Gabriel's Story : Endovenous Laser Treatment for Varicose Veins

39 year old Gabriel Quiroga is an air conditioner contractor. Part of his everyday routine is going house- to -house or business- to -business, where he climbs up ladders get up to 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.

Quiroga was experiencing severe 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 South Florida Vascular Associates and Dr. William Julien to discuss his symptoms and determine a treatment option. 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.

Varicose vein treatment, also known as endovenous laser treatment (EVLT), is a minimally invasive procedure that uses radiofrequency or laser energy to seal off and close varicose veins in the legs. It may be used for cosmetic purposes, but it is most commonly used to help alleviate related symptoms such as aching, swelling, skin irritation, discoloration or inflammation. EVLT is safe, less invasive than conventional surgery known as vein stripping and leaves virtually no scars.

EVLT is an alternative to traditional open surgery and it requires minimal access to the vein.  In the past, if a patient was suffering from painful varicose veins they would need to undergo an open surgical procedure (vein stripping) to seal off the vein. Vein stripping is very painful and a difficult experience for the patient.
                                                     Dr. William Julien Explains EVLT

Vein stripping is done using general anesthesia and the procedure usually takes up to 1 1/2 hours. After surgery patients have bandages and compression stockings on their leg and the leg may need to be wrapped to control swelling and bleeding for 3 - 5 days or longer after surgery.

EVLT on the other hand, is a much easier on the patient. The procedure typically takes less than one hour, provides immediate relief, no general anesthesia, recovery period is minimized and a patient can immediately return to normal activities, without scarring or stitches. There is a lower rate of complication and a higher success rate.

“I can’t believe how simple this procedure was”, said Quiroga. “I postponed having 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 or call 954-725-4141

Frank's Story: Peripheral Artery Disease

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!

Bartilotta says, “I never thought I would be back to normal, but now I can do what I want to do. I can walk a good 10-to-15 minutes at a time and it’s getting better all the time. Life is pretty close to back to normal. I went on a cruise recently and I walked the whole ship and it’s the biggest ship in the world. I can go to the gym, swim the pool, do anything I want to do.”

If PAD is your problem, talk to your physician about iliac stenting.

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 an office-based endovascular 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.

Dent's Story: Carotid Artery Disease

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

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