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A member of Milford Medical & Aesthetic Care and Dr Paul Fischer's team needs our help. Linda Riso, Dr. Fischer's second in command for over 20 years, needs to be matched with a liver donor. MVI works very closely with this team and it breaks our heart to hear of the struggle Linda has endured over the last few years. If you or someone you know has ever considered being a living donor, please follow this link: LINDA NEEDS A LIVER DONOR. More About Live Liver Donation Liver transplantation has been accepted as a life-saving treatment and standard of care for many forms of end-stage liver disease since the early 1980s. Initially, all liver transplants used deceased donor livers. As the number of patients awaiting transplantation began to increase, the number of deceased donors could not meet the demand for livers across the United States. To meet these demands, living donor liver transplantation was developed. Technical advances in liver surgery, as well as the liver's tremendous ability to regenerate, have made this procedure a life-saving reality. Can I be a living donor? If a liver transplant candidate is eligible to receive from a living donor, then a family member, relative or close friend can be considered for donation. There are several requirements to becoming a living donor, which include: Donor must be in good physical and mental health Donor must be between the ages of 18 and 60 Donor must have a body mass index (BMI) that is less than 35 Donor must have a compatible blood type with the recipient Donor must be free from the following: Significant organ diseases (i.e., heart disease, kidney disease, etc.) Ongoing malignancy (cancer) Hepatitis Active or chronic infections Active substance abuse Living donors also need a strong support system to rely on for emotional and physical needs during recovery. SOURCE: https://www.hopkinsmedicine.org/transplant/programs/liver/living-donor-liver-transplant/

February is Heart Month! ❤️ According to the Center for Disease Control, 647,000 Americans die from heart disease each year. That's 2% of the population! It is the leading cause of death in the United States. What's even scarier is heart disease is considered a silent killer; most people don't know they have heart disease until it is too late. So, what is heart disease? Heart disease is used to describe a range of conditions which effect the heart. The most common forms of heart disease fall under three main subcategories; diseases which effect the blood vessels, the heart's beating, or congenital heart defects. The term heart disease is often used interchangeably with the term cardiovascular disease. However, cardiovascular disease more accurately refers to narrowed or blocked vessels. This form of heart disease is what most frequently leads to heart attack. Cardiovascular disease is an atherosclerotic disease. Atherosclerosis can occur in any artery in the body. Typically, when a patient has been diagnosed with atherosclerosis in one area of the body, the disease will also be elsewhere, undiagnosed. This is why anti-platelet therapies and life style modifications are so important for people who have been diagnosed with vascular disease. Watch this video below for Dr. Esposito's explanation of how intertwined heart and vascular health can be: If you're interested in being screened for vascular disease, call us today to schedule an appointment: (203)882-VEIN(8346). cdc.gov, mayoclinic.org

UPDATED 5/4/2020 - At Milford Vascular Institute, our top concern is providing the highest quality care for our patients. Our team is committed to being your trusted and reliable vascular treatment facility during this crucial time. With ongoing concerns surrounding the COVID-19 outbreak, the health and safety of our patients remain our top priority. We have been closely monitoring this evolving situation and putting precautionary measures in place to ensure the safety of our staff and facility, while keeping our services open and available for the patients in need of continuous treatments. We are truly committed to the safety and well-being of each of our patients and will make it our due diligence to ensure the absolute safest possible care is delivered. Our Precautionary Measures: - Effective May 4, 2020: we will return to normal office hours, 7:30 AM to 5:00 PM. - There will be a provider available in the office every weekday. - While we will be open normal office hours, we will be seeing a significantly decreased patient volume in accordance with social distancing guidelines. Patient appointments will be spaced apart to limit the number of patients in the office. - There will be only 4 chairs in our waiting room, spaced 6 feet apart. - Only one family member will be allowed to accompany a patient, unless there are extenuating circumstances. If your office is scheduling an appointment for your patient and you are aware of such circumstances, please discuss this when scheduling the appointment with