20, 9, 2022

Symptoms to look out for: non healing ulcers and wounds

2022-08-18T15:54:57-07:00

Symptoms of Non-Healing Ulcers

As we've seen, there is a very wide range of causes that may contribute to the formation and persistence of non-healing ulcers. It follows that the methods or treatment options at the disposal of healthcare professionals will also be varied.

You shouldn't allow a wound to fester for weeks on end before seeking professional assistance, especially if you fall under one or more of the risk categories we've outlined above. The following are some warning signs to look out for:

  • -Darkening or bluish discoloration around the wound edges
  • -Significant pain around the wound that persists without improvement or progressively grows worse
  • -Foul odor or smell emanating from the wound
  • -Swelling and redness emanating from the wound and spreading to surrounding skin and tissue
  • -Continuous leaking, draining, or weeping from the wound

Notice that these symptoms are mostly indicative of infection. This is a good measure as it often indicates a failure of the body's natural mechanisms to deal with the wound through its normal processes. The rapid and timely intervention will be called for to forestall further tissue damage and complications.

Treatment of Non-Healing Wounds

Doctors will discuss the available options with their patients in order to arrive at the best possible options, but the type and severity of the wound will be the decisive point of consideration. These measures include:

Compression Wrapping

Specialized Dressings and Topical Medication

Patient Self-Care and Education

Negative Pressure Therapy (NPWT)

Surgery

Growth Factor Therapy

Debridement (removal of dead tissue)

 "Bringing Experts Together for Unparalleled Vein and Vascular Care"

La Jolla Vein & Vascular (formerly La Jolla Vein Care) is committed to bringing experts together for unparalleled vein and vascular care. 

Nisha Bunke, MD, Sarah Lucas, MD, and Elliot DeYoung, MD are specialists who combine their experience and expertise to offer world-class vascular care. 

Our accredited center is also a nationally known teaching site and center of excellence. 

For more information and to book a consultation, please give our office a call at 858-550-0330. 

For more information please check out our Youtube Channel at this link.

For more information on varicose veins and eliminating underlying venous insufficiency, check this link out full of resources. 

Symptoms to look out for: non healing ulcers and wounds2022-08-18T15:54:57-07:00

What you need to know about: Non-Healing Ulcers & Wounds

2022-08-18T15:55:24-07:00

Non-Healing Ulcers &  Wounds

We might all be familiar with ulcers in a general manner, but certain types of ulcers behave quite differently due to various contributing factors. These are non healing ulcers or non healing wounds, and if not treated with care and in good time, such wounds can pose a serious risk to the patient's health. Severe cases may lead to amputation of the affected limbs or loss of life in the most extreme circumstances. The nonhealing ulcers cases we treat here at La Jolla Vein & Vascular fall under peripheral arterial disease (PAD) and a subcategory of arterial disease.

Non-healing wounds or ulcers do not follow the usual healing process and are referred to as chronic wounds should they persist beyond 3 weeks. Such wounds can be a heavy burden to live with for anyone. Still, the board-certified vascular surgeons and specialists at La Jolla Vein & Vascular are dedicated to administering effective treatment and management solutions to all patients so they may resume a healthy, productive, and pain-free life.

Types of Non-Healing Ulcers

In general, patients will present with one of three categories of non-healing ulcers, with these categories being broadly defined by the major causative factors allowing for their development. These are:

Arterial or Venous Ulcers

These are found to account for between 70% up to 90% of non-healing wounds or non-healing ulcers. Mostly occurring in elderly patients, they are believed to come about as a result of a failure of the valves in a person's blood vessels of both arteries and veins. These valves are responsible for preventing the backflow of blood as it passes within them. The consequent outcome is a lack of nutrient and oxygen-rich blood from reaching the affected tissues and sets up the conditions favoring non-healing wounds.

Pressure Ulcers

These are ulcers that are brought about by the restriction of blood flow to certain regions of the body due to the persistent and prolonged application of pressure upon them. It is mostly encountered among patients with full or partial paralysis and those who are bedridden for extended periods.

Diabetic Ulcers

These are also highly prevalent chronic wounds, and are on the increase among patients owing to the ever-increasing cases of diabetes among the population. In fact, the prevalence of chronic wounds among diabetics makes this demographic 15% more likely to have to undergo limb amputation as a complication of the condition.

