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Vascular Update – SPRING 2016

Posted by on Apr 23, 2016 in Newsletters | Comments Off on Vascular Update – SPRING 2016

THE VASCULAR EXPERTS —

Advanced Medical Care from the Nation’s Top Team of Vascular Surgeons — Founded in 2001 to deliver expert vascular medical and surgical care to the communities of Southern Connecticut and New York, The Vascular Experts is now one of the largest groups of board-certified vascular surgeons in the country.

NEW TECHNOLOGY:
Drug-coated Balloons (DCB’s)

A new era in the treatment of peripheral artery disease

The last decade has seen an explosion in new techniques and devices for peripheral artery disease (PAD). These percutaneous endovascular approaches have allowed for the treatment of limbthreatening ischemia in older patients with multiple co-morbidities, who may not previously have been candidates for revascularization. Procedures including atherectomy (plaque excision), angioplasty, and stent placement have truly revolutionized the field. These approaches continue to become further refined with smaller device profiles, more options for sizing, and better long-term outcomes.

dcb-2The newest advancement has been the recent introduction of drug-coated balloons (“DCBs”). These are standard angioplasty balloons that have been covered with particular formulations of Paclitaxel – an antiproliferative agent for the prevention of restenosis (recurrent narrowing).

The balloon is inflated in the region being treated, and the drug is transferred to the arterial wall. The benefit of these balloons was recently published in the New England Journal of Medicine in July of 2015 (Rosenfield K, Et al. Trial of a Paclitaxel-Coated Balloon for Femoropopliteal Artery Disease. NEJM 2015; 373:145-153.

dcb-3Paclitaxel, originally used as a chemotherapeutic drug, was discovered in the bark of the Pacific Yew tree, and has been used successfully in the coronary arteries. Adding this drug to our current interventions will hopefully limit neointimal hyperplasia (scar tissue) that commonly forms following interventions on the vasculature.

The Vascular Experts have already begun treating patients with these new breakthrough balloons. Hospitals across the region have embraced these products, and many have stock on the shelf today.

Recent Publication

Lee Goldstein, MD, FACS, CWS recently authored another publication in the Journal of Vascular Access. Minimally invasive axillary to right atrial graft for hemodialysis access utilizing the intraluminal flow guard graft describes a creative approach to challenging dialysis access. The patient described has significant developmental disabilities and multiple, complex central venous occlusions. When he presented he had an indwelling transhepatic catheter that would routinely become dislodged by the patient. The patient was treated with a minimally invasive axillary to right atrial graft across the chest wall. The access is still in use years after placement.

Goldstein LJ, Balabanoff C, Carillo R, de Mendoza VL, Bornak A, Tabbara M. Minimally invasive axillary to right atrial graft for hemodialysis access utilizing the intraluminal flow guard graft. J Vasc Access. 2015;16(5):e87–e88. doi:10.5301/ jva.5000441


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Ask Dr. Goldstein about:

Pulmonary Embolism

Improvement in Care:
Endovascular treatment of acute pulmonary embolism with ultrasound-facilitated catheter-directed low-dose thrombolysis.

A major shift is occurring in the treatment of acute pulmonary embolism. Traditionally treated with anticoagulants or systemic thrombolysis, these events were often fatal, or resulted in long-term morbidity and mortality (pulmonary hypertension). Additionally, systemic thrombolysis has the potential to cause hemorrhagic stroke.

Endovascular treatment of acute pulmonary embolism with ultrasound-facilitated catheter-directed low-dose thrombolysis.

A new method of delivering low dose thrombolytic therapy via a catheter or catheters placed in the pulmonary arteries allows treatment of acute pulmonary embolism with fewer complications. This catheter produces high-frequency ultrasonic energy, which makes the clot more permeable to thrombolytic drugs. Ideal patients for this approach have massive or submassive pulmonary emboli with strain on the right heart.

This summer the SEATTLE II study was published in JACC Cardiovascular Interventions. Though a single arm study, it shows the safety and efficacy of this technique. Additionally, there was a significant decrease in post-procedure pulmonary hypertension. This can relieve patients of devastating long term complications.

This therapy is available in Bridgeport Hospital. Dr. Lee Goldstein, working along with Drs. Edward Tuohy, Mitchell Driesman, and Robert Fishman, has successfully begun treating patients.

Vascular Update – SPRING 2015

Posted by on Jul 8, 2015 in Newsletters | Comments Off on Vascular Update – SPRING 2015

Featured Doctor –

Lee J. Goldstein, MD, FACS

LEE GOLDSTEIN_MD_001Lee J. Goldstein is a board certified general and vascular surgeon who joined The Vascular Experts in 2014, after spending 5 years as an Assistant Professor of Surgery at the University of Miami. While in Miami, Dr. Goldstein had been the Principal Investigator at the University for several national vascular surgery research trials including the Percutaneous Aneurysm Repair (PEVAR) Trial. During his career, he has authored dozens of peerreviewed research articles and abstract presentations at national meetings. He graduated from Yale University School of Medicine and continued his general surgery training at The Hospital of the University of Pennsylvania. He further specialized in vascular and endovascular surgery at The New York Presbyterian Hospital (Cornell and Columbia Universities).

In 2011, Dr. Goldstein became a Certified Wound Specialist (CWS, American Board of Wound Management), and has an active interest in wound care, limb salvage, and amputation prevention. He has expert experience treating carotid disease, abdominal aneurysms (including both open surgery and complex endovascular repair), and venous disorders. Dr. Goldstein is a Fellow of the American College of Surgeons, a member of the Vascular and Endovascular Surgery Society, the Association for Advanced Wound Care, and the South Florida Society for Vascular Surgery. Dr. Goldstein operates at Bridgeport Hospital and other area hospitals. He sees patients by appointment at our Stratford location.

