Bellapianta Orthopedics General Orthopedics 2

Leg pain is often caused by venous conditions which are abnormalities that affect your veins. They span from very common, like varicose and spider veins, to very rare, like pulmonary embolism (PE). Veins are important because they help circulate blood and oxygen through the body. Unhealthy veins lead to venous diseases, which can cause chronic pain and swelling of the legs, ankles, and other parts of the body.

There are many different types of venous disorders, and they can develop for many different reasons. Some of the more common disorders include: chronic venous insufficiency, deep vein thrombosis, phlebitis, and varicose/spider veins.

Dr. Bellapianta and his team offer vascular treatment that consists of either sealing off the damaged vein or removing it entirely—allowing blood flow to return to normal using the latest, most state-of-the-art, and minimally invasive vein treatments available.

Conditions of Venous Diseases

Venous disorders are conditions that damage your veins. Veins are the blood vessels that carry deoxygenated blood from your organs and tissues back to your heart. In contrast, arteries carry oxygen-rich blood from your heart to your organs and tissues.

Damaged vein walls hinder the circulatory system, allowing blood to collect and flow in a retrograde (backward) fashion when the muscles relax. This creates an unusually high pressure buildup in the veins. This buildup causes further stretching and twisting of the veins, increased swelling, more valve incompetence, sluggish blood flow and potential blood clot formation. Eventually, this condition can lead to various disorders known as venous disease.

Venous disease is quite common. Approximately 15 percent of the United States population is affected by varicose veins, which generally do not pose great health risk. However, thrombophlebitis can be much more serious, even life-threatening, affecting millions of people each year.

Symptoms

Symptoms can vary depending on the type of venous disorder. Some common symptoms you may experience include:

Pain in legs, knees or hips
Swollen ankles or legs
Cramping
Sciatica/radiating pain
Burning, itchy or discolored skin on your leg
Tingling or numbness in legs
Pain, swelling or inflammation in a leg or along a vein
Leg sores that are slow to heal
Fatigue
Varicose or spider veins
Restless Legs

Diagnosis

If you have symptoms of a venous disorder, we can to help. Our Vascular specialists start with a complete physical exam and may order lab and diagnostic tests for you to see how well blood is flowing through your veins. Tests we may use include:

Blood tests
Radiographic imaging, such as X-rays, CT scan, and MRI
Ultrasound that uses sound waves to detect blood clots and observe blood flow in the legs

Treatment

Dr. Bellapianta and his team will thoroughly explain to you all the options available to treat your venous disorder. Depending on the condition and severity of your symptoms, these options can range from lifestyle changes like wearing compression stockings to the latest in minimally invasive procedures or surgery. Together, we’ll develop a treatment plan that’s right for you.

We may recommend:

Medications to prevent and dissolve clots in your veins
Compression therapy or stockings
Angioplasty or stenting to open blocked or narrowed veins
Sclerotherapy, where we insert a solution into varicose or spider veins so they collapse and eventually disappear
Vein ligation and stripping to tie off and remove damaged veins
Vena cava filter, where we insert a device inside your vein to catch blood clots before they travel to your lungs
Vascular or endovascular surgery for more advanced conditions

Chronic Venous Insufficiency (CVI)

Bulging leg veins can often be more than a cosmetic issue – it can be a sign of venous insufficiency. Our vein specialists are here to help you, providing expertise in venous insufficiency treatment and varicose vein removal.

Description

Your veins are the blood vessels that bring blood back to your heart. Venous insufficiency occurs when your leg veins can’t do this effectively. Blood pools in the superficial and deep veins in your legs instead of flowing up to your heart.

Chronic venous insufficiency can happen with or without varicose veins. Varicose veins appear as blue bulging lumps when excess blood pools in the superficial leg veins, which lie closest to the skin surface.

Symptoms

Symptoms of venous insufficiency include:

Edema, or swelling, in the lower legs and ankles, especially after standing
Itchy or flaky skin on the legs and feet
Leg cramping or weakness
New varicose veins or worsening of existing varicose veins
Skin discolorations or leathery skin on the legs
Tired, achy legs and feet, sometimes with burning or throbbing sensations
Ulcers or wounds on the legs and ankles that have trouble healing

Causes & Risk Factors

Chronic venous insufficiency is fairly common in both women and men but tends to be seen more often in women. You’re more likely to get venous insufficiency if you have certain conditions or risk factors. These include:

Family history of the condition
Obesity
Pregnancy
High blood pressure
Age 50 and over

Diagnosis

To diagnose venous insufficiency, your doctor will start with a physical exam and ask about your family history. We’ll carefully examine your legs for varicose veins or other related signs. We may check the blood pressure in your legs, too.

To confirm a diagnosis, we may perform a duplex ultrasound, a test that uses sound waves to detect blood clots and observe blood flow in the legs.

Treatment

Like with many conditions, it’s always better to prevent venous insufficiency from occurring in the first place. If that’s not possible, early treatment is the next best option.

Tips for prevention and early treatment include:

Get regular exercise.
If you sit or stand for long periods, try to take short walking breaks whenever possible.
Quit smoking.
Maintain a healthy weight.
Take antibiotics to treat skin infections as directed by your doctor.
Take care of your legs and feet. Wash your skin frequently and use a moisturizing lotion.
Wear compression stockings.

