Vascular information from Dr. Bunke

Vein & Vascular News, Tips, Treatments and More!

What is a Venous Insufficiency / Duplex Ultrasound Test?

The Duplex Ultrasound examination, also called a venous insufficiency study allows us to visualize the blood vessels that are not visible to the naked eye, even blood vessels that are deep within the muscles.  The ultrasound examination is used to both identify the veins that have faulty valves and to map the anatomy of the veins, creating a ‘road map.’  This is necessary to make an accurate assessment of the cause and extent of the varicose veins, as well as to formulate the best treatment plan.  This should be done for any individual being evaluated for varicose veins, leg swelling, patients who have failed prior treatment, patients who are symptomatic and in some patients with certain anatomic patterns of spider veins.

Duplex ultrasound uses sound waves to get images of your blood vessels.  It also helps determine how fast blood moves through the vessels.

Darkening of skin, and itchiness are a sign of chronic venous insufficiency or venous reflux disease

Darkening of skin, and itchiness are a sign of chronic venous insufficiency or venous reflux disease

At La Jolla Vein Care, the venous duplex study will be performed by one of our registered vascular technologists, who have specialized training in the science of vascular sonography (RVT). It is performed in the standing position, which is important in obtaining an accurate study result.  This examination takes approximately 45-60 minutes. Following the study, the doctor will personally discuss the results with our patients to ensure a complete understanding of the ultrasound findings.  Insurance typically covers this type of diagnostic study.

 

What is a Venous Insufficiency / Duplex Ultrasound Test?2021-11-04T00:54:25-07:00

Spider Vein Sclerotherapy: Before & After Photos

Before and after pictures of spider veins that were treated with sclerotherapy.

Before and after pictures of spider veins that were treated with sclerotherapy. This patient had spider veins behind the knees, which is a common location for spider veins and larger blue, ‘reticular veins.’

Spider vein patient treated at La Jolla Vein Care with sclerotherapy.

Spider vein patient treated at La Jolla Vein Care with sclerotherapy. Notice the presence of a blue ‘feeder vein’ that gives rise to the spider veins. It is important to treat ‘feeder veins’ to successfully eliminate the spider veins. It is similar to ‘pulling the root’ of a weed rather than clipping the weed to eliminate it.

Spider vein patient treated at La Jolla Vein Care with sclerotherapy. Note that spider veins can vary in size, location and severity. Depending on the severity of the condition, multiple treatment sessions may be required for optimal

Note that spider veins can vary in size, location, and severity. This patient had a large cluster of spider veins that appear as a bluish-purple discoloration on the outside of the knee. This patient has bruising after treatment which will fade over several weeks.

Spider Vein Sclerotherapy: Before & After Photos2021-11-04T19:10:42-07:00

New Cosmetic Spider Vein Clinic

While the doctors at La Jolla Vein Care are committed to advancing vein care through medicine, education and research (Dr. Bunke just published the 2nd edition of the Vein Book and Dr. Fronek remains an integral part of the American College of Phlebology), we are pleased to offer our new RN/ PA (Registered Nurse/ Physician Assistant) cosmetic sclerotherapy clinic for simple spider vein conditions offered on Mondays and Tuesdays.  Simple spider vein conditions are those that are cosmetic and can be treated with liquid sclerotherapy.  This does not include foam sclerotherapy for larger varicose veins, which is administered by the doctor.

The cost is based on how much solution is used, so it is a cost-efficient means of treating that ‘stubborn patch of veins’ or ‘clean up’ of small spider veins after larger varicose vein removal.  The cost is $100 for the first syringe (2cc) and $75 for each additional syringe.

spider veins

Spider veins can come in different sizes and severity. Depending on the severity of the spider veins, multiple sclerotherapy treatments may be required.

New patients or patients not seen within two years will be required a physician consultation first.  For more information or to schedule your consultation, call 858-550-0330.

