Author: Texas Endovascular

Hemorrhoid Embolization vs Other Treatment Options

How does hemorrhoid embolization compare to other minimally invasive treatments for internal hemorrhoids? And how can you choose the best treatment for your condition? Keep reading to find out!

What are hemorrhoids?

Between 5 and 40% of the population have hemorrhoids,  or swollen veins in your anus or lower rectum.  There are two kinds of hemorrhoids: internal, located inside your rectum, and external, located outside. While external hemorrhoids are more likely to cause pain, internal hemorrhoids can be painful, but prone to bleeding.

In fact, chronic bleeding is the main symptom people with internal hemorrhoids complain about. As such, our patients typically seek treatment for internal hemorrhoids when they notice blood in their stool.

Hemorrhoid Treatment Options woman sitting on toilet

There are several minimally invasive treatment options for internal hemorrhoids. These include changes to your diet; oral medications; injections; and therapies such as rubber band ligation. However, for a good 10% of patients with internal hemorrhoids, these treatments failed. The result? Until recently, those individuals were left with two options: continue suffering, or schedule a hemorrhoidectomy. (That’s the surgical removal of these swollen veins.)  But surgery comes with its own risk of complications. And that led to the development of a superior treatment option: hemorrhoid embolization.

Hemorrhoid Embolization: A Superior Treatment Option

Developed approximately 10 years ago, hemorrhoid embolization is a new way to treat stage 1 through 3 internal hemorrhoids. But how does it compare to other treatment options? Here’s what you need to know. When you choose hemorrhoid embolization, you don’t have to worry about anal incontinence or rectal wounds. Plus, this procedure allows you to retain the tissue surrounding your hemorrhoids, and you get to avoid general anesthesia and an overnight hospital stay. Best of all, most patients can resume their full activity level just three days after the procedure.

Of course, all of that sounds great. But we know you have one more question. Does hemorrhoid embolization last? Well, here’s some more great news. While other treatments for internal hemorrhoids have a 49% recurrence rate (meaning your hemorrhoids come back again) hemorrhoid embolizations have a success rate that hovers around 90%. So, what does that mean for you?

If you want relief from the discomfort, itchiness and bleeding of internal hemorrhoids, you can do so without invasive surgery. Contact our interventional radiologists in Houston and Dallas. We’ll schedule a consultation to determine if you’re a candidate for hemorrhoid embolization.



Varicose Vein Risk Factors: Can I Get Them from Lifting Weights?

Are you worried about varicose vein risk factors? Have you been hitting the gym, and you’re worried about getting varicose veins from lifting weights? If so, this is the read for you! After all, most of us work out to look and feel better. So you want to know if your workout is hurting your vein health!

And worrying about weightlifting is actually legitimate. If you’ve ever done squats with weights, you may have noticed your leg veins become prominent. So, you may be concerned that the effect will become permanent. And that’s why we’re telling you everything you need to know about lifting weights and varicose veins. (Along with other varicose vein risk factors.)   

What Are Varicose Veins?

Varicose veins are visible through your skin because of their enlarged size or darker color. These veins change color or bulge due to a build-up of excess blood, and that blood builds up because of problems with your valves.

But let’s backtrack a bit and talk about blood flow. Your veins have one important job. They carry blood from your extremities back towards your heart. When they’re working properly, the valves in your veins help blood fight gravity. They do so by closing, preventing the blood from flowing back down to your legs and feet.

But when those valves aren’t working properly (a condition known as venous reflux) the blood can travel back downwards, allowing for the pooling that causes those prominent varicose veins to show up.

What Causes Venous Reflex?

A major contributing factor is genetics—if your mom or dad had varicose veins, you are more likely to experience the same problem. But other factors can play a role in vein disease. And these include advanced age, pregnancy or menopause, blood clots and obesity.

Job related hazards, like extended sitting or standing, can also contribute to this issue. As such, teachers, nurses and hairdressers may have a higher risk than those in other professions. But even your diet plays a role, since some unhealthy foods can impact your circulation. Plus, constipation increases your risk for varicose veins, so foods that take a toll on digestion can hurt your vein health.

And that’s not all you need to worry about. Because, as it turns out, staying in one position for too long takes a toll on your veins, too. In fact, it can lead to the same kind of blood pooling we see in people with malfunctioning valves.

Sex Differences in Varicose Vein Risk Factors

Before we return to discussing weight lifting’s impact on your vein health, let’s discuss gender as a varicose vein risk factor. For several reasons, women are more likely than men to develop this symptom of vein disease. Why is that the case?

First, only women get pregnant. (For now, at least. Who knows what medical and scientific advances we’ll see in the future?) And that matters, because pregnancy is one of the largest varicose vein risk factors, as your growing fetus and increased blood volume put lots of pressure on the valves inside your veins.

