4, 5, 2022

What are Non Healing Ulcers & Wounds?
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What are Non Healing Ulcers & Wounds?

LJVascular2022-04-28T17:17:13-07:00

Non-Healing Ulcers & Wounds

We might all be familiar with non healing ulcers & wounds 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.

What are Non Healing Ulcers & Wounds?LJVascular2022-04-28T17:17:13-07:00

Varicose Veins: Patient Transformations Part 2
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Varicose Veins: Patient Transformations Part 2

LJVascular2022-04-28T14:52:04-07:00

What are varicose veins?

Varicose Veins are the twisted, bulging veins just beneath the surface of the skin. They 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, and are very common.

Varicose veins are caused by leaky vein valves, which allow blood to pool within the veins causing them to stretch and become enlarged. They 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.

What are the symptoms?

The symptoms 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

Over time, complications can develop from untreated veins. These include:

Superficial phlebitis (painful inflammation of the vein)
Superficial thrombophlebitis (blood clots within the varicose veins)
Spontaneous vein hemorrhage (the vein can rupture spontaneously)
Skin discoloration and eczema around the ankle (venous eczema)
Skin sores or ulcers usually near the ankle

Duplex ultrasound technology is used to evaluate the veins beneath the surface of the skin. The ultrasound allows us to see if the valves are leaky; it can detect the direction of blood flow and also detects blockages in the veins, for example from blood clots or scars within the veins from previous clots. The ultrasound will determine exactly which veins are ‘bad’ or incompetent. Reflux may be detected in the deep veins (within the muscle), the great and small saphenous veins, and/or branches of the saphenous veins. This will help determine the treatment plan.

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 vein treatment.

Varicose Veins: Patient Transformations Part 2LJVascular2022-04-28T14:52:04-07:00

29, 4, 2022

What is VenaCure?
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What is VenaCure?

LJVascular2022-04-15T15:42:25-07:00

VenaCure is an endovenous laser ablation (EVLA) procedure for backwards flow (or “reflux”) in your saphenous vein(s).

VenaCure Laser is also referred to as endovenous laser ablation therapy (EVLT). 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 VenaCure 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.

The VenaCure 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 (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 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.

Videos of the treatment, as well as after care instructions can be found on our website and our YouTube channel.

What is VenaCure?LJVascular2022-04-15T15:42:25-07:00

Understanding Venous Disease: Venous Ulcers
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Understanding Venous Disease: Venous Ulcers

LJVascular2022-04-23T14:20:59-07:00

Understanding Venous Disease: Venous Ulcers

A venous leg ulcer is the most severe form of chronic venous insufficiency. This is referred to as a ‘venous leg ulcer.’ Venous ulcers of the leg make up 70% of all chronic leg wounds. Therefore, a venous leg ulcer is much more common than a diabetic or arterial ulcer. It is caused by 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 of 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. Venous ulcers on the leg 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.

Before and after treatment of a venous ulcers.

Venous leg ulcers make up 70% of all chronic leg wounds. They usually occur in the inner ankle or outer ankle locations.

The treatment of venous leg ulcers is to correct the underlying problem: the faulty veins. Treatment of the underlying non-functional veins will reduce pressure from venous hypertension, allowing the wound to heal. There are a number of non-surgical treatment options that can accomplish this including foam sclerotherapy and endovenous ablation, depending on the affected veins. To determine if your leg wound is related to a vein problem or for treatment options, call us for more information.

Understanding Venous Disease: Venous UlcersLJVascular2022-04-23T14:20:59-07:00

3 Reasons to Wear Compression Stockings
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3 Reasons to Wear Compression Stockings

LJVascular2022-04-15T15:40:11-07:00

Why Compression Stockings:

Compression stockings are an important part of the overall healing process. As a result, you’ll need to wear the stockings following the vein treatments from La Jolla Vein Care to ensure you get the best outcomes. Physiologically, compression therapy increases venous blood flow back to the heart, reduces reflux in diseased veins, increases venous blood flow, reduces elevated water content of the tissue, reduces inflammation, and sustains reparative processes. In short, compression therapy not only improves results after treatment, but it also improves blood flow and reduces symptoms and swelling in the legs.

Compression stockings offer style after vein treatment:

In the past, patients recovering from varicose vein treatments were limited in both mobility and style. After a procedure, patients were required to wear compression stockings in a lovely shade of beige. This might work if you’re looking to hang around the house for a couple months. If you’re ready to live an active life while you heal, however, you can get medical grade compression stockings that are fashionable, stylish, and comfortable. At La Jolla Vein Care, you get more than a safe and effective alternative to surgery—you get access to customized compression stockings in a variety of styles from the leading brands, including Sigvaris, Medi, ComfoMed, Ames Walker, and JOBST. While we are more than happy to order beige stockings for you, it’s good to know that you have options—the option to look good, feel good, and heal in style.

