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21, 4, 2022

Understanding Venous Stasis Dermatitis

2022-04-15T15:36:58-07:00

Understanding Venous Stasis Dermatitis

Venous stasis dermatitis is a change in the skin that occur when blood collects (pools) in the veins of the lower leg. ‘Stasis’ refers to pooling of the blood in the lower legs from venous insufficiency, and ‘dermatitis’ refers to the inflammation and related skin changes. Because of the inflammation, the skin around the ankles is usually itchy and discolored.

In venous stasis dermatitis, the skin of the ankles and lower legs may look thin or tissue-like. You may slowly get brown stains on the skin.The skin may become irritated or crack if you scratch it. It may also become red or swollen, crusted, or weepy.Over time, some skin changes become permanent. Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis)

Here’s what to look out for:

  • A bumpy or cobblestone appearance of the skin
  • Dark brown color

Venous stasis can cause skin sores (ulcers) may develop (called a venous ulcer or stasis ulcer). These most often form on the inside of the ankle. For this reason, skin changes are noticed around the ankle, you should see your doctor or vein specialist to stop the progression of venous insufficiency and prevent the skin from forming an ulceration.

  Stasis dermatitis

Chronic venous insufficiency over time can lead to skin changes and eventually ulceration. This image demonstrates stasis dermatitis (also known as venous dermatitis). Stasis dermatitis refers to the skin changes including skin discoloration around the ankles, dry itchy skin that can be thin, and it may eventually break down to cause an ulceration. You need to see a doctor if these signs are present.

Eight symptoms to watch out for:

  1. Swelling around ankles
  2. Heavy legs
  3. Varicose Veins, which can be twisted, bulging, dark, or purple
  4. Itching
  5. Pain
  6. Sores that ooze, crust or become scaly
  7. Thickened skin around ankles or your shins
  8. Hair loss on ankles and shins
Understanding Venous Stasis Dermatitis2022-04-15T15:36:58-07:00

Chronic venous insufficiency and leg ulcers

2022-04-15T15:35:10-07:00

Stages of Development of Varicose

Chronic venous insufficiency (CVI) is an inflammatory condition caused by long standing, untreated venous reflux disease that causes leg ulcers.  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 leg ulcers or (wounds) occur 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, which can help decrease leg ulcers.

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.

leg ulcers

4 BA VLU ulcer DSCF9906 fotor

5 BA VLU ulcer foam results 6 fotor

Chronic venous insufficiency and leg ulcers2022-04-15T15:35:10-07:00

Varicose Veins Before & After: Patient Transformations Part 1

2022-04-15T15:34:00-07:00

What are varicose veins?

varicose

Varicose veins are the twisted, bulging veins just beneath the surface of the skin. 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 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 this vein disease. 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. 

La Jolla Vein Care Before and After Transformations:

 

At La Jolla Vein Care, we are here for our patients from beginning to the end. We love seeing the transformations that take place. Below are a few cases from our patient transformations from before varicose vein treatment to after treatment.

pt1

pt2

pt3

 

Varicose Veins Before & After: Patient Transformations Part 12022-04-15T15:34:00-07:00

Two Venous Reflux Disease Treatments for visible bulging veins

2022-04-15T15:32:43-07:00

 

Two Venous Reflux Disease Treatments for visible bulging veins include: 

 

Asclera, and Phlebectomy. We at La Jolla Vein Care offer a variety of methods for vein disease. Below is some helpful information about both procedures. 

 

Ultrasound-guided foam sclerotherapy works well for treating surface varicose veins and veins that are not visible to the naked eye. The foam medication can be seen on ultrasound, which allows us to administer it precisely and direct it towards nearby varicose veins. Foam sclerotherapy can be safely used for bulging veins that travel close to the skin or nerves. It also travels easily through veins with many twists and turns.

Asclera for bulging veins:

A variety of sclerosant medications can be used for veins, but we prefer polidocanol (brand name Asclera®) because it is the most comfortable for the patient and has the lowest risk of side effects. It is a detergent-type medication that injures the inner lining of the veins. This causes the vein to stop flowing, then eventually close down completely. Polidocanol has been well-studied and has been approved by the FDA since 2010 for the treatment of varicose veins and has been used in Europe for decades. Polidocanol is turned into a foam to treat larger veins. This is an off-label use of the sclerosant but very effective and well tolerated. La Jolla Vein Care providers have extensive experience with foam sclerotherapy for the treatment of bulging veins. 

