Dr. Erin Moore, the Director of Vascular and Endovascular Surgery at Baptist Medical Center shows us a new device changing lives.

Could your chronic pelvic pain be Pelvic Congestion Syndrome (PCS)? Chronic pelvic pain is common problem among women that prompts them to see their doctor. According to the National Institutes of Health, chronic pelvic pain accounts for up to 40% of outpatient gynecologic visits. And of those patients reporting chronic pelvic pain, 30-40% of cases are associated with a condition called Pelvic Congestion Syndrome (PCS).

What is Pelvic Congestion Syndrome (PCS)?

Pelvic Congestion Syndrome occurs when the veins in the pelvic region stop working properly. Veins are responsible for carrying blood back to the heart. When these veins are not functioning well, blood can back up, causing varicosities. Varicosities, or varicose veins, in the pelvic region are like those in your legs. The vessels can become enlarged causing pelvic pain along with several other symptoms.

Pelvic Congestion Syndrome Symptoms

The most common symptom of PCS is chronic pelvic pain, meaning it lasts for more than 6 months. This is often described as a dull, aching pain that worsens throughout the day, especially after long periods of standing. Women can also experience:

• Varicose veins in the thighs and vaginal area
• Painful intercourse
• Painful menstrual cycles
• Pelvic pain after physician activity
• Lower back pain
• Swollen vulvar
• Abnormal vaginal bleeding

What are the risk factors for Pelvic Congestion Syndrome?

Pelvic Congestions Syndrome is more likely to develop in women who have given birth. Pregnancy can put added stress on the veins in the pelvic region, causing them to weaken. Also, women who have a family history of PCS are at increased risk.

Diagnosis of Pelvic Congestion Syndrome

Pelvic Congestion Syndrome can be seen through a variety of different imaging tests, including ultrasound, CT scan, MRI, laparoscopy, or venogram. Your doctor may request one or several tests to confirm diagnosis.

Treatment Options for Pelvic Congestion Syndrome

There are several treatment options for Pelvic Congestion Syndrome including hormonal therapy, sclerotherapy and embolization. At Cardiothoracic & Vascular Surgical Associates, we offer pelvic vein embolization as a minimally invasive treatment option.

During this outpatient procedure, one of our vascular surgeons will insert a small catheter into a central vein. Using x-ray guidance, the surgeon will guide the catheter to the problem area and permanently close it off. There are no stiches, and IV medications are used to help comfort you during the procedure.

As an alternative to the hospital, this procedure can be performed at our private, outpatient facility – the Jacksonville Vascular Center.

If you suffer from chronic pelvic pain, you should report this along with any other symptoms you experience to your gynecologist or primary care physician. Through proper testing and evaluation, a correct diagnosis can be made to help relieve your symptoms. If you are diagnosed with Pelvic Congestion Syndrome and treatment is recommended, the vascular surgeons at Cardiothoracic & Vascular Surgical Associates are well versed in the latest minimally invasive treatment techniques. Learn more about our surgeons and the conditions we treat on our website.

Preparing for Heart Bypass Surgery

If you have been recommended for heart bypass surgery to treat your coronary artery disease, preparing ahead of time can help the recovery process go a lot smoother. Here are a few tips to help you and your caregiver prepare.

What is Coronary Artery Disease (CAD)?

The three main coronary arteries and their branches course along the surface of the heart providing blood to the heart muscle. When these arteries become blocked by plaque, the blood supply is compromised causing chest pain (angina), and when severe enough will cause a heart attack. Several risk factors put you at risk for CAD. These include family history, high blood pressure, diabetes, high cholesterol, cigarette smoking, inactivity, and obesity.

How is it treated?

Depending on the severity, number, and location of the blockages your cardiologist will determine (often in conjunction with the cardiac surgeon) whether medical management, balloon angioplasty and stenting, or coronary artery bypass grafting (CABG) is necessary.

What is Heart Bypass Surgery?