Then, there are more recent concerns that increase gender-based risk. During the COVID lockdowns, women were disproportionately chosen as the ones to stay home with out-of-school kids. And this contributed to sedentary lifestyles along with weight gain, both of which are varicose vein risk factors.

Now, exercise could actually help minimize the effects of gender risks for varicose veins. But only if you do so wisely. Which brings us back to talk of weightlifting and varicose veins.

Varicose Vein Risk Factors: Does Exercise Cause or Worsen Varicose Veins?

Here’s the good news: it doesn’t! Your veins may appear more prominent while you’re lifting weights, but it’s unlikely to be a permanent issue. In fact, regular exercise can actually decrease your chances of getting varicose veins because it helps boost your circulation.

Of course, there are exceptions to this rule: lifting very heavy weights. If you are an extreme weight lifter, you may put enough pressure on your muscles and veins to cause valve damage. But, this type of problem would take time to set it, and there are easy steps you can take to prevent exercise-related vein damage.

The first step is to use proper form when lifting heavy weights, and to work with a spotter for additional safety. It’s also important to incorporate rest days into your training schedule, and it may be worthwhile to wear compression socks during lifting sessions to help protect your veins and improve your blood flow.

Of course, if you already have varicose veins and the symptoms are causing you discomfort during workouts, you may need to discuss cutting back with your doctor. But the important thing to remember is this: working out won’t cause you to experience venous reflex; it can’t make you develop varicose veins. And as long as you discuss your training plans with your vein doctor, it may even help you manage existing issues, while lessening certain symptoms of varicose veins!

What does all that mean for you? Well, if weight lifting is part of your current or future exercise plans, don’t wait until your vein health takes a hit. Be proactive, and schedule a consultation with our Houston and Dallas area veinschedule a consultation with our Houston and Dallas area veinschedule a consultation with our Houston and Dallas area vein specialists, so you can stay safe and train appropriately!

Sources: Shape Magazine


Here’s Your Best Leg Ulcer Care Plan

Are you in need of a leg ulcer care plan, but find it challenging to make frequent visits to a medical office? Well, here’s some good news! When you call one of our Houston or Dallas area offices for an appointment slot, you can specify your preference for location, whether that’s in our newest office on Wheatland Rd in Dallas, or at one of our locations in Houston, Katy, Clear Lake, Sugar Land, or the Woodlands. Whichever Texas Endovascular Associates location you select, expect to receive expert ulcer care from our highly experienced team.  During your appointment, you’ll be able to show us your leg ulcer, and discuss your problem, highlighting your prior vein health history. After that, you’ll receive a leg ulcer care plan, and we’ll come up with a treatment protocol that you can follow with fewer trips back and forth to the office.

What is a Venous Leg Ulcer?

A venous leg ulcer, or VLU, is a defect of the skin that won’t heal on its own, due to chronic venous disease (CVD). As one of the most serious complications of CVD, ulcers tend to be a chronic problem, with about 50% of patients seeing them remain an active concern for between 6 and 12 months, according to research. As such, treatment plans will be delivered over an extended period of time. And that means some patients may prefer remote care plans being integrated into their treatment.

Why Venous Leg Ulcers Respond Well to Remote Care

While we’re newer to out-of-office care here in the U.S., this is already  a well-established practice in Canada, which has allowed physicians there to study patient outcomes. And here’s some good news: many conditions, especially ulcers, do just as well with remote follow-up care as they do with in person visits.

This is why we believe you can receive quality ulcer care from a distance: when you have an ulcer (an non-healing sore on your leg, typically the result of underlying vein problems) traveling may be difficult. But if you can receive remote follow-up care via telemedicine, travel is no longer an obstacle to your recovery. This means you’ll stick to your scheduled visits and stay on track with our team of vein specialists. And, by sticking to a strict schedule of care, we can also prevent future complications by spotting problems when they first develop.

And there’s this: for some people, coming into a major metro area can be challenging. But with the rise of Telemedicine, we can now extend our high-quality vein care to patients living almost anywhere.  In our books, that’s a very important development. Especially since, in the wake of the COVID-19 pandemic, many insurance companies now cover the cost of your telemedicine visit (check with your individual provider for details before booking your visit.) And now here’s what researchers discovered about ulcers and telemedicine

Scientific Findings on Remote Ulcer Care

In 2014, researchers in Norway compared two groups of patient outcomes for foot ulcers groups. Twenty patients received follow-up care via telemedicine; 120 came for in-person follow ups.

Now, get ready for the exciting findings: Patients in both groups showed similar healing times for their ulcers. And, in both groups, nearly identical numbers of patients were completely healed at the 12-week mark. In other words, if you need to receive remote follow-up care for an ulcer, your quality of care won’t suffer in any way. So, go ahead and feel confident booking an in-office appointmentbooking an in-office appointmentbooking an in-office appointment for your ulcer care, and feel confident that, following your first visit, we may well be able to manage your leg ulcer care plan via remote visits!