In more severe cases of chronic venous insufficiency, we may recommend:

Compression wraps over your ankles and legs
Medication

Nonsurgical treatments for varicose veins, such as sclerotherapy or endovenous thermal ablation

Surgery, such as:

Ambulatory phlebectomy, a minimally invasive procedure that removes problem veins through tiny incisions
Vein ligation and stripping, surgically tying and removing the affected vein
Surgical bypass to reroute blood flow around a blocked vein, using a portion of a normal vein taken from another place in the body

Deep Vein Thrombosis (DVT)

It’s natural to be concerned when you find out you may have deep vein thrombosis. You want to be sure you’re in the right place for your care.

At Bellapianta Orthpaedics, we have a dedicated vascular medicine program that many other ortho practices don’t offer, which means you’ll receive comprehensive care and support throughout your diagnosis, treatment and beyond. Plus, our team regularly participate in research and clinical trials, giving you access to the newest, most effective technologies and procedures available to treat deep vein thrombosis.

Description

A deep vein thrombosis (DVT) occurs when a blood clot, or thrombus, forms in a vein deep inside your body. The clot limits blood flow or blocks it completely. These clots can break free and travel to the arteries in your lungs, causing a life-threatening blockage called pulmonary embolism.

A blood clot can form in any deep vein, but most commonly happens in the lower leg. This is called a lower extremity thrombosis.

Symptoms & Complications

Deep vein thrombosis doesn’t always cause symptoms. But because it can quickly become life threatening, you should see your doctor or dial 911 right away if you have any signs of the condition.

The most common symptoms of deep vein thrombosis include:

Pain, inflammation or warmth in one of your legs, which may initially feel like a leg cramp
Leg pain that gets worse over time (pulled muscles and other conditions usually get better in time)
Redness or discoloration of the skin on one leg
Leg sores (ulcers) that are slow to heal
Swelling in one leg or along a vein, or swelling that doesn’t go down when you elevate the leg
Pain in the back of your calf muscle (injured muscles tend to occur in one side of your calf)

Warning Signs of a Pulmonary Embolism

Deep vein thrombosis can lead to a pulmonary embolism, which is extremely serious. Get medical help immediately or call 911 if you develop any of these symptoms:

Sudden shortness of breath
Coughing up blood
Chest pain that gets worse when you breathe deeply or cough
Feeling dizzy or faint
Extremely rapid pulse
Excessive sweating

Causes & Risk Factors

Doctors don’t always know why deep vein thrombosis happens. Sometimes, lifestyle and habits may contribute to developing the condition. Other times, certain inherited disorders can cause it.

Certain risk factors are associated with deep vein thrombosis. You’re more likely to develop it if you:

Are over 60
Are overweight or obese
Are pregnant or recently gave birth
Are receiving certain cancer treatments
Don’t move for a long time because you’re traveling, ill or recovering from surgery
Have a central venous catheter to receive medication
Have vein damage from surgery, autoimmune condition or recent injury, particularly a broken leg, hip or pelvis
Have a family history of a blood-clotting disorder
Take birth control pills or hormone therapy
Smoke

Diagnosis

To determine if you have deep vein thrombosis, your doctor will give you a thorough physical exam, review your medical history and ask about any symptoms. We may order diagnostic tests for you, too, such as:

Echocardiogram, a heart ultrasound
Radiographic imaging, including X-ray, CT scan or MRI

Treatment

We treat many patients with deep vein thrombosis every year, successfully treating even the most complex cases. This means our expertise continually grows, giving you the latest, most effective care possible.

Your vascular specialist will work with you to develop a treatment plan tailored to you. We may recommend things you can do at home as well as medical options.

Your treatment plan may include:

Elevating your feet whenever possible to prevent blood from pooling in your legs
Wearing compression stockings to help reduce pain and swelling after deep vein thrombosis treatment and prevent blood from pooling in your legs
Medications, such as blood thinners (anticoagulants) to prevent blood clots from forming, getting larger or breaking off
Catheter-directed thrombolysis, a procedure that uses a thin tube to direct medication into a blood clot to dissolve it
Vena cava filter procedure, where your specialist inserts a filter into the vein to catch blood clots before they travel to your lungs or heart

Phlebitis

Pain and swelling in the leg can be concerning, and our experts are here to care for you quickly. From medication and compression socks to minimally invasive surgery, we’ll provide the treatment you need to be well again.

Description

Phlebitis, or thrombophlebitis, is an inflammation that causes a blood clot to form in a vein, usually in your leg. When it affects a vein close to your skin’s surface, it’s called superficial phlebitis. When it affects a deeper vein, it’s called deep vein thrombosis (DVT).

Superficial phlebitis usually develops after you’ve had a mild trauma to one of your veins, such as having an IV line. It typically subsides quickly and doesn’t cause any serious health problems.

In deep vein thrombosis, the blood clot in the deep vein can break loose and travel through your bloodstream to your lungs. This can cause a pulmonary embolism, a dangerous blockage that prevents blood from reaching your lungs.

Symptoms

If you have either type of phlebitis, the most common signs are:

Pain, swelling and tenderness of the skin, which, if on your leg, may get worse when you
lower your leg
Red, itchy skin that feels warm to the touch
Low-grade fever if related to an infection

Diagnosis

To diagnose phlebitis, we’ll begin with a thorough physical exam and ask about any symptoms you’re having. We may order diagnostic tests for you, too, such as blood tests or an ultrasound.

