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VEIN DISEASE AND THERAPY



Diseases of the veins are extremely prevalent, yet underdiagnosed, medical conditions. In fact, approximately 50% Americans suffer from some type of venous dysfunction. There are two main vein systems of the leg; namely the superficial and deep systems, which can be affected. The deep system is the dominant system, contributing around 90% of blood return from the legs back to the heart. It lives deeps in the muscles and is a very robust system in most patients. By comparison, the superficial system lives under the skin and contributes only 10 % of venous return. Valves exist in both systems, and when malfunctioning, can cause a great degree of symptomatology.

Superficial System


Superficial disease typically manifests itself as venous insufficiency (also known as venous reflux). This occurs when the valves weaken in the superficial veins of the leg, and blood starts to reflux backwards and pool in the legs/feet. Risk factors include age, genetic predospition, pregnancy, obesity and lifestyle (standing on legs for long periods of time). Symptoms include pain, swelling, itching, bleeding, cramping, varicose veins, heaviness, skin discoloration, skin thickening, ulceration and infection.

Non-surgical treatments vary but can include compression stockings, leg elevation and exercise. Despite conservative therapy, most symptomatic patients end up requiring some form of intervention to help alleviate their symptoms and/or prevent progression of disease. Previously, traditional surgical treatment had involved vein stripping to remove the affected veins. This, however, was very invasive in nature and required post procedural admission to the hospital with significant post operative pain and discomfort. As such, newer techniques evolved that are performed quicker and more efficiently, almost exclusively on an outpatient basis. At OMNY Vein & Cardiovascular, we use all current modalities available on the market for treatment of superficial vein disease. We are thus able to tailor treatment specifically to the patient, rather than use a ‘one size fits all’ model employed by other practitioners of vein procedures. Modalities include radiofrequency ablation, endovenous laser treatment, ultrasound-guided foam sclerotherapy, mechanic-chemical occlusion (MOCA), and venous adhesion (Venaseal). Treatment essentially centers on closing the malfunctioning superficial vein and allowing blood to be redirected into the well-functioning deep system.

Deep system


Deep vein medical conditions can include blood clots, narrowing of the veins or complete blockages of the veins. Treatment is disease specific and can involve removal of the thrombus, ballooning of the narrowing and/or stent placement. A form of X-ray technology (Flouroscopy) combined with intravascular ultrasound (IVUS) is typically used to obtain the best results possible. These procedures are typically performed under intravenous sedation. Deep vein disease often coexists with superficial vein disease, thus complicating treatment. Unfortunately, many vein practitioners tend to ignore the deep system when treating patients, thus yielding suboptimal results. OMNY Vein & Cardiovascular’s experienced team, on the other hand, has the expertise to appropriately diagnose and treat the entire spectrum of venous disease.

RADIOFREQUENCY ABLATION AND LASER ABLATION TREATMENTS



How is the procedure performed?

This outpatient procedure is performed using local anesthesia. First, the patient experiences a small numbing needle injection after which a catheter is inserted into the vein under ultrasound guidance. A layer of anesthesia is then injected around the vein for additional numbing, and energy subsequently delivered between electrodes to heat the vein (for radiofrequency ablation) or via a laser (for laser ablation). This will eventually lead to vein closure and improved venous circulation. There is minimal to no scarring at the catheter entry site and patient are able to return to daily activities as tolerated the same day as the procedure.

What can I expect after the procedure?

Your leg will be wrapped after the procedure with an Ace bandage, and this should not be removed until going to bed. Compression stockings should then be worn during the day until the patient’s first post operative ultrasound. An ultrasound following the procedure is performed to exclude the possibility of a blood clot ( a rare complication of thermal ablation) and to ensure closure of the vein being treated. Some soreness and bruising in the treated area is to be expected. Over the first two weeks, patients may experience a pulling sensation in the leg as the vein inflames, heals and closes. After a few weeks, patient should notice significant improvement in their symptoms. No rigorous activities are recommended until 10 days after the procedure. Advil and/or Tylenol may be used for any mild pain that is experienced.

ULTRASOUND GUIDED FOAM SCLEROTHERAPY TREATMENTS



How is the procedure performed?

