Seeking Medical Vein Treatment

March 2nd, 2013 by Dr. Charles Gould, ll Leave a reply »

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In general, there are two reasons why people seek treatment for venous disorders of the lower extremities. Some people have only cosmetic concerns and are unhappy with the appearance of their legs or worse are frankly embarrassed of the presence of their spider and varicose veins. Others seek treatment because of health concerns from symptoms ranging from annoying to incapacitating spider veins, varicose veins, edema, ulcers, bleeding and generalized leg pain. Typical pain includes a heavy, aching fatiguing discomfort alleviated by elevation, usually ambulation (walking) and sometimes by compression stockings. I remember several years ago a 35 year old patient who after his legs were treated stated post operatively that the “cinder blocks that he had been caring around for so many years were gone!” The common theme of venous disease of the legs is one of an annoying, heavy, aching feeling which almost always is relieved by correcting the venous abnormality.

The leg veins rely on a coordinated and complex system of valves and pumps to move blood out of the leg “uphill against gravity” and return it to the heart. When this process fails, either by weakened and incompetent valves located in the veins or by the vein walls themselves becoming tired (aging), weak and dilated, the leg veins especially in the calf muscles “fill-up” with venous blood which pools in the leg causing it to feel heavy and ache and ultimately fatigue. This is called chronic venous hypertension or insufficiency (CVI). As pressure builds up in the deeper leg veins, stress is placed on the surface veins and they become enlarged and result in varicose veins or spider veins.

Treatments of venous disorders until relatively recently (past 15 years) has been for the most part sketchy and poorly organized. Spider veins have been treated by dermatologist, plastic surgeons, general and vascular surgeons, and even primary care physicians with various areas of expertise and training.

The treatment of varicose veins has been historically the “stripping procedure” where a wire is passed along the abnormal vein from the groin to the ankle. A barb was then placed on the distal end (near the ankle) and the vein was then “pulled out” of the leg from the groin until the entire superficial vein was removed. This required general anesthesia, several nights stay in the hospital and weeks of recovery.

In 2000, a paradigm shift occurred when a vascular surgeon in California suggested that by using a thermal ablation catheter it might be possible to cauterize (collapse) from within the vein and close it off eliminating the need to perform the major stripping procedure. The procedure (VNUS Closure) was successful and an entirely new industry was born: The Out Patient Vein Clinic. The idea of treating venous leg pathology exclusively in an outpatient setting (physician’s office), revolutionized vein treatment and provided access to thousands of patients who otherwise would not have been candidates for treatment. Consequently, hundreds if not thousands of Vein Clinics have sprung up worldwide and it is as if “Cinderella finally has arrived at the ball”.

Treatment, never imagined before, can now be performed with local anesthesia, minimal risk and pain and essentially little to no loss from work. To keep pace with the ever growing number of Vein Clinics, two Venous Societies (American College of Phlebology, American Venous Forum) have led the way to establish standards of excellence in promoting advanced vein care.

Many vascular surgeons have changed direction from hospital work and responsibilities to perform office vein surgery. Other physician specialities have also begun treating venous disorders i.e. plastic surgeons, dermatologist, radiologist, cardiologists, general surgeons and primary care physicians.

As with any medical treatment finding a qualified specialist is important to obtain the best result. Vein specialist are called “phlebologists” and have had advanced training in ultrasound, sclerotherapy of spider veins, surgical removal of small vein and catheter ablation techniques for longer, larger and straight veins.

In general, it is a good idea to find a phlebologist who spends the majority of his time treating patients with venous diseases, who has had advanced training and who is a member of the major vein societies such as the American College of Phlegology and the American Venous Forum.

According to the American College of Phlebology Patient’s Guide to Phlebology
Handbook “Healthy Veins…Healthy Legs” there are ten important questions to ask your phlebologist (found in chapter 22):

  1. What training do you have in phlebology and where did you receive it?
  2. What is your primary specialty and are you board certified in it?
  3. What percentage of your practice do you devote to phlebology?
  4. Are you a Diplomate of the American Board of Phlebology?
  5. Are you a member of a professional phlebology society?
  6. Are you trained in ultrasound?
  7. What procedures do you perform, how many have you done, and who actually performs the treatments?
  8. Will I need more than one procedure? Why or why not?
  9. What complications have you seen with these procedures?
  10. What kind of follow-up will I need, and what should I do after the treatment to decrease recurrence of my varicose and spider veins?
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