MEN S AND WOMEN S HEALTH MINIMALLY INVASIVE TREATMENT OPTIONS

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1 SOUTH FLORIDA VASCULAR ASSOCIATES Leading Change in Vascular Care MEN S AND WOMEN S HEALTH MINIMALLY INVASIVE TREATMENT OPTIONS William H. Julien, MD

2 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. African- American 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 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. 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

3 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.

4 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.

5 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.

6 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.

7 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!

8 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.

9 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.

10 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.

11 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.

12 SOUTH FLORIDA VASCULAR ASSOCIATES Leading Change in Vascular Care 5300 W. Hillsboro Blvd, Suite 107 Coconut Creek, FL USA Telephone: Facsmile: (Se habla Español) 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.