31, 8, 2022

Skin Darkening and Varicose Veins

2022-07-20T16:21:50-07:00

Untreated varicose veins and underlying venous insufficiency can cause changes in the skin, including skin darkening. We call this skin hyperpigmentation.  This usually occurs in the inner ankle and can worsen to involve the lower portion of the leg as shown in the picture.  Over time, the skin becomes firm, dry, eczema-like, and can even break open, causing a venous leg ulcer. When the skin becomes darker as a result of a vein problem, this is referred to as chronic venous insufficiency (CVI). This can be prevented by addressing the underlying venous insufficiency and varicose veins early on. 

 

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

How La Jolla Vein & Vascular treats patients who experience darkening of the skin:

 

Step 1: The Underlying Problem

The first step is to treat the underlying problem, the venous reflux. The specific pattern of venous reflux 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 eventual 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 Step recommendation is customized, based on where reflux is present and other clinical factors.

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).

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 a 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.

 

Skin Darkening and Varicose Veins2022-07-20T16:21:50-07:00

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

La Jolla Vein & Vascular Featured in a Fox 5 Segment

2022-12-13T13:25:29-08:00

At La Jolla Vein and Vascular, we are excited to share with you our FOX 5 Localist Segment where Dr Nisha Bunke shares what our clinic can offer. 

 “Bringing Experts Together for Unparalleled Vein and Vascular Care”

 

Check out our Fox 5 segment here 

fox5segment

 

La Jolla Vein & Vascular (formerly La Jolla Vein Care) is committed to bringing experts together for unparalleled vein and vascular care. As mentioned in the Fox 5 segment, La Jolla Vein and Vascular offers a variety of services for vein and vascular health. 

 

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. 

 

➡Vascular conditions we treat: 

 

-varicose veins and spider veins

 

 -chronic venous insufficiency 

 

-pelvic congestion and labial veins 

 

-varicocele (varicose veins in the scrotum) 

 

-uterine fibroids 

 

-deep vein thrombosis 

 

-May Thurner peripheral arterial disease 

 

-knee arthritis (genicular artery embolization) 

 

-leg ulcers 

 

-chronic leg swelling 

 

-lymphedema

 

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 mentioned in our Fox 5 segment please check out our Youtube Channel or visit our helpful guide of resources. 

 

La Jolla Vein & Vascular Featured in a Fox 5 Segment2022-12-13T13:25:29-08:00

La Jolla Vein Care EXPANDS SERVICES, RENAMES LA JOLLA VEIN & VASCULAR

2022-07-20T13:26:27-07:00

La Jolla Vein Care EXPANDS SERVICES, RENAMES LA JOLLA VEIN & VASCULAR

 

Renowned vein clinic welcomes new physician, offers new services, and rebrands to La Jolla Vein & Vascular

 

La Jolla Vein and Vascular is a leader in vein treatment serving the Southern California community since 2010, announces a new name to reflect their recent expansion of services. La Jolla Vein Care is known for their renowned physicians, technically advanced and innovative approach to vein care. It was one of the first vein centers in the region to earn esteemed accreditation by the Intersocietal Accreditation Commission (IAC) for its dedication to quality patient care, positive patient outcomes, safety and physician expertise in the evaluation and management of superficial venous disorders. IAC accreditation is a “seal of approval” that patients can rely on as an indicator of consistent quality care and a dedication to continuous improvement. Varicose veins affect more than half of one half of Americans age 50 and older. Varicose veins occur when the valves in the leg veins no longer function, causing blood to pool in the legs. In some cases, this condition progresses to a more serious form of venous disease called chronic venous insufficiency (CVI). 

 

While LJVC has provided relief of painful varicose veins and ulcers of the legs, many people suffer from varicose veins in other areas of the body, such as the pelvic region in both men and women. These and other vascular conditions can be diagnosed and treated by interventional radiologists with special vascular training. Dr. Elliot DeYoung has joined LJVC’s  powerhouse team to continue its renowned venous care and add a complementary layer of medical specialization to the practice. 

