Advanced Vein Care

If you suffer from varicose veins you are among some 25 million Americans who struggle with daily leg pain, swelling and unsitely ropey veins that cause throbbing, heavy tired legs.  Half of all Americans over age 50 and two thirds of women over age 60 suffer from varicose veins.  Varicose veins are caused by venous reflux disease.  

Factors which increase your likelihood of developing venous reflux disease and subsequent varicose veins include heredity, occupations which require prolonged standing or sitting, pregnancy, history of trauma to a lower limb, obesity and immobilty.  Your lifestyle, particularly physical activity, can affect your odds of developing venous reflux disease as well.  People whose occupation requires them to stand in place or sit for long periods of time such as nurses, teachers, waitresses, flight attendants and other service personnel,  have a higher than average risk of developing venous reflux disease.  People who do a great deal of heavy lifting are also at risk.

Once it appears, venous reflux disease never goes away by itself.  It is a progressive disease that only gets worse if left untreated.  Both conservative therapy such as lifestyle modification and the use of graduated compression support stockings can slow progression as well as relieve symptoms. Minimally invasive office based Endovenous Lazer and Radiofrequency Catheter Ablation as well as ambulatory phlebectomy and sclerotherapy can be combined to treat venous reflux disease adequately to slow progression, abolish symptoms and achieve a cosmetically acceptable result.

At our Advanced Vein Care program we take a comprehensive approach to treating your vein problems.  A full evaluation, including history and physical examination, is performed by our professionals in a comfortable environment.  Non invasive venous ultrasound and venous plesmythography is performed when required in our vascular laboratory to determine the location of your venous problems such as abnormal varicose vein, spider veins and clots.

A customized treatment plan is formulated by our vein specialists and discussed with you in detail.  You will have the opportunity to participate in the process of decision making and have all of your questions and concerns addressed prior to instituting any treatment.

* Registered Phlebologist- Registered with the American College of Phlebology, a Phlebologist is a medical specialist in the diagnosis and treatment of disorders of the venous system.  A significant part of the phlebologist's work is involved with the treatment of superficial venous disease, specifically in the legs.

*R.P.V.I. Certified- RPVI (Registered Physician in Vascular Interpretation) Certified.  This gives him the skills and the knowledge to perform vascular ultrasound in the diagnosis of venous disease and accurately interpret the test results in the determination of the most optimal treatment protocol.

*R.V.T. Certified- RVT (Registered vascular technologist) Certified


Compression Stockings

Compression therapy is frequently the first and most conservative step in the management of varicose veins. In fact, insurers often require that patients undergo conservative compression therapy prior to becoming eligible for reimbursement for the VenaCure EVLT™ system or other more aggressive varicose vein treatments. Compression stockings are also often used following those same treatments to promote healing by lessening pain, swelling and bruising.

It is important to recognize that compression stockings can alleviate some symptoms of varicose veins but they cannot treat their underlying cause, failed valves (also called venous reflux). Even with faithful use of compression stockings, the disease may progress to the point that more advanced treatment is necessary.

Gradient compression stockings and hosiery provided pressure that is strongest around the foot and ankle and looser as it moves up the leg. The steady pressure provided by compression stockings assists the leg muscles and veins in moving blood more efficiently and quickly up the leg to the heart. They also prevent the superficial veins directly beneath the stockings from over expanding with pooled blood. For best results, compression stocking should be worn throughout the day.

Compression stockings and hosiery are available in varying degrees of compression that are expressed in units called “mmHg”, or millimeters of mercury. The range is from 10 mmHg to over 50 mmHg. Compression stockings at the lower end of the scale are used for milder cases of vein disease and can be purchased over the counter. Higher compression stockings require a prescription from your physician.

Compression stockings and hosiery come in a variety of types and brands and in styles and colors to suit both women and men. They are readily available online as well as at most pharmacies and medical supply stores.

The main potential complication linked to graduated compression stockings is that a poor fit may obstruct venous or arterial blood flow. When trying on compression stockings, choose a comfortably supportive fit over one that’s overly tight.

[Sources: http://www.phlebology.org/patientinfo/treatment.html]


Phlebectomy


Phlebectomy is a minimally-invasive surgical procedure that removes surface varicose veins. There are two basic types of phlebectomy: Ambulatory and Transilluminated Powered Phlebectomy (TIPP).
Ambulatory Phlebectomy

An ambulatory phlebectomy is usually performed in a doctor's office using local anesthesia. First, a local anesthetic fluid is injected into the area of varicose vein clusters to be treated. The doctor then uses a small scalpel or needle to puncture the skin next to the varicose vein, inserts a small hook into the hole, grasps the vein and removes it. The area is covered with a compression bandage and/or compression stockings. No stitches are required and the scars are nearly imperceptible. The patient is able to walk immediately following the procedure, which is often performed following the VenaCure EVLTÖ procedure to remove any large surface veins left behind after the procedure. The possible risks of ambulatory phlebectomy include an allergic reaction to the anesthetic and localized numbness.


VNUS RF Ablation


VNUS® RF (radiofrequency) Ablation system (also called the Closure® procedure) is a minimally invasive varicose vein treatment procedure that uses radiofrequency energy (electricity) to heat, collapse and seal off the targeted blood vessels.

After using ultrasound to map the course of the vein to be treated, the physician guides a catheter (thin tube) through a small incision into the diseased vein, threading it through the blood vessel into the groin area. Electricity is delivered to a heating element in 20-second pulses, heating and contracting the collagen within the walls of the vein until they shrink and shut down. This process is called ablation. The vein is treated in segments as the catheter is gradually inched back down towards the incision. When the entire vein has been ablated, the blood flow is automatically rerouted through healthier adjacent veins, restoring healthy circulation and reducing swelling. The ablated vein becomes scar tissue and is absorbed by the body.

