Ashchi Heart & Vascular Center offers articles on the diagnosis and treatment of heart and vascular diseases (arteries and veins) and a lifestyle blog, including easy-to-share healthy recipes

Case of the Day – Dr. Ashchi

This wonderful patient came to #AHV from another hospital for a second opinion in regards to gangrene and poor circulation in her leg. Before she came to us, she had a procedure done on her legs, but suddenly it worsened and became cold and gangrenous and eventually was offered amputation as her last resort.

This condition is called Peripheral Arterial Disease (PAD). Dr. Ashchi and the AHV team took her in on a Saturday morning at the AHV Outpatient Cath Lab and was able to open up the arteries and restore blood flow to the leg rather than performing the suggested below-the-knee amputation. Two years later the patient is still walking. That’s a win for all of us!

Too many amputations happen and we believe that two or three opinions should be made prior to amputation. These amputations are occurring without proper care at a rate of almost 40-50%.

Not all specialists can perform below-the-knee vascular work and limb salvage. Do your research first! It is easy to look at the Medicare website and see which hospital or doctors have the lowest amputation rates in your region.

Are you having similar issues? Schedule a consultation today by calling us at 904.222.6656.

What is Peripheral Artery Disease (PAD)?

PAD is similar to coronary artery disease (CAD)

Peripheral artery disease is a narrowing of the peripheral arteries serving the legs, stomach, arms, and head. (“Peripheral” in this case means away from the heart, in the outer regions of the body.) PAD most commonly affects arteries in the legs.

Both PAD and coronary artery disease (CAD) are caused by atherosclerosis. Atherosclerosis narrows and blocks arteries in critical regions of the body.

Quick facts about PAD

The most common symptoms of PAD involving the lower extremities are cramping, pain, or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again.

Be aware that:

  • Many people mistake the symptoms of PAD for something else.
  • PAD often goes undiagnosed by healthcare professionals.
  • People with peripheral arterial disease have a higher risk of coronary artery disease, heart attack or stroke.
  • Left untreated, PAD can lead to gangrene and amputation.

Added risks for PAD

Other factors can increase your chances for peripheral artery disease, including:

The good news is…

If you’re at risk for peripheral artery disease or have been diagnosed with PAD, it’s worth knowing that:

Atherosclerosis and PAD

PAD watch learn and live blood flow thumbnail

If you have atherosclerosis, that means that plaque has built up inside your artery walls. Plaque is made up of deposits of fats, cholesterol, and other substances. Atherosclerosis in the peripheral arteries is the most common cause of PAD.

What happens is this: First, plaque builds up enough to narrow an artery, which chokes off blood flow. Next, if that plaque becomes brittle or inflamed, it may rupture, triggering a blood clot to form. A clot can further narrow the artery or completely block it.

If that blockage remains in the peripheral arteries of the legs, it can cause pain, changes in skin color, difficulty walking and sores, or ulcers. Total loss of circulation to the legs and feet can cause gangrene and the loss of a limb. If the blockage occurs in a carotid artery, it can cause a stroke.

It’s important to learn the facts about PAD. As with any disease, the more you understand, the more you’ll be able to help your doctor make an early diagnosis. PAD has common symptoms, but many people with PAD never have any symptoms at all.

Learn the facts, talk to your cardiologist, and take control of your cardiovascular health. Schedule an appointment today by calling (904) 222.6656.

Article from:

Heart Healthy Recipe: Banana Bread


Have your cake and eat it with this low-fat, healthy banana loaf – perfect for breakfast and beyond.


  • low-fat spread, for the tin, plus extra to serve
  • 140g wholemeal flour
  • 100g self-raising flour
  • 1 tsp bicarbonate of soda
  • 1 tsp baking powder
  • 300g mashed banana from overripe black bananas
  • 4 tbsp agave syrup
  • 3 large eggs, beaten with a fork
  • 150ml pot low-fat natural yogurt
  • 25g chopped pecan or walnuts (optional)


  1. Heat oven to 320 F. Grease and line a 2lb loaf tin with baking parchment (allow it to come 2cm above the top of tin). Mix the flours, bicarb, baking powder and a pinch of salt in a large bowl.
  2. Mix the bananas, syrup, eggs, and yogurt. Quickly stir into dry ingredients, then gently scrape into the tin and scatter with nuts, if using. Bake for 1 hr 10 mins-1 hr 15 mins or until a skewer comes out clean.
  3. Cool in tin on a wire rack. Eat warm or at room temperature, with low-fat spread.