Specializing in interventional radiology, with expertise The practice is enthusiastic to welcome Dr. Elliot DeYoung to their medical staff. Dr. DeYoung’s expertise spans vascular disease from angioplasty and stenting to embolization and ablation.  He will lead the center in the expansion of vascular services to provide crucial out-patient care to the community. The practice is enthusiastic to offer a wide variety of interventional procedures including treatments for other vascular conditions such as peripheral arterial disease, pelvic congestion, may thurners, deep vein thrombosis, varicocele, and uterine fibroids. 

 

‘It’s always been our mission to offer the most comprehensive vein care possible. Now, we are able to offer even more comprehensive vein and vascular care to the community. “Dr. Deyoung’s expertise and skills will help us continue to provide patients with leading edge therapeutics for venous disease,” said Dr. Nisha Bunke, founder of La Jolla Vein Care. We are proud to welcome him to our team.”The treatments Dr. DeYoung is able to offer are endovascular procedures that rely on “real-time” advanced medical imaging to precisely target areas of the body for treatment through millimeter-size incisions. It takes medical care to the next level beyond vein care. As a result, we saw fit to change the medical practice’s name to La Jolla Vein & Vascular (LJVV) to reflect these changes.’ Says Dr. Nisha Bunke, the clinic’s Founder and Medical Director. 

 

Dr. Elliot DeYoung is a board-certified interventional radiologist who has spent his career focused on minimally invasive procedures. He completed his training at University of California, San Diego where he specialized in vascular interventions and served on the patient safety committee. Dr. DeYoung’s expertise spans vascular disease from angioplasty and stenting to embolization and ablation. He values thorough patient education and the continuity of patient care. Dr. DeYoung received his bachelor’s degree from USC in Psychology followed by his medical degree from the University of Sydney, School of Medicine. He initially trained as a General Surgery resident in New York before transitioning his training to Interventional Radiology in San Diego. He has a passion for water sports and his free time is spent enjoying the outdoors with his family.

 

To learn more about La Jolla Vein and Vascular, visit ljvascular.com.  Connect with LJVV on Instagram and Facebook.

 

About La Jolla Vein & Vascular: 

La Jolla Vein & Vascular is San Diego’s most comprehensive endovascular center, dedicated exclusively to the diagnosis and treatment of vascular disorders. Vascular conditions permeate both women and men’s health. Vascular disorders treated include peripheral arterial disease, pelvic congestion, labial varicose veins, uterine fibroids,  may thurners, deep vein thrombosis, varicocele, varicose veins, leg ulcers and uterine fibroids.

 

La Jolla Vein Care enjoys positively impacting patient lives, health and overall well-being with its minimally invasive procedures, including an array of endovenous techniques such as radiofrequency, laser and foam sclerotherapy treatments. Learn more about La Jolla Vein Care’s specialty physicians, approach and what has driven its 10+ years of success at LJVascular.com.

 

La Jolla Vein Care EXPANDS SERVICES, RENAMES LA JOLLA VEIN & VASCULAR2022-07-20T13:26:27-07:00

Cellulitis & Varicose Veins

2022-07-19T17:21:50-07:00

Complications of Untreated Varicose Veins and Venous Insufficiency: Cellulitis

Cellulitis is a bacterial infection of the skin and tissues beneath the skin. Cellulitis infections can occur in the legs of people with untreated varicose veins and chronic venous insufficiency.  The reason for this is chronic venous insufficiency-which causes inflammation within the skin and underlying tissues. This inflammatory process causes the skin to become firm, eczema-like, dry, itchy, and fragile. Healthy skin acts as a barrier to bacteria, preventing infections. But, in chronic venous insufficiency, the skin is fragile and this barrier is susceptible to bacterial infections that can enter the tissues through cracks or breakages within the skin.  In chronic venous insufficiency, the skin around the ankles is most affected and infections can begin here.

Cellulitis usually begins as a small area of pain and redness on the skin. This area spreads to surrounding tissues, resulting in the typical signs of inflammation such as redness, swelling, warmth, and pain. Fever and chills may develop and the redness will spread affecting more of the leg. It is treated with antibiotics. If you believe you have signs of cellulitis, you need to contact your doctor right away as untreated cellulitis can spread rapidly.

This complication can be avoided by treating the varicose veins and eliminating underlying venous insufficiency, which will, in turn, reduce inflammation and improve the skin condition. 