The operation involves a median sternotomy, exposing the heart, placing the patient on the heart-lung machine (or occasionally left beating known as off-pump), and using the internal mammary artery, the greater saphenous vein, and/or the radial artery to bypass the blockages in the coronary arteries. This will provide blood flow to the heart muscle beyond the blockages to prevent a heart attack, eliminate angina, improve heart function, and prolong the patient’s life.

Preparing for Your Heart Bypass Surgery

Preparing ahead of time for your heart bypass surgery can make the recovery process less stressful for you and your caregiver. Here are a few tips to help you prepare:

1. Review all your questions with the doctor – Bring a list of questions with you to the doctor and take notes so you can reference back to details later. You may even want to bring a caregiver with you to help take notes and ask questions. Be sure to ask about your current medications and supplements (when to start/stop), personal risk factors, and ways you can reduce complications.

2. Quit Smoking – Smoking is a significant risk factor in complications after surgery. Smokers also take longer to heal after surgery and smoking increases your risk for heart attack and stroke. Talk with your doctor about resources available to help you quit.

3. Get a dental exam- Ask your doctor if you need dental clearance prior to surgery. Heart health and oral health are strongly linked – sometimes oral bacteria can spread to the heart causing complications.

4. Establish a heart healthy lifestyle – If you haven’t already, now is a good time to implement some lifestyle changes such as eating a heart-healthy diet and exercise. Be sure to check with your doctor before starting a new exercise program.

5. Prepare your home and caregivers – You will need a caregiver to assist you at home following surgery. If you do not have friends or family that are able to help, consider arranging home health services. It can be helpful to prep freezer meals ahead of time, schedule house cleaning services and schedule bill pay so you can focus on recovery.

6. Pack your hospital bag – Packing your bag ahead of time can help ensure you bring everything you need to the hospital. A few things to remember are: medications, supplements, photo ID, and insurance card. Bringing a few comfort items from home can make the hospital stay more enjoyable – robe, pillow, blanket, slippers, special toiletries, puzzles and books. Don’t forget your phone charger and leave your valuables, such as money and jewelry, at home.

Coronary artery disease is a serious condition that often requires surgical intervention. When bypass surgery has been recommended, you can trust the experts at Cardiothoracic and Vascular Surgical Associates. Our surgeons are leaders in the industry for bypass surgery and can help get you on a path to wellness. Contact us to schedule a consultation.

May is Stroke Awareness Month – Every Second Counts

May is Stroke Awareness Month, a condition that effects someone in the United States every 40 seconds. Unfortunately, during the COVID-19 pandemic, we have seen a 40% decline in patients seeking urgent or emergent care. This includes carotid artery disease, one of the leading causes of stroke.

What is Carotid Artery Disease?

Up to a third of stroke cases are caused by carotid artery disease, the narrowing or blockage of the carotid artery by plaque. The carotid arteries are large blood vessels in the neck that supply the brain and head with blood. When there is too much plaque, blood cannot properly flow to the brain or plaque can break off and travel to the brain. Both of these have the potential to cause a stroke.

Recognize the Signs of Stroke

Early action is one of key indicator in surviving a stroke. To recognize the signs and symptoms, remember BE FAST: Balance, Eyes, Face, Arms, Speech, Time.

Stroke Prevention

Stroke is also preventable through lifestyle changes, disease management and proper screening:

1. Live a healthy lifestyle – quitting smoking, eating a healthy diet, exercising regularly and maintaining a healthy weight. It is also important to limit alcohol consumption and get adequate sleep.
2. Don’t ignore mini-strokes – Tell your doctor about Transient Ischemic Attacks (TIAs), also known as mini-strokes”. They can be an indicator of an underlying problem and potentially lead to a full stroke.
3. Treat diabetes – people with diabetes are 2-4 times more likely to have a stroke. High blood sugar can damage the blood vessels and allow clots to form. These clots have the potential to break off and travel to the brain, causing a stroke.
4. Manage blood pressure and cholesterol – high blood pressure and high cholesterol can cause plaque build-up in your arteries, leading to a heart attack or stroke.
5. Get screened for carotid artery disease – screening is as simple as an ultrasound. If you have been diagnosed with heart disease or peripheral artery disease, you are at an increased risk for carotid artery disease. Other risk factors include being over age 65, smoking, and a family history of stroke.

