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13, 7, 2022

Vein Health & Working From Home

2022-12-13T13:18:14-08:00

Prolonged desk work can increase the risk of blood clots in leg veins and decline your vein health.

As many Americans are working from home, we have received many calls from patients regarding thrombophlebitis, which is a big concern for vein health. This is not a new scenario for us, over the years frequently patients come in for assessment of leg pain after working on their computers for 12 hours straight.

ThromboPhlebitis refers to blood clots in the leg veins and inflammation of the surrounding vein. The inflammation causes leg pain and redness of the surrounding skin. You may also feel hard lumps in the leg veins.

Inactivity, sitting for long periods of time, like sitting at your desk, working on your computer for many hours without walking or getting up for a light walk or exercise, affects the blood flow in the leg veins. Your calf muscle pump, which is used when walking and moving about helps to move blood back to your heart. Sitting for too long of periods, increases the risk of your blood pooling in the leg veins and can even form blood clots. Blood clots that form in the deep veins are serious as they can travel to the heart and lungs (deep venous thrombosis). Blood clots that form in the surface veins, are called superficial thrombophlebitis (STP).  With STP, you can typically feel lumps that can be painful. People who have varicose veins, have an increased risk of developing STP especially with inactivity. Being mindful about your vein health while working remotely will help in the longer run when it comes to vein disease. 

Tips to Avoid Phlebitis When Working From Home:

  1. Avoid sitting at your desk or computer for longer than 45 minutes without taking a break to get up and walk about.
  2. Try to walk at least 30 minutes a day or other exercise
  3. When sitting, do calf raises to pump the calf veins.
  4. If you have varicose veins, you should wear compression stockings during the day time.

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. 

 

Vein Health & Working From Home2022-12-13T13:18:14-08:00

Vein Health: Helpful Anatomy Phrases to Better Understand

2022-12-13T14:15:11-08:00

If you’re not a vascular specialist, it may be difficult to understand the words used to describe your vein condition and understand vein health. Vein terms are not used in everyday life.  Especially, when it comes to the anatomy of the veins. Below is a glossary of the terms, we as vein specialists, use on a daily basis but may be foreign to the patient.  This is provided from the American Vein and Lymphatic Society (AVLS) healthyveins.org.

Anatomical Vein Terms for Vein Health:

Anterior: The front of a body part.

Posterior: Back of a body part.

​Deep Leg Vein: The veins that are deep in the thigh and leg that carry blood back to the heart.

​Connective Tissue: This strong tissue is the white tissue that covers muscle.

Great Saphenous Vein: (sometimes called GSV or long saphenous vein) A long vein that can be seen just in front of the ankle bone. This vein travels along the inside of the leg and thigh (about one-half inch beneath the skin in the thigh) until it empties into the deep vein called the common femoral vein in the groin.

Perforating Vein: A vein that passes directly from a superficial vein to a deep vein.

Popliteal Vein: The deep vein located behind the knee. The small saphenous vein originates from the popliteal vein.

Small Saphenous Vein: (sometimes called SSV, Lesser Saphenous Vein, or LSV) A superficial vein that starts at the outside of the foot and travels up the back of the calf where it empties into the deep vein (popliteal vein) in the crease of the knee.

​Spider Vein: A tiny varicose vein that may be blue or red color that does not protrude above the skin surface and frequently looks like a spider. Common medical terms you may hear for spider veins are telangiectasias and telangiectatic veins. Slightly larger varicose veins that do not protrude above the skin are called reticular veins.

​Superficial Vein: Any vein in the lower extremity above the deep fascia that covers the muscles of the thigh and leg.

​Varicose Vein: A bulging vein that protrudes past the skin surface and usually measures greater than one-fourth of an inch (6.4 mm) in diameter.

Vein Function Terms

Competent Vein: Blood flow occurs in the proper direction back to the heart. Also referred to as Having No Reflux Or Normal Flow Direction.

Incompetent Vein: Blood flows in the wrong direction. Also referred to as a vein that has reflux.

Reflux: Blood that flows backward in the veins.

 

Anatomical Images and Explanations

Normal Blood Flow: After the blood has been replenished with oxygen in the lungs, it is pumped to the body by the heart. Blood that is pumped to the lower extremities is pumped back to the heart partially by the action of the calf muscle pump. The blood returning from the lower extremities in the deep and superficial veins goes past a series of one-way valves. These valves stop the blood from flowing backwards in the vein.

