins and arteries

The Vein Viewer™, which became available in June, is a new technology that uses infrared light to image red blood cells, allowing a video camera to capture the images through a computer and project them onto a patient’s skin. This device allows healthcare providers to quickly and accurately map a patient’s veins, regardless of age, gender, body type or skin tone. It is particularly beneficial for patients with hard-to-find veins, including blood donors, children and cancer patients whose veins have been weakened by chemotherapy.

"It’s a breakthrough technology that allows you to see veins that you wouldn’t see with the naked eye," said Dr. William Julien, an endovascular surgeon and President of South Florida Vascular Associates in Margate. Dr. Julien was one of six doctors in the country and the first in South Florida to acquire the technology.

In his practice, the Vein Viewer™ has been successfully used to guide the physicians while they perform sclerotherapy, a procedure where spider veins are eliminated by injecting them with caustic chemicals.

"Without this sophisticated viewing technology, physicians can only see the veins on the surface," Dr. Julien said. "If you want to destroy the veins that are at the root of the spider veins, it’s a bit of a problem because you can’t see them with the naked eye, but you can see them with the Vein Viewer™."

It’s like being Superman and having X-ray vision, he said.

Dr. Julien said hospitals could benefit from this technology for inserting I.V.s, drawing blood, administering chemotherapy or even identifying good-quality veins in dialysis patients. Because the Vein Viewer™ illuminates the position of the target area, doctors know exactly where to access a vein, alleviating multiple needle sticks that can cause stress, bruising and discomfort for the patient.

"Its uses are quite dramatic for the patient", says Dr. Julien. The Vein Viewer™ is even being used to help wounded soldiers in the battle field by shortening the time it takes to insert an IV. There’s even talk of Homeland Security one day using it as an identification system, since no two persons’ veins are alike.
"Because this technology is so new, we are still determining the full extent of all of its uses in the medical community," Dr. Julien said.

A nother recent technological advance in imaging and radiology relates to carotid artery stenting, a procedure which is utilized to prevent strokes.

In addition to preventing strokes, "There’s new information that the carotid artery stenting procedure may actually improve executive brain functions such as memory and mental acuity," Dr. Julien said.

During the procedure, an angioplasty balloon and then a stent are used to widen the carotid artery narrowed by plaque. Prior to the angioplasty, a tiny filter is placed in the carotid artery to capture any particles that are unintentionally dislodged during the procedure. The final step is to remove the filter along with any trapped debris.

"Filtering takes place because there was a concern that the particles were causing a subtle deterioration in mental function," Dr. Julien said. "Instead, they found, in a statistically significant number of people, that there were increased mental functions. Colors were brighter. Memory was sharper."

Dr. Julien said the Food and Drug Administration has approved carotid artery stenting for use only in high-risk patients.

"These new findings indicate that if you have a patient with reduced mental function, they may have a narrowing of the carotid artery that no one may be aware of and can be screened for it," he said. "If there is depression or dementia in the elderly, there are many possible causes, but it may be caused by stenosis, a narrowing of the carotid artery, and carotid stenting may help that."

Dr. Julien said advances in image guided technology are reducing instances when patients have to go "under the knife."

"Endovascular surgery is guided by imaging, and advancements in imaging techniques are nearing us to the day where people won’t necessarily have to be subjected to major surgery," he said. "If you don’t have to cut people open, it means faster surgery, less pain for the patient and faster recovery time."

Dr. William Julien is a board certified interventional radiologist with a full-time endovascular practice. He is president of South Florida Vascular Associates in Margate and is on staff at Northwest Medical Center. Dr. Julien can be reached at (954) 975-6161 or www.southfloridavascular.com. www.southfloridavascular.com.

Vein Viewer

High-Tech Device Makes It Easy To Locate Hard-To-Find Veins

Using a high -tech device placed on top of the skin, doctors can now see veins inside your body. The device is called the Vein Viewer and will benefit many patients, including children and cancer patients. It also works well for spider veins. Debbie Andersen, 52, is a breast cancer survivor. But after going through chemotherapy, her veins didn't survive the trauma.

"After the chemotherapy I did not have a port at the time. I could only use my right arm. So they pretty much burnt out all the veins," said Andersen.

Now she gets her blood taken every three months.So it can be difficult and painful finding a vein. That's where the Vein Viewer comes in.

Endovascular Surgeon William Julien uses the Vein Viewer in his practice.

"The Vein Viewer is breakthrough technology, that uses an infrared camera to see the veins immediately under the skin, that you can't see with the naked eye, but because of the heat in the blood vessel, you can see with the infrared camera. The computer processes that information and projects an LCD image back onto the skin surface," said Dr. Julien.