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

Practicing good skin hygiene is important. Keep your skin moisturized so that it doesn’t flake or crack easily. If the skin is not broken or leaking fluid but is inflamed, your doctor may recommend an anti-itch cream, such as one containing hydrocortisone; a cream containing zinc oxide to protect the skin; or an antifungal cream to prevent fungal infections.

Skin that is leaking fluid is treated with wet compresses. If you have ulcers on your legs, we at La Jolla Vein & Vascular will show you how to apply layered compression bandages to protect the skin and maintain blood flow.

 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.

Cellulitis & Varicose Veins2022-07-19T17:21:50-07:00

26, 7, 2022

Do varicose veins cause leg cramps?

2022-12-13T13:23:37-08:00

Leg cramps occurring at night (nocturnal leg cramps) are a common symptom of venous disease. In fact, in the San Diego Population Study, leg cramps were the second most common symptom in people with the venous disease with a prevalence of 14.3%. Leg aching (17.7%) was the most common complaint and tired and swollen legs were also predominant symptoms.

Healthy veins collect the deoxygenated blood from the tissues. The venous blood, which is low in oxygen and high in waste products is returned to the heart and lungs where it is replenished with oxygen and nutrients.  In diseased veins, the blood circulates poorly, allowing blood to pool and become stagnant. The exact mechanism that causes cramping in the legs is uncertain.  But, when the cramping is caused by poorly functioning veins, the symptoms are often alleviated by correcting the underlying problem.  Conservative measures, such as elevating the legs, walking regularly, and wearing compression therapy may reduce the frequency of night cramps. Treating the underlying venous insufficiency may be curative.

There are many causes for leg cramps and if you suffer from night cramps it is important to be properly evaluated to determine the cause.  Cramps that occur with exercise are more likely to be associated with a more serious condition. If your muscles cramp with walking for a short time and recover with rest this may indicate arterial disease.  Other causes for leg cramps include muscle injury, thyroid conditions, pregnancy, electrolyte imbalance, dehydration or other causes.

To help identify the cause, it may be helpful to keep a log of daily activities, or change in activities; for example, heavy exertion may indicate a muscular cause or long periods of standing or sitting may favor the venous disease.  A recent study showed that prolonged standing at work may be an important risk factor for varicose veins and nocturnal leg cramps.

Check with your primary care physician to rule out other causes for leg cramps. Blood tests can check for thyroid, kidney and electrolyte conditions.  You may also have undiagnosed venous reflux.

At La Jolla Vein Care, our vascular imaging scanners help us detect vascular causes of leg pain. For example, we can utilize one of our three duplex ultrasound imaging systems to scan for blood clots in the leg veins (deep venous thrombosis), venous insufficiency and identify significant problems in the arterial circulation.

 

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 please check out our Youtube Channel or visit our helpful guide of resources

 

Do varicose veins cause leg cramps?2022-12-13T13:23:37-08:00

Improving your vein health through exercise

2022-12-13T14:12:46-08:00

Physical activity and exercise provides a wide range of benefits for vascular health and may help to avoid evolution of mild cases of varicose veins. In fact, exercise is considered to be a fundamental element in improving the symptomatology of patients affected by varicose veins. A sedentary person diagnosed with this medical condition has a much higher risk of worsening the symptoms when compared with an active person with the same condition. This is a result of blood pooling in the veins, causing an increase in venous hypertension and symptoms.

The main goal of exercise in regards to varicose veins is to contract and move the muscles of the leg, helping to pump the blood upwards, avoiding edema or retention of liquid in the ankles. With this in mind, the recommended exercises are those with aerobic characteristics rather than those with anaerobic ones. Through this physical activity, the pressure in the veins is improved, as well as the resulting symptomatology.

Therefore, any exercise that involves moving the lower limbs and promote cyclical muscle contractions is advisable, including stand on tiptoes, move the toes, perform foot bending and rotation, do pedaling movements, among others. These can be easily performed throughout the day without the necessity to go out and exercise, and are especially useful during work hours or while doing daily tasks at home.

When walking or running, pressure is exerted on the sole of the foot, which causes the circulation to be activated from the bottom up, while the constant contraction of the muscles during cycling causes the same effect, but without the presence of high impact, an important factor for those with joint issues.