Sources: BMC Health Service Research



What is the main BPH treatment?

If you’re suffering from benign protastic hyperplasia (BPH, or prostate enlargement), you may want to know: what is the main treatment for BPH? Well, thanks to today’s medical advancements, there are several effective treatment options. Let’s take a closer look at this condition and how our Houston and Dallas interventional radiologists can relieve its symptoms.

What is BPH?

Men are diagnosed with this condition when their prostate gland becomes enlarged for reasons other than cancer. Remember, the prostate is part of men’s reproductive system; shaped like a walnut, this gland produces the fluid portion of semen. Located at the neck of your bladder, the gland surrounds the urethra. As such, if it becomes enlarged, it can cause what are described as LUTS (lower urinary tract symptoms.)

What are 2 Symptoms of BPH? toilet paper roll with the words Don't Panic printed on it

Two of the most common symptoms of an enlarged prostate include an inability to urinate or dribbling at the endo of urinary flow. Other BPH symptoms include:

  • Inability to completely empty the bladder
  • Incontinence
  • 2 or more nightly urination needs
  • Blood in the urine
  • Painful urination 
  • A slow, delayed start to urination
  • Sudden need to urinate, without any warning

What is the main BPH treatment?

If you want to relieve these symptoms, you’ll need to treat BPH. And the treatment you choose will depend on the severity of your symptoms. For some men, watchful waiting will be the best option. This involves monitoring your symptoms for changes, and ensuring that your condition isn’t progressing.

With this approach, you can also make lifestyle changes that could reduce the impact of your symptoms. Experts suggest urinating as soon as you feel the urge, and scheduling regular bathroom trips, even when you don’t feel the need to go.

Additionally, you should skip alcoholic or caffeinated beverages, especially in the evening. Avoid all fluids within two hours of your desired bedtime, and try to sip small amounts of fluid throughout the day, rather than consuming large beverages in one sitting.

When experiencing LUTS, you should try to stick to a regular exercise schedule, since a sedentary lifestyle can worsen symptoms. Manage your stress, since tension can increase your urge to urinate. And use decongestants and antihistamines with care, since they can worsen your symptoms as well.

BPH Treatment Medications

Some men will need to treat BPH with prescription medications. Drugs such as finasteride and dutasteride can reduce your prostate’s hormonal production, simultaneously helping reduce its size. (Most men need to take these medications for three to six months before seeing symptom improvement.) Others can try Alpha-1 blockers, a group of medications designed to lower blood pressure, since they relax your bladder neck muscles and prostate, making it easier for you to urinate. However, every medication comes with side effects and the possibility of interacting with medications. As such, you may wish to seek other ways to treat BPH.

BPH Treatment without Medication or Surgery

Recently, the FDA approved Prostate Artery Embolization, or PAE as an effective form of BPH treatment. We perform this outpatient procedure in our Houston and Dallas interventional radiology offices, helping relieve symptoms of an enlarged prostate. While not everyone is a candidate for this treatment option, you may benefit from PAE if you continue to experience BPH symptoms after trying medications, if you prefer to avoid surgery or are not a candidate for an invasive procedure.

Ready to find relief from LUTS and other effects of benign prostatic hyperplasia? When lifestyle measures and medications fail, non-surgical relief is still available. Contact our Houston and Dallas specialists today to discuss PAE as a BPH treatment.


A New Way to Treat BPH

When you have Benign Prostatic Hyperplasia (BPH), we know that you’ll be researching ways to treat BPH. But what is this condition, what symptoms does it cause, and when should you seek medical intervention? Keep reading for all these answers and more.

What is Benign Prostatic Hyperplasia? An older man on a hike

BPH is a common condition that affects males, enlarging their prostates and causing a variety of symptoms. Now, not every affected individual will experience the same symptoms. Yet some of the more common effects of this condition involve Lower Urinary Tract Symptoms (LUTS), including:

  • Urge Incontinence, or a sudden need to urinate without warning, and without the ability to control the urge
  • Incontinence
  • Nocturia, when you have to wake up in the middle of the night to urinate two or more times
  • Hesitancy, when you have a difficult time getting urine to start flowing
  • Straining to pass urine
  • Pain when urinating
  • An inability to completely empty your bladder with urination
  • Dribbling of urine at the end of the flow
  • Frequent UTIs (Urinary Tract Infections)
  • Bladder stones
  • Blood in your urine
  • Smaller bladder capacity (decompensation)

Causes of BPH

We don’t know exactly why men develop this condition. But we do know that your age, your testosterone levels, and changes to your testicular cells can increase your risk. In fact, most men over 40 have some degree of prostate enlargement, and close to 100% of men over the age of 80 develop this condition.