our staff. - Adults and older children should arrive wearing a mask. - All employees and providers will be wearing masks at all times. - Taking all necessary precautions to protect the health and well-being of our patients and staff. - Ensuring medical equipment is cleaned and disinfected thoroughly before, during, and after each patient visit. - Pre-screening our patients prior to their appointments. - Conducting on-site wellness checkups to verify the health of each patient before treatment. A clinician may take the temperature of patients and their family members prior to their appointment. - Increasing precautions at our clinics located in areas in state of emergency. - Increasing sanitation of high-traffic areas. Steps You Can Take to Protect Yourself: - Wash your hands often with soap and water for at least 20 seconds. - If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. - Avoid touching your eyes, nose, and mouth with unwashed hands. - Avoid close contact with people who are sick. - Practice social distancing. Put distance between yourself and other people if COVID-19 is spreading in your community. Should you come in for your appointment? At this time, Milford Vascular Institute is discouraging patients with compromised immunity or over the age of 65 years old from keeping routine, follow-up visits. Due to the nature of vein and artery disease and the potential for the condition to become more complicated, we encourage our patients to continue with their current treatment plan to avoid developing any serious issues. As a surgical facility for all aspects of vascular and thoracic disease, we are continuing to see patients with an array of symptoms. If you are an existing patient seeing us for any of the below listed diagnoses and are experiencing any of the below outlined symptoms, please contact the office immediately to schedule an appointment. Milford Vascular Institute will continue to provide high level vascular care to our patients. If you or someone you know is suffering from any aspect of vascular disease, know we are making every effort to keep Milford Vascular Institute a safe environment for you to receive care. Call (203)882-VEIN (8346) if you have any further questions. Stay healthy and safe.

What is NIVL? NIVL stands for non-thrombotic iliac vein lesion. This vascular occurrence was previously coined May-Thurner Syndrome, after the doctors who discovered the phenomena. NIVL is caused when the left iliac vein is compressed by the right iliac artery. This incidence increases a patient's risk significantly of developing blood clots. How was NIVL discovered? In 1851, Rudolf Virchow observed that patients were five times more likely to develop blood clots in the left iliofemoral vein compared to the right. In 1957, May and Thurner provided an explanation of this phenomenon. They found that the left common iliac vein had a vascular thickening at the point where it was crossed by the overlying right common iliac artery. They called this lesion, “a venous spur” and suggested that the chronic pulsation of the overlying iliac artery is responsible for the formation of this spur. They continued that the spur is what leads to a venous obstruction. This anatomic variant later became widely recognized as the May-Thurner syndrome (MTS). Recently, this definition has been expanded to a broader disease profile known as NIVLs. What exactly is a venous spur? A venous spur occurs as a result of the trauma induced by the direct pulsation of an artery against a vein. This chronic force on the vein leads to the build up of elastin and collagen on the inner side of the vein wall. The resulting potential appearances of a cross section of the internal left common iliac vein are demonstrated in Figure 2. How many people have NIVL? The actual number of people who suffer from NIVL is unknown. According to autopsy studies performed in the early twentieth century, it is believed that between 22 and 32% of people develop NIVL throughout their lifetime. What are the symptoms of NIVL? People are often diagnosed with NIVL after seeking treatment for left lower extremity swelling, pain, or tenderness. Their primary care doctor often sends them for an ultrasound study to rule out a deep vein thrombosis (DVT), or blood clot. How is NIVL diagnosed? After a blood clot has been ruled out using ultrasound, the patient will undergo a CT of their abdomen and pelvis. The CT imaging will give the physician their first clear image of the compressed iliac vein. However, a patient will not have a definitive diagnosis of a non-thrombotic iliac vein lesion until a Venogram is performed. How is NIVL treated? During a venogram, a special dye is injected into the veins. This dye allows the veins to be photographed using x-ray imaging. Venograms are a diagnostic radiology tool. At Milford Vascular Institute in our Outpatient Based Laboratory, once a diagnosis is confirmed for NIVL, a stent can be placed inside the left common iliac vein to expand and reopen the vein.