​

Reflux: The valves in the veins close just as blood begins to flow backwards. If the valves do not close properly, the blood falls backwards through the poorly closing or leaking valves. The veins downstream that are now unprotected by valves further upstream are exposed to the weight of an increasingly high column of blood. These downstream veins cannot endure the pressure of the column of blood and expand becoming snake-like in appearance. This causes the vein to bulge through the skin surface and become varicose veins.

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. 

Vein Health: Helpful Anatomy Phrases to Better Understand2022-12-13T14:15:11-08:00

4, 5, 2022

What are Non Healing Ulcers & Wounds?

2022-04-28T17:17:13-07:00

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.

foot ulcer

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.

foot ulcer2

What are Non Healing Ulcers & Wounds?2022-04-28T17:17:13-07:00

25, 4, 2022

La Jolla Vein & Vascular welcomes Dr. Elliot DeYoung, M.D.

2022-04-23T14:16:23-07:00

La Jolla Vein & vascular welcomes our newest doctor at the La Jolla location, Dr. Elliot DeYoung, MD.

new doctor

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 is excited about joining La Jolla Vein & Vascular team to continue its renowned venous care. 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 treatments for peripheral arterial disease, may thurners, and uterine fibroids.

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.

Dr. DeYoung is looking forward to treating your vascular needs at La Jolla Vein & Vascular.

Dr. DeYoung is a vascular specialist with focus on aortic and peripheral vascular disease, pelvic congestion syndrome, and interventional oncology. His skills include varicocele embolization, venous interventions, uterine fibroid embolization, prostate artery embolization, and genicular artery embolization.

Please check out Dr DeYoung’s video for more information.

La Jolla Vein & Vascular welcomes Dr. Elliot DeYoung, M.D.2022-04-23T14:16:23-07:00

A deeper look into chronic venous insufficiency

2022-04-15T15:36:06-07:00

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 insufficiency2022-04-15T15:36:06-07:00

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

22, 3, 2022

What are the risks for Microphlebectomy

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

MicroPhlebectomy for varicose veins 

 

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

 

Risks of Microphlebectomy:

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

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

 

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

The Four Best Ways to Treat Venous Disease

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

Symptoms to look for in venous disease:

 

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

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

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

 

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

 

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

 

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

 

Venous Disease Treatment: Branch Vein Reflux

 

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

 

Venous Disease Treatment: Spider Veins with Cosmetic Sclerotherapy 

 

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

 

Venous Disease Treatment: Compression of Stockings 

 

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

 

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

The Best Treatment for Saphenous Vein Reflux

2022-03-17T10:11:22-07:00

The best treatment for Saphenous Vein Reflux is tailored to the individual 

 

Fortunately, there are a variety of non-surgical treatment options for saphenous vein reflux, the underlying cause for varicose veins and it’s symptoms. Because vein treatment is not, ‘one treatment fits all,’ the treatment plan should be customized to the patient. Non-surgical options include, laser vein ablation, radiofrequency vein ablation, varithena foam, venaseal an mechanical-chemical ablation, also known as clarivein. This article will specifically discuss features about Clarivein which make it a good option for some patients.

Mechanical-Chemical Ablation (Clarivein) for Saphenous Vein Reflux 

The ClariVein procedure for treatment of backwards flow (or reflux) in your saphenous veins. 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. This minimally invasive procedure can be performed in the office in less than an hour. This offers patients the benefit of being able to 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. 

 

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

 

What should I expect on the day of treatment? 

The procedure is performed with local anesthesia, but many patients elect to use a mild oral sedative (Valium), which is taken after checking in and completing all paperwork. The patient will change into a gown and leave underwear on. Depending on the vein to be treated, the patient will lay on the back or on the belly. We do our best to make special accommodations (for example, if the patient cannot lie flat or cannot bend a knee very well) with body positioning and using pillows. We will do our best to make the patient comfortable. Then, we will give the option of watching a movie on Netflix or listen to music. Once the patient is comfortable, the leg will be prepped with a cleansing solution for the sterile procedure. The doctor will perform an ultrasound to map the vein to be treated. Then, a numbing agent (lidocaine) will be injected into the skin. In the numb area of the skin, a tiny puncture is made to pass the ClariVein catheter. Once the catheter and rotating wire are in place, the doctor will start the treatment. It is common to feel a tickling or vibrating sensation as the doctor treats the vein. Patients usually have minimal to no pain during this procedure. Once the vein has been treated, the patient will wear compression stockings for 72 hours continuously. The benefits of wearing compression stockings during post surgical recovery are mentioned here. 