Under ultrasound guidance, a very small needle is placed precisely into the vein that requires treatment. Afterwards, a special medication called a sclerosant is injected into the vein. Previously, a medication called Sotradecol was mixed with air and injected. Our practice has evolved to utilize Varithena (Polidconol) instead for a more homogenous mixture and because of an increased safety profile. Regardless of the medication selected, the medication acts as a ‘detergent’ and inflames the vein wall, causing subsequent closure. The needle is then removed and the leg wrapped with an ACE bandage. Activities can resume as tolerated that same day.

What can I expect after the procedure?

You will be asked to wear your compression stockings for 2 weeks after the procedure. Daily activities can be resumed immediately, although rigorous activities should be avoided for the first week. Itching, soreness and swelling in the injected area is to be expected for the first few days. An ultrasound is performed following the procedure to ensure close of the vein and to assess for blood clots (rare). It is common for patients to describe bumps or bulges near sites of large varicosities. This typically occurs due to inflammation of the vein and will resolve over the next few weeks. Finally, it is encouraged to avoid sun exposure for the first few weeks as it can cause skin discoloration in the treated area.

MECHANICAL OCCLUSION CHEMICALLY ASSISTED (MOCA)



How is the procedure performed?

This outpatient procedure is performed using local anesthesia. First, the patient experiences a small numbing injection after which a small catheter is inserted into the vein under ultrasound guidance. That typically is the only uncomfortable part of the procedure. An angled wire is then placed into the vein. After activating the catheter, it starts to spin rapidly causing irritation and spasm of the vein. Sotradecol, a sclerosing medicine, is then injected as the wire is withdrawn. This causes irritation and inflammation of the vein, causing it to eventually close down. The leg is wrapped with an ACE bandage and activities can resume that day as tolerated. There is minimal to no scarring at the catheter entry site.

What can I expect after the procedure?

Remove the ACE bandage before going to bed. Compression stockings are encouraged for the first two weeks after the procedure. Avoid vigorous activities for one week after the procedure. Some soreness and bruising in the treated area can be seen as with other treatment modalities. Over the first two weeks, patients may experience a pulling sensation in the leg as the vein inflames, heals and closes. An ultrasound following the procedure is performed to exclude the possibility of a blood clot ( a rare complication) and to ensure closure of the vein being treated.

VENOUS ADHESION (VENASEAL)



How is the procedure performed?

This outpatient procedure is performed using local anesthesia. First, the patient experiences a small ‘numbing needle after which a small catheter is inserted into the vein under ultrasound guidance. A small catheter is then placed. Through this catheter (hollow tube), medical glue is injected and compression held at the site of injection. This is repeated down the leg until the entire vein is treated. As with other modalities, there is minimal to no scarring at the catheter entry site. The leg is wrapped post procedure and patient can resume daily activites as tolerated.

What can I expect after the procedure?

Compression stockings are encouraged for two weeks post procedure. Some soreness and/or bruising in the treated area is to be expected. Over the first two weeks, patients may experience a pulling sensation in the leg as the vein inflames, heals and closes. An ultrasound following the procedure is performed to exclude the possibility of a blood clot (a rare complication) and to ensure closure of the vein being treated. Unique to Venseal is a hypersentivity reaction (rash, redness, pain), which can occur if the patient is allergic to the adhesive.

AMBULATORY (‘STAB’) PHLEBECTOMY



How is the procedure performed?

This procedure is only needed in a small subset of our patients. It involves removal of the enlarged (varicose) veins through the skin. Local anesthesia, often paired with oral/intravenous sedation, is provided. Tiny incisions, 1-2mm in size, are then performed along the course of the vein and a vein hook (similar to a crochet needle) used to pull veins out. Steri-strips or a similar adhesive are placed at each site. Scarring is minimal if present at all.

What can I expect after the procedure?

Compression stockings are to be worn for the first two weeks after the procedure. Steri-strips should remain on till they fall off naturally (i.e. do not remove them). Soreness, drainage and/or bruising in the treated area is to be expected. Recovery time at home is 1-2 days of light activities. All phlebectomy sites heal within 10-14 days. Sometime, patients will be given a prescription for antibiotics which will need to taken for 5 days.

COSMETIC VEIN TREATMENTS
(Spider Veins and Reticular Veins)