Do you have unsightly varicose veins? Do your legs ache and feel restless morning and night? Do you cringe at the thought of wearing shorts or skirts in the summer? Varicose veins, while unsightly and annoying, are usually a sign of a more serious condition happening below the skin's surface called venous insufficiency. Veins have a difficult job. They are tasked with bringing blood back to your heart. This means, the veins in your legs have to fight against gravity to keep the blood moving in the right direction. By the time blood passes through the tiny capillaries which connect the arteries to the veins, there is very little pressure left to carry the blood along back up to the heart. For that reason, veins rely heavily on muscular contractions and the valves inside them to prevent the blood from traveling back toward your toes. In some patients, the valves in their veins become "leaky." These valves do not close properly as blood travels through them. This allows blood to flow backwards inside the veins. The result is a disease we call venous insufficiency. Symptoms of venous insufficiency include achy, restless legs; swelling; and varicose veins. Here at Milford Vascular, we like to relate the treatment of varicose veins to a row boat with a hole in it. It does no good to bail out the water from the rowboat until the hole is plugged. Otherwise, the boat will continue to fill up with water as you bail it out. First, you must plug the hole, then you can bail out the water and empty the boat efficiently. Many people have had superficial veins treated in the past and simply see them return in a short time. This is because the underlying problem, the hole in the boat, has not been addressed. The underlying problem is the leaking valves in the veins that you cannot see. We treat the valves first with a closure procedure. This decreases the venous pressure and cuts the supply to the superficial veins that you can see on your legs. After closure, we can remove the bigger veins and inject the smaller veins. So, why is now, at the beginning of the year, a great time to treat your veins? Once you have your legs treated, it can take 6-12 months to fully see results. If you're hoping to have better looking legs by summer, now is the time to seek treatment. Additionally, most people have insurance plans that restart at the beginning of the year. With the restart of insurance plans comes the restart of deductibles. Intuitively, yes this sounds like the worst time to have a procedure done. However, most people end up accumulating medical expenses throughout the year. The billing team at Milford Vascular is able to work with any budget to find a payment plan that works for you. New year, new you, new legs, and no more varicose veins. Schedule your appointment with our Vein Team for the New Year today: (203)882-VEIN (8346)!

Recently, the doctors at Milford Vascular Institute diagnosed a patient with a very rare form of venous disease. The patient presented with abdominal pain. After some simple testing, Dr. Davis was able to deduce this patient was suffering from nutcracker syndrome. What is Nutcracker Syndrome? Nutcracker syndrome occurs when the arteries near the kidney compress the left kidney vein. In most cases, the compression is caused by a pinching of the left renal vein between the abdominal aorta and the superior mesenteric artery. Nutcracker syndrome gets its name because this compression is like a nutcracker crushing a nut. Normally, the left renal vein takes blood from the left kidney and brings it to the inferior vena cava. Compression of the left renal vein can cause blood to flow backward into other nearby veins and make them swell. This causes symptoms like flank pain and blood in urine. How is Nutcracker Syndrome Detected? Patients typically first present with abdominal pain and bloody urine. The diagnosis of nutcracker syndrome is particularly difficult because it tends to present similarly to gynecologic or urinary issues. To reach a definitive diagnosis of this syndrome, the patient must undergo a CT scan or MRI. How is Nutcracker Syndrome Treated? Depending on the age of the patient and level of severity of the disease, it may be recommended the patient does not require immediate intervention. Typically, intervention would only be recommended if the patient is symptomatic. In severe cases of the disease, patients may be recommended to undergo endovenous stenting or surgery. A stent is a small mesh tube used to hold open the walls of a vein. During this form of treatment for nutcracker syndrome, a stent is placed inside the compressed renal vein to restore normal blood flow. Stenting is performed under x-ray guidance during a procedure called a venogram. In very severe cases of nutcracker syndrome, the patient and the doctor may decide surgical intervention is the best treatment option. Surgical treatment for nutcracker syndrome can include removing the left renal vein and reattaching it, or a left renal vein bypass. Bypass surgery is the process of using a bypass graft to reroute blood around a blockage in a blood vessel. Bypass grafts can be made of organic or artificial materials. To make an appointment with a member of the leading vascular team in Connecticut, call the office at (203)882-VEIN (8346). Wishing you all a very happy and healthy holiday season!

