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Hypertension/COPD FAQs

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For additional information about Hypertension and COPD, please refer to the following links.




How is the ROX FLOW procedure different than taking medications for my hypertension?

You need to remember to take your medications each day and your doctor may change them from time to time.  The FlOW procedure is done once and you don't need to do anything after that.  Nothing is changed or adjusted and the benefit should last as long as the device is in place.  It is possible that you may need one follow-up to ensure your blood vessels remain open and healthy.

Will I be able to stop some of my medications after having the FLOW procedure?

The FLOW procedure is not intended to replace your medications. However, once your doctor determines how much your blood pressure has gone down after the FLOW procedure, he/she may decide to adjust or eliminate some of your medications.

How is the ROX FLOW procedure performed?

The FLOW procedure is done in a catheterization lab by a cardiologist, interventional radiologist or endovascular surgeon. Two small introducer tubes are placed in the artery and vein in your upper leg. Catheters are placed through the introducers and a crossing is made between your vein and artery just above the entry point. A small metallic Coupler is placed to keep a small hole open between the artery and vein. This open connection between artery and vein is called an anastomosis and allows a modest amount of blood to flow from artery to bein where it returns directly to the heart and lungs.

How does the ROX FLOW procedure reduce blood pressure?

Arteries are under pressure as they conduct blood pumped by the heart to the rest of the body where it is eventually forced through very tiny passages called capillaries. When you have hypertension, this pressure in the arteries has become dangerously high. Veins collect blood from the capillareis and allow it to flow back to the heart. Veins are generally soft and not pressurized like arteries. The ROX FLOW procedure creates a passageway between an artery and vein in your upper leg. By allowing some of the pressure in the arterial system to flow to the veins, arterial pressure is lowered. Your heart will pump the modest additional amount of blood that flows through the passageway so there is no less blood flow to your leg.

How does the ROX FLOW procedure compare with Renal denervation?

Both are catheter procedures done through a small access point in the upper leg and will likely require one over-night stay in the hospital. Renal denervation involves heating and destroying the nerves along the (renal) artery leading to the kidney. Some people have renal arteries that are not suitable for renal denervation. The ROX FLOW procedure changes blood flow in one artery and vein as described above and does not directly affect any nerves. Since they work in different ways, the ROX FLOW procedure and renal denervation are complementary and may be combined.

How will I know if the ROX FLOW procedure is successful?

Physicians clearly see the ROX Coupler placement, confirm the desired flow of blood from artery to vein, and know the procedure has been successfully performed. They will also typically see an immediate drop in systolic and/or diastolic blood pressure from the catheter lab. The reduction in blood pressure is confirmed upon discharge from hospital the following day. It is also very easy for your physician to confirm that the ROX Couple is till open by listening with a stethoscope.

Can the ROX FLOW procedure be reversed?

Yes, the ROX procedure is fully reversible by placing a small covered tube called a stent or endograft over the Coupler and opening between blood vessels. It is not necessary to remove the ROX coupler.

What are the risks of the ROX FLOW procedure?

Literally thousands of artery to vein connections, known as AV anastomoses or fistulas, have been performed over the years for dialysis patients. The effects and safety of AV anastomosis are well known and understood. The ROX FLOW procedure is similar to dialysis fistulas in the effect on the heart and circulation. The ROX procedure differs from most dialysis forearm fistulas since it is created in larger vessels of the leg. The FLOW procedure is done minimally invasively, without the need for surgical cutting, dissection, and sewing together of vessels. As a result, the ROX anastomosis is generally more stable and not prone to changes or closing like dialysis fistulas. There is a potential for venous stenosis - a narrowing of the vein in response to blood flow - with both the ROX procedure and dialysis fistulas.


Is there a cure for COPD?
No. The “C” in COPD stands for “chronic,” which means there is currently no COPD cure. But with the help of doctors, respiratory symptoms can be treated and damage to the lungs can be slowed.

Can I stop the progression of COPD?
While no treatment can fully stop or reverse COPD, the single best way to slow the advancement of the disease is to stop smoking. Even those with severe COPD symptoms are likely to benefit and reduce further progression of the disease if they quit smoking.

Learn more about Treatment Options for COPD.

