Monthly Archives: June 2020

Case of the Day – Dr. Ashchi

Do you have swollen leg(s)? Are you familiar with May-Thurner Syndrome?

We present to you a great case of May-Thurner Syndrome also known as Iliac Vein Compression Syndrome. It’s usually due to the right common iliac artery compressing the left common iliac vein resulting in Thrombus (clot) formation and/or Stenosis (blockage of the vein).

Once this occurs, the patient develops swelling in the leg, heaviness, tiredness, and fatigue in the leg. More advanced cases can result in chronic venous insufficiency (leaking in veins) and ulcers. Diagnosis is mainly by excellent history and physical exam. To verify the diagnosis, we have a few modalities with different sensitivity and specificity which is IVUS (Intravascular Ultrasound). Other modalities that are less sensitive and more specific are CAT Scan Venography, MRI Venography or a simple ultrasound of the pelvic veins and arteries.

Treatment is involved with a minimally invasive procedure by placing IV or catheters in the common femoral veins and performing venography and IVUS. If the patient has compression, stenosis, or total occlusion, then we perform angioplasty and stenting. There are several stents available in the market, however, the best of which is the Vici Stent by Boston Scientific. Our patient in this case received Vici Stent and angioplasty by Atlas Balloon. One video shows before and one shows after an intervention. The left common iliac vein as well as the left external iliac vein are now widely patent. The collaterals that were seen from left to right before interventions have disappeared.

The patient was sent home on Aspirin and Eliquis and already started having improvement in her symptoms. We are blessed and lucky to be living during this era of cutting edge technology.

I want to thank the Ashchi Heart & Vascular Center Cath Lab team and my partners for their professionalism and dedication.

Case of the Day – Dr. M. Bisharat

Treating totally and chronically occluded leg vessels has been a big challenge for decades. Luckily, with newer and safer technologies, totally occluded vessels are not a challenge to us at AHV using multiple techniques where outpatient intervention with different points of access allows safe and patient opening and reconstruction of these vessels.

In this example, a 65-year-old gentleman with disease smoker, presented with absent circulation in the left lower extremity, the angiographic assessment showed occluded femoral artery, which is a condition causing severe symptoms and predisposes the patient for risk of amputation. This was a 45-minute outpatient procedure that ended up with gradient and excellent results and InStent resolution of severe leg symptoms. The picture below shows the occluded blood vessel before and the results of the open vessel after.

We spare no disease at #AHV.

Case of the Day – Dr. M. Bisharat

Arterial aneurysms in the peripheral vessels are not benign, they can be a source of major complications if they rupture and bleed, they can be also painful and can harbor blood clots that eventually transfer to other healthy organs.

With the new advancements in #Endoprosthesis, this case, performed by Dr. Bisharat, demonstrates how to seal and cover a popliteal artery aneurysm located behind the knee using the most advanced covered stent technology made by GORE® VIABAHN®.

The patient had a long history of severe knee pain ended up walking out happy after a 30-minute procedure. Special thanks to Memorial Hospital for providing the best available technology for our #AHV doctors to best serve the patients.


Case of the Day – Dr. M. Bisharat

Coronary bypass grafts are an excellent choice to manage Coronary Artery Disease, however, they are not time-proof. Graft decay and occlusion is a common problem that worsens with time and suboptimal management of risk factors. Treating such a severe disease doesn’t require repeating the open-heart surgery. With modern treatment options, the occluded grafts can be treated to normal with a safe and quick catheter-based approach.

We share with you a case of a patient who had a stress test, followed by a catheter procedure based on the abnormality of the test, which showed a critical occlusion of the graft to the right side of the heart.

Our team at #AHV was able to identify the problem and provide a timely same-day intervention to save the graft, all in one day.

Thanks to the AHV team, the Memorial Hospital Cath Lab team, and Dr. Bisharat for your hard work and dedication for optimal patient care. #Heartdisease doesn’t wait and we won’t either!

#AshchiHeart #ATeam #CoronaryArteryDisease

Case of the Day – Dr. M. Bisharat

Another exciting case we wanted to share with you all:

Occlusive Venous Disease treatment is expanding very rapidly with new devices and techniques adapted daily. We keep ourselves ahead of the game to provide the best, safest, and most up-to-date care fo our patients.

This is a case of critical #occlusion and #thrombosis of the right subclavian vein and right shoulder area. A painful and very disabled clot formed in that big vein on a pleasant 65-year-old gentleman.

With the use of the most efficient clot-removing technology (INARI FlowTriever device), the clot was successfully removed and the flow in the vein was restored to normal levels.

This procedure was performed courtesy of Dr. M. Bisharat and the Cath Lab team at 📍 Memorial Hospital.

#ATeam #AshchiHeart #OcculsiveVenousDisease

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