Treatment

If you’re diagnosed with phlebitis, we’ll tailor a treatment plan to you. If your symptoms are relatively mild, we may suggest self-care measures such as:

Applying heat to the affected area
Elevating the affected leg as much as possible
Compression stockings
Using over-the-counter medications (nonsteroidal anti-inflammatory drugs)

For more serious conditions, we may recommend:

Medication such as antibiotics, anti-inflammatories or blood thinners
Prescription-strength compression stockings
Vein ligation and stripping for severe phlebitis, where we surgically tie off and remove the vein through a small incision

Varicose & Spider Veins

We understand that spider veins and varicose veins on the legs can be uncomfortable for you. Whether your veins are linked to other health conditions or cause embarrassment that makes it difficult for you to fully enjoy life, we can help.

Description

Varicose veins are enlarged, twisted, bulging veins. Typically, they appear on your legs because standing and walking increases the pressure in these veins. Spider veins are a common, mild form of varicose veins and look like thin, red or blue lines in a spiderweb pattern.

Fortunately, spider veins and varicose veins usually are more of a cosmetic concern than a health issue. But sometimes varicose veins can be painful and lead to more serious health conditions, so it’s wise to seek treatment.

It’s also a good idea to talk with your doctor even if you don’t have discomfort but are avoiding activities that show your legs. We have many simple procedures for removing varicose veins or making them less visible so you can get back to doing the things you love.

Symptoms

If you have varicose veins, you’re not alone. Millions of people in the United States have varicose veins.

In general, varicose veins are clearly visible. They appear dark blue or purple, twisted and bulging just beneath the surface of your skin, usually on your legs. You also may have more serious symptoms, including:

Itchiness
Leg pain, aching and cramping
Leg swelling
Leg wounds that won’t heal
Discolored skin
Blood clots in the swollen veins

Causes & Risk Factors

Varicose veins and spider veins form when gravity causes blood to pool in the lower part of your body. Your vein walls weaken and stretch, allowing blood to back up in your veins, causing them to bulge, twist, and look like swollen, blue or purple ropes.

You’re more likely to get varicose veins if you’re a woman, particularly as you get older. However, men get varicose veins, too.

Other factors that can weaken your vein walls and lead to varicose veins include:

Obesity
Pregnancy
Birth control pills or hormone replacements
Long periods of standing or sitting
Family history of varicose veins

Diagnosis

To diagnose your varicose veins and their severity, we’ll ask about any symptoms you may be having. We’ll carefully examine your legs while you’re standing to check for swelling.

We may also recommend an ultrasound. This diagnostic test creates images of your veins to help us detect blockages or narrowing that may affect blood flow.

Treatment

Your comfort and health are important to us. We’ll suggest the varicose vein treatment options that best fit you and your life. Your treatment plan may include:

Lifestyle changes, such as:
Avoiding standing or sitting for long periods of time or taking frequent breaks
Elevating your legs
Wearing compression stockings, which are socks that put pressure on your lower legs to move blood and reduce swelling

Medical treatments, such as:

Sclerotherapy, where we insert a solution into varicose or spider veins so they collapse and eventually disappear
Vein ligation and stripping, a minimally invasive procedure where we tie off and remove the veins
Other minimally invasive varicose and spider vein treatments, using lasers and other advanced techniques

Deep Vein Thrombosis treatment

Your vascular specialist will work with you to develop a treatment plan tailored to you. We may recommend things you can do at home as well as medical options.

Your treatment plan may include:

Elevating your feet whenever possible to prevent blood from pooling in your legs
Wearing compression stockings to help reduce pain and swelling after deep vein thrombosis treatment and prevent blood from pooling in your legs
Medications, such as blood thinners (anticoagulants) to prevent blood clots from forming, getting larger or breaking off
Catheter-directed thrombolysis, a procedure that uses a thin tube to direct medication into a blood clot to dissolve it
Vena cava filter procedure, where your specialist inserts a filter into the vein to catch blood clots before they travel to your lungs or heart

Vena cava filter placement

Getting a blood clot in your veins could lead to serious health conditions. A vena cava filter can help reduce this risk by stopping blood clots from traveling in your body.

What is a vena cava filter?

The inferior vena cava (IVC) is a large vein in your abdomen that returns blood from your lower body to your heart. A vena cava filter is a small device placed in a vein that can trap blood clot fragments before they travel into the heart or lungs.

This serious condition, called deep vein thrombosis can be dangerous if the blood clot breaks off and travels to your heart or lungs, where it can cause severe damage. If a clot travels to your lungs, it’s called a pulmonary embolism.

In the past, IVC filters were permanently placed, but new filters can stay in or be removed if your risk of blood clots decreases.

Before surgery

Prior to surgery, you may be given a blood test, IV fluids to help protect your kidney function, an electrocardiogram (EKG) or a chest X-ray.

You’ll also see your physician or surgeon for personalized guidelines to prepare for surgery including:

Refraining from eating or drinking anything after midnight the night before your procedure
How to get ready for your procedure including any medications you may need to stop taking
Answering your questions and concerns

During surgery

A vena cava filter placement takes about an hour. You may get a mild sedative to help you relax, but you’ll be awake during the procedure.

Your surgeon will numb a site on your groin or neck and insert a catheter through a plastic introducer sheath into the blood vessel. We’ll guide the catheter through the blood vessel to the inferior vena cava vein with the aid of a special X-ray machine.

