.:: Treatment methods would include but are not limited to the following: .:: Understanding Venous Circulation .:: Sclerotherapy .:: Endovenous Laser Treatment .:: Ambulatory Phlebectomy

Blood rich in oxygen and nutrients is pumped through the body by the heart. Once it reaches its destination, oxygen is released into the tissues and the veins are responsible for getting the blood back to the heart for repeat cycles. Veins do not have muscles to pump blood towards the heart. They are thin-walled tubes, which get squeezed by surrounding muscles as they contract. This squeezing in conjunction with a series of one-way valves, open to allow blood to move toward the heart and closes when gravity tries to pull blood back down to the feet. These valves ensure that blood flows toward the heart. If the valves become faulty and fail to close, then blood can flow backward and pool in the veins of the legs.

• What causes Varicose and Spider Veins?
Venous disease is not a disorder of modern times. Hippocrates observed the association between varicose vein and leg ulcerations more than 2,000 years ago (B.C.). This disorder has been described for many years with different method of treatment used.

An estimated 80 million Americans suffer from this leg vein disorder with as many as 60% of all women and 10-25% of all men eventually developing varicose/spider veins at some point during their lifetime.

The exact cause of spider and varicose veins is unknown, however heredity is a predisposing condition with hormonal influences (hormonal replacement therapy, oral contraceptive pills, pregnancy, puberty), circulatory problems, continued prolonged standing, and trauma being contributing factors. The end result is that valves inside veins no longer function properly. As we age, the veins begin to stretch and lose their elasticity and function poorly. This allows blood to flow backwards and pool in veins of the legs. This creates increased venous pressure, the end result being varicose and spider veins.

• What is the difference between Varicose and Spider Veins?
Spider veins are tiny, dilated blood vessels located below the skin surface, which become swollen and visible because of stagnant blood. They often appear darker and more prominent being red, blue or purple in color and are located mostly on the face and legs. Varicose veins are large, swollen protruding veins, irregularly shaped with blood that should be flowing back to the heart.

What are the Symptoms?
Poorly oxygenated blood stagnates in veins creating secondary symptoms such as cramping, burning, tiredness, aching, pain, restlessness and heaviness in the leg with long-term consequences such as eczema, ulceration, bleeding and pigmentation changes. Visual signs would include ropy and prominent veins extending along the leg, swelling of the leg and spidery-type veins.

• Can Varicose and Spider Veins be prevented?
Since some causes are natural (heredity, hormonal influences, pregnancy), these cannot be prevented but preventative measures such as prescribed therapeutic support stockings may delay the progression. These work in conjunction with muscles in the calf helping to push the blood out of the legs and back toward the heart. This support may help during pregnancy and occupations that require prolonged standing.

• Treatment Methods?
Treatment is individualized for each person. An initial evaluation is performed and a treatment plan is based on the examination of your legs and other factors. If there are underlying sources for the pooling and varicosities, this should be treated first; in other words, the larger veins and damaged valves should always be treated before smaller veins.

No matter what size vein you have, ask to have your legs examined with ultrasound (Duplex or Doppler ultrasound), which listens to and evaluates the veins and valves, this should be performed before any treatment begins. Sometimes faulty valves beneath the skin, which cannot be seen, will be detected by Duplex or Doppler sonogram and should be repaired first.

There is a major vein (Greater Saphenous), which connects many of the surface superficial veins. Failure of the valves in this vein is quite common and is, therefore, a cause of reflux and subsequent pooling of blood in the legs. This vein extends from the hip to the lower leg with the faulty/damaged valves being located near the top. Thus, varicose and spider veins in the leg may be due to a cause higher up. The larger vein should be treated before treating smaller ones.

We use several methods to treat varicose veins. The procedure or combination of procedures recommended depends on the severity of your condition.

Treatment methods would include but are not limited to the following:

•  Support Hose
Conservative treatment would include special support stockings to slow down the progression of varicose veins; this provides symptomatic relief and must continue as a part of your daily lifestyle.

•  Endovenous laser treatment (EVLT)
This procedure deals with incompetence of the Greater Saphenous vein and is performed in the office under local anesthesia through a tiny nick in the skin and, therefore, no postoperative scarring. A thin laser fiber is inserted into the diseased vein and directed into place using ultrasound-guidance. The vein is sealed permanently and not removed from the body; it becomes absorbed. The procedure is short with also a short recovery time.