When to Treat BPH

The decision to treat an enlarged prostate will depend on how intrusive your symptoms are to your daily life. Also, the severity of symptoms will help determine your appropriate treatment plan. For some men, simple lifestyle changes, such as urinating as soon as you feel the need; limiting caffeine and alcohol intake; getting regular exercise; managing stress; and avoiding certain medications can help you manage symptoms of an enlarged prostate.

Other men, however, will need more serious interventions to relieve BPH symptoms. In the past, the best available options were prescribed medications or surgery. Today, however, there’s a new way to treat BPH, with a minimally invasive procedure known as Prostate Artery Embolization, or PAE.

PAE to Treat BPH: A New Hope for Men with LUTS

Recently, the American Urologic Association approved PAE for treating BPH. This minimally invasive, same-day, outpatient procedure can relieve BPH symptoms with minimal risks for sexual side effects or for causing incontinence. Performed with mild sedation or general anesthesia, our interventional radiologists in the greater Dallas/Fort Worth and Houston areas start PAE by inserting a small catheter into your wrist. Next, guided by X-ray technology, we can insert beads that block blood flow to the prostate, causing it to shrink within two weeks of the procedure. In turn, bothersome BPH symptoms should improve, and you may even enjoy improved sexual health.

Ready to treat BPH without surgery or added side effects? Reach out to our team today. We’ll review your  symptoms and determine if PAE is your best treatment option.

6 PAD Symptoms to Know and Watch For

It’s officially PAD Awareness Month, so it’s the perfect time to teach you about identifying PAD symptoms. First, a definition: Peripheral Arterial Disease (PAD) is a disease. It develops when arteries in your lower legs narrow.

Because many PAD symptoms mimic those of other conditions, this disease is often hard to diagnose. About 20 million Americans have this disease. In fact, this disease affects three times the number of women as those affected by breast cancer. Even worse? Almost 500,000 people end up in the hospital because of PAD each year. (A number that rose sharply between 2011 and 2017, according to a study from Yale University. Especially for men younger men, under the age of 65.)

Unfortunately, the fallout doesn’t always end with hospitalization. Statistics reveal that the five-year mortality rate for women with PAD is about 27%. Then, if those women develop critical limb ischemia, that mortality rate increases to 60% for those female patients. On their own, these are scary statistics. But here’s a fact that should shake you up further. Up to 200,000 Americans with PAD don’t even know they have it! So, in order to prevent a missed diagnosis, we need you to know and identify PAD symptoms. If you experience any of these problems, it’s important to see your Houston vein specialist right away.

Painful Symptoms of PAD

Muscle pain is one of several symptoms of PAD

  1. Pain in Your Legs After Walking or Exercise. One of the most common symptoms of PAD, this pain or cramping occurs with movement because your lower extremities don’t get enough oxygen to support the increased activity.  Most often, PAD sufferers will experience this pain in their calf muscles, but it may manifest anywhere in the lower legs. Pain will typically not resolve until the PAD sufferer stops all physical activity.
  2. Wounds, Sores or Ulcers. This second symptom is also caused by a lack of oxygen reaching your lower limbs. When you cut yourself, and you don’t have PAD, proper circulation and blood flow will help your injury heal quickly. When you have PAD, however, even a small scrape can remain open and unhealed as the plaque in their arteries blocks blood flow to the wound. This symptom must be addressed immediately: left unchecked, a wound can lead to serious infection and even amputation.

    Physical PAD Warning Signs

  3. Skin Changes on Your Legs. Once again, poor circulation is behind this PAD symptom. Some of the physical changes that occur with PAD include skin that appears to be shiny, loss of leg and/or toe hair, and a blue-ish tinge to your skin. Your lower legs, especially your toes, may also feel cold, even when your feet are covered and should otherwise feel toasty.
  4. Muscle, Not Joint, Pain. We’ve already noted that leg pain and cramps are a symptom of PAD, but it’s important to note where that pain is located. Many people think of leg pain as a normal part of aging, and it CAN be–when that pain is happening in your joints. When it’s located in your muscles, however, that is a sign that something beyond normal aches and pains is going on.
  5. Dead tissue. Most people will identify their PAD before reaching this point, but if you have gangrenous or dead tissue on your toes, feet or legs and you haven’t been checked for PAD, get a diagnostic vein scan ASAP.
  6. Changes in bowel habits. In some cases, PAD impacts the arteries that supply blood flow to the intestines, resulting in changes to your bowel movements. The need to empty your bowels could become urgent, and your stool could be bloody. Additional symptoms include severe and diffuse stomach pain, frequent vomiting, a drop in abdominal blood pressure and an elevated white blood cell count. Finally, hydrogen can start building up in your blood, a condition known as acidosis.

    Emotional PAD Symptoms

  7. Depression. Especially for women, your depression symptoms may develop or worsen with PAD. So if you have the symptoms we described above, and depression, it’s time for a PAD check.