Next, we’ll inject a small amount of contrast material through the catheter and take X-ray pictures as the contrast moves through the veins. Your doctor will use the X-ray pictures of the contrast material to precisely identify where to place the filter. Once the filter is in place, we’ll remove the sheath.

Recovery

You’ll rest for a few hours in a recovery room. It’s important to drink plenty of water to help flush out the contrast agent. Most likely you’ll stay in the hospital overnight. Be sure to arrange for someone to drive you home.

Before going home, we’ll go over care instructions with you and let you know when you can resume your normal activities. You’ll also receive instructions on your medications, when to follow up with your doctor and how to care for your procedure site.

Endovenous Thermal Ablation

Endovenous thermal ablation is a minimally invasive procedure to treat varicose veins. It’s also called endovenous laser or radiofrequency therapy.

Varicose veins are swollen, twisted blood vessels that bulge just under your skin’s surface. These blue or purple bulges usually appear in your legs, feet and ankles.

During endovenous thermal ablation, your provider seals off varicose veins with a laser or high-frequency radio waves. Closing off varicose veins allows healthy veins to restore normal blood flow.

Why is endovenous thermal ablation done?

You might need endovenous thermal ablation if you have medium to large varicose veins in your legs. Varicose veins often look like bulges in the legs that are bluish or skin-colored.

Your blood vessels have one-way valves that move blood toward your heart. Varicose veins develop when these valves become damaged or weak. When valves aren’t working properly, blood can pool in your veins, causing a bulge or swelling that you can see and feel. Symptoms of varicose veins include:

Achiness.
Feeling of heaviness in your legs and feet.
Itching.
Leg cramps, especially at night.
Swelling.

Some people have varicose veins removed for cosmetic reasons. After endovenous ablation, varicose veins shrink and blood reroutes to your healthy veins. You won’t be able to see or feel varicose veins after successful treatment.

In other cases, we might recommend treating varicose veins because they can cause complications like deep vein thrombosis (DVT), skin sores or bleeding.

Is endovenous thermal ablation considered surgery?

Endovenous thermal ablation is a nonsurgical, minimally invasive procedure. This treatment requires a small incision, but it’s much less invasive than varicose vein surgery.

During varicose vein surgery, your surgeon removes the affected veins through several incisions. This type of surgery requires several weeks of recovery.

If you have endovenous thermal ablation, your veins are left in place. It has fewer complications than surgery and your recovery is usually much shorter.

Before the Procedure

Before scheduling your procedure, we will ask about all the medications, vitamins and supplements you’re taking. You may need to stop taking certain medications before your procedure. We will give you detailed instructions on any medication changes you need to make.

We will also talk with you about your symptoms and any other health conditions you have.

During the Procedure

Before your procedure, the doctor will give you anesthesia to keep you from feeling pain. You’ll receive:

Local anesthesia to numb the area around your vein
Sedative medications to help you relax during your procedure

During endovenous thermal ablation, the doctor will:

Find your vein with an ultrasound.

Make a small incision in your leg, usually below your knee or near your ankle.
Insert a catheter (thin tube) into the incision and guide it into your vein.
Guide a thin tool into the catheter to your vein. The tool uses a laser or radiofrequency waves to generate heat. This permanently seals off the vein.
Place a numbing fluid around the vein for anesthesia through a series of small injections.
Put a bandage over your incision. Most people don’t need stitches.

How long does endovenous thermal ablation last?

Endovenous thermal ablation usually takes one hour. The laser treatment itself takes three to five minutes. It’s usually an outpatient procedure, which means you can go home the same day.

Is endovenous thermal ablation painful?

You’ll receive anesthesia for endovenous thermal ablation, so you won’t feel any pain.

After your procedure, you might experience some soreness, tingling or bruising near the vein that was treated. Usually, you can manage any pain with over-the-counter medications. Ask us which pain relief medications are safe for you to use.

What happens after endovenous thermal ablation?

We will tell you how to take care of your incision as it heals. You’ll probably need to:

Avoid swimming or going in hot tubs.
Elevate your treated leg when possible.
Keep your incisions clean and dry.
Wear compression socks.

After one week of healing, your provider will perform an ultrasound to look at the vein and confirm that it’s sealed.

Risks/Benefits

Endovenous thermal ablation seals off varicose veins but doesn’t remove them. This means you’ll have a faster recovery time and a lower risk of complications.

Endovenous thermal ablation has several benefits compared to varicose vein surgery, including:

Less pain.
Fewer complications.
Minimal scarring.
Positive cosmetic results (usually equal to or better than surgery).
Shorter recovery (you can return to your normal routine sooner).

What are the risks or complications of endovenous thermal ablation?

Endovenous thermal ablation is a safe procedure. Side effects include:

Bruising.
Numbness or tingling.
Pain.
Blood clots in the legs (this is rare).

If you experience side effects after your procedure, they should get better in a few weeks.

Recovery and Outlook

After the procedure, you’ll need someone to drive you home. Ask your provider about what you should do to help your body heal. You should:

Avoid strenuous exercise until your provider says it’s safe to resume physical activity.
Not fly for two weeks.
Get adequate sleep to help your body recover.
Move and walk around frequently during the day.

You should be able to return to work a few days after your procedure. You might need to take some time off work if you have a physically demanding job that requires you to be on your feet all day. Ask the doctor when you can return to work.