•  Benefits of EVLT
Simple procedure with short procedure time Performed with local anesthesia Minimal risk of scarring and postoperative infection Rapid recovery Reduced postoperative pain Normal activities can almost be resumed immediately Very good clinical esthetic results

•  Ambulatory Phlebotomy (Micro-extraction Surgery)
An in office procedure also performed with local anesthesia for the removal of large surface varicosities through very small incisions that require no stitches. This allows us to pull the vein up and remove it in sections. The incisions are closed with small pieces of sterile tape. The procedure is minimally invasive, virtually scar-free and most patients can return to normal activities within 24 hours. Patients usually require no postoperative medication beyond Tylenol or Ibuprofen, a compression bandage and support is worn for three days. The bandage minimizes swelling and discomfort and allows for proper healing. The legs are elevated for the first day and support stockings are worn postoperatively for 72 hours, sometimes up to five days. There will be some bruising, which clears within a few weeks. This procedure may be performed in conjunction with EVLT and sclerotherapy. This is not VEIN STRIPPING!

•  Sclerotherapy
Sclerotherapy has been considered the "Gold Standard" treatment for removing spider and some varicose veins. It is a very cost-effective procedure that seldom leaves a scar or produces adverse effects. This is performed on an outpatient basis whereby a concentrated specially developed chemical solution is injected with a very small needle into the spider or varicose vein. This solution causes the vein to collapse and is eventually absorbed by the body. The work of carrying the blood is shifted to other healthy blood vessels nearby. Sclerotherapy generally requires multiple treatment sessions. The same area should not be retreated for 4 to 6 weeks to allow for complete healing although other areas may undergo treatment during this time. Post-treatment therapy includes wearing support hose for 7 to 10 days, walking and moderate exercise. Although sclerotherapy works for existing spider veins, it does not prevent new ones from developing. Most patients report few, if any, minor side effects, which usually disappear in time. These may include swelling of the leg or foot, bruising, itching, redness and some soreness. Few people report allergic reactions. No anesthesia is involved.

For larger varicosities, ultrasound guidance is used for the injections into the diseased vessels below the surface of the skin. This allows accurate and precise administration of the medication. Normal activities may be started right away.

 Post procedure instructions:
All patients are instructed to walk at least 30 minutes per day following treatment. This helps to reroute the blood through the deeper, healthier veins. Support stockings are used for 7 to 10 days to assist in healing and reduce any mild discomfort or swelling which may occur. Treatments are relatively painless and you can go right back to your normal routine and back to work in a day. For Sclerotherapy you can go back to work the same day.

For all treatments except laser occlusion of the vein and microsurgical procedures, you can drive to your appointments. If you require a mild sedative prior to a procedure, you should have someone available to drive you home.

Your vein disorder did not develop overnight so no matter what method of treatment is used, the end result will not occur overnight.

Please call or visit us for a evaluation at A.T. RADIOLOGY

863 419-VEIN(8346)

We take care of your legs as though they were ours.

What is Sclerotherapy?
Sclerotherapy is a non-surgical procedure that involves injecting a medication into a diseased dilated vein. This causes a reaction within the wall of the vein allowing it to close, be absorbed and the unsightly vein disappears. Blood is rerouted to the heart through other healthy veins.

How safe is Sclerotherapy?
Sclerotherapy is extremely safe. There are many different types of solutions, which may be injected, and each one carries its own risk, which would include redness, itching, and hyperpigmentation as only a few. These or other minor skin reactions usually disappear in time. Because of the different vein sizes, pigmentation of the skin and location the vein, different solutions and concentrations are frequently employed on an individual basis.

Can Sclerotherapy solution cause an allergic reaction?
Despite a detailed history examination, there is always the possibility of an allergic reaction. This rare complication may range from slight tingling sensations to hives, and even an anaphylactic reaction. Extremely rare cases of deep vein thrombosis and pulmonary embolus have been reported in the medical literature.

Are there any other side effects that may occur?
There are two other rare complications, which may arise from Sclerotherapy. In some patients, there are superficial A-V malformations, arterial-venous abnormalities and, if one of these is injected, a small ulcer may appear on the skin. Secondly, a small amount of sclerosing solution may spill into the subcutaneous tissue. Both of these may leave a small scar on the skin.