Varicose veins are gnarled, bulging veins that occur most commonly in your legs. What causes these unsightly and often painful vessel to appear? The veins in your legs are fighting an uphill battle as they carry blood from your toes to your heart. To counteract the effects of gravity, your veins have one-way valves built into them. Over time, in some people, the valves begin to leak, causing blood in the veins to flow backwards. This backflow causes an increase in venous pressure which can eventually lead to the appearance of bulging varicose and spider veins. In recent years, there have been many advances in our understanding of varicose veins. To help you understand more about varicose veins, we're setting the record straight about some common statements you may hear about them. 1. Varicose veins are a cosmetic issue. This statement is false; varicose veins are not solely a cosmetic issue. What classifies varicose veins as cosmetic versus medically necessary, is the severity of the underlying disease which causes them - venous insufficiency. Venous insufficiency is a chronic disease that can lead to severe side effects if left untreated. While varicose and spider veins may at first present as a cosmetic issue, if the symptoms are not well controlled, the disease will almost always continue to progress. People with advanced stages of venous insufficiency will often develop severe side effects, like skin discoloration or ulcers. Having varicose veins puts you at a greater risk for bleeding, blood clots, or infections. Therefore, if you have varicose veins, it is very important to have them evaluated by a vascular expert. 2. Varicose veins happen to everyone - they are a normal sign of aging. Varicose veins are an abnormal process. While you are more likely to develop varicose veins as you age, due to the degenerative nature of the disease, not everyone will develop varicose veins. Varicose veins are caused by gravity. There are certain risk factors which put people at a higher risk for developing varicose veins. These factors are typically related to your lifestyle or genetics. People who sit or stand for long periods of time at work, people with a family history of venous insufficiency, people who are overweight, and women who have had children are all examples of factors which increase a person's likelihood of developing varicose veins. 3. Only women develop varicose veins. Varicose veins are more prominent problem among women, but men can also suffer from varicose veins. Hormones within the female blood stream and pregnancy make women more susceptible to developing varicose veins. However, there are millions of men with varicose veins. Dr. Esposito says, "In my experience, usually men's varicose veins tend to be worse than women's.'' He says this is often the case because men are more likely to allow the disease to progress further. 4. Running can cause varicose veins Exercise is usually a good thing for your veins. However, Dr. Esposito says that, in a way, running can cause varicose veins due to the trauma running inflicts on the veins. Walking is the best treatment for your veins. Moving your legs and allowing your muscles to contract typically allows for improved circulation toward the heart. Weightlifters, runners who are really pushing themselves, and other athletes who are really straining during exercise do put themselves at a higher risk for developing varicose veins. 5. Varicose veins are always visible This is not true. Dr. Esposito says closer to 90% of venous disease occurs below the skin. "Venous disease is like an iceberg; what you see on the tip, the varicose veins that you see on the surface, represent a network of abnormal veins that are underneath the surface. It's that pressure underneath the surface that is causing those superficial veins to come out." Although we only see what is on the surface, varicose veins are typically an indicator that there is a lot more going on in your deep venous system. 6. Varicose veins can be cured Varicose veins can be removed or injected; however, as Dr. Esposito explains in our "Weeding the Garden" analogy, without proper follow up varicose veins will almost always come back. Venous insufficiency is a chronic disease. Once the valves in your deep venous system become defective, they will continue to cause new varicose veins to develop. Therefore, there is no cure for varicose veins. However, with routine follow up you will most likely not require surgery to treat your varicose veins again. 7. Crossing your legs can cause varicose veins. This may be true - crossing your legs can cause an increase in venous pressure at the knee. However, crossing your legs would be very low on Dr. Esposito’s list of "Things that cause varicose veins." As long as you stay healthy, walk regularly, and maintain a healthy weight, crossing your legs will not significantly increase your chances of developing venous insufficiency. 8. Varicose vein treatment is painful Varicose vein treatments of today are very different than your parents’ or grandparents’ varicose vein treatments. In the early 2000s, alternatives to vein stripping started to become the common practice for varicose vein treatment. Vein stripping was a process of making multiple incisions in the leg and completely removing the greater saphenous vein. The procedure was done in an operating room and sometimes required an overnight stay in the hospital. This procedure was painful and carried a greater risk for bleeding and nerve damage. Recovery from this procedure typically took 4 to 6 weeks. Varicose vein treatment does not look like this anymore. We now use a method called an endovenous ablation. During this procedure, a laser or catheter is inserted into the malfunctioning vein. The laser uses heat energy to cause the vein to collapse and seal shut. This procedure is relatively painless - the only pain you should feel is from the needle used to inject the local anesthetic. The procedure takes less than an hour and you will walk out of the office the same day. There is little to no downtown associated with this form of varicose vein treatment. There are many misconceptions about varicose vein treatment. If you ever have any questions about venous disease, call Milford Vascular Institute at (203)882-8346.