New Cosmetic Spider Vein Clinic2021-11-04T19:15:57-07:00

Watch A Phlebectomy: Varicose Vein Removal

 

microphlebectomy

Microphlebectomy is one treatment option for removing varicose veins on the surface of the legs. It is performed in the office at La Jolla Vein Care using a local anesthetic.  It involves making a tiny puncture/incision and using a tool that resembles a ‘crochet hook’ to remove the varicose veins.  The incision is so small that stitches are not required.   This procedure may take 1 to 2 hours, depending on the extent of the varicose veins.  Return to normal activities after the procedure is possible. Compression stockings are required after treatment.  There are different treatment options to remove varicose veins. It is important to discuss what is best for you with your doctor.

To understand more, watch a video of a microphlebectomy performed at La Jolla Vein Care this week by clicking here: Microphlebectomy

Watch A Phlebectomy: Varicose Vein Removal2021-11-03T23:51:15-07:00

New Foam Treatment of Varicose Veins

In November of 2013, the US Food and Drug Administration (FDA)  approved Varithena,™   a new type of foam treatment for the treatment of patients with incompetent veins and visible varicosities of the great saphenous vein (GSV) system. Varithena is a pharmaceutical-grade, low-nitrogen, polidocanol foam dispensed from a canister device. In two pivotal, placebo-controlled Phase III trials, VANISH-1 and VANISH-2, Varithena achieved a clinically meaningful improvement in the symptoms of superficial venous incompetence and the appearance of visible varicosities and addressed the underlying venous incompetence in the majority of patients treated. Varithena (polidocanol injectable foam) is a sclerosing agent indicated for the treatment of incompetent great saphenous veins, accessory saphenous veins, and visible varicosities of the great saphenous vein system above and below the knee.  Varithena improves the symptoms of superficial venous incompetence and the appearance of visible varicosities.  Treatment is a minimally invasive, non-surgical procedure that requires neither tumescent anesthesia nor sedation.  Foam sclerotherapy has been used for years by medical doctors. What is new with Varithena, is that the foam is pre-made with low-nitrogen as opposed to room air, and is dispensed in a proprietary canister.   It is not yet available in doctor’s offices. Making Foam

New Foam Treatment of Varicose Veins2021-11-04T19:24:26-07:00

Dr. Fronek teaches primary care doctors to care for patients with vein problems

Dr. Fronek was recently invited to discuss vein disorders with the Family Medicine Residency Program at Scripps Chula Vista.  The doctors-in-training were excited to learn about the variety of problems that patients have with their veins – including spider veins,  varicose veins,  blood clots, and leg ulcers.  Primary care doctors see patients with vein disorders every day, and yet very few medical schools or residency training programs include any information about these common problems.  Dr. Fronek and Dr. Bunke-Pacquette are committed to sharing their expertise with colleagues and are frequently asked to speak at medical meetings.  Primary care doctors, in particular, can often start patients with vein disorders on conservative treatment, including graduated compression stockings and regular exercise (walking is usually the best exercise for vein disorders), as well as certain supplements such as horse chestnut seed extract, that can alleviate the symptoms that many patients with vein disease suffer from.  Informed primary care doctors can also refer patients to a vein specialist when symptoms aren’t diminished with conservative treatment, if the varicose veins worsen while a patient is using compression and exercise, or if the patient suffers from a venous leg ulcer.

Dr. Fronek teaches primary care doctors to care for patients with vein problems2022-01-04T05:17:54-08:00

Oxford University Press releases The Vein Book

The second edition of The Vein Book, edited by Dr. Nisha Bunke Paquette and Dr. John Bergan will be released on January 30th, 2014 by the Oxford University Press.

Since its initial publication nearly a decade ago, The Vein Book continues to serves as the ultimate comprehensive resource on venous disease. Upholding its reputation as the go-to reference for complete, authoritative, and up-to-date information about venous function and dysfunction, this second edition effectively bridges the gap between clinical medicine and basic science, suitable both for the seasoned surgeon as well as the medical student.

La Jolla Vein Care's Dr. Bunke releases The Vein Book

La Jolla Vein Care’s Dr. Bunke releases The Vein Book

The book is divided into five essential sections: basic considerations, primary superficial venous insufficiency, venous thromboembolism, chronic venous insufficiency, and congenital venous malformations. The book covers the entire spectrum of venous conditions from clarification of the pathophysiology of venous insufficiency, molecular mechanisms in the cause of varicose veins, new treatment options for varicose veins and spider veins, startling new treatment for venous thromboembolic disease, and effective treatment for leg ulcers.