The high amputation rate among diabetics is attributable, in part, to the neuropathic effects of the ailment. Neuropathy leads to a lack of pain perception in the affected individual, meaning that they may be entirely unaware of minor wounds on their feet and legs in good time, allowing for their infection or repeat injury. It is also made more likely by the immunosuppressive effects of the condition, which makes the patient more vulnerable to infection.

"Bringing Experts Together for Unparalleled Vein and Vascular Care"

La Jolla Vein & Vascular (formerly La Jolla Vein Care) is committed to bringing experts together for unparalleled vein and vascular care. 

Nisha Bunke, MD, Sarah Lucas, MD, and Elliot DeYoung, MD are specialists who combine their experience and expertise to offer world-class vascular care. 

Our accredited center is also a nationally known teaching site and center of excellence. 

For more information and to book a consultation, please give our office a call at 858-550-0330. 

For more information please check out our Youtube Channel at this link.

For more information on varicose veins and eliminating underlying venous insufficiency, check this link out full of resources. 

What you need to know about: Non-Healing Ulcers & Wounds2022-08-18T15:55:24-07:00

Restless Leg Syndrome & Venous Insufficiency

2022-08-18T16:00:48-07:00

Patients with varicose veins often report a feeling of restless legs, especially at night when in bed. In our study, about 30% of patients with varicose veins complained of restless legs. 

Restless legs syndrome (RLS) is a sensorimotor movement disorder characterized by uncomfortable sensations in the legs and an urge to move them. There are other causes of restless legs syndrome such as, neurological disorders, anemia, and kidney disease to name a few and are often treated with medication. Venous insufficiency is often neglected as a cause of Restless Legs Syndrome. However, when recognized, it is easily treatable leading to resolution of symptoms.

Treatment is aimed at correcting the underlying venous insufficiency. This usually is accomplished by removing the varicose veins or incompetent veins by new, minimally invasive, non-surgical methods. In our study, 98% of the patients with venous insufficiency and restless legs, had resolution of symptoms following treatment.

In another study, by Hayes, CL et. al, 35 patients with RLS and superficial venous insufficiency underwent endovenous ablation of refluxing superficial veins and ultrasound-guided sclerotherapy of varicose veins. 89% of patients reported alleviation of symptoms.

If a patient has restless legs symptoms and evidence of varicose veins of the legs, a work-up for venous insufficiency should be considered. The work-up involves a duplex ultrasound evaluation of the leg veins. This may eliminate the need for medication for RLS.

"Bringing Experts Together for Unparalleled Vein and Vascular Care"

La Jolla Vein & Vascular (formerly La Jolla Vein Care) is committed to bringing experts together for unparalleled vein and vascular care. 

Nisha Bunke, MD, Sarah Lucas, MD, and Elliot DeYoung, MD are specialists who combine their experience and expertise to offer world-class vascular care. 

Our accredited center is also a nationally known teaching site and center of excellence. 

For more information and to book a consultation, please give our office a call at 858-550-0330. 

For more information please check out our Youtube Channel at this link.

For more information on varicose veins and eliminating underlying venous insufficiency, check this link out full of resources. 

Restless Leg Syndrome & Venous Insufficiency2022-08-18T16:00:48-07:00

Flying after vein treatment

2025-09-04T12:25:13-07:00

Patients traveling and flying from different states or countries to seek treatment at La Jolla Vein & Vascular can return to the air within 24-hours after the procedure (although it's understandable if the stay is extended to take in the beautiful sights of San Diego). Although a patient can easily resume most day-to-day activities right after treatment, it's recommended to avoid air travel for the first 24-hours. Once in the air, however, it's important to wear the prescribed compression stockings and work on increasing the circulation in your legs. To do this, please make sure to pump the calf muscles regularly and get up from your chair every two hours. It's the best way to facilitate healing in the air—and it's a sure fire way to avoid economy class syndrome.

There are risks of flying after vein treatment that you need to know about. 

Factors that influence the risks after vein treatment include: 

  • The length of the flight
  • How soon after treatment
  • The type of vein procedure

For flying longer than 4 hours:

If patients have been treated with endovenous laser ablation (EVLA) or ultrasound guided sclerotherapy (UGS), there is an increased risk in development of in-flight deep vein thrombosis (DVT, a leg blood clot). 

