22, 3, 2022

What are the risks for Microphlebectomy

2022-03-22T12:47:08-07:00

MicroPhlebectomy for varicose veins 

 

A microphlebectomy is a minimally invasive procedure, which is the surgical removal of bulging varicose veins through tiny skin incisions. This procedure is performed in the office with local anesthesia. Phlebectomy is also known as micro phlebectomy (because the incisions are tiny) or it can also be referred to as ambulatory phlebectomy. A microphlebectomy is for someone who is suffering from complications from varicose veins. The complications can include persistent pain, cramping, or discoloration of the skin. 

 

Risks of Microphlebectomy:

With any procedure, there are risks. In microphlebectomy the risks are listed below:

  • There is a low risk of infection at the vein removal sites, which we minimize by using sterile technique and prophylactic antibiotics. You will start the antibiotic on the morning of your procedure and continue it for 24 hours after the procedure. 
  • As with any vein treatment, there are also very small risks of deep vein clots and nerve injury. 
  • You will have bruising where the veins were removed, which fades over about two weeks. To reduce bruising, swelling or redness, try RECOVA cream
  • A nerve injury to the skin.
  • Numbness or pain in the feet
  • Adverse reaction to sedative or anesthetic 
  • Severe bleeding or swelling
  • Thrombophlebitis 

 

What are the risks for Microphlebectomy2022-03-22T12:47:08-07:00

After care for Foam Sclerotherapy

2022-03-21T15:15:18-07:00

After care for foam sclerotherapy

After Treatment Care

You will be instructed on how long to wear compression stockings after treatment, depending on the size of the veins that are treated. Most patients wear thigh-high compression stockings continuously for 1-3 days, then another 7 days.

For the first 24 hours after the procedure, you should not get the area wet. But after, you may shower with the stockings on or take a quick cool shower with them off. Avoid heated showers for one week after the foam sclerotherapy treatment.

You should walk 30 minutes twice daily after treatment and move your legs frequently throughout the day with short walks and/or calf exercises. This avoids pooling of blood in the legs. Avoid prolonged sitting during the day, and when you are sitting have your legs be elevated.

Avoid direct sun exposure during the healing process. The two weeks after treatment. Using sun tan lotion after is recommended.

No swimming in public pools, lakes, or oceans for one week to reduce risk of infection.

It is normal to have aching in the treated veins. This responds well to walking, ice packs, and anti-inflammatory medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve).

What to avoid after foam sclerotherapy treatment

For at least two weeks after treatment, you should avoid strenuous exercise (anything more than a brisk walk), heavy lifting, saunas or hot tubs, and leg massages. All of these dilate the superficial veins and interfere with their healing. You should also avoid airline travel for two weeks after treatment.

Possible side effects after foam sclerotherapy treatment

You will likely have some bruising over the injection sites, then the treated veins may become firm and blue. We recommend patients use the product, RECOVA cream, as this helps reduce swelling, redness, and bruising post procedure.

The skin overlying the treated veins may also develop brownish hyperpigmentation as the blood products within those veins are absorbed by the body; in some patients it can take up to a year to fade.

An uncommon complication is a blood clot within a deep vein. The risk is minimized by using ultrasound guidance and performing calf exercises throughout the procedure.

 

After care for Foam Sclerotherapy2022-03-21T15:15:18-07:00

EVLA Treatment for Varicose Veins Aftercare 

2022-03-18T15:37:25-07:00

Endovenous laser vein ablation, also known as endovenous laser therapy (EVLA), is a type of treatment for saphenous vein reflux, the underlying cause of most varicose veins. At La Jolla Vein Care, we offer ALL treatment modalities for varicose veins, not just one. Treatment is customized based on a person’s individual pattern of venous reflux (determined by ultrasound examination), personal preference, and personal health history.

 

What should I do to optimize recovery after treatment? 

 

Walking is essential to optimize recovery and avoid pooling of blood in the legs. You should walk 30 minutes twice daily during treatment and to do other calf exercises throughout the day. 

 

Thigh-high compression stockings must be worn continuously for 72 hours after each treatment and for an additional week during the day after the last treatment. This improves your recovery and reduces complications. 

 

Ice packs can be used as well as anti-inflammatory medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve) for pain relief. 

 

No strenuous exercise, hot tubs, or leg massages for two weeks to allow veins to heal. 

 

Avoid airline travel for two weeks to minimize risk of deep vein clots. 

 

Avoid Saunas as these dilate the superficial veins and interfere with healing.

 

We look forward to helping you achieve your treatment goals! 

Please reach us at (858) 550-0330 with any questions. 