Compression stockings help prevent deep vein thrombosis:

Stay moving, avoid prolonged sitting. For example, when flying or traveling, the risk of DVT is 1% on a long haul flight (greater than 6 hours).

To minimize this risk, you should wear compression stockings (which helps increase the blood flow in the legs), stay hydrated, avoid excessive alcohol, use the calf muscles- walk about the cabin and frequently pump the calf muscles by doing foot lifts.

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

Compression stockings increase athletic performance:

Compression is known for improving circulation after the removal of varicose veins. But can they improve athletic performance? The answer is a resounding yes. According to Medi, compression sport stockings are clinically proven to increase performance. Over the course of a marathon, for example, running time is reduced by approximately five minutes while the exertion on your muscles is reduced by roughly six percent. Moreover, a study by Technische Universität Dresden reveals that blood circulation is 30% higher at rest after engaging in certain athletic activities when wearing compression sport stockings. So whether you’re a jogger checking out the scenery or a hard-core athlete training for a marathon, there’s something to help you reach your peak.

3 Reasons to Wear Compression StockingsLJVascular2022-04-15T15:40:11-07:00

La Jolla Vein and Vascular welcomes Jodi Hirsch, PA-C
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La Jolla Vein and Vascular welcomes Jodi Hirsch, PA-C

LJVascular2022-04-23T14:24:17-07:00

La Jolla Vein and Vascular welcomes Jodi Hirsch, PA-C

Jodi Hirsch PA-C is a board-certified physician assistant who has spent her career specializing in the field of peripheral vascular disease and venous disease. She gained her undergraduate degree in chemistry and pursued her degree in Physician Assistant Studies from Touro University in NY in 2006. She has spent her professional career in San Diego, previously working in the Department of Vascular Surgery at Scripps. When not at work, she enjoys spending time with her husband and two little boys.

For more information please watch Jodi’s video here.

La Jolla Vein and Vascular welcomes Jodi Hirsch, PA-CLJVascular2022-04-23T14:24:17-07:00

A deeper look into chronic venous insufficiency
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A deeper look into chronic venous insufficiency

LJVascular2022-04-15T15:36:06-07:00

What is chronic venous insufficiency?

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

Chronic Venous Insufficiency is progressive and worsens over time.

Chronic Venous Insufficiency is also known as venous stasis, 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 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.

A deeper look into chronic venous insufficiencyLJVascular2022-04-15T15:36:06-07:00

Chronic venous insufficiency and leg ulcers
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Chronic venous insufficiency and leg ulcers

LJVascular2022-04-15T15:35:10-07:00

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.

Chronic venous insufficiency and leg ulcersLJVascular2022-04-15T15:35:10-07:00

Varicose Veins Before & After: Patient Transformations Part 1
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Varicose Veins Before & After: Patient Transformations Part 1

LJVascular2022-04-15T15:34:00-07:00

What are varicose veins?

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:

Varicose Veins Before & After: Patient Transformations Part 1LJVascular2022-04-15T15:34:00-07:00

Two Venous Reflux Disease Treatments for visible bulging veins
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Two Venous Reflux Disease Treatments for visible bulging veins

LJVascular2022-04-15T15:32:43-07:00

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.

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 veinsLJVascular2022-04-15T15:32:43-07:00

4, 5, 2022

Non-Healing Ulcers & Wounds

Types of Non-Healing Ulcers

What are varicose veins?

Varicose Veins are the twisted, bulging veins just beneath the surface of the skin. They 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, and are very common.

What are the symptoms?

29, 4, 2022

VenaCure is an endovenous laser ablation (EVLA) procedure for backwards flow (or “reflux”) in your saphenous vein(s).

How does the VenaCure treatment work?

What is chronic venous insufficiency?

Venous stasis skin changes associated with venous insufficiency include:

Venous stasis skin changes associated with venous insufficiency include:

HOW IS CVI TREATED?

HOW ARE LEG ULCERS TREATED?

What are varicose veins?

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.

Asclera for bulging veins:

How many treatments will I need?

WHAT ARE THE OPTIONS FOR TREATING BULGING VEINS AT THE SKIN SURFACE?

HOW DOES THE PROCEDURE WORK?

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

La Jolla/UTC

Vista

Patient Privacy Practices

TWO CONVENIENT LOCATIONS THROUGHOUT SAN DIEGO

La Jolla/ UTC

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

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

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