Endovenous Glue Treatment

The Endovenous Glue Treatment procedure delivers a small amount of a specially formulated medical adhesive to seal — or close — the diseased vein, rerouting blood to nearby healthy veins and providing symptom relief.

This procedure is a safe and effective treatment, offering significant improvement in quality of life. The procedure has four steps:

Catheter is placed in the vein-Using an ultrasound, your doctor will position a catheter into the diseased vein through a small access site.
Specialized adhesive is placed-A specially formulated medical adhesive is placed in the diseased vein via a small catheter.
Light external pressure is applied-Light external pressure is applied to adhere the vein walls together. This step is repeated for the length of the vein.
Catheter is removed-The catheter is removed and a single adhesive bandage is applied to the vein access site.

Before the procedure

You will have an ultrasound imaging exam of the leg being treated. This exam is important for assessing the diseased superficial vein and planning the procedure.

During the procedure

Your doctor can discuss the procedure with you. Here is a brief summary of what to expect:

You may feel some minor pain or stinging with a needle stick to numb the site where the doctor will access your vein.
Once the area is numb, your doctor will insert the catheter (i.e., a small hollow tube) into your leg. You may feel some pressure from the placement of the catheter.
The catheter will be placed in specific areas along the diseased vein to deliver small amounts of the medical adhesive. You may feel a mild sensation of pulling. An ultrasound will be used during the procedure to guide and position the catheter.

After the procedure

After treatment, the catheter is removed and a small adhesive bandage is placed over the puncture site.

You will be taken to the recovery area to rest.

The doctor will recommend follow-up care as needed.

Sclerotherapy

Sclerotherapy is a medical procedure that treats varicose veins and spider veins, usually on your legs. The doctor uses a needle to inject a special solution into your varicose vein or spider vein. This chemical solution irritates your blood vessel lining, making it expand, stick together and form a scar. This closes off your vein, making it look and feel better.

Who needs to have sclerotherapy treatment?

Sclerotherapy may be appropriate for people with varicose veins or spider veins, but it’s not for everyone.

Before the procedure, you’ll meet with the doctor who’ll decide if you qualify for sclerotherapy.

You’re not eligible for sclerotherapy if you:

Have an active deep vein thrombosis or superficial vein thrombosis (blood clot).
Are pregnant. You’ll have to wait at least three months after delivery before you can have sclerotherapy.
Breastfeeding.
Unable to get out of bed.

If you’ve had a blood clot in the past, you may be able to have sclerotherapy, depending on what caused the clot and how serious it was.

In most cases, the doctor won’t do sclerotherapy on a vein you might need for future surgical bypass procedures, such as the saphenous vein for coronary artery bypass graft surgery (unless that vein is already unusable).

It’s a good idea to talk with the doctor about how successful they think sclerotherapy treatment will be for you. Some people with high expectations are disappointed with their results. Knowing what to expect can help you avoid feeling disappointed. You should also know that results aren’t immediate. You won’t walk out of our office looking like a leg model!

Before the Procedure

Before your sclerotherapy treatment, you should avoid certain medications. Follow these guidelines:

Antibiotics such as tetracycline or minocycline (Minocin^® or Dynacin^®) may make your skin stain if you take them seven to 10 days before or after sclerotherapy. Ask the doctor about other antibiotic medications you may take, or ask for safe guidelines for stopping these medications. Tell your provider if you need to take an antibiotic before invasive procedures.

Don’t take aspirin, ibuprofen (Advil^® and Nuprin^®) or other anti-inflammatory medications for 48 hours before and after sclerotherapy. These medicines may get in the way of the action of the sclerosing agent or make you bleed more. It’s ok to take acetaminophen (Tylenol^® or Panadol^®). Ask your provider for specific instructions before you stop taking any medication.

Prednisone (Rayos^® or Sterapred^®) makes the sclerosing agent less effective. Ask the provider who prescribed your prednisone if you can safely stop taking it for 48 hours before your sclerotherapy treatment.

Other guidelines before your procedure:

Don’t put any lotion on your legs before or after sclerotherapy.
Bring a pair of shorts to wear for your procedure.
If you have compression hosiery (support stockings) from previous treatments, bring them with you so your provider can make sure they’ll give you enough support after your procedure.

During the Procedure

We will perform sclerotherapy in our office and may use an ultrasound to help find the right vein to treat.

Sclerotherapy treatment takes about 30 to 45 minutes. You’ll lie on your back or your stomach, depending on the location of the vein they’re treating.

the doctor can choose from several chemicals available for use in sclerotherapy. They’ll select the appropriate chemical and concentration of it based on the size of the vein they’re treating.

Before starting, the doctor may try a test injection and wait a bit to make sure you don’t have a reaction.

They’ll follow these steps:

Clean the treatment area.
Stretch your skin out around the injection site. An assistant may use their hands to help with this while the doctor gets ready to put the needle into your skin.
Inject a liquid or foam solution directly into your blood vessel, using very fine needles.
You’ll feel the needle pinch your skin, and possibly a mild burning feeling. You may feel mild discomfort when the injection goes into your veins. In larger veins, you may feel cramping for a minute or two during the injection.
The number of veins your provider treats in one session depends on the size and location of your veins, as well as your overall medical condition.

After the Procedure

After your treatment, the doctor may ask you to keep lying down for 15 minutes or so to make sure you don’t have a bad reaction to the injected material.