Even during the COVID-19 pandemic people should not delay care for life-threatening conditions such as carotid artery disease which may lead to a stroke. It is important to talk to your doctor about your personal risk factors and decide if you could benefit from screening.

Cardiothoracic and Vascular Surgical Associates was the first practice in the southeastern United States to introduce the FDA-approved Gore EXCLUDER® Conformable AAA Endoprosthesis to treat abdominal aortic aneurysms (AAA) – aneurysms found inside the largest blood vessel of the body. Our vascular surgeon, Erin Moore, MD, FACS, RPVI, implanted his first device yesterday, March 31, 2021, in the cardiovascular operating room located at Baptist Medical Center Jacksonville, Florida.

What are Abdominal Aortic Aneurysms (AAA)?

The abdominal aorta is a section of the aorta blood vessel located within the abdomen. The main function of the aorta is to carry blood away from the heart to the rest of the body. Sometimes, due to vascular disease, injury or genetic defect, the walls of the aorta can become weakened. When there is continuous pressure against a weakened area, an aneurysm can occur.

Risk Factors for developing a AAA include:

• Smoking
• Family History of AAA
• Heart Disease
• High Blood Pressure

Symptoms & Treatment

Symptoms of AAA can include:

• Pain in the abdomen, chest or back
• Throbbing sensation in the abdomen
• Tenderness of the abdomen
• There are also many cases where patients experience no symptoms at all

If left untreated, aneurysms can grow and have the potential to burst (rupture) which causes bleeding inside the body.

There are two approaches for treatment: open-surgical repair or endovascular repair. During open-surgical repair, the patient is placed under general anesthesia and an incision is made in the abdomen. The aorta is repaired by removing the aneurysm and replacing with a fabric graft that is sewn in.

Benefits of Endovascular Repair

The Gore EXCLUDER® Conformable AAA Endoprosthesis permanently seals off aneurysms located in the abdominal section of the aorta and maintains the pathway for blood to circulate unobstructed. The device can be implanted while a patient is under local, regional or general anesthesia through a small puncture site in the groin, eliminating the need for invasive, open surgery to restore blood flow.

Implanted by a physician using real-time X-ray imaging called fluoroscopy, the device is made up of two pieces, a flexible body created from a long-lasting synthetic material and a sturdy outer metal stent structure. When inserted, it reduces blood loss compared to traditional, open surgery where the abdomen is cut open to access the aneurysm, speeding recovery and helping patients leave the hospital faster following their procedure.

Dr. Erin Moore was one of six physicians in the U.S. to be the first to offer this device to patients affected by abdominal aortic aneurysms (AAA).

“AAAs can cause the largest blood vessel in a patient’s body, the aorta, to swell to several times its normal size. If the aneurysm grows too large, it can rupture, resulting in significant injury or even death,” Dr. Moore said. “This device eliminates the risk of aortic aneurysm rupture through a low-risk, minimally invasive intervention and will significantly improve the peace of mind for AAA patients post-procedure.”

Learn More

Cardiothoracic and Vascular Surgical Associates prides itself in being at the forefront of innovation and technology for the benefit of our patients. Our board-certified vascular surgeons are trained in both open-surgical and minimally invasive endovascular procedures. To learn more about the conditions we treat, visit our website here.

To learn more about Gore EXCLUDER Conformable AAA Endoprosthesis, click here.

What is dialysis?

For those with kidney disease, hemodialysis is a life-saving treatment option. Dialysis helps keep your body functioning properly by removing substances, such as waste, salt and water, from your blood to prevent them from accumulating in the body.

To allow the most blood flow to and from the dialysis machine and your body, a vascular surgeon will create what is called an arteriovenous fistula. A fistula is created by connecting an artery and a vein – this makes the vessel larger and stronger so it can handle the frequent treatments.