Recipe from:

What are Varicose Veins?

Varicose veins are veins that have become twisted and/or enlarged. Any vein can technically become varicose, but the most affected area is the legs. This is due to constant standing/walking which will increase the pressure in your veins of your legs. Most often this is just a cosmetic issue with people, but varicose veins can lead to other serious problems.

 Signs of Varicose Veins

Some physical signs of varicose veins can be veins that have a dark purple or blue hue to them. Another sign is that the veins appear to look like bulging cords on your legs. Other internal signs can be achy, burning, throbbing, cramping, and/or itching of your lower legs. Pain can also occur when sitting or standing for long periods of time.  

Cause of Varicose Veins

The causes of varicose veins are due to weak or damaged valves. These tiny valves open when the blood is flowing towards your heart and close to prevent blood from flowing backward. If the valves are weak or damaged, then blood will flow backward and cause pooling which in turn makes the veins stretch and twist. 

Risk Factors

Risk factors can include age, gender, pregnancy, family history, obesity, and/or standing/ sitting for extended periods of time. With age, the valves have had a lot of wear and tear, so regulating blood flow becomes more difficult over time. Women are more likely to develop this condition due to hormonal changes, pregnancy, menopause, or pre-menstruation because of relaxed vein walls. Being overweight and standing/sitting for a long time will add pressure to your veins and the blood does not flow as smoothly.

Personal/At-Home Treatments

There are many kinds of at-home treatments as well as medical treatments. Some at-home remedies include regular exercise and movement, compression stockings, dietary changes, keeping the legs elevated when sitting/laying down, and eating more flavonoids.

Regular movement can include low impact workouts such as yoga, swimming, walking, and cycling. Compression socks will aid the muscles and veins to move blood towards the heart. Dietary changes to consider can be reducing your sodium intake and increase your potassium intake. This can be done by including foods such as almonds, pistachio nuts, lentils, and white beans to your daily meals. Flavonoids are phytonutrients (plant chemicals) that will improve your blood circulation. Some foods that contain flavonoids are vegetables (onions, bell peppers, spinach, broccoli), citrus fruits, cocoa, and garlic.

 Medicinal/Surgical Treatments

Medicinal/surgical treatments can include sclerotherapy, micro sclerotherapy, laser surgery, vein stripping and ligation, ambulatory phlebectomy, endoscopic vein surgery, and endovenous ablation therapy. Sclerotherapy is the use of a liquid chemical that will close off a varicose vein. The chemical will be injected into the vein and then over time the vein will close off and fade away. Micro sclerotherapy is used to treat small varicose veins. This is almost the same process of sclerotherapy, which is when a small amount of liquid chemical is injected into the vein. Then, the chemical will scar the inner lining of a vein and allow the vein to close off.

Laser surgery is when light energy is applied using a laser to the varicose vein which allows for the vein to fade away without the use of chemicals or injections. This is primarily used for smaller varicose veins. Vein stripping and ligation are only used for extreme cases of varicose veins. The vein would potentially be tied off shut and removed. This is an outpatient procedure done under anesthetics.

Ambulatory phlebectomy is when incisions are made into the skin to remove the smaller varicose veins. This is only done when the varicose veins are close to the surface of the skin. Endoscopic vein surgery is also when an incision would be made into the skin and a camera is used to move through the vein. This procedure is only used when the varicose veins are causing skin ulcers.

Endovenous ablation surgery is when radio waves are used to create heat and close off the varicose veins. An incision is made near the disrupted vein and a catheter will be inserted. The laser at the tip will heat up inside the vein and close it off. As described above, there are many treatments and resources that can be utilized for varicose veins. 