 

EVLA Treatment for Varicose Veins Aftercare 2022-03-18T15:37:25-07:00

The Four Best Ways to Treat Venous Disease

2022-03-17T10:25:13-07:00

Symptoms to look for in venous disease:

 

La Jolla Vein Care offers various ways for venous disease treatment. While there are numerous excellent ways to treat venous disease, we have named four of our favorite ways to treat it. What is venous disease and how does it happen? Venous disease occurs when backwards flow (or “reflux”) is present in the superficial veins of the legs. This can cause pain, fatigue, itching, swelling, and varicose veins, which can lead to venous disease. Night-time symptoms include leg cramps and restless legs. Advanced disease can produce skin damage and wounds that do not heal. 

At La Jolla Vein Care, an ultrasound is used to identify the source of backwards flow in the veins and develop a personalized treatment plan. 

The best symptomatic and cosmetic results are achieved when superficial vein reflux is treated from its source, starting with the main superficial veins of the legs and leaving the skin-level (cosmetic) treatment for last. 

 

Each specific treatment plan depends on the patient’s goals. Some patients are only concerned about symptomatic improvement and avoiding complications of long term venous reflux disease. Others may be interested in cosmetic improvement. In either case, we can generally achieve an 80% improvement in symptoms and appearance of the legs. Many patients also report improvement in swelling  after venous disease treatment.  

 

Venous Disease Treatment: Saphenous Vein Reflux with a Catheter Ablation Procedure

 

The great and small saphenous travel down the inner leg and back of the leg, respectively. These veins tend to be straight and far from skin and nerves, which allows us to treat them with minimally invasive catheter procedures that are potent and precise. A catheter is a very thin tube that is inserted into the vein, similar to an IV, through which the doctor can apply heat, a rotating wire, and or medication. All modalities are about 95% effective in closing the diseased vein. None require a skin incision, so they do not leave a scar. 

 

Venous Disease Treatment: Branch Vein Reflux

 

Ultrasound-guided foam sclerotherapy is the most common treatment for branches of the saphenous veins and portions of the saphenous veins which cannot be treated with a catheter procedure (e.g. if they are too close to skin or nerves). The veins are localized with ultrasound, then the medication is given through a tiny needle. Several treatments may be needed, as we can only administer a small amount of foam per day. Large or resistant veins may require more than one injection. For very large bulging varicose veins through tiny skin incisions. This allows many veins to be treated in one day. 

 

Venous Disease Treatment: Spider Veins with Cosmetic Sclerotherapy 

 

Following treatment of the “underlying reflux” with the ultrasound-guided procedures, you may still have some prominent veins at the skin level. These can be treated with cosmetic sclerotherapy. 

 

Venous Disease Treatment: Compression of Stockings 

 

Prior to approval of treatments for vein disease, insurers require patients to try compression stockings. Medicare requires a 3-month trial of compression supervised by the treating physician. We recommend patients should wear the 20-30 mmHg thigh-high stockings for at least a day before treatment to confirm they fit. 

 

The Four Best Ways to Treat Venous Disease2022-03-17T10:25:13-07:00

What are the adverse effects of Vein treatment?

2022-03-17T10:21:05-07:00

What are the adverse effects of Vein treatment?

Patients generally do very well with vein treatments, all of which have a low risk of complications. Some post treatment effects can include:

 

Aching over the treated veins is normal after vein treatment. This responds well to walking, ice packs, and anti-inflammatory medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve). 

vein treatment pain

Bruising over injection sites is also normal after vein treatment and resolves in about two weeks. 

vein treatment bruise

Hyperpigmentation over a vein can occur from blood pigments that are released as the vein is healing. It is more common in patients with large bulging veins and certain complexions. Hyperpigmentation tends to fade over many weeks after vein treatment if you stay out of direct sunlight. 

deep vein clots

Intravascular hematoma refers to a large varicose vein that becomes firm and tender days to weeks after treatment. This also responds well to ice packs and anti-inflammatory medications. We may also recommend a confirmatory ultrasound and/or offer needle drainage of the trapped blood to alleviate discomfort and minimize skin pigmentation. 

 

Deep vein clots are very uncommon, and usually are limited to patients with poor mobility, advanced age, hormone treatment, and/or genetic tendency for clotting. We monitor all patients with ultrasound throughout treatment so we can detect clots at a very early stage before they cause a symptom. We may recommend surveillance ultrasounds, extra walking, and/or a short course of blood thinners. 

deep vein thrombosis

Numb spot over a treated vein is another uncommon event after radiofrequency or laser vein ablation. This occurs when a branch of a skin nerve gets stunned during the heat treatment. It tends to improve over several weeks. The nerves that control the movement of the leg and foot are located far from the superficial veins. 