More user-friendly and encyclopedic than ever, The Vein Book is still a must-have for vascular surgeons, phlebologists, interventional radiologists, research scientists, epidemiologists, and surgeons at all levels.  It is available for pre-order at Amazon.com.

Oxford University Press releases The Vein Book2014-01-24T22:49:10-08:00

New Varicose Vein Treatments 2014: Clarivein

CLARIVEIN Procedure to Treat Varicose Veins

The newest alternative to vein stripping surgery and endovenous ablation procedures is Clarivein. The ClariVein procedure, also known as mechanochemical ablation (MOCA) utilizes a wire and sclerosant medication to seal shut incompetent veins. It can be performed in the office in less than an hour without using a local anesthetic.  A thin catheter is introduced into the vein under ultrasound guidance. A sclerosant medication, such as is used in sclerotherapy, is delivered via the catheter, to seal the veins shut. La Jolla Vein Care is one of the few southern California vein centers to offer the Clarivein or mechanochemical ablation procedure. To read more about Clarivein, go to www.july01ljvascular.com.

Clarivein insertion

Clarivein insertion

New Varicose Vein Treatments 2014: Clarivein2021-11-04T18:59:12-07:00

Dr. Oz discusses DVT (blood clots in the veins)

Yesterday, the Emmy award-winning television show, Dr. Oz featured information about blood clots in the veins, specifically, deep venous thrombosis (DVT).  He demonstrated how they can break off and travel to the heart and lungs. But, what was missing from this segment was more information about what causes DVT and how can you prevent them.

What are some of the most common causes of DVT?

DVT:  There are many causes of DVT. You can categorize these into three main groups.   (Medically, these 3 risk factors for DVT are collectively called Virchow’s Triad)

A)   Decreased movement of blood (venous stasis),

  1. Decreased movement of blood can be caused by immobilization: sedentary, prolonged sitting, long plane flights or car trips, or post-surgery being inactive, and bed rest like in hospitals or nursing homes. This is where compression is crucial to preventing blood clots since the external compression increases the venous return back to the heart and reduces pooling. Venous insufficiency allows blood to pool.

B)   Increased tendency to clot (hypercoagulability)

  1. Temporary conditions such as pregnancy, cancer and obesity cause the blood to become hypercoagulable. The use of oral contraceptives, estrogens hormone replacement, testosterone, increase the risk of blood clots.
    • The likelihood of a blood clot during pregnancy is 5-20 for every 10,000 women.
    • The likelihood of a blood clot post partum is 40-65 for every 10,000 women.
  2. Genetic conditions that are inherited can increase the risk of blood clots. For example, Factor V Leiden and antiphospholipid antibody. 5% of the population carry one copy of the Factor V Leiden mutation.

C)   Damage to the blood vessel wall

  1. Trauma, injury to the leg, surgery

What can you do to prevent DVT?

Stay moving, avoid prolonged sitting. For example, when flying or traveling, the risk of DVT is 1% on a long haul flight (greater than 6 hours).  To minimize this risk, you should wear compression stockings (which helps increase the blood flow in the legs), stay hydrated, avoid excessive alcohol, use the calf muscles- walk about the cabin and frequently pump the calf muscles by doing foot lifts.

During pregnancy, compression stockings should be worn and after pregnancy, when the risk of DVT is highest (the likelihood of a blood clot post partum is 40-65 for every 10,000 women).

Your doctor can recommend to you what type of compression socks to use.  For more information about compression socks, go to compressrx.com.

Dr. Oz discusses DVT (blood clots in the veins)2013-11-01T15:22:46-07:00

La Jolla Vein Care Receives BBB Accreditation

La Jolla Vein Care is pleased to announce that it is among the handful of medical practices that is accredited by the Better Business Bureau (BBB) in San Diego.  The BBB was founded in 1912 and its accreditation means BBB has determined that the business meets accreditation standards which include a commitment to ethical practices and a pledge to continue to adhere to the BB Code of Business Practices.  The BBB Code of Business Practices is built on the BBB Standards for Trust, including eight principles that summarize important elements of creating and maintaining trust in business.

La Jolla Vein Care Receives BBB Accreditation2013-11-01T15:05:58-07:00
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