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So far Nisha Bunke has created 112 blog entries.

20, 4, 2022

Labial Veins and Pelvic Pain May Be Signs of Vascular Disease


Pelvic vein disorder, also known as pelvic congestion syndrome (PCS), is a common disease of the vascular system in women. Pelvic vein disease is a condition in which varicose veins develop in the veins of the pelvis. Like varicose veins in the legs, pelvic vein disease results from impairment of the valves in the veins and engorgement of the blood vessels. It is estimated to occur in approximately 15% of women in the US. Instead of flowing properly to the heart, blood pools in the pelvic veins and causes symptoms such as dull pain, heaviness, and pressure. Symptoms include a dull, aching pain in the pelvic region or lower back, irritable bowel and bladder, pain after sexual intercourse, and vulvar or labial varicose veins. You may also notice varicose veins in the groin or in the upper thigh.
Pelvic Varicose veins
PCS is a highly treatable condition. If you have symptoms of PCS or bulging veins in the vulvar region that affect your quality of life, you should consider being evaluated for PCS. PCS is diagnosed by your medical history, physical examination and special imaging using magnetic resonance venogram to see the blood vessels within the pelvis. Often, we will see large clusters of varicose veins surrounding the ovaries.
Dr. Elliot DeYoung treats PCS. Call us if you would like to discuss concerns about pelvic congestion.

Labial Veins and Pelvic Pain May Be Signs of Vascular Disease2022-04-20T09:58:43-07:00

25, 2, 2022

Can your height influence varicose veins?


Does height play a role in developing varicose veins? Yes. We initially presented this information in 2018, after a study at Stanford University School of Medicine found a person’s height to be a significant risk factor for developing varicose veins. “We not only found an association between height and varicose veins, but the genetic studies we did showed a causal link,” said cardiologist and study author Dr. Nicholas Leeper, an associate professor of surgery and cardiovascular medicine at Stanford. “That suggests that the genes and pathways that drive human height are also likely to be causing varicose veins.” The study originally published in 2018, found a significant link between above-average height and vein health. In this population-based study of ~500,00 individuals, greater height appeared as a novel predictor of varicose vein disease in machine learning analyses, and was independently associated in multivariable-adjusted Cox regression.

Other known influences such as age, excess weight, being female, and genetics also play a role in the development of them. This study, reveals that taller individuals, the study concluded, have a greater chance of developing them and possibly even blood clots in the legs.

The reason has to do with gravity — blood from the legs of taller people must travel a greater distance to the heart, which forces the veins to work harder. But it also has to do with genetics. The study’s authors found above-average height was not only associated with varicose veins, but could be the underlying cause of the swollen veins that rise to the surface of the legs and feet as well.

Lifestyle modifications to reduce the risk of developing them by including use of compression stockings when traveling and sitting or standing for longer periods of time, exercise, weight loss (if indicated), and leg elevation. Read about measures to reduce symptoms related to varicose veins.

Original Study Published in Circulation.
Clinical and Genetic Determinants of Varicose Veins: A Prospective, Community-Based Study of ~500,000 IndividualsEri Fukaya, Alyssa M. Flores, Daniel Lindholm, Stefan Gustafsson, Daniela Zanetti, Erik Ingelsson, Nicholas J. LeeperCirculation.

Can your height influence varicose veins?2022-02-28T17:01:39-08:00

How to Earn Vein Center Accreditation by IAC in 2022


How to earn vein center accreditation by IAC in 2022

More than one half of Americans age 50 and older are affected by varicose veins. Varicose veins occur when the valves in the leg veins no longer function, causing blood to pool in the legs. In some cases, this condition progresses to a more serious form of venous disease called chronic venous insufficiency (CVI). Whether to relieve symptoms and/or improve appearance, treating varicose veins can be performed by vein centers that specialize in the evaluation and management of superficial venous disorders. Through vein center accreditation, one can feel confident in choosing the best providers and treatments for their vein disease.

There are many factors that contribute to an accurate vein treatment and management. The training and experience of the vein specialist performing the procedure, the type of equipment used and the quality assessment metrics each facility is required to measure, all contribute to a positive patient outcome. IAC accreditation is a “seal of approval” that patients can rely on as an indicator of consistent quality care and a dedication to continuous improvement.

La Jolla Vein Care located in La Jolla, CA has been granted vein center accreditation by the Intersocietal Accreditation Commission (IAC) in the area of Superficial Venous Treatment and Management.