If patients have had varicose veins treated, the risk of deep vein thrombosis increases when flying on long-haul flights. 

Although waiting to fly long distances for 3-4 weeks is ideal, sometimes there is no choice. If it cannot be avoided, here are some preventative measures to follow.

1.Wear compression stockings or compression socks: wearing compression helps support consistent blood flow, prevents blood settling in the lower legs because of gravity, and improves lymphatic drainage preventing swelling.

2.Keep moving: Movement is key. It helps contract the calf muscle which helps to move blood around the legs.

3.Hydrate well: Drink water and avoid alcohol (which causes dehydration).

4.Blood thinners: Patients at a particularly high risk of DVT may be prescribed and be taking blood thinners.

5.Most importantly, if you have any questions or concerns to discuss about flying during this time, please contact our office, so you can both be well informed and prepared.

"Bringing Experts Together for Unparalleled Vein and Vascular Care"

La Jolla Vein & Vascular (formerly La Jolla Vein Care) is committed to bringing experts together for unparalleled vein and vascular care. 

Nisha Bunke, MD, Sarah Lucas, MD, and Elliot DeYoung, MD are specialists who combine their experience and expertise to offer world-class vascular care. 

Our accredited center is also a nationally known teaching site and center of excellence. 

For more information and to book a consultation, please give our office a call at 858-550-0330. 

For more information please check out our Youtube Channel at this link.

For more information on varicose veins and eliminating underlying venous insufficiency, check this link out full of resources. 

Flying after vein treatment2025-09-04T12:25:13-07:00

Is it Varicose Veins or Spider Veins?

2022-08-17T15:43:09-07:00

Varicose and spider veins develop gradually and progressively. They are unsightly and are often a source of considerable discomfort. Both varicose and spider can cause symptoms. Symptoms often become worse during the menstrual cycle and pregnancy for women. 

The symptoms of varicose veins can include:

  • Aching, tenderness
  • Heaviness, fatigue
  • General restlessness in the legs
  • Burning pain
  • Throbbing pain
  • Itching
  • Leg cramps, particularly at night
  • Ankle swelling
  • Skin discoloration at the ankle
  • Skin ulcers above the ankle

The symptoms of spider veins can include: 

  • Aching in legs
  • Heaviness in legs
  • Worsened pain after sitting down 
  • Itching around one or more of the veins
  • Changes in skin color around the veins 
  • Web like pattern of blue, red, or purple lines in the skin 
  • Skin darkening 
  • Burning sensation when standing for long periods of time

At La Jolla Vein & Vascular, we treat both varicose and spider veins with various types of treatments depending on the patient’s case. 

So, how can you tell if you have spider or varicose ? 

Varicose are large, raised, swollen blood vessels that twist and turn. They usually develop in the legs and can be seen through the skin. Spiders are smaller, red, purple, and blue vessels that are also twisted and turning. Spiders are easily visible through the skin as well.

Below you will see numerous cases of both varicose and spider treated at La Jolla Vein & Vascular. 

Varicose Before & After: 

42 BA VV varicose DSCF6710 Fotor Collage scaled 2
49 BA VV varicose DSCF9517 fotor
50 BA VV varicose DSCF9555 fotor

Spider Before & After: 

veins
10 BA SV spider DSCF4737 Fotor Collage scaled 1
11 BA SV spider DSCF4741 Fotor Collage scaled 1

Treatments for Varicose include: 

1.Conservative Management & Lifestyle Modifications

2.Radiofrequency Ablation

3.Laser Ablation 

4.Mechanico-chemical ablation

5.Varithena Foam

6.VenaSeal

Treatments for Spider Veins include: 

1.Sclerotherapy 

 For more information and to book a consultation, please give our office a call at 858-550-0330. 

For more information please check out our Youtube Channel at this link.

For more information on varicose veins and eliminating underlying venous insufficiency, check this link out full of resources. 

Is it Varicose Veins or Spider Veins?2022-08-17T15:43:09-07:00

30, 8, 2022

Varicose veins or muscle hernia?

2022-07-20T16:14:11-07:00

A muscle hernia of the legs is frequently confused with varicose veins. Patients may present with bulging along the outer part of the shin, that looks like a varicose vein. It may or may not be painful. It goes away with flexing the foot (pointing your toes to your head).  But, to experienced vein care specialists, it is clearly a muscle herniation.