You’ll be able to drive yourself home. You may go back to your regular activities, especially walking.

You should wear support hosiery or compression wraps for three to seven days to compress the treated vessels. Support stockings purchased from a department store may not work if your healthcare provider prescribes a heavy compression stocking.

For 48 hours after your procedure, follow these guidelines:

Avoid aspirin, ibuprofen and other anti-inflammatory medications. You may take acetaminophen if you need it for pain relief.
Don’t take hot baths or sit in a whirlpool or sauna. You may take showers, but the water should be cooler than usual.
Wash the injection sites with mild soap and lukewarm water.
Don’t apply hot compresses or any form of heat to the treated areas.
Avoid direct exposure to sunlight (including sun tanning and tanning beds).
Call your provider if you have any concerns or questions after your procedure.

Risks/Benefits

Advantages of sclerotherapy include:

No anesthesia. With enough compression from the bandage on the vein, there is little pain. Compression also may help with bruising and swelling.
Good results for most people. Sclerotherapy works especially well on smaller varicose veins. A session may get rid of an estimated 50% to 80% of injected veins. In about 10% of cases, sclerotherapy doesn’t work. If this happens, your healthcare provider can try different solutions or a different method, such as laser therapy.
Fairly quick results for small veins. Spider veins usually respond to treatment in three to six weeks, but it may take three to four months for larger veins.
With successful treatment, varicose veins or spider veins won’t reappear. However, you may need treatment for new varicose veins that form.

Risks or complications of sclerotherapy:

Sclerotherapy takes longer than surgery for varicose veins or spider veins. It can also have side effects::
Larger injected veins may get lumpy or hard for several months.
The redness where the needle went in should go away within a few days.
Brown lines or spots on your skin at the site of the injection usually go away within three to six months. However, about 5% of the time, they can be permanent.
Bruising where the injection happened can last several days or weeks.
Tiny blood vessels may develop in the treated area. They may appear days or weeks after your sclerotherapy but should fade within a few months. Usually, they don’t need further treatment.
Allergic reactions to the injected chemical may happen at the time of the injection and are rarely serious. Symptoms include itching and swelling.

Other side effects rarely develop after sclerotherapy. If you have any of these rare side effects, contact our office immediately:

Inflammation (swelling) within five inches of your groin.
Sudden swelling in your leg.
Formation of small ulcers at an injection site.
Red streaking, especially in your groin area.
Recovery and Outlook

What is the recovery time?

It doesn’t take long to recover from sclerotherapy. After treatment, you can drive home and get back to your normal activities. Walking is good for your recovery, so don’t be surprised if the doctor recommends it.

Micro-foam Sclerotherapy

Micro-foam sclerotherapy represents a significant advancement in the management of varicose veins, offering a less invasive, effective, and safer alternative to traditional methods. Its ability to provide relief and cosmetic improvement with minimal downtime is a testament to the progress in vascular treatments.

At the heart of micro-foam sclerotherapy is the innovative use of a sclerosant substance, transformed into a micro-foam. This transformation enhances the sclerosant’s ability to contact and treat the vein walls effectively.

Advantages Over Conventional Treatments

The distinction of micro-foam sclerotherapy lies in its array of benefits, which include:

Minimally Invasive Nature: Foregoing the need for surgery, this procedure minimizes pain, reduces the risk of complications, and allows for a quicker return to daily activities.
High Efficacy: It boasts a commendable success rate, significantly improving or completely resolving symptoms and cosmetic concerns.
Enhanced Precision: The use of ultrasound imaging enables accurate targeting of affected veins, including those not visible externally, ensuring a thorough treatment.
Safety Profile: Side effects are rare and generally mild, making it a preferable option for many patients.

During the Procedure

Preparation and Injection: A specialized blend of sclerosant is converted into a foam. Under ultrasound guidance, this foam is precisely injected into the afflicted veins.
Vein Closure: The foam expands within the vein, displacing blood and ensuring comprehensive contact with the vein walls. This triggers a reaction that causes the vein walls to collapse and stick together, halting blood flow.
Natural Absorption: Over time, the body naturally absorbs the closed vein, leading to a reduction or elimination of the varicose veins.

After the Procedure

Recovery from micro-foam sclerotherapy is notably swift, with most patients resuming normal activities immediately after the procedure. Recommendations typically include wearing compression stockings to aid the healing process and optimize outcomes. Success rates are high, with the majority of patients witnessing substantial improvements in symptoms and the appearance of their legs.

Risk/Complications

Micro-foam sclerotherapy is not a one-size-fits-all solution. The treatment’s appropriateness is contingent upon the size, location, and severity of the varicose veins, along with the patient’s overall health status. It may not be the preferred option for individuals with deep vein thrombosis or those with veins too large for the procedure.

Side effects, while uncommon, can include skin discoloration, mild inflammation, or rare allergic reactions to the sclerosant.

Compression Therapy

Compression therapy helps increase blood circulation in the lower legs, ankles and feet. It is an effective treatment for pain and swelling caused by conditions associated with poor circulation, such as chronic venous insufficiency and varicose veins. There are many types of compression therapy devices available over the counter or with a prescription.

What are the types of compression therapy?

The types of compression therapy devices include:

Compression stockings: Stockings that go up to the knee are the most common type of compression apparel. If swelling extends above your knee, you may need longer stockings or tights that come up to your waist.
Bandages and wraps: Elastic bandages and Velcro wraps may be easier to apply for people who have difficulty putting on socks. Bandages are usually applied in multiple layers.
Inflatable devices: These garments fully cover the legs and inflate to provide pressure. They are mostly used by athletes.