This latest accreditation awarded to La Jolla Vein Care demonstrates the facility’s ongoing commitment to providing quality patient care in vein treatment and management.

How to earn vein center accreditation:

Accreditation by the IAC indicates that La Jolla Vein Care has undergone an intensive application and review process and is found to be in compliance with the published Standards, thus demonstrating a commitment to quality patient care in vein treatment and management.

  • A detailed self-evaluation
  • Followed by a thorough review by a panel of medical experts

The IAC accreditation process enables both the critical operational and technical components of the applicant facility to be assessed, including representative case studies and their corresponding final reports.

About IAC

IAC provides accreditation programs for vascular testing, echocardiography, nuclear/PET, MRI, diagnostic CT, dental CT, carotid stenting, vein treatment and management and cardiac electrophysiology.

The IAC programs for accreditation are dedicated to ensuring quality patient care and promoting health care and all support one common mission:

Improving health care through accreditation®. IAC accreditation is widely respected within the medical community, as illustrated by the support of the national medical societies related to venous disorders, which include physicians, physician extenders, nurses and ultrasound technologists. To date, the IAC accrediting divisions have granted accreditation to more than 14,000 sites throughout the United States, Canada and Puerto Rico.

How to Earn Vein Center Accreditation by IAC in 20222022-02-11T17:53:26-08:00

21, 1, 2022

La Jolla Vein Care Doctors Make History, First to Use Live Stream Teaching in San Diego


On Tuesday, January 18, 2022, La Jolla Vein Care doctors were the first in the region to utilize a special type of live streaming technology to teach other physicians. Over a hundred physicians around the globe dialed in to watch Dr. Armin Foghi of La Jolla Vein Care perform endovenous laser ablation (EVLA) procedures using Avail technology to livestream the procedure. Dr. Nisha Bunke of La Jolla Vein Care was the moderator. The live cases included EVLA of a great saphenous vein and of a perforator vein on patients who consented to participate. In addition to teaching, Avail, technology can be used to facilitate collaboration during procedures in real time with other physicians, sharing knowledge about surgical techniques all while bringing together the medical community to advance care for all.


Dr. Armin Foghi demonstrates EVLA procedure on a perforator vein while physicians around the globe observe the case. Dr. Nisha Bunke is the moderator.

La Jolla Vein Care Doctors Make History, First to Use Live Stream Teaching in San Diego2022-01-21T12:17:28-08:00

AVANTA IPA is the Newest Insurance Accepted for Vein Care



Avanta IPA

We are pleased to announce that we accept AVANTA IPA healthcare insurance at La Jolla Vein Care. Now offering vein care services including evaluation and treatment of varicose veins, venous reflux disease, leg swelling, chronic venous insufficiency, deep venous thrombosis (DVT) and ultrasound imaging for DVT and other vascular conditions,
AVANTA IPA San Diego, La Jolla, Carmel Valley, Chula Vista, San Marcos, Vista, Escondido, La Mesa.

We accept several other insurance types, click here to read our full list of insurances accepted by La Jolla Vein Care.

AVANTA IPA is the Newest Insurance Accepted for Vein Care2022-01-21T12:03:53-08:00

11, 11, 2021

How We Support Veterans and Military


We provide vein care services for all veterans and active military. We provide treatment and diagnosis of varicose veins, chronic venous insufficiency, venous leg ulcers, and deep vein thrombosis.

First off, on this 11th day of November, we honor all who have served and sacrifice. We greatly appreciate our military personnel. Being a military daughter myself, and then working at the VA Healthcare and providing vein care for veteran’s, I continue to be committed to providing vein care services to promote healthy legs for veterans and active military. While military personnel have some of the most fit and healthy legs veteranman-and-woman_web copy

Triwest and VA Champs

La Jolla Vein Care has partnered with Veterans Affairs and Tricare to take care of our veteran’s varicose vein and leg health needs.

amongst all of us, military personnel and even Olympic athletes even can develop vein conditions. Certain occupations are known to increase the risk of developing vein disorders, such as standing occupations. At the VA, I often saw patients who stood guard for many hours on end, or had other risk factors for developing varicose vein disease such as leg trauma, or jumping out of airplanes. The range of vein disease I frequently saw at the VA included chronic venous insufficiency and venous leg ulcers, varicose veins, and venous reflux disease.