 

What should I do after treatment? 

You should walk 30 minutes twice daily after treatment and move your legs frequently throughout the day with short walks and/or calf exercises. This will alleviate discomfort and avoid pooling of blood in the legs. It is normal to have aching in the treated veins. This responds well to walking, ice packs, and anti-inflammatory medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve). Compression stockings are recommended for after treatment. 

 

What should I avoid after treatment? 

 

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

 

What are the possible adverse effects? 

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

Videos of the treatment, as well as after care instructions can be found on our website or our Youtube Channel.

The Best Treatment for Saphenous Vein Reflux2022-03-17T10:11:22-07:00

One Way To Reduce Bruising After Surgery

2022-03-17T10:10:31-07:00

One of the most common side effects after surgery is bruising. Whether it is due to plastic surgery or vein surgery, bruising and swelling are inevitable. One of the most powerful tools that we recommend for patients undergoing any type of surgery and one way to reduce bruising after surgery is RECOVA post surgery cream. 

 

Dr Nishe Bunke created RECOVA cream as a post surgical recovery cream specifically designed to reduce bruising, swelling, redness, and pain. RECOVA skin creams are packed with antioxidants and natural ingredients that promote healing and reduce inflammation. 

 

RECOVA cream aids in reducing pain, swelling, and discoloration after cosmetic surgery, injections, and procedures, laser treatments, varicose vein procedures, Sclerotherapy, minor injuries, and is one way to reduce bruising after surgery.

 

Our patients at La Jolla Vein Care have seen quick transformation post procedures. The combination of natural ingredients in RECOVA cream helps aid in quicker recovery.

 

 The powerful ingredients included in RECOVA are listed below:  

 

  • Arnica Montana is a flower extract that helps with inflammation, swelling, and bruise recovery. 

 

  • Grapeseed Oil has numerous benefits and includes numerous vitamins such as vitamin E. It is a flavonoid that aids in chronic venous insufficiency, varicose veins, and edema. 

 

  • Bromelain is an enzyme that is a natural remedy for inflammation and swelling.

 

  • Horse Chestnut is used to improve poor blood circulation, reduce swelling, and for varicose vein symptoms. 

 

  • Caprylhydroxamic Acid is an amino acid derived from coconut oil used as a gentle preservative that ensures product safety and longevity. 

 

  • Witch Hazel is used for swelling and inflammation. It is used to shrink varicose veins and hemorrhoids as well as reduce rosacea and clear redness of the skin. 

 

  • Butcher’s Broom is used for natural anti-inflammatory properties. It is used to reduce swelling and reduce varicose vein symptoms. 

 

  • Sunflower Seed Oil is packed with vitamins A, E, C, and D. 

 

  • Menthol is not present in the tinted RECOVA, since Tinted Arnica is often used around the eyes. 

 

The combination of these ingredients contributes to an overall comforting and healing sensation when applied to the skin. 

 

RECOVA is a tool that stands out due to its natural ingredients that aid in venous disease symptoms. RECOVA is hypoallergenic, and non comedogenic. RECOVA is also free of parabens, phthalates, preservatives, synthetic additives, and dyes, and never tested on animals. 

 

Patients have used RECOVA cream after vein procedures and have seen quick and lasting results. We recommend physicians offer this for patients if they complain of redness, itching, and bruising after their procedures. RECOVA offers immediate soothing relief of discomfort for our patients. 

 

Check out RECOVA online for more information and to purchase RECOVA tinted arnica cream and RECOVA post surgery cream. 

Below are a few patient transformations while using RECOVA Cream post surgical procedures.

one way to reduce bruising after surgery one way to reduce bruising after surgery

before 3 after 3one way to reduce bruising after surgery

One Way To Reduce Bruising After Surgery2022-03-17T10:10:31-07:00
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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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