Varicose veins are the twisted, bulging veins just beneath the surface of the skin. Unlike a muscle hernia. Varicose veins are swollen, twisted veins that you can see just under the surface of the skin. These veins usually occur in the legs, but they also can form in other parts of the body. Varicose veins are a common condition.

Varicose veins are caused by leaky vein valves, which allow blood to pool within the veins causing them to stretch and become enlarged. Varicose veins can be an isolated finding, but the majority of the time, they are caused by underlying venous reflux disease. Venous reflux disease is also known as venous stasis, venous insufficiency or venous incompetence. Reflux may occur in the deep and/or superficial leg veins.

In our study, led by Dr. Nisha Bunke and published in the Journal of Vascular Ultrasound in 2018, we studied over 1,000 legs with varicose veins. Over 90% of the time, the source of the varicose veins were the great and small saphenous veins. The Great Saphenous Vein (GSV) courses up the middle of the thigh and calf and the small saphenous vein (SSV), which courses along the back of the calf. Normally, there are one-way valves within the leg veins, which help blood flow in one direction: toward the heart. This means blood is traveling against gravity. The calf muscle also helps move blood toward the heart. When vein valves are leaky, blood flows backward (reflux) towards the feet. Blood pools in the lower legs, causing bulging veins at the surface.

A Muscle hernia is a focal protrusion of muscle tissue through a defect in the deep fascial layer. Anterior tibial muscle is the most commonly affected muscle of the lower extremities because its fascia is the most vulnerable to trauma. Clinically it is characterized by asymptomatic or painful, skin-coloured, soft, subcutaneous nodules of various size depending on the position. The diagnosis is usually made clinically based on its typical manifestations, but ultrasonographic examination is useful for detecting the fascial defect and excluding other conditions caused by soft tissue tumors such as lipomas, angiolipomas, fibromas, schwannomas, or varicosities.

Usually, surgical treatment is not needed for a muscle hernia, but may be necessary for increasingly painful hernias.

At La Jolla Vein and Vascular, we frequently see muscle herniations that are confused with varicose veins. Using ultrasound technology and a clinical examination, we can make an accurate diagnosis.

 

 For more information and to book a consultation, please give our office a call at 858-550-0330. 

 

For more information please check out our Youtube Channel at this link.

 

For more information on varicose veins and eliminating underlying venous insufficiency, check this link out full of resources. 

 

Varicose veins or muscle hernia?2022-07-20T16:14:11-07:00

What you need to know about vein valves

2022-07-20T15:40:53-07:00

In the circulatory system, the vein valves carry deoxygenated blood back to the heart. The leg veins carry blood toward the heart, against gravity. Therefore, the leg veins have one-way valves to prevent backflow of blood. When the valves do not function properly, they allow blood to flow backward, causing the pooling of blood. This is referred to as venous reflux or venous insufficiency. Eventually, the backflow of the blood will cause varicose veins to develop and symptoms related to the increased pressure in the leg veins such as leg heaviness, aching, swelling, restless legs, night cramps, throbbing, and pain. Varicose veins  can be treated with different lifestyle changes.

 

Conservative Management & Lifestyle Modifications Include for varicose veins and vein valves:

 

The goals of treatment are to relieve symptoms, prevent complications and for some to improve appearance.  Lifestyle changes can ease the symptoms, but do not cause the veins to vanish.  These treatments include:

  • Avoid standing or sitting for long periods of time:  To keep blood moving when you have to sit or stand for long periods, try these tips: at work, take walking breaks and try walking during your lunch hour. While sitting, try flexing your feet up and down ten times an hour.
  • Exercise: Exercising is good for your veins because it improves blood flow. Walking, cycling or swimming are great exercises for vein health. But be sure to check with your doctor before starting any exercise program.
  • Weight loss or maintaining a healthy weight: Being overweight puts extra pressure on your veins.
  • Leg elevation: Use leg elevation three or four times a day for about 15 minutes at a time. Even elevating your legs on a step stool or ottoman is beneficial. If you need to sit or stand for a long period of time, flexing (bending) your legs occasionally can help keep blood circulating. If you have mild to moderate varicose veins, elevating your legs can help reduce leg swelling and relieve other symptoms.
  • Compression stockings: These elastic stockings squeeze or compress the veins and prevent blood from flowing backward. Compression stockings must be graduated, medical-grade compression to be beneficial. Over the counter,support hose or TED hose are not adequate to reduce symptoms in venous disease for active patients.
  • Supplements such as horse chestnut and grape seed extract can help reduce symptoms of venous disease. Check with your doctor before starting supplements.
  • Anti-inflammatory medications such as ibuprofen.
  • Anti-inflammatory topical agents such as OTC Arnica, or prescription voltaren gel may be helpful for painful phlebitis.
  • Ice packs can be applied to veins that are tender to reduce inflammation