PAD Diagnostic Checklist for Clinicians

Even when patients come in complaining of these symptoms, some general care physicians may find it difficult to diagnose this condition. Too often, according to this review in The BMJ journal, patients with claudication are told to rest and take aspirin. (Claudication is the medical term for symptom 1 in the list above, or leg pain that manifests with movement and improves with rest.)

As such, they offered a basic guideline for clinicians to use when deciding to refer patients for PAD care. Basically, the study suggests that a PAD diagnosis should be made for patients with claudication or rest pain; who don’t have regular peripheral arterial pulses; and whose tests reveal a reduced ankle brachial pressure index (ABPI). They note that the ABPI score is one of the best PAD indicators, since patients with spinal claudication will have a normal test score, even though their other symptoms may mimic those of peripheral arterial disease.

Can You Prevent PAD Symptoms?

According to the American Heart Association, following life’s “Essential 8” rules can help prevent cardiovascular diseases, including PAD. (In 2022, this list was updated from the Simple 7, adding sleep as an essential lifestyle choice to prevent cardiovascular disease.)

What are these crucial eight steps you can take to prevent periphery arterial disease and other forms of heart disease?

  1. Follow a healthy diet
  2. Move more, every day
  3. Get sufficient, quality sleep each night
  4. Manage weight
  5. Control your cholesterol levels
  6. Watch your blood sugar levels, too
  7. Control your blood pressure
  8. Break up with tobacco

Preventing and Treating PAD in Houston, TX

We urge you to watch for PAD symptoms. But it’s also important to know your risk for this disease, since you may not develop symptoms until your disease has progressed dramatically. After all, if there’s one thing we need you to remember, it’s this: PAD is a progressive disease. If you ignore early warning signs, your symptoms of PAD will get worse. Don’t wait until you’re in pain. Call our Houston and Dallas area clinics today and schedule an immediate PAD consultation!


Sources: Mayoclinic.org , Healio Cardiology 

These 5 Things Raise Women’s Blood Clot Risk


hormonal birth control blood clot risk

Women have a higher blood clot risk than men. Especially for one dangerous clotting condition: Deep Vein Thrombosis (DVT). This develops when you form a blood clot in the deep veins of your legs. As it circulates, there’s a risk that the blood clot will break free. Then, it could lodge in your lungs (pulmonary embolism), causing a potentially fatal complication.

Now, certain factors such as atherosclerosis, diabetes, vascular inflammation and obesity raise everyone’s risk for blood clots. But all women have an elevated risk. And should look out for warning signs such as tingling or numbness in your hands. And your risk for DVT may be increased if you take a hormonal birth control pill or IUD. Because some of the hormones in your birth control makes your blood more likely to clot, you may prefer a on-hormonal option if you have other risk factors. These include condoms or a copper IUD.

Birth control that contains estrogen is more likely to make your blood clot. For that reason, newer forms of birth control combine forms of progestin and estradiol, leaving out estrogen to improve the safety profile. If you prefer a hormonal birth control, but are worried about clotting, you may want to discuss options such as Yasmine or Mircette with your healthcare provider.

Caffeine and Blood Clot Risk

When you drink caffeinated beverages like coffee and soda, you’re more likely to dehydrate. If that happens, your blood clot risk will increase for a few reasons. You see, without enough hydration, your blood thickens and gets stickier. And that means it’s more likely to form clots. Especially if you have the habit of meeting up for daily coffee dates. Or if you swap a diet soda for a water bottle when you feel thirsty.

Blood Clots and Colitis

Men and women with Ulcerative Colitis, a form of Inflammatory Bowel Disease (IBD) are at a higher risk for blood clots. In fact, according to the Chron’s and Colitis Foundation, having any kind of IBD gives you a three times higher clot risk compared to the general population. Furthermore, if you’ve ever had to stay in the hospital, that risk is further increased. As such, you’ll want to watch for blood clot warning signs if you’ve been diagnosed with IBD, or have these other blood clot risk factors.

Pregnancy and Clotting

You may think that stopping birth control to conceive eliminates your clot risk. But pregnant women are in even greater danger if they develop blood clots. That’s because, when pregnant women get clots in the deep veins of their legs, groin or arms, the condition is called Venous Thromboembolism (VTE), not DVT.

Now, the condition’s name is different. But the danger to your lungs is the same. And that’s why VTE during pregnancy and post-partum is one of the leading causes of maternal deaths. (Even worse? The CDC says that 33% of people who develop VTE will experience another clot within 10 years. So prevention is very important.)