What is PVI? Pelvic venous insufficiency (PVI), occurs when a patient has broken valves inside their gonadal (ovarian) veins. Previously, this disease was referred to as Pelvic Congestion Syndrome; however, the term PVI identifies the root cause of the patient's symptoms. Instead of ovarian veins bringing blood up and out of the pelvis, the leaky valves cause the blood to be pulled by gravity in the wrong direction. This causes swelling in the pelvic veins. What are the symptoms of PVI? PVI tends to present as chronic cramping and pelvic pain. While this condition is not exclusive to women, PVI is often a misdiagnosis in women. More than 30% of women in a gynecologist's office report feeling Chronic Pelvic Pain (CPP). However, 10% or more of these women with CPP have no diagnosis of their condition. "The American College of Gynecology and Obstetrics have no mention of pelvic venous insufficiency (PVI) as a cause on their website's patient information page" (Vein Therapy News, Aggarwal, p 26). How is PVI Treated? There is no universal and ultimate decision on the best course of treatment for PVI. Most insurance companies still consider Pelvic Vein Reflux to be "investigational." One "investigational" treatment that is gaining popularity through clinical effectiveness is The BlueLeaf System by InterVene. This is a new system which is gaining popularity in treating deep vein reflux. "The system allows a physician to fashion new valves from the inner layer of the vein wall. The resulting "autogenous" values aim to reduce retrograde blood flow and alleviate the symptoms associated with elevated venous pressures" (Vein Therapy News, Aggarwal, p 27). The question then becomes: how do we change this mindset? Up to 40% of women have ovarian reflux. Patterns must be identified to link PVI to Chronic Venous Insufficiency. Venous reflux in ovarian veins in the pelvis can give rise to venous reflux exhibited in the greater saphenous veins (GSV) more distally. Therefore, women with venous insufficiency in their GSV should consider being tested for PVI. What is the best way to diagnose PVI? Historically, Pelvic Congestion Syndrome has been diagnosed with CT scan or MRI. Recently, studies have shown that CT/MRI may misdiagnose or overestimate the size of the vessels. The best method for measuring ovarian vein sizes and reflux is by using both a transabdominal and a transvaginal ultrasound. Why is it so important to properly diagnose PVI? When a patient presents with deep pain in her pelvis with long periods of sitting or standing, her symptoms can sometimes be dismissed as CPP. After years of medicating with pain pills, these patients may undergo a partial hysterectomy. Unfortunately, because of the misdiagnosis, these women will continue to experience pain even after the surgery. If you experience chronic pelvic pain, and your gynecologist has not been able to pinpoint a diagnosis for you, consider contacting a vascular surgeon.