If you are experiencing any issues with varicose veins, give us a call at 904-222-6656 or visit our website at

What is Edema?

Edema is swelling that is caused by fluid trapped in your body’s tissues. Edema happens most often in the feet, ankles, and legs, but can affect other parts of the body, such as the face, hands, and abdomen. It can also involve the entire body.

What causes Edema?

Edema has many possible causes:

  • Edema can occur as a result of gravity, especially from sitting or standing in one place for too long. Water naturally gets pulled down into your legs and feet.
  • Edema can happen from a weakening in the valves of the veins in the legs (a condition called venous insufficiency). This problem makes it hard for the veins to push blood back up to the heart and leads to varicose veins and a buildup of fluid in the legs.
  • Certain diseases — such as congestive heart failure and lung, liver, kidney, and thyroid diseases — can cause edema or make it worse.
  • Some drugs, such as medications that you are taking for your blood pressure or to control pain, may cause or worsen edema.
  • An allergic reaction, severe inflammation, burns, trauma, clot(s), or poor nutrition can also cause edema.
  • Too much salt from your diet can make edema worse.
  • Being pregnant can cause edema in the legs as the uterus puts pressure on the blood vessels in the lower trunk of the body.

What are the symptoms of Edema?

Signs that you might have edema include the following:

  • The affected area is swollen.
  • The skin over the swollen area might look stretched and shiny.
  • Pushing in gently on the swollen area with your finger for at least 5 seconds and then removing your finger will leave a dimple in the skin.
  • You may have trouble walking if your legs are swollen.
  • You may be coughing or have trouble breathing if you have edema in the lungs.

To keep swelling down, your health care provider may recommend keeping your legs raised when sitting, wearing support stockings, limiting how much salt you eat, or taking a medicine called a diuretic – also called a water pill.

If you feel like you are experiencing any signs of edema, give us a call to schedule a consultation today at 904-222-6656.

What are Vascular Diseases?

Your vascular system is your body’s network of blood vessels. It includes your

  • Arteries, which carry oxygen-rich blood from your heart to your tissues and organs
  • Veins, which carry the blood and waste products back to your heart
  • Capillaries, which are tiny blood vessels that connect your small arteries to your small veins. The walls of the capillaries are thin and leaky, to allow for an exchange of materials between your tissues and blood.

Vascular diseases are conditions that affect your vascular system. They are common and can be serious. Some types include:

  • Aneurysm – a bulge or “ballooning” in the wall of an artery
  • Atherosclerosis – a disease in which plaque builds up inside your arteries. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood.
  • Blood clots, including deep vein thrombosis and pulmonary embolism
  • Coronary artery disease and carotid artery disease, diseases that involve the narrowing or blockage of an artery. The cause is usually a buildup of plaque.
  • Raynaud’s disease – a disorder that causes the blood vessels to narrow when you are cold or feeling stressed
  • Stroke – a serious condition that happens when blood flow to your brain stops.
  • Varicose veins – swollen, twisted veins that you can see just under the skin
  • Vasculitis – inflammation of the blood vessels

What causes vascular diseases?

The causes of vascular diseases depend on the specific disease. These causes can include:

  • Genetics
  • Heart diseases such as high cholesterol and high blood pressure
  • Infection
  • Injury
  • Medicines, including hormones

Sometimes the cause is unknown.

Who is at risk for vascular diseases?

The risk factors for vascular diseases can vary, depending on the specific disease. Some of the more common risk factors include:

  • Age – your risk of some diseases goes up as you get older
  • Conditions that can affect the heart and blood vessels, such as diabetes or high cholesterol
  • Family history of vascular or heart diseases
  • Infection or injury that damages your veins
  • Lack of exercise
  • Obesity
  • Pregnancy
  • Sitting or standing still for long periods of time
  • Smoking

What are the symptoms of vascular diseases?

The symptoms of each disease can be very different.

How are vascular diseases diagnosed?

To make a diagnosis, your health care provider will do a physical exam and ask about your symptoms and medical history. You may have imaging tests and/or blood tests.

How are vascular diseases treated?