What We Know About Blood Clot Risk and VTE Varicose Veins & Pregnancy: What You Need to Do (and Why You Shouldn’t Worry)

Until recently, only a few VTE risk factors had been identified. During pregnancy these included:

  • A previous episode of VTE
  • A relative with a previous VTE episode
  • Advanced maternal age
  • Smoking
  • High BMIs
  • In-vitro fertilization

For post-partum VTEs, risk factors include:

  • Emergency c-sections
  • Still births
  • Pre-eclampsia (high blood pressure during pregnancy)
  • Varicose veins 
  • Post-partum infection

New VTE Risk Factors Identified

Now, thanks to a study in Japan, two new VTE risk factors have been identified: Endometriosis and recurring miscarriages.  To reach these findings, the study authors reviwed data from 103,070 pregnant Japanese women, collected between January 2011 and March 2014. Participants completed questionnaires in their first, second and/or third trimester, and their medical records were then transcribed immediately after delivery and one month post-partum.

First, researchers found that the frequency of VTE in the Japanese population was 7.5 per 10,000 pregnancies during both the pregnancy and post-partum period.

After identifying previous known risk factors, and adjusting for their presence, researchers were able to discover two new predictors for VTE: the presence of endometriosis and recurrent pregnancy loss. Women with endometriosis were 2.7 times more likely to develop VTE; women with multiple miscarriages had a risk factor that was 6.13 times higher.

In the wake of this information, we now know that more research will be necessary to keep people safe. And it should be coming soon. Just recently, the National Heart, Lung and Blood Institue announced it will launch clinical trials in 2023 to determine whether certain body scans can detect blood clots right as they form. But, until then, it’s important to understand your risk. And address it with your doctor.

Pregnancy with VTE Risk Factors

Knowing your risk for VTE is important, since pregnant women with one or more predictors may need to take precautionary measures. In fact, VTE is such a dangerous complication, at-risk pregnant women may need to take anti-coagulants (with the supervision of and recommendation from their physicians.) To learn more about managing VTE and other venous conditions, schedule a consultationschedule a consultationschedule a consultation with our Houston vein specialists.

Sources:  The Journal of Thrombosis and Haemostasis

Move it Monday: Best Exercise for Peripheral Arterial Disease

Did you know you can boost your health with the best exercise for peripheral arterial disease? When you have peripheral arterial disease (PAD), your arteries narrow. First, that reduces the amount of blood flow to your legs and feet. Then, you may experience painful muscle cramps in your hips, thighs and calves. This pain is typically at its worst when you’re walking, climbing stairs or exercising. And it should improve when you rest. At least at first.

Now, while exercising may make you experience painful cramps, research shows that certain exercises will, in fact, help you manage PAD.person walking through grass

According to one study in the Intervention Journal, supervised treadmill workouts are the most effective form of exercise for people with PAD. Study authors suggest: “exercise sessions should progress up to a target goal of accumulating 30 to 45 minutes of treadmill walking per session” and “exercise should be carried out at an intensity that elicits mild claudication pain within 5 minutes, and moderate to moderately severe claudication within 10 minutes followed by rest until claudication pain subsides.” In other words, the goal of this workout is to work to the point of pain until the pain takes longer to show up. In this way, PAD patients can experience longer periods of walking comfort in their real lives as well.

Optimal Walking Times

When you’re beginning a walking program, you may wonder how much time is enough? Luckily, according to the World Health Organization, it doesn’t have to be that long. In fact, 150 minutes of walking a week gives you so many health benefits!

What does that mean for you, if you’re doing supervised treadmill sessions for PAD? To hit your weekly walking goal, you could do three 45-minute sessions, and one 30 minute session. That way, you’d get all the benefits of walking workouts. And, you’d see progress with PAD symptoms such as claudication.

Not able to hit that 150 minute per week mark? Or struggling to hit 10,000 steps? Don’t worry. Any walking you can fit into your day will improve your health. Of course, it doesn’t have to be on a treadmill either. It can be scattered throughout your day. Or a part of these alternative workouts for PAD.

Alternatives to Treadmill Workouts for PAD

Of course, for some PAD patients, treadmill walking may be too difficult–or simply unappealing. Not to worry: the study suggests other forms of exercise that can also be effective. The authors suggested walking around your neighborhood as one obvious alternative to treadmill workouts. Seated exercise bikes can also help people with PAD, as can workouts that involve resistance training, with your body weight, bands or weighted dumbbells.

Another great choice that doesn’t require any equipment? Try leg extensions, since they boost blood flow to the fronts of your legs, helping support your walking muscles. To get started, sit on a chair with a straight back, holding the chair edges with your hands for stability. Now, lift one extended leg off the floor so it is parallel, straightening at the knee without locking out your joints. Slowly lower the leg to the floor, and repeat on the other side, alternating legs for at least 30 seconds. In this way, you can work some of the best exercises for peripheral arterial disease seamlessly into the busy schedule of your day.

What to Avoid When Exercising with PAD

While walking is one of the best exercises for PAD, you want to steer clear of high-impact workouts that put lots of pressure on your feet. (Think long runs, heavy weight lifting, or sports with lots of jumping.) Also, since temperature can increase stress on your body, try to avoid outdoor workouts when it’s very hot outside.