Swimming is one of the best exercises to practice when affected by varicose veins. The double effect of the water and the movement of the lower limbs cause an incredible increase in blood circulation. This is helpful also for patients who have significant symptoms related to the effects of gravity, like standing.

Other disciplines like yoga, pilates, or rhythmic gymnastics also help stimulate circulation by mobilizing the accumulated blood in the thighs, while relaxing the whole body.

Hiking is a great activity for using the calf-muscle pump. However, in warm weather, symptoms of varicose veins worsen. To get the maximal benefit of exercise and reducing symptoms, outdoor exercising when the weather is cooler, like in the morning is advised.

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 please check out our Youtube Channel or visit our helpful guide of resources

Improving your vein health through exercise2022-12-13T14:12:46-08:00

Blood Clots and Leg Vein Ultrasounds

2022-12-13T14:13:46-08:00

Most vein disease is not visible to the naked eye, but can be detected in a leg vein ultrasound.

What Leg Vein Ultrasound Can Uncover About Your Veins: blood clots and leaky valves

We can see beneath the surface of the skin with an ultrasound. Duplex ultrasound combines Doppler flow information and conventional imaging information, sometimes called B-mode, to allow physicians to see the structure of your blood vessels. Duplex ultrasound uses sound waves to get images of your blood vessels.  It also helps determine how fast blood moves through the vessels. It can also be useful to estimate the diameter of a blood vessel as well as the amount of obstruction, if any, in the blood vessel. Using duplex ultrasound technology, the structure of your blood vessels, the valve function, the movement of your red blood cells, and the direction of blood flow through the vessels, any blockages, blood clots, and leaky valves can be seen.

Venous Reflux (leaky valves)

Ultrasounds of the leg veins that look for leaky valves (venous reflux) are usually performed in the standing position.

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 reflux or 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, patients who have failed prior treatment, patients who are symptomatic, and in some patients with certain anatomic patterns of spider veins.

Before your test:

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

How long does it take?

An ultrasound only checking for blood clots typically takes less than 30 minutes. An ultrasound that looks at both the deep and superficial veins including mapping is less than 60 minutes, the part of this exam that checks if the valves are leaky is performed in the standing position.

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 please check out our Youtube Channel or visit our helpful guide of resources

Blood Clots and Leg Vein Ultrasounds2022-12-13T14:13:46-08:00

Before & After Varicose Vein Treatment

2022-12-13T13:08:14-08:00

Varicose Veins: Patient Transformations 

What are varicose veins?

They are the twisted, bulging veins just beneath the surface of the skin. These 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.

What causes them?

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

As you can see below, these patient transformations after varicose vein treatment are remarkable!

varicose veinvaricose veinvaricose vein

 

 

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 varicose vein treatment. 

 

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 please check out our Youtube Channel or visit our helpful guide of resources. 

 

Before & After Varicose Vein Treatment2022-12-13T13:08:14-08:00

What a Duplex Ultrasound can detect

2022-06-25T17:57:32-07:00

Duplex ultrasound combines Doppler flow information and conventional imaging information, sometimes called B-mode, to allow physicians to see the structure of your blood vessels. Duplex ultrasound uses sound waves to get images of your blood vessels. It also helps determine how fast blood moves through the vessels. It can also be useful to estimate the diameter of a blood vessel as well as the amount of obstruction, if any, in the blood vessel. Using duplex ultrasound technology, the structure of your blood vessels, the valve function, the movement of your red blood cells and direction of blood flow through the vessels, and any blockages or blood clots can be seen.

 

Diseases of the blood vessels can affect both veins and arteries.

Vascular refers to the blood vessels in the body. There are two main types of blood vessels; the arteries and veins. Arteries bring oxygen-rich blood from the heart to every inch of the body; vein return the blood back to the heart and lungs for more oxygen. Vascular disease is when the blood vessels are no longer healthy.

Common types of vein disease include:

  • Varicose veins
  • Chronic venous insufficiency
  • Deep venous thrombosis

Common types of artery disease includes:

  • Carotid artery disease and stroke (TIA or Stroke)*
  • Lower extremity arterial disease (PAD)**
  • Upper extremity arterial disease
  • Abdominal aortic aneurysm (AAA)

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

 

What a Duplex Ultrasound can detect2022-06-25T17:57:32-07:00
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