Archive for April, 2009

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 American College of Phlebology 

 http://www.phlebology.org/

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Sclerotherapy has made a major evoloution with the introduction of microfoam. Traditional  sclerotherapy causes damage to the linning of the vein,  causing it to collapse and making the walls of the vein then stick together.  The vein is then slowly reabsorbed and disappears.  Foam sclerotherapy works in the same way only is much more efficient.  Foam is made by adding air to a liquid sclerosant, such as, the detergent sodium tetradecyl sulphate.  The liquid and the air are agitated to produce a foam mixture. The foam is then injected directly into the vein. Foam is not diluted like the conventional sclerosant,so much less is needed, and it remains in the vein for a longer period of time. Foam also works  better because it seems to push the blood out of the vein and making better contact with the vein walls. This enables us to treat much larger veins then with liquid sclerotherapy.

Another advantage to using foam is that it is very echogenic, making it very easy to see on ultrasound. We can track the entire vein that has been treated. We also  track the travel of the foam in a particular vein and stop  the flow by applying pressure with the ultrasound probe, the flow can then be redirected, if necessary. The selective treatment of veins with foam is more complete than with surgical removal or microphlebectomy.

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Dr. Leary wanted to inform you that the coalition to prevent Deep-Vein Thrombosis (DVT) is starting its sixth annual National Deep-Vein Thrombosis awareness month.  This is a very important campaign to educate Americans about the dangers of DVT and to help reduce the risks. Did you know that in the United States DVT effects up to 2 million people annually?  Approximately 300,000 Americans die each year from a pulmonary embolism (PE) that resulted from a DVT.  DVT related PE is the most common cause of preventable hospital death. Complications from DVT kill more people each year in the U.S. than breast cancer and AIDS combined.

Risk factors for Deep-Vein Thrombosis are common and include some of the following:

Age over 60 years
Any recent surgery
Recent air travel flights over four hours double the risk for Cattle class passengers
Prior DVT
Immobility, Paralysis, trauma
Malignancy
Obesity
Pregnancy or postpartum period
Infection
Inherited blood clotting disorders

History of varicose veins and venous disease makes you at higher risk for a Deep-Vein Thrombosis, so Dr. Leary at California Vein Specialists would like to extend to you a special pricing for endovenous laser treatments during the month of Deep-Vein Thrombosis awareness.  He deeply cares about his patients and would like to address this very real risk.

 Varicose veins are commonly found in both women and men and can be very painful and unsightly.

 In order for a vein doctor to determine the cause of varicose veins, the doctor will use a non-invasive ultrasound, which will help assist the doctor in evaluating the veins that are not visible on the surface of the skin, and help decide the best treatment plan for a patient with varicose veins. Varicose veins are commonly caused by the incompetent valves of the saphenous vein that can lead to venous hypertension, dilatation, chronic venous stasis and then finally chronic inflammation.

 Veins depend on one-way valves that keep blood moving in an upward motion.  Without the correct blood flow, the blood reverses its flow and causes the valves to close improperly.  When a valve fails to close correctly, it can cause a vein to swell and become painful, and bulging varicose veins result. Increased pressure to the vein can cause a person’s legs or ankles to swell and to have severe pain and aching.  Skin changes, and ulceration are a result of the chronic inflammation.   Phlebitis can also occur when suffering from  varicose veins.  The risk of a deep vein thrombosis is also increased in patients with chronic venous insufficiency.

 To help the severity of the symptoms graded compression stockings are highly recommended.  Compression stockings help the fluid out of the legs and help it flow to the heart.  Staying active and minimizing the amount of time a person sits or stands is also very helpful. Compression stockings also reduce the risk of DVT.

 Treatments for varicose veins  have come a long way over the years.  Instead of vein stripping, many doctors use an endovenous laser treatment  that is virtually painless. With using this exciting new technology, patients are able to receive their treatment in a comfortable office atmosphere, instead of visiting a hospital.  Patients receive a local anesthetic that is administered around the vein.

 During the procedure, heat energy, from a laser or radio frequency is released to eliminate the improper flow in the affected vein, which is called Endovenous Ablation of the saphenous vein.  Endovenous laser procedure allows for a virtually painless correction of chronic venous disease.  Now the phlebology specialist can treat serious venous disease in the office setting, all patients are awake without the need for general anesthesia. Laser energy painlessly eliminates the abnormal flow in the vein without incisions, without scaring and with no down time. A compression stocking is worn after the procedure for five days.  The patient is encouraged to walk and even exercise immediately after the procedure.  Most of our patients miss no work.  Normal daily activities can be resumed immediately. 

These procedures are extremely safe and effective procedures. There are risks, as no procedure is risk-free. Severe complications are extremely rare and unlikely.  Endovenous procedures are minimally invasive and much less chance of thrombosis when compared to older methods such as vein stripping.  Endovenous ablation allow for safer, less expensive and superior cosmetic results.

Patients considering treatments should consult with a highly trained phlebologist who is familiar with all aspects of vein disease. Board certification in Phlebology is preferred.  Phlebology is the specialty of venous disease.

At California Vein Specialists, Dr. Michael Leary is board certified in phlebology and is a National Training Physician, training other Doctors from all over the US.

Superficial Thrombophlebitis

I have many patients come to my office for the first time with phlebitis of the superficial veins.  This is a condition that is rarely life threatening and fairly common in patients with varicose veins.  My concern is that many patients referred to my office have already been seen and diagnosed by their physician, and in my opinion, have not been properly diagnosed.  A complete diagnostic work up is very important because many cases of simple superficial phlebitis are associated with deep vein thrombosis which I have already discussed.  Deep vein thrombosis is associated to very serious complications and can even lead to death.

Importance of a complete diagnostic work up.

Phlebitis of the superficial veins can occur spontaneously or from trauma, sometimes after surgical and/or medical procedures.  Clinical examination alone can not rule out a deep vein thrombosis that may co-exist.  When they co-exist, it is common to see no signs of the deep vein thrombosis, so the deep vein thrombosis remains silent. Studies have shown that up to 30% of people with the harmless superficial variety have occult deep vein thrombosis and if patients are not followed up properly with an ultrasound treatment, it has been found that 45% will develop DVT.  In patients that are hospitalized and develop Superficial Phlebitis, 10% will develop a pulmonary embolus and 20% of these patients will die. The reason for this is that the mechanisms that cause superficial phlebitis are the same that cause a clot in the deep system.  The pathogenesis is the same and the risk factors are the same.

Signs and symptoms of superficial phlebitis.

Patients experience localized tenderness over the involved vein.  Usually, the vein is tender and can have a hard feeling to it.  The skin over the involved vein may become red.  Most patients can be treated with anti-inflammatory medicine like Advil or Aleve.  The important thing is to make sure your doctor rules out a more serious DVT.  Patients need a Duplex ultrasound.  It is also important to obtain a duplex ultrasound of the unaffected leg also, because if the phlebitis was from a clotting problem or hypercoagulable state it could affect the other leg in the same way.  Patients should also have lab work drawn to rule out a hypercoagulable state.  This is called a thrombotic risk profile which checks to see if there is something in your blood to make you more prone to blood clots. Once a DVT has been ruled out, the patient with superficial phlebitis should be followed closely with repeat ultrasounds until the phlebitis has resolved.  Sometimes the superficial vein can extend into the deep system so repeat ultrasounds are mandatory.

To learn more about California Vein Specialists , search more topics and give us a call.