 

What are the adverse effects of Vein treatment?2022-03-17T10:21:05-07:00

Why have I been offered an endovenous laser ablation (EVLA) procedure? 

2022-03-17T10:20:32-07:00

Endovenous Laser Ablation for Saphenous Vein Reflux 

Endovenous laser vein ablation, also known as endovenous laser therapy (EVLA), is a type of treatment for saphenous vein reflux, the underlying cause of most varicose veins. At La Jolla Vein Care, we offer ALL treatment modalities for varicose veins, not just one. Treatment is customized based on a person’s individual pattern of venous reflux (determined by ultrasound examination), personal preference, and personal health history.

The  endovenous laser vein ablation procedure may be offered for backward flow (or “reflux”) in your saphenous vein(s).  The great and small saphenous veins are the two main superficial veins that run along the inner thigh/ calf and the back of the legs, respectively. Some people have anatomic variations where the small saphenous vein in the back of the calf extends to the thigh. Many people also have reflux in their anterior or posterior saphenous veins.

evla

This minimally invasive procedure can be performed in the office in less than 30 minutes and patients return to their usual level of activity the same day.

evla treatment

How does the treatment work?

The skin is numbed with lidocaine, then a tiny wire and the laser catheter are inserted into the vein. The catheter delivers laser energy to the vein wall, causing it to seal shut. The remaining healthy veins continue to bring blood back to the heart. 

 

What should I expect on the day of treatment?

The procedure is performed with local anesthesia, but many patients elect to use a mild oral sedative (Valium), which is taken after checking in and completing all paperwork. You will change into a gown and leave underwear on.

Depending on the vein to be treated, you will lay on your back or on your belly. We do our best to make special accommodations (for example, if you cannot lie flat or cannot bend a knee very well) with body positioning and using pillows. We will do our best to make you comfortable. Then, we will give you the option of watching a movie on Netflix or listen to music. Once you are comfortable, your leg will be prepped with cleansing solution for the sterile procedure. The doctor will perform an ultrasound to map the vein to be treated.

Then, a numbing agent (lidocaine) will be injected into the skin. In the numb area of the skin, a tiny puncture is made to pass the laser catheter under ultrasound guidance. Your doctor will then use a needle to administer a combination of cool saline and local anesthetic around the vein. This solution numbs the vein and insulates it from the surrounding tissue. Laser energy will then be used to painlessly treat the vein. Once your vein has been treated, we will help you into your compression stocking, which you will wear for 72 hours continuously. You will walk for 30 minutes prior to getting in your car. 

 

Why have I been offered an endovenous laser ablation (EVLA) procedure? 2022-03-17T10:20:32-07:00

How is Venous Reflux Disease Treated?

2022-03-17T10:19:57-07:00

How is Venous Reflux Disease Treated? 

 

Step 1: Identifying the underlying problem

The first step is to treat the underlying problem, venous reflux disease. The specific pattern of venous reflux disease was detected by ultrasound. Venous reflux usually starts in the saphenous veins. The saphenous veins are most effectively treated with vein ablation procedures. This involves placing a small catheter within the vein and using heat or a solution to produce injury and eventful closure of the vein. The most commonly used treatments for the saphenous veins are radiofrequency ablation (RFA), laser ablation, mechanico-chemical ablation (MOCA or Clarivein), and in some cases Varithena Foam. The treatment recommendation is customized, based on where reflux is present and other clinical factors.  

radiofreqgraphic

Step 2: Varicose Veins

 

After the underlying saphenous vein reflux is corrected, the bulging veins (varicose veins) can be treated by injecting a foamed medication that will cause them to scar and eventually dissolve (foam sclerotherapy), or to remove them using tiny incisions. The most common method is foam sclerotherapy. This is also known as ultrasound-guided foam sclerotherapy (UGFS). Both these treatments can treat venous reflux disease. 

 

Step 3: Spider Veins 

 

Spider vein treatment is always considered a cosmetic procedure. If improved cosmesis is a goal of treatment, make sure to discuss this with your doctor and plan on having cosmetic treatment as the last step. Spider vein treatment is accomplished by sclerotherapy, which is an injection of liquid medication into the spider veins. Ask your provider for an estimate about how many treatment sessions/ vials are necessary to get the results you want. 

 

How is Venous Reflux Disease Treated?2022-03-17T10:19:57-07:00

Why Was I Offered a Phlebectomy?

