The Vein Center of Arizona Blog

Medical Treatment for Vein Disease - Venous Insufficiency and Varicose Veins

Lower-extremity venous insufficiency is a common medical condition affecting between 45-55% of adult women and 25-35% of adult men. Venous insufficiency typically results from primary valvular incompetence or less commonly from previous deep venous thrombosis. Venous insufficiency can lead to varicose veins that may be of cosmetic concern and cause symptoms such as extremity swelling, pain, skin hyper pigmentation, skin hardening or ulceration. Affected veins may thrombose or bleed.

Venous insufficiency most commonly results from reflux originating from the great saphenous vein (GSV), anterior accessory saphenous vein (AASV), anterior circumflex saphenous vein (ACSV), posterior accessory saphenous vein (PASV) or posterior circumflex saphenous vein (PCSV) in the thigh.  Additional  sources of venous insufficiency include the small saphenous vein (SSV), thigh extensions of the small saphenous vein and perforating veins among other more rare anatomical variations.

Treatment of venous insufficiency is intended to alleviate symptoms and reduce the risk of complications. Conventional management of great saphenous vein reflux has been surgical removal of the saphenous vein from the level of the sapheno-femoral junction to the level of the knee or ankle (stripping), along with ligation of the saphenous branches in the groin. Since 1999 an alternative to ligation and stripping of the saphenous vein is endovenous ablation of the vein using radio-frequency generated thermal energy, laser energy, or a chemical sclerosing agent. Treatment is aimed at relief of symptoms, prevention of progression of venous insufficiency, prevention of complications and the improvement in the cosmetic appearance associated with venous insufficiency. There are additional methods of ablation being tested in clinical trials that include the use of surgical glue and the use of steam in the ablation.

 

Physical Exam and History

 

Venous disease of the legs can be categorized according to the severity, cause, site, and specific abnormality using the CEAP classification. The elements of the CEAP classification are: Clinical severity (Grade 0-6, asymptomatic, symptomatic), Etiology (congenital, primary, secondary), Anatomical distribution (superficial, deep, perforator veins), and Pathophysiological dysfunction (reflux, obstruction).


Noninvasive Diagnosis


Noninvasive studies are used to confirm the presence of venous insufficiency, define the anatomical distribution of venous insufficiency, and identify the presence of venous anomalies and venous thrombosis. Diagnostic ultrasound by a registered vascular technologist (RVT) should be used for initial evaluation and evaluation of treatment adequacy. Real-time US guidance is used during endovenous treatment. Having an experienced technologist is imperative as the initial diagnosis often depends on their ability to assess and show the correct disease state presented.

Treatment Options

Compression Stockings

Graduated compression stockings are used to control venous insufficiency symptoms. They provide external support that can constrict dilated veins and restore competence to incompetent valves. Compression stockings are particularly helpful during pregnancy, and they are frequently used following venous ablation. They come in many different styles, sizes and compression ranges. It is beneficial to be fitted by someone who is an expert in compression garments.


Surgery


GSV stripping with branch ligation had historically been the primary treatment option for venous insufficiency. The GSV is ligated near the groin. Ligation alone can preserve the vein for subsequent harvesting in case of arterial bypass; however, ligation alone has proven unsatisfactory for preventing the occurrence of reflux, so it is often supplemented by vein stripping.

Ambulatory phlebectomy is primarily used to treat surface varicose veins. Performed as an adjunct to endovenous ablation or stripping it has also become less common with the advancement of endovenous therapy’s. This procedure involves making tiny punctures or incisions through which the varicose veins are removed. Other surgical methods to treat venous insufficiency have been described, including subfascial endoscopic perforator surgery (SEPS) for treating venous ulcers and valvular surgery for treating reflux caused by incompetent valves of the deep veins.

Injection Sclerotherapy

Injection sclerotherapy is a common treatment for telangiectasias and can be used to treat smaller varicose veins. The sclerotherapy solution can be in liquid form or can be injected as "foam" (mixed with a gas such as air). Sclerotherapy has not been shown to have long-term effectiveness for large veins, such as the GSV unless it is used to treat the distal portions post endovenous ablation.  Ultrasound guided sclerotherapy is suggested for larger tributaries and has taken the place of ambulatory phlebectomy in many practices.


Endovenous Ablation


Endovenous ablation is a minimally invasive alternative to surgery. The treatment is done percutaneously and can be used to treat the GSV, SSV, and other superficial veins. A catheter is placed near the sapheno-femoral junction using ultrasound guidance and the length of the treated vein is injected with Tumescent anesthesia to prevent injury to the surrounding tissues. Endovenous ablation uses radio-frequency (RFA) or laser energy (EVLA) applied inside the vein to cause occlusion.