Which treatment you get depends on which vascular disease you have and how severe it is. Types of treatments for vascular diseases include:

  • Lifestyle changes, such as eating a heart-healthy diet and getting more exercise
  • Medicines, such as blood pressure medicines, blood thinners, cholesterol medicines, and clot-dissolving drugs. In some cases, providers use a catheter to send medicine directly to a blood vessel.
  • Non-surgical procedures, such as angioplasty, stenting, and vein ablation
  • Surgery

Can vascular diseases be prevented?

There are steps you can take to help prevent vascular diseases:

  • Make healthy lifestyle changes, such as eating a heart-healthy diet and getting more exercise
  • Don’t smoke. If you are already a smoker, talk to your health care provider for help in finding the best way for you to quit.
  • Keep your blood pressure and cholesterol in check
  • If you have diabetes, control your blood sugar
  • Try not to sit or stand for up long periods of time. If you do need to sit all day, get up and move around every hour or so. If you traveling on a long trip, you can also wear compression stockings and regularly stretch your legs.

If you are experiencing any issues in relation to vascular disease, give us a call today at 904-222-6656 or visit our website at

Case of the Day – Dr. M. Bisharat

Treating Peripheral Arterial Disease is challenging and requires a unique set of skills for optimal outcomes especially if the disease process involves any or all three vessels that reins from the knee to the foot, also known as Infra-Popliteal Artery Intervention or Below-knee Angioplasty. A successful limb angioplasty is never complete without addressing the below-knee arteries. At the #AHV outpatient lab, we perform these complex procedures on a daily basis with an outstanding success rate. This case demonstrates a successful angioplasty for the three below-knee vessels of the right leg restoring flow to the right lower limb.

Our AHV team led by Dr. M. Bisharat managed to perform this complex case safely and successfully in less than an hour and the patient was able to walk home happily after two hours of recovery.

Case of the Day – Dr. M. Bisharat

Renal Artery Stenosis is a major player in resistant hypertension, often missed until the patient is on several medications with resistant blood pressure. Screening for renal artery stenosis is very important in such cases and a detailed ultrasound study can detect this issue. ⁠

This is the case of a 65-year-old patient struggling with elevated blood pressure for many years. Careful assessment by our team at #AHV demonstrated this issue and our Cath Lab team led by Dr. M. Bisharat was able to treat the stenosis in the right renal artery in a short and safe outpatient procedure. The patient’s blood pressure responded quickly to the new stent and was able to drop two out of three blood pressure medications in a few days. ⁠



There are many diagnostic tests available that a cardiologist can recommend. Each test has its own purpose, use, and benefit in monitoring heart health. One of the more popular tests is the POSITRON EMISSION TOMOGRAPHY (PET) scan. 

These tests are used to evaluate a range of heart symptoms and conditions with more superior image quality and higher diagnostic accuracy than many alternatives. 


PET scans are imaging tests that can give doctors better insight into the function and structure of one’s body tissues and organs. These tests are performed with the use of a specula dye containing radioactive tracers. One the dye has been injected, the patient will lay on a table that slides into a large, tunnel-shaped machine. This machine scans the area of concern and picks up specific signals from the tracers. Computers will then create a series of images from these signals which then will be used to create a three-dimensional map of the heart.


Your doctor may order a PET scan if you’re experiencing symptoms of heart trouble which include:

  • irregular heartbeat (arrhythmia)
  • pain in your chest
  • tightness in your chest
  • trouble breathing
  • weakness
  • profuse sweating


One of the greatest benefits is the ability to accurately measure blood flow between the coronary arteries and heart muscle. Another is being able to detect dead or injured tissue through high-resolution images. With this information, cardiologists are able to diagnose conditions such as Coronary Artery Disease and tissue damage that follow a heart attack. 

PET Scans also help cardiologists determine whether or not a patient will need any type of surgical procedure such as angioplasty, to open clogged arteries or a coronary artery bypass surgery.

To learn more about this test and if it may be beneficial to you, give us a call to schedule an appointment at 904.222.6656. 

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.

Skip to content