2022-03-17T10:19:18-07:00

Micro-Phlebectomy for varicose veins 

 

A phlebectomy is a minimally invasive procedure, which is the surgical removal of bulging varicose veins through tiny skin incisions. This procedure is performed in the office with local anesthesia. Phlebectomy is also known as micro phlebectomy (because the incisions are tiny) or it can also be referred to as ambulatory phlebectomy. 

microphlebectomy

What are the options for treating bulging varicose veins at the skin surface? 

 

There are two main techniques to treat varicose veins: 

 

  1. Phlebectomy: surgical removal of the veins
  2. Foam sclerotherapy: injection of a medicated foam to close the veins

 

Sclerotherapy is the least invasive, but patients with large and or numerous bulging veins may require several sclerotherapy appointments over two or more months. This is because we can only administer a small amount of foam medication per day and larger veins may require two or more injections to close. Larger veins can also become firm and tender after sclerotherapy and/or deposit brownish blood pigments in the skin as the veins are healing. 

 

Why was I offered a phlebectomy?

Patients with bulging varicose veins may prefer to start with micro-phlebectomy removal of the largest veins, then sclerotherapy treatment for the remaining veins. This reduces the number of appointments and accelerates recovery. 

How does the procedure work?

The skin is numbed with lidocaine, then a tiny puncture is made in the skin (about ½ the size of a grain of rice). We then infuse additional numbing medication around the veins. A small hook is used to bring the vein to the skin surface, then the vein is removed. 

 

What should I expect on the day of treatment? 

The procedure is performed with local anesthesia, but many patients elect to use a mild oral sedative (Valium), which is taken after checking in and completing all paperwork. We will mark your bulging veins with a marker. A small hook will be used to bring the veins to the surface. More numbing medication will be infused around the veins. You will feel pressure as the veins are removed but not pain. Usually about 10-12 veins are removed.

Once the procedure is done, we will apply skin glue to the tiny puncture sites, then sterile bandages. We will help you into your compression stocking and place an ACE wrap around the treated area. You will walk for 30 minutes prior to getting in your car. The ACE wrap can be removed that night or the next day. You will wear the compression stocking for 72 hours continuously. 

 

Why Was I Offered a Phlebectomy?2022-03-17T10:19:18-07:00

What is Radiofrequency Treatment for Varicose Veins?

2022-03-17T10:17:50-07:00

At La Jolla Vein Care, we use a special procedure called radiofrequency treatment for varicose veins. This treatment uses a radiofrequency energy to heat up the wall of the vein. This treatment is used for varicose veins. Varicose veins develop when valves in the veins are damaged and this causes the veins to bulge or twist and stand out in the legs. Radiofrequency ablation treatment closes off the blood flow in the vein that causes the varicose veins. 

radiofrequency treatment for varicose veins

 

Radiofrequency Ablation for Saphenous Vein Reflux 

Why was I offered an endovenous radiofrequency ablation procedure?

Most patients who are offered a radiofrequency ablation procedure is for backwards flow (or reflux) in the saphenous vein(s). The great and small saphenous veins are the two main superficial veins of the leg. They run along the inner leg and the back of the leg, respectively. This minimally invasive procedure can be performed in the office in less than an hour and patients return to their usual level of activity the same day. 

 

How does the treatment work?

 

The skin is numbed with lidocaine, then a tiny wire and the Closurefast catheter are inserted into the vein. The catheter delivers radio-frequency energy to the vein wall, causing it to seal shut. The remaining healthy veins continue to bring blood back to the heart. 

 

What should I expect on the day of treatment?

 

The procedure is performed with local anesthesia, but many patients elect to use a mild oral sedative (Valium), which is taken after checking in and completing all paperwork. You will change into a gown and leave underwear on. Depending on the vein to be treated, you will lay on your back or on your belly. We do our best to make special accommodations (for example, if you cannot lie flat or cannot bend a knee very well) with body positioning and using pillows. We will do our best to make you comfortable. Then, we will give you the option of watching a movie on Netflix or listen to music. Once you are comfortable, your leg will be prepped with a cleansing solution for the sterile procedure. The doctor will perform an ultrasound to map the vein to be treated. Then, a numbing agent (lidocaine) will be injected into the skin.

In the numb area of the skin, a tiny puncture is made to pass the radiofrequency catheter. Your doctor will then use a  needle to administer a combination of cool saline and local anesthetic around the vein either in the thigh or calf (depending on which vein is treated). This solution numbs the vein and insulates it from the surrounding tissue. After the numbing solution is applied, the vein is painlessly treated with radiofrequency energy. Once your vein has been treated, we will clean your leg and apply a compression stocking which you will wear for 72 hours continuously. You will walk for 30 minutes prior to getting in your car. 