Adjunctive Treatments


Adjunctive treatments may be required to help eliminate venous insufficiency. Patients with venous insufficiency and associated venous occlusion or stenosis of the common iliac vein may require venous re-canalization with angioplasty and stenting to achieve a pathway for venous return. The use of IVUS (intravascular ultrasound) can be used to assess the inside of the pelvic veins. Patients with pelvic venous insufficiency may require percutaneous embolization of the ovarian veins. Patients with deep venous thrombosis are typically treated with anti-coagulation to reduce the risk of thrombus propagation, embolization, and post thrombotic syndrome.

 

Complications


All forms of lower-extremity venous insufficiency treatment are subject to recurrence. Risks of vein ligation and stripping surgery include: scarring, anesthetic risk, bleeding, pain, deep venous injury or thrombosis, nerve injury, and infection. Complications of the endovenous ablation procedure include bruising, swelling, transient numbness, and very rarely deep venous thrombosis.

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Varicose Vein and Spider Vein Treatment in Yuma is covered by Insurance.

The Vein Center of Arizona offers advanced treatment of varicose veins and spider vein in Yuma, Arizona.

When performed for medical reasons, varicose vein treatment is covered by most insurance companies. The first line of treatment is endovenous ablation. The second line of treatment is sclerotherapy and/or microphlebectomy.

The symptoms of venous disease include leg pain, leg swelling, itchy achy legs, heaviness in the legs and swelling of the ankles. Many patients suffer from venous disease but are not aware.  To find out if you may have medically treatable vein disease take our online vein quiz or call us and schedule your free vein screening

Check with your insurance company to determine which treatment options are covered under your plan. 

The CSI of Vein Care

Vein Investigation

On TV shows like "CSI," viewers get to watch as police investigators find and collect evidence at the scene of a crime, using science to make blood splatter appear as if by magic and swabbing every mouth they can get their hands on. Many of us believe we have a pretty good grip on the process, and rumor has it criminals are actually getting a jump on the good guys using tips they pick up from these shows about forensics. CSI is the number one television show in the world, while it doesn't have a direct connection to varicose veins or the treatment of veins the concepts that are used to determine crimes are similar to those used by a vein center to determine the root cause of your varicose veins, spider veins, leg swelling and other symptoms. 

 

CSI Basics

Crime scene investigation is the meeting point of science, logic and law. "Processing a crime scene" is a long, tedious process that involves purposeful documentation of the conditions at the scene and the collection of any physical evidence that coul­d possibly illuminate what happened and point to who did it. Likewise the physical exam in the vein practice is a collection of evidence to determine if the symptoms and signs of vein disease are medical in nature. Just like in the CSI office the vein practitioner has to build up a mountain of evidence to present to the insurance companies. This can be a long and tedious process, depending on the insurance company at hand. Everyone has differing vein anatomy, and symptomology can widely vary among patients. In the case of vein treatment, there is no typical crime scene, there is some typical body of evidence and there is a practical investigative approach.

 

Individual, friends and family are typically the first to notice vein problems. They often point out the spider veins, swelling or skin changes that often occur with vein problems. 

The Vein Specialist documents the evidence, performs a thorough evaluation of the areas of interest and collects any physical evidence and starts the documentation. 

Specialists (vascular technologist) perform extensive venous duplex examination of all of the deep and superficial veins in the lower extremities to determine the anatomy and physiologic impact of the vein disease in question. The testing directly impacts the treatment options that will be considered and proper diagnosis is paramount to good treatment. 

 

The physical evidence itself is only part of the equation. The ultimate goal is to identify the underlying cause of patient’s vein symptoms. The collection of the evidence needs to be performed in the correct manner, documented according to the insurance specifications and should be performed based on IAC standards of care.  

 

The investigation of varicose veins or spider veins begins when the individual initiates contact with the vein specialist either by referral, direct advertising or via a free vein screening.  The overall system works something like this:

  • The patient arrives at the office and fills out several forms (this can also be done before arrival at the vein center). An initial evaluation is performed to include a physical exam, overview of symptoms, measurements of the lower extremities and overview of exercises, compression garments and other conservative treatment options. This initial consultation allows the physician and the patient to get an overall mutual understanding for the problem at hand. The vein specialist generates initial theories based on visual examination and evidence from the patient history as to the root cause of the varicose veins, spider veins or leg swelling in question. The specialist makes recommendations based on physical evidence and symptoms to determines what diagnostic testing is needed. 
  • The Vein Specialist  may document the examination by taking photographs and schematic drawings. 
  • The pre-certification specialist processes all of the evidence the vein specialist has collected during the consultation, any diagnostic testing results and the review of conservative management and presents to the insurance company. 