What to avoid before Sclerotherapy?
Do not shave, wax or apply lotion to your legs 24-hours prior to treatment.

Are there any medicines I should not take prior to Sclerotherapy?
Avoid the use of aspirin and anti-coagulants (Blood thinners) for one week prior to treatment. Iron supplements may add to skin staining risk.

What should I do after treatment?
Wear compression stockings continuously for 7 to 10 days. Exercise at least 30 minutes after treatment by walking, biking, or using exercise equipment involving leg motion.

How successful is EVLT?
Early results have been extremely favorable with success rates as high as the conventional surgical approach, which is accepted as the "Gold Standard" treatment. EVLT will normally treat the cause of most vein reflux disease but additional therapy may be necessary in some cases.

What are the benefits of EVLT?
•  Simple procedure with short procedure time
•  Performed with local anesthesia
•  Minimal risk of scarring and postoperative infection
•  Rapid recovery
•  Reduced postoperative pain
•  Normal activities can almost be resumed immediately
•  Very good clinical esthetic results

Is loss of this vein a problem?
No. There are many veins in the leg and, after treatment, blood is diverted to normal veins then back to the heart.

What are the complications of this procedure?
There are potential complications with any medical procedure. However, the only minimal complication experienced with the EVLT procedure has been a small number of cases of transient paresthesia (numbness), which improves with time.

Am I at risk from the laser?
No.You will be given a pair of special glasses to wear to protect your eyes, as a precaution against accidental firing of laser energy outside the body.

What is the alternative to this treatment?
Traditionally, faulty saphenous veins have been treated with surgical ligation and stripping. This involves at least two surgical incisions in order to tie off and pull out the faulty vein. It is usually performed under local anesthesia. EVLT appears to have a lower risk and a shorter recovery, lower cost and no scarring compared with surgery.

Are there alternative minimally invasive treatments available?
Yes.The two most common ones are ultrasound-guided sclerotherapy (injection therapy) and radiofrequency electrosurgery. Injection therapy for the saphenous vein appears to have a high recurrence rate frequently requiring treatment. However, it is excellent for cosmetic treatment of any visible veins remaining after EVLT. Radiofrequency electrosurgery is more limited in the range of patients it can treat and the treatment time is longer than EVLT.

Will I be able to drive myself home?
Yes, you may; however, if you are given a mild sedative, then someone should be available to take you home.

Is this a new procedure?
No . This procedure has been performed for many years, as early as the mid 1950's in Switzerland and is being utilized in most parts of the world for removal of varicose veins.

How long does the procedure take?
Depending on the severity of your varicose veins, this may be anywhere from 1-1/2 to 3 hours.

Is Ambulatory Phlebectomy similar to vein stripping?
This procedure is totally different from vein stripping. Since only micro-incisions are made, this virtually eliminates scars. There is no hospitalization required, local anesthesia is used, you can walk at once, and resume work the next day.

Will all of the varicose veins be removed at once?
This depends on the extent and severity of your condition. This type of surgery may be performed in stages.

Will there be stitches?
The incisions are small, so paper sutures (Steri-Strips) are used.

Are bandages used to wrap the legs?
Yes. Bandages and compression stockings are used; they will be worn for three days. The compression stockings may be worn much longer after the dressing and bandages are removed.

Will bruising occur?
Bruising will occur; some people bruise more easily than others, however the bruising that occurs should clear up within a few weeks.

What is the total recovery time?
The Steri-Strips are allowed to fall off on their own. Some patients continue wearing the compression stockings for up to two weeks; however, this is not required.

Is there pain after the procedure?
A small percentage of our patients reported they took Tylenol or Ibuprofen. Most patients do not require any medication.

What is the patient satisfaction rate?
95% to 98% of all patients are happy with A.P. over standard vein stripping which leaves scars; Ambulatory Phlebectomy usually leaves no scars.

Will I need the veins being removed during Ambulatory Phlebectomy later if heart surgery is required in the future?

The veins being removed are diseased, and are already dilated and are of no use in heart surgery. The diseased veins cannot be used in such a vital organ as the heart and function normally.

Will I be able to drive myself home?
Yes, you may . Some patients may require a mild sedative, in this instance, someone has to be available to drive you home. If this is not the case, then you may drive yourself home.