 

What should I do after treatment? 

 

You should walk 30 minutes twice daily after treatment and move your legs frequently throughout the day with short walks and/or calf exercises. This will alleviate discomfort and avoid pooling of blood in the legs. Most of the numbing solution around the vein will be absorbed by your body within a few hours, but you may have a small amount of blood-tinged saline leak from your puncture site onto the gauze. In that case, just remove the gauze and roll your stockings back up. 

 

What should I avoid after treatment?

 

For at least two weeks after treatment, you should avoid airline travel to minimize pooling of blood in the legs. You should avoid strenuous exercise (anything more than a brisk walk), heavy lifting, saunas or hot tubs, and leg massages. All of these dilate the superficial veins and interfere with their healing. 

 

What are the possible adverse effects? 

 

Expect some bruising over the injection sites, which fades over about two weeks. The skin overlying larger varicose veins may also develop some temporary inflammation and/or brownish hyperpigmentation as the blood products within those veins are absorbed by the body. An uncommon complication is a blood clot within a deep vein.

 

Before and After Varicose Vein Treatment 

4 BA VV NOR21553 BA VV varicose NOR2149

What is Radiofrequency Treatment for Varicose Veins?2022-03-17T10:17:50-07:00

The Best Way to Treat Reticular Veins

2022-03-17T10:17:12-07:00

The best treatment for Reticular Veins is through a painless alternative to traditional sclerotherapy: Cryo-Sclerotherapy.

Why have I been offered cryo-sclerotherapy?

 

We recommend patients undergo cry-sclerotherapy to mainly treat spider veins and small varicose veins at the skin surface (also known as reticular veins). Traditional sclerotherapy involves injection of a medication into the vein using a tiny needle. This causes the vein to collapse and eventually fade away. The medication will be administered in a liquid and /or foam formulation, depending on the size of the veins. Cryo-sclerotherapy is the combination of traditional sclerotherapy in combination with the use of a cryo device. The cryo device delivers puffs of cold air simultaneously during sclerotherapy. The result  is the cold air anesthetizes the skin so the treatment is relatively painless. This is especially helpful for treatment of sensitive areas like the inner ankles and thighs. Instead of feeling the needle prick, you will feel puffs of cold air instead. The cold air may also reduce bruising and pain. 

 

What should I expect on my treatment days? 

 

You will sign your consent form then change into shorts provided by the office. We will clean your skin with alcohol. The sclerosant medication will then be injected into your veins with a fine needle. Just before the needle is used, you will feel puffs of cold air. The cold air will anesthetize the skin, so that the prick from the needle is not felt or lessened. Every time the needle is used, you will feel puffs of cold air instead. After your treatment, we will help you into your compression stockings, then you will walk for 30 minutes prior to getting in your car. It is normal for your legs to be achy and tender to the touch after treatment. 

 

What should I do after treatment?

 

You will be instructed on how long to wear compression stockings after treatment, depending on the size of the veins that are treated. Most patients wear thigh-high compression stockings continuously for 1-3 days, then another 7 days. 

 

You may shower with the stockings on or take a quick cool shower with them off. 

 

You should walk 30 minutes twice daily after treatment and move your legs frequently throughout the day with short walks and/or calf exercises. This avoids pooling of blood in the legs. Avoid prolonged sitting during the day. 

 

It is normal to have aching in the treated veins. This responds well to walking, ice packs, and anti-inflammatory medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve). 

 

What should I avoid after treatment? 

 

For at least two weeks after treatment, you should avoid strenuous exercise (anything more than a brisk walk), heavy lifting, saunas or hot tubs, and leg massages. All of these dilate the superficial veins and interfere with their healing. You should also avoid airline travel for two weeks after treatment. 

 

What are the possible side effects? 

 

You will likely have some bruising over the injection sites, then the treated veins may become firm and blue. 

 

The skin overlying treated veins may also develop brownish hyperpigmentation as the blood products within those veins are absorbed by the body; in some patients it can take up to a year to fade. Some patients temporarily develop some very fine, pink spider veins in areas where veins have been treated (telangiectatic matting). These usually resolve spontaneously over several weeks but occasionally require additional treatment to clear. 

 

Many patients will feel their veins look a bit worse in the first month after sclerotherapy, but through the best treatment for reticular veins, cryo-sclerotherapy, patients have reported it to be a more painless approach for treatment.  

 

The Best Way to Treat Reticular Veins2022-03-17T10:17:12-07:00
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