men`s and women`s health - South Florida Vascular Associates

SOUTH FLORIDA
VASCULAR ASSOCIATES
Leading Change in Vascular Care
MEN’S AND WOMEN’S HEALTH
MINIMALLY INVASIVE TREATMENT OPTIONS
William H. Julien, MD
UTERINE FIBROIDS
Fibroids are benign, non-cancerous growths
in or on the walls of the uterus, or womb.
They can range from less than an inch
around to more than six inches. AfricanAmerican women and those with a family
history are more likely to develop fibroids.
Most fibroids cause no symptoms, and are
only discovered when a woman has a routine
pelvic examination. If you do experience
fibroid symptoms, they may include:
• Heavy, prolonged monthly periods,
sometimes with clots
• Fatigue, secondary to a low blood count
• Pain or pressure between the hip bones
or in the back of the legs
• Pain during sexual intercourse
• Frequent need to urinate
• Constipation or bloating
• An enlarged belly
Treatment Options
If you do not have symptoms, treatment is
probably unnecessary. Your doctor may want
to continue to monitor your fibroids. If you do
have symptoms, several options are available.
Medical Treatments
Birth control pills can often decrease heavy
bleeding. Other hormone treatments can
shrink fibroids, but these treatments may
cause menopause-like side effects such as
hot flashes and bone loss. Fibroid symptoms
usually return when medical treatment stops.
Surgical Treatments
Surgical
treatment
options
include
hysterectomy, which is the removal of the
uterus, and myomectomy, the removal of
just the fibroids. While these options are
generally effective, they require general
anesthesia and lengthy recovery times and
carry risk of surgical complications. Many
women are not candidates for myomectomy
because of the size, number, or location of
their fibroids. Fibroids commonly recur after
myomectomy.
Uterine Fibroid Embolization
Uterine fibroid embolization (UFE), also known as uterine artery embolization, 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.
The procedure is performed by making a tiny nick in the skin in the groin and inserting
a tube, known as a catheter, into the femoral artery. Using x-ray imaging, the catheter is
guided through the arterial system and into the arteries supplying the uterus. Tiny particles,
the size of grains of sand, are then injected into the uterine arteries to block the blood flow
to the fibroid.
Recovery Time
Fibroid embolization is done in an outpatient setting in our office with no overnight stay.
Pain-killing medications and drugs that control swelling typically are prescribed following
the procedure to treat cramping and pain. Many women resume light activities in a few days
and the majority of women are able to return to normal activities within seven to ten days.
VARICOSE VEINS AND VENOUS INSUFFICIENCY
Venous insufficiency is a very common condition resulting from decreased blood flow
from the leg veins up to the heart, with pooling of blood in the veins. Normally, one-way
valves in the veins keep blood flowing toward the heart, against the force of gravity. When
the valves become weak and don’t close properly, they allow blood to flow backward, a
condition called reflux. Veins that have lost their valve effectiveness become elongated,
rope-like, bulged, and thickened. These enlarged, swollen vessels are known as varicose
veins and are a direct result of increased pressure from reflux. A common cause of
varicose veins in the legs is reflux in a thigh vein called the great saphenous, which leads
to pooling in the visible varicose veins as shown below.
Symptoms
• Aching leg pain.
• Easy leg fatigue.
• Leg heaviness.
*All of which worsen as the day progresses.
Before EVLT
After EVLT
In more severe cases, venous insufficiency and reflux can cause:
• Skin discoloration.
• Leg ulceration which may be very difficult to treat.
• Bleeding varicose veins.
Treatments
• Vein Stripping and ligation - typically performed in a hospital under general anesthesia
and has largely fallen out of favor for new minimally invasive techniques.
• Endovascular Laser Treatment (EVLT) - an office-based procedure performed using
imaging guidance, in where the abnormal vein is sealed shut with a laser fiber.
• Microphlebectomy – when tortuous veins are removed through tiny skin incisions
(micro) under local anesthesia.
• Ultrasound-guided Sclerotherapy - using ultrasound guidance and injecting a substance
that causes the veins to scar and close rerouting the blood to healthier veins.
Benefits of EVLT
• The treatment takes less than an hour.
• Performed in our office.
• Immediate relief of symptoms.
• Return to normal activity immediately.
• No anesthesia or hospitalization.
• No scars.
VARICOCELE
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
(see diagram) has weak defective valves resulting in the blood pooling in varicose veins
in the scrotum. It is a relatively common condition (affecting approximately 10 percent
of men) that tends to occur in young men, usually during the second or third decade of
life. Sometimes, varicoceles cause no symptoms and are harmless. But sometimes a
varicocele causes pain, testicular atrophy (shrinkage), or fertility problems.
Treatment Options
Surgical
In varicocele ligation surgery, an incision is made in the skin above the scrotum, cutting
down to the testicular veins, and tying them off with sutures. It is usually performed under
general anesthesia. Although patients leave the hospital the same day, there is a two to
three week recovery period.