What is the difference between COPD and asthma?
While the symptoms of asthma and COPD are similar, they are different diseases. In COPD, there is permanent damage to the lungs, so treatment to open up the airways is limited. In asthma, inflammation causes muscles in the airways to constrict and the airways to narrow. Unlike COPD, asthma symptoms are sporadic and treatment to reduce inflammation usually works well.

What is the difference between chronic bronchitis and emphysema?
Both chronic bronchitis and emphysema fall under the umbrella of COPD. Chronic bronchitis is the inflammation of the lining of the bronchial tubes, which connect the windpipe to the lungs. When the tubes are inflamed or infected, less air is able to flow to and from the lungs resulting in a mucus-inducing cough. Emphysema affects the air sacs and the smallest breathing tubes in the lungs, which lose elasticity similar to an overused rubber band. When lungs lose their elasticity, the affected areas become enlarged and it becomes difficult to get air into and out of the lungs.

Can COPD cause heart disease?
The heart and lungs work together. The heart pumps oxygen-rich blood from the lungs into the arteries and pumps deoxygenated blood from the veins into the lungs for reoxygenation. In COPD patients, decreased oxygen levels cause the lung's blood vessels to narrow making it difficult for the heart to pump blood into the lungs. Over time, the heart muscle weakens and pumps less effectively. This is a type of heart failure.

Will I have to go on oxygen to tret my COPD? And if so, when?
For people with severe COPD, doctors may recommend home oxygen therapy to help with shortness of breath. The need for oxygen therapy is found by measuring the amount of oxygen in your blood stream with a test called an arterial blood gas (ABG) or using a pulse oximeter, a tiny computer that is painlessly clipped to the finger.

Some people with COPD do not need oxygen when they are inactive, but do need it when exercising or doing other activities. Using extra oxygen more than 15 hours per day can not only help with shortness of breath, but also protect the heart and other organs from damage, help you sleep, improve alertness and help you live longer.

What is life like on supplemental oxygen?
Using supplemental oxygen is common for COPD patients and is referred to as "wearing" oxygen. While long-term oxygen therapy has been shown to improve quality and length of life, it does mean a big change in lifestyle. Many patients feel self-conscious about wearing oxygen in public, while others are intimidated by the physical challenge of using oxygen and have concerns about safety.

Some individuals may only need to use oxygen when they are active or while sleeping, but most patients use oxygen 24 hours a day. Many convenient portable systems are available, and you’ll probably be able to do more activities than before because your body will be getting the oxygen it needs.  When used as prescribed, oxygen therapy does not cause any harm to your lungs or body and is not addictive. Oxygen therapy is very safe as long as you keep your face and oxygen away from flames.

How is severe COPD treated?
Smoking cessation is the single most effective intervention to slowing the progression of COPD. Treatment typically includes pulmonary rehabilitation, which includes education, counseling, exercise, nutrition and breathing therapies, combined with drug therapies such as long-acting bronchodilators and short-acting inhalers. In severe cases, inhaled steroids and long-term oxygen therapy are often prescribed. However, as the disease progresses, patients are less likely to get symptomatic relief from traditional treatments. At this point, doctors may begin exploring surgical options.

Learn more about Treatment Options for COPD.

When is surgery recommended?
Surgery is usually performed on patients with very severe symptoms who have not improved with medication and have a hard time breathing most of the time. Two types of surgery are considered in cases of severe COPD: lung volume reduction surgery and lung transplantation. Learn more about these surgeries.

Why is it so important to exercise?
Exercise decreases shortness of breath and improves your energy level. It also decreases the risks of heart disease, high blood pressure and depression. Exercise increases bone and muscle strength, endurance, relaxation, restful sleep and overall quality of life.

How can I exercise when I can't breathe?
By starting slowly and using coordinated breathing techniques, you will be able to find an exercise program that works for you. Difficult breathing can cause you to become anxious, which can lead to inactivity. The more inactive you are, the more short of breath you become. The increased shortness of breath in turn increases your anxiety about activity. If you exercise, you can beat this cycle.

I’ve tried to stop smoking and failed. What should I do?
You should continue to try to quit smoking, and seek additional help. Ask your doctor to help you find the right smoking cessation program. Many smokers are addicted to nicotine, and your doctor can help you find the right nicotine replacement therapy or other medication to help avoid the urge to smoke and relieve withdrawal symptoms. Support groups and smokers’ hotlines are also available to assist you.

Where can I find more information about COPD?

Global Initiative for Chronic Obstructive Lung Disease

COPD International