Fistula Care

Once your fistula is established, it is important to care for it properly:

• Keep the fistula area clean by washing the area with antibacterial soap daily and before each treatment.
• Report any pain, swelling or redness of the fistula area to your doctor immediately. A fever could be a sign of infection.
• Maintain proper blood flow through the fistula – be sure not to put extra pressure on the area. Avoid tight clothing, heavy jewelry, carrying heavy bags or sleeping on the area.
• Check for the “thrill” – check the blood flow through the fistula area daily by placing your fingers over the area. You should feel the motion of blood moving through it, called the “thrill”.

Fistula Complications

Even with proper care, complications can occur. It is important to always report changes to your physician immediately. If there are any indications your fistula is not working properly, you may be sent for a fistulagram. A fistulagram is an x-ray procedure performed by a vascular surgeon to help identify any issues with blood flow through your fistula. This procedure can detect clots, narrowing, enlargement or blockages. Once the problem is identified, a treatment plan can be developed.

Cardiothoracic and Vascular Surgical Associates and the Jacksonville Vascular Center is proud to be a resource for dialysis patients by offering the full spectrum of access management procedures including:

• Dialysis Fistula Creation
• Dialysis Catheter Placement and Removal
• Fistulagrams

For more information on the services we provide, click here.

We are excited to be a part of bringing advanced technology to patients in Northeast Florida! This past Friday, Dr. Erin Moore performed Baptist Health’s first endovascular fistula using the WavelinQ system. This new technology provides renal disease patients with a non-surgical option for fistula creation so they can receive life-saving dialysis treatment.

A fistula is a connection that is made between a vein and an artery which provides access to the bloodstream so patients can receive hemodialysis treatment (cleansing of the blood).

Previously, fistula creation has only been possible through open surgery. However, the WavelinQ system offers an alternative to open surgery using a completely endovascular approach. During the procedure, the surgeon utilizes a dual-catheter system and radiofrequency to connect the vein and artery in the lower arm.

WavelinQ is the first major advancement in fistula creation in over 50 years and can offer many benefits to patients, such as minimizing arm disfigurement and scarring after surgery.

For patients diagnosed with renal disease and in need of a fistula, being evaluated by a vascular surgeon is an important step in the treatment process. Vascular surgeons specialize in blood vessel surgery and can fully evaluate if you are a candidate for this procedure.

Memorial Hospital has just announced a new cancer-fighting technology for patients in Northeast Florida – minimally invasive robotic-assisted bronchoscopy for the early detection of lung cancer.

Dr. Dale Mueller, one of our Cardiothoracic Surgeons, will be one of the first physicians to be trained to use the new robot with patient cases beginning the week of December 7^th.

This new robotic-assisted bronchoscopy technology will allow surgeons to make an earlier lung cancer diagnosis with greater accuracy. Unlike a traditional bronchoscopy, the robotic platform allows the physician to reach the entire lung safely and obtain tissue samples of small and hard-to-reach nodules in the periphery of the lung. It also has a lower risk for complications than traditional biopsy techniques.

Memorial Hospital is the first healthcare system in Northeast Florida and among the first hospitals in the U.S. to offer this technology.

Dr. Mueller appeared on the News 4 Jax Morning Show to discuss this new technology and performed a live demonstration at Memorial Hospital. To watch the full news interview online, click here.

At Cardiothoracic & Vascular Surgical Associates, P.A., being at the forefront of innovation and technology is at the core of our mission and we are excited to be a part of bringing this advanced technology to patients in Northeast Florida.

Listen to your legs! Peripheral vascular disease (PVD), also known as peripheral artery disease (PAD), is a common yet serious disease that affects millions of Americans.

One of our vascular surgeons, Dr. Jared Feyko, wrote an article for the Times Union to increase awareness of this disease and provide information on diagnosis and treatment.

You can access the full article here.

The Jacksonville Vascular Center (JVC) is an office-based surgical facility conveniently located in the Southpoint area of Jacksonville, FL.