Maggie McKay (Host): Welcome to conversations like no other: heart care, presented by the Heart and Vascular Institute of Valley Health System in Paramus, New Jersey. Our podcast goes beyond broad, everyday cardiac topics to discuss very real and very specific subjects that impact your heart health. We think you'll enjoy our fresh take. Thanks for listening. I'm Maggie McKay. Today we have with us Dr. Daniel Char, Director of Vascular Intervention at the Valley Hospital. Thank you so much for joining us.

Daniel Char, MD: Thanks for having me today.

Host: Would you please begin by providing us with an overview of our vascular system?

Daniel Char, MD: Absolutely. Most people are aware of their arteries and veins. The very basics are that arteries bring blood and oxygen that comes pumping from our heart to all of our organs and our extremities. However, today we're going to concentrate on our veins, specifically the veins in our legs. As most people are probably aware, our veins collect the blood in our body and it returns it to the heart.

And when we look at our veins, we talk about two systems of veins in our body. The first system is the deep veins, and specifically in our legs; these are very large veins, which can be larger than the size of your thumb. And these are the main drainage of blood from our legs back up to our heart.

Host: Well, you mentioned the deep veins. Are these the veins that we hear people getting blood clots in?

Daniel Char, MD: That's correct. Blood clots or deep venous thrombosis or DVT for short are a serious problem. Complications from deep venous thrombosis actually represent the third leading cause of cardiovascular death after heart disease and stroke. And unfortunately, DVT can occur in patients admitted to the hospital and is actually the leading cause of preventable death in patients within the hospital.

 There's several risk factors for developing a DVT, and these include recent serious injuries such as breaking a bone, recent major surgery, or having an active cancer. There are other risk factors. These can include family history of blood clotting disorders, being pregnant or recently giving birth, taking birth control pills that contain estrogen or even hormone replacement therapies.

Maggie McKay (Host): That's a lot of risk. Dr. Char, how common of a problem is this?

Daniel Char, MD: Yeah. Unfortunately, DVT or deep venous thrombosis is all too common. DVT can result in a pulmonary embolism, which occurs when one of these blood clots breaks free. It travels up to the heart and lungs. This compromises our breathing and our heart function. According to the CDC estimates, anywhere from 60,000 to up to 100,000 people will die each year as a result of a deep venous thrombosis causing a pulmonary embolism.

Again, just to put this number in perspective, approximately 42,000 women will die of breast cancer each year in the United States, and approximately 34,000 men will die of prostate cancer. So again, you can see how DVT and pulmonary embolism is a major problem in the United States.

Host: You mentioned earlier that pregnancy is a risk factor for developing a DVT. How common is that?

Daniel Char, MD: Approximately three out of 1000 pregnancies will be complicated by DVT, so fortunately it's a relatively low number. Unfortunately, pulmonary embolism is the leading cause of maternal death.

Host: Wow. Doctor, what are the treatments available for DVT and pulmonary embolism?

Daniel Char, MD: Well, the number one treatment for both DVT and pulmonary embolism is blood thinners and the way blood thinners work, they help stabilize blood clots and they'll actually allow our body to dissolve them. For patients with severe symptoms related to DVT, such as severe swelling or in patients with life-threatening pulmonary embolism, the good news, minimally invasive procedures can help with these symptoms and even be lifesaving.

Host: Well, let's hear more about these procedures.

Daniel Char, MD: Absolutely. For patients with DVT, the vascular surgeons at Valley Hospital perform minimally invasive procedures that can really help these patients with severe symptoms. With just a local anesthetic, blood clots can actually be removed from anywhere in the body, and even a stent can be placed to help maintain flow in these blocked veins.

And the way it works, we simply numb the skin overlying the vein. We then puncture the skin with a needle. You don't feel that, it's all numb, and our veins don't actually have sensory nerves inside, and that allows us to insert a special catheter, which is a flexible hollow tube. It goes directly into the vein.

Then using these catheters, we can actually remove clots and even place a stent. This can be done as an outpatient and it actually can provide immediate relief for patients with symptoms such as severe arm or leg swelling. The other good news, at Valley Hospital, we're fortunate to have a multidisciplinary team of vascular surgeons, interventional cardiologists, and pulmonologists who all collaborate to help treat hospital patients with life-threatening pulmonary embolism.

Here too, we can treat these patients with minimally invasive techniques. We can remove these blood clots directly from their heart and lungs. And this can be lifesaving in patients with severe pulmonary embolism.

Host: Earlier you mentioned that we have two systems of veins. Could you give us some more information about the second system of veins?

Daniel Char, MD: Absolutely. Our second set of veins, these are the superficial veins. These are the veins that actually run under our skin. Specifically in our legs, there's one main superficial vein that we all have. It travels from the area of our inside ankle up through our calf and up the side of the thigh, and then it actually dives deep down in the area of the crease of our groin, and it connects up to those deep veins that we were talking about earlier.

And this main trunk, it has many branches. However, when these veins malfunction, they lead to what we commonly see as varicose veins.

Host: I know about those all too well, Dr. Char. Sadly, but what exactly do you mean by malfunction?

Daniel Char, MD: Within our veins we have these valves. And these valves, they act like little one-way trap doors, and they help direct flow of blood in our veins. For example, in our legs when we're walking, our muscles, they're squeezing on these veins in the legs and these valves inside, they swing open and they allow blood to go up in a one-way direction, traveling from our legs right up to the heart.