How many treatments will I need?

The number and frequency of treatments depends on a patient’s anatomy, how well the veins respond to each treatment, and the patient’s treatment goals. The national average is 2 to 5 treatment sessions to achieve 80% improvement. Some larger or resistant veins require two or more treatments to respond completely.

Phlebectomy Procedure: 

Phlebectomy is the surgical removal of bulging veins though tiny skin incisions. This minimally invasive procedure is performed in the office with local anesthesia. Phlebectomy is also known as micro phlebectomy (because the incisions are tiny) or ambulatory phlebectomy.

WHAT ARE THE OPTIONS FOR TREATING BULGING  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 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.

Phlebectomy

HOW DOES THE PROCEDURE WORK?

The skin is numbed with lidocaine, then a tiny puncture is made in the skin (about half 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.

 

Two Venous Reflux Disease Treatments for visible bulging veins2022-04-15T15:32:43-07:00

What is VenaSeal?

2022-04-15T11:21:27-07:00

The U.S. Food and Drug Administration (FDA) approved the VenaSeal Closure System to permanently treat varicose veins by sealing the affected superficial veins using an adhesive agent.

vseal

The VenaSeal Closure System is a unique, minimally invasive treatment that uses a safe-for-the-body medical glue to quickly and effectively treat varicose veins (venous reflux disease). Using ultrasound, a doctor will guide a tiny catheter through a small access site in the skin and into the diseased area of the vein. Next, the VenaSeal dispenser delivers a very small amount of medical glue to close the vein. Once the affected vein is closed, blood is immediately re-routed through other healthy veins in the leg.

Unlike other treatments, it does not require anesthesia to be injected into the leg via multiple needle sticks (tumescent anesthesia), and because there are no pre-procedures drugs involved, patients can return to their normal activities right after the treatment. Unlike heat-based procedures, with VenaSeal there is no risk of skin burns or nerve damage. VenaSeal usually does not require any post-treatment pain medication or uncomfortable compression stockings.

procedure

The VenaSeal closure system is the only non-tumescent, non-thermal, non-sclerosant procedure that uses a proprietary medical adhesive delivered endovenously to close the vein. This unique approach eliminates the risk of nerve injury when treating the small saphenous vein, which is a risk sometimes associated with certain thermal-based procedures. Clinical studies have demonstrated that the procedure is safe and effective.

Call La Jolla Vein Care at 858-550-0330 to find out if VenaSeal is a good option for your vein treatment!

Check out our youtube channel for more information on VenaSeal.

 

What is VenaSeal?2022-04-15T11:21:27-07:00

Understanding The Stages of Venous Disease

2022-04-14T10:28:50-07:00

The six stages of Venous Disease include:

  1. Spider Veins
  2. Reticular Varicose Veins
  3. Venous Nodes
  4. Chronic Venous Insufficiency
  5. Trophic Ulcers
  6. Varicose Eczema

La Jolla Vein Care gives patients the tailored treatment plan for whichever stage they come in with. A diagnostic test is run called the Duplex Ultrasound. This displays a deeper look into the patient’s veins.

Venous reflux disease is also known as venous stasis, chronic venous insufficiency, or venous incompetence. Venous 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 of venous disease 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 skin changes. The skin can become dry and itchy (venous eczema). 

venous stage

 

 

Understanding The Stages of Venous Disease2022-04-14T10:28:50-07:00

Spider Veins Before and After Patient Transformation

2022-04-13T11:56:42-07:00

What are spider veins?

They are the fine, thread-like reddish veins at the surface of the skin, and are often considered a cosmetic issue, but they can be associated with underlying feeder veins, not visible to the naked eye.  Feeder veins are the ‘blue veins’ also known as ‘reticular veins,’ that give rise to spider veins. They may also be a sign of underlying venous insufficiency. For example, they are usually located in the inner ankles and inner thighs can indicate an underlying problem with the saphenous vein. As a result, an ultrasound examination may be recommended to identify and effectively treat the underlying source.

What are the symptoms?

Vein conditions affect people differently. For some, they can be a painless cosmetic concern, and for others they may cause symptoms. The most common symptoms are burning, throbbing, and localized pain. They can also feel hot and itchy and bleed.