Dealing with an ulcer? Skip those walks and try engaging in gentle chair workouts. And, whether or not you have a leg or foot wound, always clean and dry your feet before and after a workout. Also, make sure to exercise with your shoes on, checking that the supportive foot gear is well-fitted.

Now, while exercise can help improve your ability to walk comfortably with PAD, it cannot cure the condition. Fortunately, in our Houston vein center, we can easily diagnose and treat your PAD. We start with a bedside test, called an Ankle-Brachial Index (ABI), which uses ultrasound and blood pressure cuffs to evaluate the circulation in your arms and legs. If this test is abnormal we may order further imaging tests such as Magnetic Resonance Angiography (MRA) or Computed Tomography (CT) to determine the extent of your problem and help us plan your treatment.

Once we determine the extent of your issue, treatment can begin. Our doctors will determine the most appropriate, and least invasive, treatment option that will help you find relief. So if you are experience leg cramps and suspect PAD may have set in, schedule an immediate consultschedule an immediate consultschedule an immediate consult to begin finding relief!

Sources: www.interventionjournal.com, Cardiology Today


Why You Get Lower Leg Ulcers and How to Treat Them


Lower leg ulcers are open sores that don’t heal or keep coming back. In fact, they’re one of the most common forms of chronic wounds in this country. Ulcers can develop on your lower legs. They usually show up around the ankles. But they also develop if you put consistent pressure on your foot. We can easily treat small ulcers. And stop them from returning. But if an ulcer is left untreated, it can grow deeper into your skin tissue. Or it may become infected.  In that case, treatment will likely be drastic–and expensive.

How does a lower leg ulcer develop? Are there different kinds of ulcers? Read on to get a better understanding of ulcers and their treatment options. Plus, learn the best methods of prevention.

Venous Ulcers

Venous ulcers are most common on your lower leg. These occur when your leg veins don’t return blood back to the heart. (It’s a condition called chronic venous insufficiency.) Then, the unreturned blood pools in your leg tissue, causing swelling and low oxygen levels. As a result, even small wounds can’t heal. Instead, they get larger, leading to venous stasis ulceration.

These ulcers range from being painless to quite painful over time. They usually develop just above the ankle and on the inner leg. A telling sign of a venous ulcer is a brown, rust-colored pigmentation. You may also feel itchy or experience a dull ache. And swelling may develop.

Once it forms, the ulcer is dark purple or red in color and possibly tinted with yellow fibrous tissue. A green or yellow discharge is also possible if it is infected. It’s usually shallow, with uneven borders. And the surrounding skin might be warm and appear shiny and tight.

Venous ulcers usually affect older patients with a history of vein disease, varicose veins, and blood clotting. The fundamental cause is poor circulation, which can be brought on a number of ways, from atherosclerosis, obesity, heart disease, or smoking. Genetics, certain medications, and simply standing or sitting for too long on a daily basis can also factor in.

Diabetic Ulcers

Though much less common, diabetic (neurotrophic) and arterial (ischemic) ulcers can be equally dangerous if left untreated. Their cause, appearance, location, and treatment are different from venous ulcers, so it is important to have an expert diagnose them. If left untreated and infected, they can lead to amputation.

Diabetic or neurotrophic ulcers are a result of an impaired sensation in the feet and a decrease in wound healing, usually from diabetic nerve damage. They occur at pressure points on the bottom of the feet or wherever a wound has formed. Because of the lack of sensation, the patient is often unaware of them. It is important that diabetic patients inspect their feet daily. They can be pink/red or brown/black with a punched out or calloused/cracked border.

Arterial Ulcers

Arterial or ischemic ulcers, on the other hand, are extremely painful and due to arterial disease. (Like atherosclerosis and peripheral arterial disease (PAD). They don’t heal well because poor circulation to your extremities lowers blood levels in the tissue. These sores often develop on the feet, especially the toes, and occasionally on the ankles. They are usually deep, with clearly-defined edges, and may appear to be yellow, brown, gray, or black. They usually do not bleed. These sores may feel cold to the touch, because of poor circulation. Like diabetic ulcers, the surrounding skin appears punched out. The pain is greatest at night and can be relieved by dangling the legs off the bed.

Ulcer Treatments and Prevention compression socks help lower leg ulcers

We can treat venous ulcers in a variety of ways. One key to successful outcomes? Early treatments! According to a new study in JAMA, treating ulcers early (with ablation and compression) is very cost-effective. And it can cut your risk of recurring ulcers.

Now, compression is the most common ulcer treatment. Lifting your legs above your heart, whenever possible, also helps. It’s also important to treat the underlying cause of the ulcer. Now, for venous ulcers, this includes closing the abnormal veins that causing venous insufficiency. Once again, you’d use ablation therapy.