Now if we're just sitting or we're standing still, then gravity's going to try to push this blood back down into our legs and feet, and these valves will then swing closed to prevent this. Unfortunately, these valves can malfunction and instead of closing properly, they begin, as I describe to my patients, they start flapping in the breeze and they no longer will swing closed.

As a result, instead of blood efficiently traveling up and out of the legs in a one-way direction, the blood can flow back in the wrong direction into those veins. Now, when this occurs in our superficial veins, in the leg, under the skin, the blood begins to pool in these veins. The veins become enlarged. Now they're visible under the skin as varicose veins. Although not typically dangerous. Varicose veins can lead to complications.

Host: What type of complications can occur?

Daniel Char, MD: Over time what happens is this blood continues to pool in our superficial veins. The veins and the legs will begin to swell. There's associated discomfort, and there's even fatigue in our legs. As a result of this blood pooling in these veins, the veins become large and they become very thin.

As a result of this thin walled veins, fluid, proteins, blood cells, they all leak out of the veins and they become deposited right under our skin. And then as these cells begin to break down under the skin, the skin can become discolored and very dry. People with this problem often report that their legs feel itchy, and they're actually surprised to find out that this is a result of their varicose veins.

Now, the worst case scenario of this is that the skin becomes so damaged from this process that it actually begins to open up as a wound, and these wounds mainly occur in the calf. Especially around our ankle, and they can be quite painful and very difficult to heal.

Host: So for some people are not veins, just simply a cosmetic issue?

Daniel Char, MD: Absolutely correct. For some people, varicose veins are simply cosmetic. As I tell my patients in the office, beauty is in the eye of the beholder, for some patients with very large varicose veins, they're not at all concerned about their appearance. And as soon as I reassure those patients that they're not particularly dangerous, they're very happy with conservative treatment.

For other patients, they can be troubled by the appearance of a single vein or a cluster of veins.

Host: So you mentioned conservative treatments for varicose veins. Can you elaborate?

Daniel Char, MD: Well, for patients with symptomatic or even cosmetic varicose veins, I recommend several things. Exercise is very good. Weight loss is very important. In addition, taking care of your skin properly with the application of just a plain old skin moisturizer daily that can help with the dry and itchy skin. A mild compression sock, also very important, can help with the swelling, the discomfort, and the fatigue.

 By doing these simple things, you can help minimize symptoms of these veins, and you can actually minimize the risk of progression of these veins.

Maggie McKay (Host): Dr. Char, how about these minimally invasive procedures to treat varicose veins? Because I know I thought of it and then I'm like just leave it alone.

Daniel Char, MD: Well, fortunately, we have these new minimally invasive techniques to treat both symptomatic patients and those patients who are troubled by their cosmetic varicose veins. And there's two main approaches. For the patients I described with malfunctioning valves in their superficial vein under the skin.

We can treat this with ablation of the vein with either a laser or a radio frequency catheter. Good news, this ablation procedure can be performed right in the office with a simple local anesthetic. Again, we simply numb the skin, overlying that malfunctioning vein, and we assert a needle right into the vein. After we numb the skin, the patient won't have any discomfort at all; as our veins, they don't really have any sensory nerves inside, so you really can't feel it. And through this needle that we insert into the vein, we then insert a laser or a radio frequency catheter directly in the vein. We then go ahead and we zap this vein and we seal these malfunctioning valves.

When we're done with that, we simply remove the needle and we put on a bandaid, and this stops any further blood from going down the vein in the wrong direction. The blood simply goes directly into the deep veins of the leg. And as I mentioned earlier, these deep veins are actually the main drainage of our leg.

So as a result, the patients don't miss their superficial vein after it's ablated with either laser or radio frequency ablation.

Host: That is amazing. What about the visible varicose veins that we all see under the skin?

Daniel Char, MD: These veins are not the main trunk that I was describing, that we use the ablation procedures for. The main trunk acts as a leaking pipe, and then it fills these branches that we actually see as our varicose veins. So first we treat that leaking pipe with the ablation procedure we were talking about.

And then right at the same time, we go ahead and tackle those branches or those large varicose veins that we're seeing. And so simply the skin is already numb, so we can simply puncture the skin, overlying the vein. And as I describe to my patients, we gently tease out those veins and those veins are gone forever.

When we're done, we simply apply band-aids and an ace wrap and the patient is free to go home. They may feel sore for a day or two. I describe it to my patients, it feels like someone came up and punched you in the thigh for the day. This is easily managed with simple Tylenol or ibuprofen.

Good news. Within a few days, patients can resume their normal activities and the results of these procedures are excellent. Symptoms resolve, and patients have a great cosmetic result.

Host: Well, you may have just changed my mind on getting that done. It sounded so easy. This has been so informative and interesting. Thank you so much for sharing your expertise and your time.

Daniel Char, MD: Well, I appreciate the invite and the chance to speak with you today.

Host: Of course. Again, that's Dr. Daniel Char. Thanks for listening to conversations like No Other: Heart Care presented by the Heart and Vascular Institute at Valley Health System in Paramus, New Jersey. For more information on today's topic, or to be connected with today's guest, please call 201-291-6090 or email Valley podcast@valleyhealth.com. We hope Dr. Daniel Char's insights have helped you better understand the critical role vascular health plays in your overall wellbeing. Remember, your arteries and veins are more than just pathways for blood. They're the lifelines that connect every part of your body. If you're experiencing symptoms or have questions about your vascular health, don't wait. Talk to your doctor. For more information and resources, visit valleyhealth.com/heart. And as always, be sure to subscribe. Share this episode and take good care.