The Vein Viewer also works well for locating spider veins, something Michele Guarnari of Coral Springs could have used a few years ago.

"The spider veins are superficial and they were injected. But a few years later, they came back, and mostly because they couldn't see the deeper veins that were feeding the superficial veins," said Guarnari.

The Vein Viewer allows doctors to locate deeper veins, cutting off the supply to those superficial spider veins. This technology may help patients avoid duplicating procedures and eliminate unnecessary pain.

Homeland Security is also investigating this technology for use as an identification device, since no two people have the same vein pattern. To contact Dr. William Julien about the Vein Viewer call 954-975-6161 or visit his Web site at www.southfloridavascular.com.

Blame Genetics for Varicose Veins

Miami Herald.com ASK DR. SEAN By Dr. Sean Kenniff

Q - Does standing or sitting for a long time cause varicose veins?

A - Varicose veins are unsightly and sometimes painful bulges of the superficial veins of the legs. According to Dr. William Julien, an interventional radiologist and vein specialist in Margate, the cause is mostly due to faulty anatomy.

“The veins in the legs have one-way valves that help keep the blood from flowing backward,” he said. “Some people have defective valves, or they begin to malfunction, and that causes the blood to pool in the legs.”

When the blood pools in the legs, the pressure inside the veins of the legs is increased and the superficial veins start to bulge. Although genetics play a strong role in determining who is at most risk, varicose veins are more common in women. It’s believed hormones like estrogen and progesterone may weaken the walls of the leg veins, causing them to expand and the valves to leak. Pregnancy raises the risk, so does estrogen replacement therapy, and taking birth control pills. Age is also important and the risk gradually increases as we get older.

Genetics, hormones, and age may be the most important causes of varicose veins, but several lifestyle factors have also been linked to their development. Prolonged standing or sitting can increase the venous pressure in the legs and therefore cause varicose veins. High heel shoes, restrictive clothing, and obesity may also be contributing factors. But there are some things you can do to protect yourself, Julien says.

“Elevating your legs, and wearing compression stockings may help”, he said. “And exercise helps because the muscles squeeze the blood in the leg veins and push it back to the heart.”

Most varicose veins pose no health risk, and do not need to be treated. But new treatments, such as Endovascular Thermal Ablation, can correct the problem in the majority of cases.

Dr. Sean Kenniff covers health for WFOR CBS-4. The advice in this column is not a substitute for consulting a physician.

Margate Hospital Takes Part in Clinical Trial

The Forum Procedure is for those who are high-risk for surgery to unclog carotid arteries

Peripheral arterial disease affects 12-20 percent of Americans 65 and older

According to the Society of Interventional Radiologists http://www.sir.org, peripheral arterial disease, or PAD, is a common condition affecting 12-20 percent of Americans age 65 and older that may be a signal of future heart attack and stroke -- and many with the disease may be unaware they have it.

For more than a decade, the Society of Interventional Radiology's national screening program, Legs For Lifehttp://www.legsforlife.com, has helped identify this very serious and potentially life-threatening condition.

An estimated 10 million people in the United States suffer from peripheral arterial disease. PAD develops mostly as a result of atherosclerosis, a condition that occurs when cholesterol and scar tissue buildup, forming a substance called plaque, which narrows and clogs the arteries and slows blood flow to the legs. Since plaque blocks the smaller leg arteries first, PAD is considered a red flag for several life-threatening vascular diseases, such as heart attack (the number one killer in the United States) and stroke. More than 50 percent of PAD patients are asymptomatic and cannot feel the classic warning sign of PAD—leg pain that occurs when walking or exercising and disappears when the person stops the activity. This symptom is typically dismissed as a sign of getting older, as is numbness and tingling in the lower legs and feet, coldness in the lower legs and feet, and ulcers or sores on the legs or feet that don't heal.

In many cases, PAD can be treated with medication (such as blood thinners or drugs that dilate an affected artery), lifestyle changes (such as smoking cessation), diet and a structured exercise program. With early detection, patients could see an interventional radiologist when intervention is most effective and less invasive treatments are still an option. If needed, interventional radiologists can perform minimally invasive angioplasty (the widening of a narrowed or obstructed blood vessel) and/or stenting (the insertion of a tiny mesh tube) to open a blocked artery in the leg and restore blood flow.

A recent study in the Journal of Vascular and Interventional Radiology noted that after a percutaneous vascular intervention (a medical procedure where vascular access is done via needle puncture, rather than by using an open surgical approach) is used to treat PAD, exercise can play an important role in recovery, health and well-being.