Category Archives: Case of the Day

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.

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. ⁠

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

Case of the Day – Dr. Bisharat

Case of the Day - Dr. BisharatCase of the Day:

This patient came in with a completely occluded femoral artery. Dr. Mohannad Bisharat and the cath lab staff at AHV were able to open the femoral artery and restore blood flow. The patient was able to go home a few hours after the outpatient procedure.

Peripheral arterial disease (PAD) is a common circulatory problem in which blocked arteries reduce blood flow to your arms or legs.

When you develop PAD, your extremities cannot receive enough blood flow to keep up with demand. The most common symptom of PAD is leg pain or cramping (claudication).

PAD is also likely a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis) throughout your body. This condition may indicate reduced blood flow to other systems in your body like your heart and brain.

Case of the Day – Dr. Majdi Ashchi

Case of the Day - Dr. Majdi Ashchi Picture 1Case of the Day - Dr. Majdi Ashchi Picture 2

The left picture shows severe blockages in left leg arteries . Patient has an ulcer / wound on left leg. The right picture shows left leg arteries below knee after Dr. Ashchi and the team did laser atherectomy or treatment followed by balloon angioplasty. The patient felt much better once we were done. We anticipate complete healing of their wound.

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