 

Leg veins have one-way valves that prevent blood from flowing backward. Diseased valves are ‘leaky’ and allow blood flow both forward and backward, eventually causing bulging of the veins, i.e., varicose veins.

 

The valves inside the leg veins can be seen on ultrasound. 

 

 For more information and to book a consultation, please give our office a call at 858-550-0330. 

 

For more information please check out our Youtube Channel at this link.

 

For more information on varicose veins and eliminating underlying venous insufficiency, check this link out full of resources. 

 

What you need to know about vein valves2022-07-20T15:40:53-07:00

Signs of Venous Disease

2022-07-20T15:06:13-07:00

Signs of Chronic Venous Insufficiency & Venous Disease

Chronic venous insufficiency (CVI) is an inflammatory condition caused by long standing, untreated venous reflux disease which can cause very unique signs and symptoms.  Commonly, venous reflux disease causes a collection of symptoms such as leg swelling, heaviness, fatigue and varicose veins. But, over time, when blood is no longer circulating properly in the leg veins, skin changes can also appear. When skin changes appear, this is termed, chronic venous insufficiency (CVI). Venous stasis is another term used for this condition.   Chronic inflammation from CVI causes the skin around the ankles to darken, become dry, itchy, and firm. In severe cases, the skin can start to break down and ulcerate. The ulcer (wound) occurs in the inner or outer ankle and is also referred to as a stasis ulcer or venous ulcer.

Venous stasis skin changes associated with venous insufficiency include:

  • Darkening of the skin along the ankles
  • Itching and dry skin around the ankles (venous eczema)
  • Development of wounds around the ankles, called venous leg ulcers

HOW IS CVI TREATED?

The treatment of CVI cannot reverse the skin changes but it can prevent it from worsening and ulceration. In our experience, treatment of underlying venous reflux reduces the inflammatory changes and the skin may become less itchy and dry, but the permanent skin discoloration does not disappear. Treatment involves correction of the underlying venous reflux.

HOW ARE LEG ULCERS TREATED?

Venous leg ulcers, depending on the severity can be healed with a combination of correction of the underlying venous reflux, wound care clinic referral, and compression therapy. A detailed ultrasound will determine what specific treatment is needed depending on where the underlying reflux lies (for example, in the saphenous veins, perforator veins and tributaries). Deep vein reflux is also present in many individuals with ulcers.

Recognize the signs and symptoms of venous disease:

-heavy, tired and aching legs

-swollen legs and or ankles

-cramping in the legs

-dull or sharp pain in the calf

-varicose veins and spider veins

-red or warm veins

-itching around the veins

-skin changes around the ankles such as pigmentation, brownish discoloration, eczema, new red and blue veins, breakdown of the skin

-Heavy legs are a common sign of venous insufficiency and varicose veins.You should see your vascular specialist for any of the above signs and symptoms

If you experience any vein disease symptoms or signs, please call our office at (858)-434-5998 to schedule a consultation with one of our knowledgeable doctors at La Jolla Vein and Vascular. 

 

For more information on vein health please check out our Youtube Channel or visit our helpful guide of resources. 

 

 

 

 

 

Signs of Venous Disease2022-07-20T15:06:13-07:00

Vein Disease Prevention

2022-12-13T13:16:18-08:00

What is chronic venous insufficiency and how can you understand it for vein disease prevention?

Chronic venous insufficiency (CVI) is an inflammatory condition caused by long standing, untreated venous reflux disease.  Commonly, venous reflux disease causes a collection of symptoms such as leg swelling, heaviness, fatigue and varicose veins. But, over time, when blood is no longer circulating properly in the leg veins, skin changes can also appear. When skin changes appear, this is termed, chronic venous insufficiency (CVI). Venous stasis is another term used for this condition.   Chronic inflammation from CVI causes the skin around the ankles to darken, become dry, itchy, and firm. In severe cases, the skin can start to break down and ulcerate. The ulcer (wound) occurs in the inner or outer ankle and is also referred to as a stasis ulcer or venous ulcer.