Varicocele Embolization
Varicocele embolization is an outpatient procedure that is performed without general
anesthesia using “twilight” sedation. In this procedure, a small tube is inserted into the
femoral vein in the groin or a vein in the neck through a small nick in the skin (about
the size of the lead in a pencil). The skin is numbed for this procedure and it is not
painful. Next, a small catheter, or tube, is painlessly guided into the abdomen and into
the varicocele vein under the guidance of x-ray imaging (see Figure). The vein is then
intentionally closed off by plugging it with small metals coils and a special medication (the
same sclerosant medication injected into leg varicose veins). The procedure takes 30
minutes and the patient goes home a few hours later with only a band aid at the puncture
site. They can immediately resume their non exertional activities.
The advantages of varicocele embolization include:
• Performed under local anesthesia with mild sedation (general anesthesia used for
varicocele ligation).
• Performed on an outpatient basis in our office endovascular suite, not in a hospital.
• No surgical incision in the groin, only a tiny hole in the skin where a catheter is placed.
Leave the office with only a band aid.
• 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.
• Lower rate of complications compared to surgery. Infection has not been reported after
embolization.
New treatment options for
varicoceles brings smiles
to men across the world!
PELVIC CONGESTION SYNDROME
It is estimated that one-third of all women will experience chronic pelvic pain in their lifetime.
Many of these women are told the problem is “all in their head” but recent advancements
now show the pain may be due to hard to detect varicose veins in the pelvis, known as
pelvic congestion syndrome. (It is the female equivalent of a man’s varicocele.)
Pelvic congestion syndrome is similar to varicose veins in the legs but in this condition a
vein called the gonadal vein (see diagram on previous page) has weak defective valves
resulting in blood pooling in varicose veins in the pelvis. These bulging veins can cause
pain and affect the uterus, ovaries and vulva. Up to 15 percent of women, generally
between the ages of 20 and 50, have varicose veins in the pelvis, although not all
experience symptoms. The diagnosis is often missed because women lie down for a
pelvic exam, relieving pressure from the ovarian veins, so that the veins no longer bulge
with blood as they do while a woman is standing.
Symptoms
The chronic pain that is associated with this disease is usually dull and aching. The pain
is usually felt in the lower abdomen and lower back.
The pain often increases during the following times:
• Following intercourse.
• Menstrual periods.
• When tired or when standing (worse at end of day).
• Pregnancy.
Embolization Treatment for Pelvic Congestion Syndrome
Embolization for Pelvic Congestion Syndrome is an outpatient procedure that is performed
without general anesthesia using “twilight” sedation. In this procedure, a small tube is inserted
into the femoral vein in the groin or a vein in the neck through a small nick in the skin (about the
size of the lead in a pencil). The skin is numbed for this procedure and it is not painful. Next, a
small catheter, or tube, is painlessly guided into the abdomen and into the gonadal vein under
the guidance of x-ray imaging. The vein is then intentionally closed off by plugging it with small
metals coils and a special medication (the same sclerosant medication injected into leg varicose
veins). The procedure takes 30 minutes and the patient goes home a few hours later with only a
band aid at the puncture site. They can immediately resume their non exertional activities.
THE DIFFERENCE
South Florida Vascular Associates specialize in image-guided, minimally invasive
techniques that are often an alternative to traditional open surgery. Our highly specialized,
board-certified physicians use state-of-the-art diagnostic technology that ensures high
quality patient focused care. Patients are seen for their private consultation at our new
8,000 sq. ft. office. If a procedure is ultimately recommended it is performed in our
sophisticated office endovascular suites, one of the first of their kind in the country.
The minimally invasive techniques used by our physicians are an advance in medicine
that often replaces open surgical procedures. They are generally easier for the patient
because they involve no large incisions, less risk, less pain and shorter recovery times.
Our dedicated and knowledgeable staff offers the best care to each and every patient. We
provide our patients with detailed information of the plan of care and are always available
to answer any questions. At South Florida Vascular Associates we strive for excellence in
patient care as the vascular experts in the community.
William H. Julien, MD
Dr. Julien graduated from the Washington University School of Medicine in St. Louis, MO.
He served his residency in Diagnostic Radiology at the University of Minnesota Hospital
in Minneapolis and completed an Interventional Radiology fellowship at Baptist Cardiac
and Vascular Institute in Miami, FL. Dr. Julien has been practicing full-time Interventional
Radiology for 19 years and has performed more than 35,000 endovascular procedures.
He is certified by the American Board of Radiology with a Certificate of Added Qualification in Interventional Radiology.
William H. Julien, M.D.
SOUTH FLORIDA
VASCULAR ASSOCIATES
Leading Change in Vascular Care
5300 W. Hillsboro Blvd, Suite 107 · Coconut Creek, FL USA 33073
Telephone: 954-725-4141 · Facsmile: 954 725 4318
(Se habla Español)
Email: [email protected]
www.SouthFloridaVascular.com
William H. Julien, MD
South Florida Vascular Associates accepts most commercial insurance as well as Medicare.
Our experienced staff is available to assist all patients with their individual needs.