You need a proper arterial ulcer diagnosis to come up with a wound healing plan. Compression therapy does not work for arterial ulcers; it can make them worse. Treatments involve attempting to re-vascularize the leg through endovascular therapy. Treatment for neuropathic ulcers include debridement or removal of infected tissue, avoiding pressure on the ulcerated leg, and special shoes to prevent contact irritation. Also, for any kind of ulcer, elevation can speed healing by improving circulation.

Ulcers of the lower leg can be prevented by checking your ankles and legs daily for early signs of ulceration. This is key to getting the preventative treatment you need. Taking daily walks, eating healthier, quitting smoking, and anything that improves overall circulation will go a long way in preventing ulcers and venous/heart conditions.

New Ulcer Wound Dressings

While ulcers are open, your vein doctor will need to dress the wounds to avoid infection. Now, German researchers are developing a new type of dressing that may better promote healing. Currently, many dressings are made of animal-based proteins, but this treatment option does create a risk of your body’s immune system responding badly to outside substances.

To better protect patients, the wound dressing currently being developed works with our body’s elastin, which gives skin stretch and resilience. Currently being tested in pre-clinical trials, this new dressing could help customize wound treatment. Scientists expect to finish their research at the end of 2021, at which point they’ll apply for medical approval. In the meantime, check out other ways to treat your ulcers.

How to Treat Your Ulcer at the Source

Whether you need an accurate diagnosis for your lower leg ulcer, or need treatment, Texas Endovascular has the vein expertise necessary to help. Schedule an appointmentSchedule an appointmentSchedule an appointment with us today and we’ll get you on the path to recovery.

Sources: JAMA NetworkCirculation Foundation, Venous News 

What is May-Thurner Syndrome and How’s it Treated?

May-Thurner Syndrome (MTS) develops when your left iliac vein gets compressed by your right common iliac artery. This hampers drainage in your left leg. And, without treatment, you’ll face an increased risk for deep vein thrombosis (DVT), a blood clot in the deep veins of your leg. Additional concerns with this condition include a higher risk for other venous complications, including a pinching or narrowing of your veins. In fact, research suggests that MTS is responsible for between two and five percent of all venous disorders of the lower extremities.

May-Thurner Syndrome: Who’s at Risk?May-Thurner syndrome after bed rest for pregnancy

This condition mostly affects younger women between the ages of 20 and 45. It’s most likely to develop if you’ve been immobile for a long time, or after a pregnancy. But it can impact women of other ages, though it’s less likely. And in rare cases, men may also be affected.

Signs and Symptoms

The most common May-Thurner symptoms include pelvic pain, painful leg swelling and varicose veins, almost always in your left leg. You may also notice changes in skin color, persistent leg pain, swollen veins and leg ulcers. And chronic hemorrhoids, as well as upper leg swelling, may both develop.

Disease Stages

Without treatment, May-Thurner syndrome will progress through a series of stages. At first, while your vein is compressed, you may not notice any symptoms. But then, if compression continues, venous spurs will form. These are fibrous growths in your vein, and they inhibit your blood flow. (That’s when your DVT risk starts to rise.)

After this stage, the next progression would be forming a DVT. At this point, you may notice DVT symptoms such as warm skin, swelling, changes in skin color as well as pain or cramping. A DVT is a medical emergency, because it can break free from your leg veins and travel to your lungs. (This is called a pulmonary embolism, a potentially fatal disease.)

Diagnosing and Treating May-Thurner Syndrome

We may screen you for May-Thurner syndrome if you come in with varicose veins or other symptoms. (Especially if you’re in the at-risk age group, or recently had a baby or went on extended bed rest.) We can usually detect the compressed vein with a diagnostic ultrasound.

As interventional radiologists, we’re often able to treat this disease by stenting or inflating your compressed vein. This technique opens up your vein, improving blood flow and reducing your risk for DVT. If you’re at risk for May-Thurner Syndrome but aren’t yet in trouble, we can also help you prevent this risky disease.

Tips for Prevention

While we can’t guarantee prevention, certain measures can lower your disease risk. These include wearing compression stockings during your pregnancy. (And when you’re going to be immobile for a long time, as with an extended flight or road trip.)

Sticking to a healthy weight, especially during pregnancy, can also help you avoid May-Thurner Syndrome. And getting regular exercise–especially with moves that involve your calf muscles–can boost blood flow in your leg veins, helping lower your risk.

Are you a woman between the ages of 20 and 45, with any symptoms of May-Thurner syndrome? Don’t wait another day to seek help for this progressive disease. Instead, schedule an immediate appointmentschedule an immediate appointmentschedule an immediate appointment with our Houston-area vein specialists. Using our non-invasive imaging devices, we can diagnose this disease in its early stages. That way, we can intervene as soon as possible, and prevent potentially life-threatening complications.

Sources: The Cleveland Clinic


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