Manufacturers rate compression socks based on how much pressure they provide. The amount of compression you need depends on your condition. The units for measuring compression are mmHg, or millimeters of mercury. There is no standard scale for rating compression stockings. In general, the categories of pressure are:

Low (less than 20 mmHg).
Medium (20 to 30 mmHg).
High (greater than 30 mmHg).

Stockings that provide low compression are available over the counter. They may be a good choice if you stand or sit for long periods of time or are pregnant. Consult your healthcare provider before purchasing over-the-counter compression stockings.

Stockings rated 20 mmHg or higher require a prescription.

When should compression therapy be used?

We will recommend compression therapy for conditions caused by poor blood circulation. These include:

Chronic venous insufficiency-This is a common condition that affects veins in the legs. It occurs when the walls of veins are weak and the valves inside the veins do not work as they should. Blood flow from the legs to the heart becomes impaired. As a result, blood builds up in the legs. Chronic venous insufficiency can be a result of deep vein thrombosis (DVT). It can also occur with age and prolonged sitting or standing. Compression therapy can reduce chronic venous insufficiency by squeezing your leg muscles. This helps push blood against gravity back to the heart.
Varicose veins-These veins are caused by chronic venous insufficiency. Varicose veins look like raised, winding ropes under your skin. Compression therapy can help relieve swelling and pain associated with varicose veins.
Deep vein thrombosis (DVT)-This is a blood clot that develops in a deep vein in the body, often in a leg.
Swelling (edema) of the feet, ankles or legs-Swelling occurs when fluid becomes trapped in your tissues. Fluid has a tendency to pool in your legs because of gravity but our body is able to prevent pooling in many different ways.
Leg ulcers and wounds-Ulcers are open sores. They can occur anywhere on your body but often affect the legs, ankles and feet. People with diabetes, varicose veins and poor circulation are at higher risk of developing ulcers on the lower legs and feet. Compression therapy can enhance recovery from leg ulcers and wounds.
Orthostatic hypotension-This is a rapid drop in blood pressure that occurs when you stand up. Low blood pressure can make you feel dizzy or lightheaded. Orthostatic hypotension is due to poor blood return to your heart from your legs when you stand. Compression therapy can help treat this condition by squeezing blood from your legs back up to your heart.

Should athletes use compression therapy?

Some athletes involved in endurance sports use compression therapy on their legs during or after exercise. The increased blood circulation is thought to improve muscle recovery and reduce soreness. Some research studies support these beneficial effects.

What happens before compression therapy?

The doctor will determine the level of compression you need based on the health condition you’re experiencing. In addition to the pressure rating, other important considerations include:

Size and fit.
How to put them on correctly.
How long to wear them.

Usually, you fill your prescription at a medical supply store. Trained staff will measure you to ensure a good fit and instruct you on how to put them on and take them off. Some people have trouble grasping socks and pulling them on. There are devices that can help with these concerns.

What happens during compression therapy?

By squeezing your lower legs, compression therapy helps the veins return blood to your heart and prevent the pooling of blood and swelling. Your healthcare provider may recommend compression therapy alone or combined with other treatments.

How often should you use compression therapy?

In general, you will wear compression socks or stockings while you are awake and take them off when you sleep. Bandages for certain types of conditions, such as ulcers or wounds, may stay on overnight. Be sure to follow the doctor’s instructions.

Risks/Benefits

Advantages of compression therapy are:

Compression therapy can improve blood circulation in the legs and reduce pain and swelling. In addition, it can help:
Heal ulcers and wounds caused by blood pooling.
Manage conditions such as chronic venous insufficiency and orthostatic hypotension.
Prevent deep vein thrombosis.

Risks of compression therapy include:

Most of the problems people experience with compression therapy are not severe. They include:
Skin irritation.
Discomfort or pain.
Bacterial or fungal
Swelling of the lower foot and toe area (where compression is usually lower).
Rarely, severe side effects can occur, such as:
Nerve damage.
Soft tissue damage.
Superficial thromboembolism.

How can I minimize the risks of compression therapy?

In many cases, you can avoid problems by making sure your compression therapy garments fit properly and you are using them as prescribed. Other tips include:

Check stockings for wrinkles or bunching.
Do not fold the top of the stockings over.
Make sure your skin is completely dry.
Protect socks by wearing slippers or shoes.
Replace socks if they become worn or stretched out.

Stab Phlebectomy

Stab phlebectomy is a minimally-invasive method of removing varicose veins. In this procedure, we make tiny cuts on your skin to remove the vein in sections. Usually, just a few incisions are needed to make a difference in the appearance of veins. Patients report feeling little pain compared to "vein stripping," which is a more invasive surgical procedure that often requires weeks of recovery. In contrast, a stab phlebectomy allows you to resume normal activities in 1-2 days.

A stab phlebectomy minimizes the appearance of varicose veins – twisted, bulging, and swollen veins that appear on the skin's surface. Varicose veins most often occur on the legs and feet due to the natural effects of gravity from walking and standing, though any superficial vein can develop the condition.

Stab phlebectomy is most effective at improving the appearance of varicose veins. To relieve pain and discomfort, it is often used in conjunction with procedures such as radiofrequency ablation (RFA) or endovenous laser therapy (EVLT). Our vein specialists can provide guidance on the most effective treatment plan for you.