Here at La Jolla Vein Care, we accept VA Champs, which allows VA patients to be seen at our clinic and TriCare for active military. If you would like to be seen at our clinic, please contact our Veteran and military new patient coordinator at 858-550-0330 extension 104.

Happy Veteran’s Day.

How We Support Veterans and Military2021-11-11T08:49:52-08:00

18, 9, 2021

New Chula Vista Location Now Open


World-class vein care is now available in your own backyard if you live in or near Chula Vista. La Jolla Vein Care has opened a convenient location to serve our San Diego patients who live near Chula Vista, National City, and other cities in the South bay. Our same team, including Dr. Lucas and vascular sonogprahers will go to the Chula Vista location on select days.
The same services as the La Jolla location will be offered including:
Varicose vein treatments, diagnosis and evaluations, physician consultations, ultrasound, and vascular lab services.
*Asclera™ *Endovenous Chemical Ablation *Endovenous Laser Ablation *Foam sclerotherapy *Laser vein ablation *Leg Ulcer treatment *Microphlebectomy *Radiofrequency Ablation *Sclerotherapy *ClariVein® *Spider Vein Treatment *Ultrasound Guided Foam Sclerotherapy *Ultrasound Imaging *Varicose Vein Treatment *Varithena *Vascular Lab Imaging *Venous Ultrasound Imaging
Call now to schedule your appointment at the Chula Vista location: 858-550-0330

New Chula Vista Location Now Open2021-09-18T17:55:19-07:00

14, 6, 2021

Complications of Untreated Varicose Veins


Varicose veins and their underlying cause, venous reflux disease can cause a wide array of symptoms, including leg pain, swelling, aching, heaviness, restless legs, and nocturnal leg cramps.

If left untreated, superficial venous reflux disease can progress to cause skin changes and other complications.

Complications of untreated venous disease include:
1. Superficial Thrombophlebitis (STP)
A thrombophlebitis is swelling and inflammation of a vein caused by a blood clot. There are two main types of thrombophlebitits: deep venous thrombosis (affects deeper, larger veins) and superficial thrombophlebitis (affects veins near the skin surface). This is often referred to as an STP.

The following symptoms are often associated with thrombophlebitis:
Inflammation (swelling) in the part of the body affected
Pain in the part of the body affected
skin redness, warm and tenderness over the vein
Often a ‘hard knot’ or lump can be felt within the vein.

An STP is common complication of varicose veins because blood is pooling and not circulating well. But, it can also indicate an underlying problem with blood clotting. In some cases, there may also be a concurrent blood clot in other veins, such as the deep veins (DVT) which can be serious. For this reason, a duplex ultrasound examination is used to look at the deep veins and other veins not visible to the naked eye for the presence of blood clots.

STP can usually be treated with aspirin or other anti-inflammatory medication to reduce pain and inflammation, compression stockings, and cold/warm packs to also reduce inflammation and discomfort. The discomfort is usually improved within 6 weeks but it can take a few months to resolve.
2. Deep Venous Thrombosis (DVT)
If the blood clot is in a varicose vein near a deep vein or perforator vein, it can extend into the deep system, causing a DVT. For example, a spontaneously thrombosed great saphenous vein, can extend into the common femoral vein and cause a pulmonary embolism (PE). Also, a varicose vein blood clot can extend into a perforator vein and travel to the deep system. It is important to have an ultrasound examination of superficial blood clots to determine a concurrent DVT is present, determine exact location and extent of the superficial clot to make sure it is not near a deep or perforator vein. If it is, a blood thinner may be recommended or serial ultrasounds to monitor the clot may be recommended.
3. Spontaneous Vein Hemorrhage
Untreated varicose veins are at a higher than usual risk of bleeding or spontaneous rupture. Over time, varicose veins become larger, and the vein wall becomes weak and stretched out. These veins, which are already weak are also under high pressure (because of venous reflux, or the ‘backflow’ and pooling of blood in these veins). As a result, the high pressure can cause the veins to spontaneous burst and bleed heavily. Because they are under high pressure, they bleed like an arterial bleed and patients describe the bleeding as ‘blood shooting across the room.’ The varicose veins that are susceptible are veins closest to the surface of the skin

Most patients describe that it occurs during or after a warm shower (warm water causes veins to relax and dilate, allowing more blood to pool within the veins) or during sleep. It is painless and patients report that they notice it because they feel something wet in bed. Patients who are on blood thinners can lose large amounts of blood, especially if it occurs while they are sleeping. Some people have required blood transfusions. The small blue spider veins around the ankle are equally at risk of rupture as are the larger bulging veins.If someone you know has experienced bleeding from their varicose veins, they should be seen by a doctor. Treatment will prevent the veins from bursting again. This is a common condition that we see at La Jolla Vein Care.