September is Aneurysm Awareness Month! Throughout the month, Milford Vascular Institute will be offering FREE Vascular Screenings for EVERYONE (not just existing patients). One scan could save your life! What is an aneurysm? An aneurysm is a ticking time bomb inside you. It is a bulge or ballooning in a blood vessel. This ballooning can occur in any blood vessel in your body, but the most deadly and common aneurysms occur in your brain or your abdominal aorta. Milford Vascular Institute offers in-house testing for Abdominal Aortic Aneurysms. Diagnosis of brain aneurysms requires more complicated testing - typically an MRI, MRA, or CTA. How do you detect an abdominal aortic aneurysm (AAA)? Most AAA's are diagnosed by sheer luck. Typically, while tests are being performed for another condition, the technician or doctor just happens to find the bulging vessel. For example, you could be receiving an ultrasound of your kidneys and the technician spots the ballooning in your aorta. Ultrasound is the quickest and least invasive way to see an image of your abdominal aorta. Aortic ultrasounds are performed in-office everyday at Milford Vascular Institute. If an aneurysm is detected, your doctor will then order a CT scan to confirm the findings. Why is it so important to take advantage of a FREE Vascular Screening? While the testing for a AAA is quick, easy, and painless, insurance companies will not pay for the ultrasound if you do not have an order from your primary care doctor. Your primary doctor will only be able to write an order for an aortic ultrasound if you have a significant family history of AAA, you are a smoker, or you have longstanding high blood pressure. In other words, while anyone could have an aneurysm growing in any blood vessel in their body at any time, only a small population of people will be able to have "preventative" ultrasounds performed. For the entire month of September, we are opening this opportunity up to EVERY member of the public! Our Vascular Screenings take about an hour to perform. You will have to fast (nothing to eat or drink, excluding water) for 4 hours prior to your exam. During the screening, one of our certified vascular sonographers will scan your Aorta to check for aneurysm and your carotid arteries to check for stenosis. A medical assistant will then perform an ABI to check for claudication in your upper and lower extremities. These tests for peripheral vascular disease can also be used as an indicator for heart disease, the leading cause of death amongst Americans. Vascular diseases claim the lives of over 17.9 million people every year, worldwide. Call us today to schedule your FREE Vascular Screening to make sure you don't have one of these silent killers living inside you. WATCH THIS VIDEO TO LEARN MORE ABOUT AAA FROM DR. DAVID ESPOSITO:

What is ascorbic acid? Ascorbic acid, or l-ascorbic acid, is more commonly called vitamin C. Ascorbic acid is a water soluble vitamin involved in the repair of tissue and the enzymatic production of certain neurotransmitters. How do we get ascorbic acid? Humans are unable to synthesize or store ascorbic acid; excess of the vitamin is excreted out of the body. Ascorbic acid is obtained through diet. It is ingested through food or oral supplements. Vitamin C is most commonly found in citrus fruits and leafy greens. Why do we need ascorbic acid? "Ascorbic acid is a potent reducing and antioxidant agent that functions in fighting bacterial infections, in detoxifying reactions, and in the formation of collagen in fibrous tissue, teeth, bones, connective tissue, skin, and capillaries." - U.S. National Library of Medicine What does that mean? Ascorbic acid is a sickness fighting, bone building, skin brightening, super nutrient! Additionally, vitamin C aids in the prevention of heart disease, increases energy, and prevents the formation of wrinkles. Its cell restoring properties aid in wound healing. Ascorbic acid can aid in stress relief and decreasing anxiety. While not definitively proven, vitamin C has also been linked to preventing Alzheimer's and Parkinson's Disease. Ascorbic Acid at MVI: Milford Vascular Institute opened an aesthetics and wellness division in May 2019 called The Glow Bar. One of the exciting services The Glow Bar offers is intramuscular (IM) vitamin injections. IM vitamin injections are highly concentrated vitamin cocktails that are injected into your muscle for maximum vitamin absorption. The Glow Bar offers a variety of vitamin Cocktails, one of which being the Beauty Cocktail. The Beauty Cocktail consists of two injections; one 1mL shot of Ascorbic Acid and one 1mL shot of Glutathione. Glutathione is a powerful antioxidant that aids in the regeneration of ascorbic acid, for maximum absorption. While this cocktail is most known for enhancing the appearance of your skin, the other health benefits are nearly infinite. Call Milford Vascular today to schedule your happy hour at The Glow Bar: (203)882-VEIN(8346).