Like the VenaCure EVLT™ procedure, which uses a laser to ablate the varicose vein, VNUS RF treatment is an alternative to more invasive leg stripping surgery. It is used primarily to treat the great saphenous veins (GSV), small saphenous vein (SSV), and other superficial veins in the legs. Varicose veins that branch off from these blood vessels are treated with sclerotherapy or phlebectomy.

Approved for use in the United States by the Food and Drug Administration in 1999, the VNUS RF treatment procedure is performed under local anesthesia in a physician’s office, ambulatory surgical center or hospital. Patients are encouraged to walk immediately following the procedure, and are usually able to resume their normal activities within a day. The use of compression stockings is generally prescribed for a week or two.

The success rate of VNUS RF treatment is reportedly slightly lower than that of the VenaCure EVLT procedure, and the risk of developing deep vein thrombosis (DVT) or a pulmonary embolism (blood clot), while rare, is higher. Other potential side effects of VNUS RF treatment include temporary bruising, swelling and numbness of the treated area, thermal skin burns, numbness that comes and goes, and an allergic reaction to anesthesia.

Like the VenaCure EVLT system, radiofrequency ablation is usually covered by most private insurers and Medicare when proof of medical necessity and previous conservative therapy is provided. Patients should consult their individual insurance carrier to determine their eligibility.

[Sources: http://www.vnus.com/physician-info/radiofrequency-ablation.aspx,
http://www.vein-treatment.com/vnus-closure.php,
http://www.phlebology.org/patientinfo/treatment.html,
http://www.evlt.com/content/patients/varicose-vein-removal/ablation.jsp]

VNUS and Closure are registered trademarks of VNUS.


Surgical Stripping of Varicose Veins


The traditional technique for surgical stripping is ligation and stripping of the great saphenous vein (GSV), the long vein that extends from the anklebone along the inside of the leg and thigh and empties into the femoral vein in the groin. Ligation and stripping involves tying off the abnormal vein (ligation) and physically removing it (stripping).

Ligation and stripping are performed in a hospital setting or outpatient surgical center under local, spinal, or general anesthesia. The surgeon makes a small incision in the groin to expose the diseased GSV, which is tied off. The surgeon then makes a series of incisions along the leg from the thigh to a point just below the knee. Using a specialized stripping tool that is inserted and threaded through the incisions, the surgeon strips out the diseased vein.

A more recent variation on this technique is PIN (Perforate Invaginate) stripping. This technique involves inserting an instrument called a PIN stripper through a small incision in the leg. The stripper is advanced through the vein, its tip is sewn to the end of the vein, and the vein is pulled in on itself as it is stripped out of the leg. PIN stripping is performed in a hospital operating room or outpatient surgical center under general anesthesia or local anesthesia with IV sedation.

During stripping, branch veins attached to the GSV are broken, causing blood to leak into surrounding tissues. This causes the postoperative pain, soreness and bruising experienced by ligation and stripping patients. Other potential complications include numbness from damage to surrounding nerves, chronic leg swelling from damaged lymphatic tissue, incision scars and allergic reaction to anesthesia. Although the patient is usually able to return home the same day, recovery from vein stripping surgery typically takes up to four weeks, with patients sidelined for several days in the beginning.

Surgical vein stripping is far more invasive than the VenaCure EVLT™ procedure. Additionally, a study published in the Journal of Vascular Surgery in 1999 revealed that vein stripping surgery was 71% effective in eliminating varicose vein, compared to a success rate of up to 98% for the VenaCure EVLT™ procedure. Endovenous laser vein therapy also causes less bruising and numbness and leaves minimal to no scars as compared to surgical ligation and vein stripping.

[Sources: http://www.vnus.com/vascular-disease/varicose-veins/vein-stripping-treatment.aspx,
http://www.phlebology.org/patientinfo/treatment.html]


Endovenous Laser Treatment


Endovenous Laser Treatment for the elimination of varicose veins is quickly becoming the gold-standard in the treatment of varicose veins. Endovenous Laser Treatment uses laser energy, which is simply a highly concentrated beam of light. Medical lasers work by delivering this light energy to the targeted tissue with extreme precision, so as not to affect the surrounding tissue. Lasers have proven their safety and effectiveness through years of use in all types of medical procedures, from eye surgery to dermatology. In the hands of a skilled physician, lasers offer far less risk for complications than conventional surgery.

In endovenous laser treatment, a thin fiber is inserted into the damaged vein through a very small entry point in the skin. A laser light is emitted through the fiber, as the fiber is pulled back through the vein, it delivers just the right amount of energy. The targeted tissue reacts with the light energy, causing the vein to close and seal shut. The veins that are closed are superficial veins that handle less than five percent of the body's blood flow. The blood is automatically routed to other, healthy veins.

Some physicians are now using a jacketed fiber, which prevents any contact between the fiber and the vein wall. This prevents much of the pain and bruising that is often associated with the more conventional method of ligation and stripping. Some patients may experience temporary soreness or some slight swelling, which can be treated effectively with over-the-counter, non-aspirin pain relievers and typically subsides within the first five days.

The procedure is minimally invasive and requires no general anesthesia. Only local anesthetic is used to numb the area where the physician is working. Patients are encouraged to walk immediately after the procedure and can resume normal activities the same day.

The VenaCure EVLT™ system utilizes this technology and method to eliminate varicose veins. Learn more about the VenaCure EVLT procedure.