Venous stasis skin changes associated with venous insufficiency include:

  • Darkening of the skin along the ankles
  • Itching and dry skin around the ankles (venous eczema)
  • Development of wounds around the ankles, called venous leg ulcers

When it comes to vein disease it is certainly possible to take measures that will help. Remember that varicose veins are veins that have been stretched so often that they have become chronically dilated. The trick is to limit the opportunity to distend the veins.

Here are some helpful tips to aid in vein disease prevention:

  1. Wear compression stockings
  2. stay fit and maintain a healthy weight
  3. exercise: exercising helps your veins pump blood.
  4. avoid prolonged sitting or standing
  5. avoid prolonged exposure to direct sunlight
  6. elevate your legs as much as possible
  7. Exercising the muscles in your legs helps your veins pump blood. This, in turn, will reduce the pressure within the veins and can help reduce symptoms related to vein problems

If you experience any vein disease symptoms, please call our office at (858)-550-0330 to schedule a consultation with one of our knowledgeable doctors at La Jolla Vein and Vascular. 

 

For more information on vein health and vein disease prevention please check out our Youtube Channel or visit our helpful guide of resources. 

 

Vein Disease Prevention2022-12-13T13:16:18-08:00

Results of non surgical vein treatment

2022-07-20T14:37:06-07:00

At La Jolla Vein and Vascular, we treat venous reflux disease which includes varicose veins. Venous reflux disease is also known as venous stasis, venous insufficiency or venous incompetence. Venous reflux disease refers to ‘leaky valves’ in the veins of the legs. Reflux may occur in the deep and/or superficial leg veins. The deep veins are those within the muscle; they bring at least 80-90% of the blood from the legs back to the heart. The superficial veins are outside of the muscle and under the skin.

The main superficial veins are the Great Saphenous Vein that courses up the middle of the thigh and calf and the small saphenous vein, which courses up the back of the calf. Normally, there are one-way valves within the leg veins, which help blood flow in one direction: toward the heart. This means blood is traveling against gravity.

The calf muscle also helps move blood toward the heart. When vein valves are leaky, blood flows backward (reflux) towards the feet. Blood pools in the lower legs, causing bulging veins at the surface. Symptoms include leg heaviness, leg fatigue, leg pain, ankle swelling, phlebitis (inflamed and painful veins), restless legs at night, and night cramps.

Venous reflux disease is progressive and worsens over time. Skin changes may also develop, including darkening of the skin around the ankles. The darkening of the skin is sometimes referred to as venous stasis skin changes. The skin can become dry and itchy (venous eczema). Eventually, the skin can break down causing a wound, called a venous leg ulcer.

 

Below you will see various before and after pictures of non-surgical removal of varicose veins at La Jolla Vein and Vascular. The before picture shows bulging varicose veins that arise from an incompetent great saphenous vein (this vein is not visible to the naked eye). In the past, these veins would have been stripped with vein stripping surgery. Fortunately, new technology allows for even large varicose veins to be removed without surgery. This patient underwent radiofrequency ablation (or endovenous ablation) of the great saphenous vein and foam sclerotherapy of the bulging varicose veins at La Jolla Vein and Vascular. 

varicose veins varicose veins 9 10 11 12 1

If you experience any vein disease symptoms, please call our office at (858)-434-5998 to schedule a consultation with one of our knowledgeable doctors at La Jolla Vein and Vascular. 

 

For more information on vein health please check out our Youtube Channel or visit our helpful guide of resources. 

 

Results of non surgical vein treatment2022-07-20T14:37:06-07:00
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CONTACT INFORMATION

La Jolla/UTC

Vista

Patient Privacy Practices

Privacy Policy

Hippa Privacy Practices
HIPAAOneTM Certified Seal 2

Use the search features below to find articles and insights for the diagnosis and treatment of vascular disease

TWO CONVENIENT LOCATIONS THROUGHOUT SAN DIEGO

La Jolla/ UTC

North County San Diego/ Vista — Endovascular Center
Now Open! Call/Text for Appointments

© Copyright 2010-2024, La Jolla Vein & Vascular | All Rights Reserved

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