What is dialysis? Dialysis is a way of cleaning your blood when your kidneys can no longer do the job. It gets rid of your body's wastes, extra salt and water, and helps to control your blood pressure. What are the different types of dialysis? There are two types of dialysis; hemodialysis and peritoneal dialysis. In hemodialysis, blood is pumped out of your body to an artificial kidney machine, called a dialyzer, and returned to your body by tubes that connect you to the machine. In peritoneal dialysis, the inside lining of your own belly acts as a natural filter. How does hemodialysis work? Should you choose to have hemodialysis, your dialysis center will need to access your blood vessels. There are two methods for gaining access to the blood vessels; via a catheter or a fistula/graft. A catheter is a soft tube that is placed in a large vein, usually in your neck. An AV fistula is an access made by joining a patient’s own artery and vein directly to each other. An AV graft is an access made by connecting an artery to a vein using a plastic blood vessel. Why would I need a catheter placement? A catheter is used when a patient needs immediate access for dialysis, typically because the patient has suddenly found out they have kidney failure. A dialysis catheter can be placed by an interventional radiologist or a surgeon. However, using a catheter puts the patient at a much higher risk for infection, since it hangs outside the body. The longer it is in, the higher the risk of infection. Why should I choose an AV Fistula for dialysis access? An AV fistula is considered the gold standard for dialysis access. With an AV fistula, blood flows from the artery directly into the vein, increasing the blood pressure and amount of blood flow through the vein. The increased flow and pressure causes the vein to enlarge. The enlarged vein will be capable of delivering the amount of blood flow necessary to provide an adequate hemodialysis treatment. AV fistulas are the preferred vascular access for long-term dialysis because they are made entirely of the patient’s own tissues. There is no plastic or foreign material. They last longer than any other dialysis access types, are less prone to infection and clotting, and can be relied upon for predictable performance. Why doesn’t everyone choose to have an AV Fistula Creation? The issue with fistula dialysis access is not everyone is able to have a successful fistula created due to individual anatomy. Usually this is due to small caliber veins. Also, once a fistula is created, it typically takes between 6 weeks and 4 months to mature. This means, if the patient needs dialysis immediately, they will still need to have a catheter placed while they wait for the fistula to mature to functionality. Why should I choose an AV Graft for dialysis access? If your vascular surgeon determines you are an unsuitable candidate for an AV Fistula creation, he may then evaluate you for an AV Graft Placement. A graft is usually about one-half inch in diameter and made of plastic (Teflon), or transplanted animal or human vessels. They are usually placed in the arm, but can also be placed in the thigh. Grafts become functional much more quickly than fistulas; they can typically be used two to six weeks after placement. Why are AV Grafts not the preferred mode of vascular access? Grafts are created from foreign materials to the body. This makes them more prone to clotting or becoming infected. For these reasons, the graft may have to be replaced yearly. However, they are still a much safer alternative to using a catheter. How can you plan to have a fistula created or a graft placed to avoid having to use a catheter for dialysis? When patients find out they are in the advanced stages of chronic kidney disease and will need dialysis, their nephrologist will advise them to be evaluated for a fistula or graft. Having the access in place well before beginning dialysis will give this lifeline time to mature, so it can be ready to use. When patients suddenly discover they have kidney failure, a catheter may be placed to allow for immediate dialysis treatment. In this case, the patient should still schedule an appointment to see a vascular surgeon. The surgeon will still be able to evaluate the patient for the fistula or graft and then perform the surgery. The catheter will be used until the fistula or graft has had time to mature. Milford Vascular Institute has relationships with many renal specialists throughout the Southern Connecticut area. When a patient suddenly develops kidney failure, MVI has the ability to see the patient within the next business day to both place a catheter and evaluate them for a vascular access. Contact us if you or your loved one may soon require dialysis.

Milford Vascular is now offering the The VenaSeal™ closure system as an option for treating varicose veins. The VenaSeal is the only venous closure procedure that does not require injections to numb the entire leg, does not use heat to close the vein, and does not use a sclerosing solution. During this procedure, a medical glue is delivered inside the vein to close it In the office, the leg is cleansed and prepped with Betadine solution.  Lidocaine is used as a local anesthetic. The abnormal vein is identified with ultrasound and punctured with a small needle.  A catheter is then inserted in the vein and advanced under ultrasound guidance to the abnormal valve. The glue is then applied in multiple steps from the valve down to the mid-thigh or knee.  Gentle compression is done to allow the glue to adhere to the walls of the vein. Advantages of this technique include the avoidance of multiple injections of anesthetic solution and the fact that a compression stocking does NOT need to worn afterward. The VenaSeal is a more gentile mode of venous closure. Unfortunately, in the state of Connecticut, the VenaSeal closure system is only covered by Medicare and Medicare Replacement plans. If you are Medicare age, ask one of our providers for more information about this new innovation in the treatment of venous insufficiency. We will continue to monitor the private insurance companies and advise our patients if this becomes a covered procedure in the future.