THE VASCULAR EXPERTS —

Advanced Medical Care from the Nation’s Top Team of Vascular Surgeons — Founded in 2001 to deliver expert vascular medical and surgical care to the communities of Southern Connecticut and New York, The Vascular Experts is now one of the largest groups of board-certified vascular surgeons in the country.

NEW FENESTRATED GRAFT TECHNOLOGY:

Technology that allows minimally invasive treatment of complex aortic aneurysms

NGTThe majority of abdominal aortic aneurysms are found below the kidneys, and are amenable to stent graft repair through the groins. Most aneurysm repairs can be approached percutaneously (without incision), and many can be performed without a general anesthetic.

“Most aneurysm repairs can be approached percutaneously (without incision), and many can be performed without a general anesthetic”

However, the subset of aneurysms that encroach on the renal arteries are more challenging to fix with an endovascular solution. Traditionally, these complex aneurysms would require open surgery to repair. Until now. The Vascular Experts now has access to the next generation of stent graft: the Zenith Fenestrated Graft. This allows aneurysms involving the renal arteries to not only be more securely treated, but it also expands the number of patients to whom we can offer an endovascular solution to this problem.

Peripheral Artery Disease (PAD) –

Does your patient have a problem with their circulation?

Do your patients complain of cold, crampy, or painful legs? Have their activities or work duties become limited due to painful leg cramps? Do they have a non-healing ulcer or wound that does not respond to wound care?

PAD is very common, and many people are not even aware they have diseased arteries. As people age, nearly 70% over the age of 80 will have PAD. There are many causes of PAD, but the most common are diabetes, cigarette smoking, high blood pressure, high cholesterol, and family history (genes).

Diabetes and smoking together are especially dangerous. People who have more than one of these risk factors increase their chances of having PAD significantly.

arteryThe symptoms of PAD are fairly reproducible: crampy leg pain or weakness brought on by walking or exercise. Most people state their symptoms improve with short periods of rest. More advanced disease may manifest itself with a non-healing, painful ulcer or wound, or even progress to gangrene of the foot or toes. Some people become so debilitated that they have constant pain, or are unable to walk any longer. Symptoms such as these require urgent attention, as they could even lead to amputation.

Diagnosis is relatively straightforward by using a combination of history and physical exam and non- invasive ultrasound testing performed in our office. Identifying PAD in your patients early can help prevent amputations, and
identify those at risk for systemic cardiovascular disease.

The Vascular Experts specialize in the treatment of PAD. Treatment includes a range of methods from conservative to minimally invasive balloon angioplasty and stenting to open surgical bypass procedures.

Recent Publication

endovascularLee Goldstein, MD, FACS, recently co-authored an accepted manuscript in the Annals of Vascular Surgery. This case report describes a young female smoker who presented with acute aortic occlusion due to a saddle embolus. She had a severe neurologic deficit. We successfully treated this condition endovascularly and restored full neurologic function. Covered stents were used in the repair.

Yang JK, Nguyen A, De Amorim H, Goldstein LJ, Bornak A. Endovascular Treatment of an Aortic Saddle Embolism Resulting in Full Neurologic Recovery. Ann Vasc Surg. 2015 (in press).


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Ask Dr. Goldstein

about: Swollen Legs
Vascular surgeons are frequently asked to comment on leg swelling. There are many reasons patients get swollen legs… and new therapies with which to treat them.

Classic venous insufficiency is often manifested by leg swelling, varicose veins, and other venous stigmata (hyperpigmentation, corona phlebectatica, and lipodermatosclerosis). Over years of chronic scarring and protein deposits, patients can progress to nonhealing ulceration.

“What can be done?”

SwollenLegs

Severe venous insufficiency with hyperpigmentation and scarring

This common complaint from patients can be quite frustrating. Many patients spend years without a definitive diagnosis or effective intervention. Others complain of itching, pain, or fatigue as well.

There are many causes for leg swelling, ranging from congenital disorders to acquired pathology. We routinely see patients with classic venous insufficiency, lipedema, lymphedema, post-thrombotic (DVT) swelling and central venous disorders.

Proper diagnosis is key. Some disorders respond to diuretic therapy, but many do not. Superifical venous reflux and varicose vein disease (with inflammation and ulceration), can often be treated with conservative therapy: limb elevation, and prescription compression stockings. Refractory cases or venous ulcerations respond well to saphenous vein ablation when indicated. These procedures can be performed in the office setting, and take less than 15 minutes.

Leg swelling and venous disorders can be effectively treated, often in the outpatient setting

Newer techniques to evaluate the central iliac veins are being routinely performed. Using flouroscopy, venography, and intravascular ultrasound (catheter based ultrasound inside of blood vessels) we can successfully treat venous outflow lesions and conditions such as May-Thurner Syndrome.

We see a large population of lymphedema and deep venous thrombosis patients as well. We are happy to work with you to help manage these challenging
patients.

The Vascular Experts — We have state-of-the-art facilities in multiple locations for angioplasty, endovascular surgery, sclerotherapy and minimally invasive surgical procedures to treat vascular disease.

Diagnostic, Preventive Care & Treatment Services Our goal is to deliver the best patient experience with the highest level of patient care. We achieve this through the use of cutting-edge medical technology and the use of modern endovascular therapies (angioplasty/stent) as well as traditional procedures for treatment of vascular disease.

Our diagnosis and treatment services include:

    • Diagnostic testing – with non-invasive methods such as Ultrasound and PVR
    • Minimally invasive treatment – with non-surgical procedures
    • Surgical treatment – performed in house or at local hospitals