What are the causes?

They are caused by the same condition that causes varicose veins. Leaky vein valves allow blood to pool within the veins causing them to stretch and become enlarged. Spider veins on other areas of the body, such as the face, and chest can be caused by sun damage, hormone changes or liver disease. Hormones, such as with pregnancy, birth control or hormone replacement therapy can weaken the vein wall.

Spider veins and reticular veins of the legs are most commonly treated with sclerotherapy. Sclerotherapy involves an injection of a medication into the vein.  This will cause the vein to collapse and gradually fade away. Sclerotherapy has been used to treat spider veins for decades, but modern solutions such as Asclera, allow for spider veins to be treated with minimal discomfort and immediate return to activities.

 

Below are La Jolla Vein Care patient transformations before and after vein treatment for spider veins. 

spider veins

spiderveins2

spider veins

Spider Veins Before and After Patient Transformation2022-04-13T11:56:42-07:00

3 Venous Reflux Disease Treatments for underlying vein reflux

2022-04-12T10:08:56-07:00

3 Venous Reflux Disease Treatments for underlying vein reflux:

 

The ClariVein procedure

When someone is diagnosed with underlying vein reflux disease, the ClariVein procedure is for the treatment of backwards flow (or “reflux”) in your 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 the ClariVein® catheter is placed into the unhealthy vein. The catheter closes the vein painlessly by delivering two treatments:

  1. Mechanical treatment with a tiny rotating wire.

  2. Chemical treatment with polidocanol. Polidocanol is a detergent-type sclerosant medication that is commonly used in varicose vein treatment.

This technique is highly effective in closing the vein and only requires one skin puncture, similar to placing an IV.

 

In the video linked here, Dr. Bunke discusses the ClariVein® procedure for vein reflux disease.  The other video shows how the treatment is done. We offer many other videos on our YouTube channel.   After care instructions can be found on our website under the patient resources tab.

 

ClosureFast an endovenous radiofrequency ablation (RFA) procedure

The procedure is for the underlying diagnosis of vein reflux disease, which can cause a  backward flow of blood (or “Venous reflux”) in your saphenous vein(s). The great saphenous veins 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 usually 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 is Varithena?

Varithena® is a “microfoam” formulation of polidocanol (sclerosing agent) and CO2. The result is a microfoam that has an appearance and consistency similar to white, foamy shave cream. Ultrasound guidance is used to inject Varithena® microfoam into the vein. The microfoam fills the lumen for circumferential contact where it’s designed to displace blood and destroy the endothelial lining efficiently.

 

3 Venous Reflux Disease Treatments for underlying vein reflux2022-04-12T10:08:56-07:00

What is ClosureFast?

2022-04-11T10:20:19-07:00

ClosureFast an endovenous radiofrequency ablation (RFA) procedure

The procedure  ClosureFast, is for the backward flow of blood (or “Venous reflux”) in your saphenous vein(s). The great saphenous veins 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 usually return to their usual level of activity the same day.

closurefast1

How does the ClosureFast 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?

closurefast2

ClosureFast 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 listening to music.  Once you are comfortable, your leg (s) will be prepped with a cleansing solution for the sterile procedure.  The doctor will perform an ultrasound to map the vein (s) 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.

Watch a live radio frequency ablation treatment at La Jolla Vein Care.

 

What is ClosureFast?2022-04-11T10:20:19-07:00

What is a Duplex Ultrasound

2022-04-08T15:04:58-07:00

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 Duplex Ultrasound 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.

 

Who Performs the test?

duplex

The ultrasound examination is performed by a Registered Vascular Technologist (RVT). An RVT is a sonographer who completed a two-year ultrasound program, plus additional clinical training and obtained certification by meeting the highest standards by The American Registry for Diagnostic Medical Sonography® (ARDMS®).  It is important that a specially trained RVT perform the study, because over 40 special images are required to meet accreditation standards. All images are reviewed with the physician.

duplexultrasound

How long does the duplex ultrasound study take?

Approximately 45 minutes to an hour.

Is it invasive?

No, it is a painless and safe study using sound waves to visualize the veins of the leg.

How to prepare?

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.

 

What is a Duplex Ultrasound2022-04-08T15:04:58-07:00
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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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