Who needs a Phlebectomy?

If you have superficial veins in your legs that are twisted and bulging, you may be a good candidate for a stab phlebectomy procedure.

Varicose veins don't always have symptoms. Sometimes, the only signs of varicose veins are their bulging, swollen appearance. For some, they can cause aching or swelling legs, pain after sitting or standing for long periods, and itchiness or discoloration around the affected vein.

We diagnose varicose veins through a physical examination and imaging procedures such as a venous Doppler ultrasound, which uses sound waves to capture blood flow.

Before the Procedure

When you come in for your procedure, we will ask you to follow some guidelines, including:

Avoid wearing perfume or cologne. Deodorant is fine.
Do not use any lotion on your legs on the day of the treatment.
Wear loose, washable pants (sweatpants or athletic pants) to your appointment, and bring a pair of loose, washable shorts for the procedure.
If you have compression stockings, please bring them with you for the procedure.

During the Procedure

A stab phlebectomy typically lasts one hour. We make every effort to ensure you are comfortable every step of the way throughout the procedure.

On the day of your procedure, a member of our staff will escort you to an exam room and your vein care specialist will examine your legs and identify which veins require treatment. Pictures of the treatment area may also be taken for clinical documentation purposes.

Before the procedure begins, we will give you medicine to help you relax. We will use a pen to mark your area of treatment so the problem areas are clearly visible while you are lying down.

Your leg will be cleaned to avoid any infections after the treatment. Then your vein specialist will numb the area and make tiny incisions next to the vein that is being treated. Using these incisions, we remove the varicose vein in sections. Afterward, the incisions are closed, and a compression stocking or bandage is applied to the leg.

Risks/Complications

Inflammation or infection at the incision site: Keeping the area clean and taking prescribed antibiotics will significantly decrease your risk of developing an infection.
Allergic reaction to the anesthetic or sedative.
Changes in skin color where your varicose veins were removed, but this typically goes away on its own after a short time.
Bleeding may occur around the incisions, but this is rare. The incisions are tiny.
Bruising is common and can last for a couple of weeks before it resolves.
Numbness and tingling on your legs.

Varicose Vein Stripping and Ligation

Varicose vein stripping and ligation is surgery to remove varicose veins in your legs. Your veins have valves inside them to help ensure that blood flows in the correct direction toward your heart. Varicose veins can occur if these valves become damaged or weakened and blood pools in your veins.

Vein ligation is “tying off” a varicose vein to stop blood from entering it. The vein is then stripped (removed from your body). After varicose vein stripping and ligation, your healthy veins take over to help restore normal blood flow.

Who needs a Varicose vein stripping?

People choose to remove varicose veins for health or cosmetic reasons. Varicose veins affect up to 35% of U.S. adults and can cause:

Feeling of heaviness in your legs
Itching
Pain, soreness and muscle cramps
Skin discoloration and sores
Swelling
Twisting, ropelike bulges in your legs that may be blue or purple

We also perform vein stripping and ligation to treat chronic venous insufficiency (CVI). CVI is another condition that can occur when valves in your leg veins become damaged. You might experience symptoms like pain, swelling and skin sores with CVI due to blood pooling in your legs. CVI usually occurs because of a blood clot in your legs known as deep vein thrombosis (DVT).

Before the Surgery

We will give you specific instructions to prepare for the procedure. For instance, you may need to stop eating or drinking several hours before your surgery. You may also need to stop taking certain medications.

During the Surgery

We perform vein stripping and ligation at an outpatient surgery center or hospital. However, you will need someone to drive you home after your surgery.

When it’s time for your procedure, the doctor gives you anesthesia to keep you from feeling pain. For vein stripping and ligation, you may receive:

A sedative (medicine to make you sleepy) with regional anesthesia (blocks pain in the area of the procedure)
General anesthesia, which makes you unconscious

Once your anesthesia is working, your provider makes small incisions in your groin and lower leg. They locate varicose veins using ultrasound imaging. Then, your provider ties off the veins and removes them.

In some cases, your provider may use endovenous thermal ablation. This newer technique uses heat or laser energy to close off varicose veins. Varicose vein stripping and ligation usually takes one to three hours.

After the Surgery

After your procedure, you go to a recovery area while your anesthesia or sedation wears off. Then, you go home with instructions for your recovery. During your recovery, you may need to:

Care for your incisions by keeping them clean and dry
Elevate your affected leg whenever possible
Wear compression stockings. Ask your provider which stockings they recommend for you.

Risks/Complications

Advantages of varicose vein stripping:

Varicose vein stripping and ligation is an effective way to treat varicose veins and some cases of CVI. This surgery generally works well even on severe cases, or very large varicose veins.

Because we remove the affected vein during the surgery, there’s no risk of the varicose vein coming back. Vein stripping and ligation is also an outpatient surgery, so you can go home the same day.

Risks or complications include:

Allergic reaction to anesthesia
Blood clot in your leg
Infection at the site of your incisions
Irritation of a nerve near the removed vein, which can cause numbness or pain
Scarring at your incision sites

What is the recovery time?

Full recovery from vein stripping and ligation takes two to four weeks and you: can resume your normal diet right away
May need to avoid vigorous exercise until you have fully recovered
Should walk and move around frequently to help prevent blood clots