4. Venous Leg Ulcer
A leg ulceration is the most severe form of chronic venous insufficiency. This is referred to as a ‘venous leg ulcer.’ Venous leg ulcers make up 70% of all chronic leg wounds. Therefore, the venous leg ulcer is much more common than a diabetic or arterial ulcer. It is caused from long-standing pressure within the leg veins, resulting from 1) venous reflux through faulty valves, 2) a blockage within the deep veins or 3) from the inability to use the calf muscles or a combination. Venous reflux is the most common cause for a venous leg ulcer. The increased pressure within the leg veins (we call this venous hypertension) causes an inflammatory response. Inflammation then causes changes in the skin, usually around the ankles (this is where pressure is the greatest). The inflammatory process will cause the skin around the ankles to become brown or discolored, and eventually the skin will break open. The leg wound can be healed by treating the underlying vein condition.

5. Venous stasis and venous eczema
Venous stasis skin changes refers to darkening around the skin. It is associated with itching often, due to inflammation of the skin. It indicates long standing venous disease, called chronic venous insufficiency. Progression can lead to ulceration.
Venous leg ulcers can also be prevented by early intervention with non-invasive procedures. If you have signs of chronic venous insufficiency (such as skin discoloration around the ankles) you should address your underlying vein condition to prevent the skin from breaking open.

Complications of Untreated Varicose Veins2021-06-14T20:00:18-07:00

How Laser Vein Ablation Works to Treat Varicose Veins


The VenaCure EVLT procedure is minimally-invasive and can be performed in a doctor’s office. It addresses both the cosmetic and medical issues associated with varicose veins.

A laser light emitted through a thin fiber inserted into the damaged vein delivers just a small amount of energy, causing the malfunctioning vein to close and seal shut.
Veins that are treatable with the VenaCure EVLT system are superficial veins. Laser therapy with the VenaCure EVLT system is indicated for varicose veins and varicosities with superficial reflux of the Greater Saphenous Vein, and in the treatment of incompetent refluxing veins in the superficial venous system in the lower limb.
After the VenaCure EVLT procedure, your body will naturally route blood flow to other veins.
Bulging and pain in the damaged and now-sealed vein will subside after the procedure.
Because VenaCure EVLT vein treatment eliminates varicose veins where they start, the results can be obvious right away.

Before undergoing any treatment, it is important to discuss with your physician the risks, benefits and alternatives to the procedure.
Complications with vein treatments are rare, but you should be aware of Potential Complications:

Potential complications include, but are not limited to the following: vessel perforation, thrombosis, pulmonary embolism, phlebitis, hematoma, infection, skin pigmentation alteration, neovascularization, paresthesia due to thermal damage of adjacent sensory nerves, anesthetic tumescence, non-target irradiation, hemorrhage, necrosis, DEHP exposure, skin burns and pain.

To read more about the VenaCure EVLT procedure that we perform at La Jolla Vein Care, click here. To schedule a consultation or telemedicine visit with one of our physicians to further discuss laser treatment and alternatives to laser, call us at 858-550-0330.

How Laser Vein Ablation Works to Treat Varicose Veins2021-06-07T13:47:35-07:00

1, 5, 2021

How Ultrasound Can Detect Hidden Dangers in Leg Veins


The Duplex Ultrasound examination allows us to visualize the blood vessels that are not visible to the naked eye, even blood vessels that are deep within the muscles. Ultrasound looks at deep and superficial veins in the legs to check for venous-valvular incompetence (the underlying condition that causes varicose veins). 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, skin changes, patients who have failed prior treatment, patients who are symptomatic and in some patients with certain anatomic patterns of spider veins.

Before your test:

This study does not require any preparation. You should not wear your compression stockings the same day as the examination. Make sure to be hydrated.

How Ultrasound Can Detect Hidden Dangers in Leg Veins2021-05-01T01:06:15-07:00
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