Usually 4-6 weeks later the vein center and patient will be notified by the insurance company to what treatments are covered based on the evidence found and the specific plan benefits provided. At this time the patient will be called and at that time any procedures will be scheduled.  

 

 

Proper vein treatment is dependent on the marriage between science, technology and investigative work. Much like the Crime Scene Investigation, experience plays a role in the ability to properly diagnose and solve the problem. The Vein Center of Arizona uses diagnostic testing, clinical evaluation and proven processes to accurately determine the root cause of your vein symptoms and how to best treat the condition. Take the Free Vein Screening now and find out if you have medical vein disease!

 

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Compression Hose - What is The Correct Compression

I am often asked what is the correct compression for me? This is a brief summary of established guidelines in respect to medical compression. This guide is for information purposes only, the advice of your physician takes precedence.

 

Compression Therapy Guide

8-15 mm Hg [Mild Compression) This level of compression provides relief and minimizes tired and achy legs. Prevents fatigued legs from long periods of standing or sitting. This level of compression also, helps relieve minor swelling of the feet, ankles, and legs. During pregnancy, mild compression helps prevent the formation of varicose and spider veins. In general mild compression helps maintain healthy, energized legs.

15-20 mm Hg (Moderate Compression) This level of compression is used for the prevention and relief of minor to moderate varicose, spider veins and reticular veins. This level of compression helps relieve tired, aching legs, and minor swelling of feet, ankles, and legs. During pregnancy, helps prevent varicose veins and spider veins. Helps prevent deep vein thrombosis (DVT), also known as economy class syndrome. Used in post sclerotherapy treatment to help prevent the reappearance of varicose veins and spider veins. Ideal compression level used for those traveling long distances.

20-30 mm Hg (Firm Compression) Relief for moderate to severe varicose veins (also during pregnancy). For post-surgical and post sclerotherapy treatment to help prevent the reappearance of varicose and spider veins. Helps the treatment of moderate to severe edema or lymphatic edema. Helps with the management of active ulcers and manifestations of post thrombotic syndrome (PTS). Helps relieve superficial thrombophlebitis. Helps reduce symptoms of Orthostatic Hypotension and Postural Hypotension Prevents deep vein thrombosis (DVT), also known as economy class syndrome.

30-40 mm Hg (Extra Firm Compression) For the relief of severe varicose veins. Used in the treatment of severe edema and lymphedema. Used in post-surgical and post sclerotherapy treatment to help prevent the reappearance of varicose and spider veins. For the management of Venous Ulcers and manifestations of Post-Thrombotic Syndrome (PTS). Helps prevent orthostatic hypotension (sudden fall in blood pressure when standing). Helps prevent deep vein thrombosis (DVT), also known as economy class syndrome.

Buying compression garments (support hose) can be a daunting and confusing to say the least. This simple but proven guide should help you or your physician decide the level of compression that is best depending on your personal medical situation. Use this guide to open up dialoque when talking to your physician. It may be that your physician is not aware of the correct compression as venous disease is often overlooked. Medical compression when used correctly can reduce pain, swelling, discomfort, and increase your venous circulation.

While there are many compression hose, garments and socks on the market, it is imperative that you buy compression garments that are graduated. Graduated compression is when the compression is higher in the foot and reduces in compression as you move toward the heart or head.

Dr.Paul Larson is a the owner of The Vein Center of Arizona. 

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Vein Screening in Yuma a Success!

The vein center of arizona logo

 

Over twenty patients attended the vein screening on August 16th. Out of all of the patients only one did not have medical venous disease. The feedback was tremendous and patients expressed hope as they have been suffering for years. "It amazes me every time we have a vein screening how many patients have had vein disease for years but feel like they didn't have any options or hope" Dr. Paul Larson

 

If you have lived with swollen legs, heaviness in the feet, varicose veins, spider veins or chronic leg pain you can't afford to miss the next Free Vein Screening.

 

At the Vein Center of Arizona treating varicose veins, swollen legs, spider veins, painful legs, restless legs, throbbing legs, venous disorders, and other Venous Disease related symptoms is all we do. 

 

Venous Disease can be very progressive and usually worsens with time until painful, bulging, unsightly, varicose veins present or venous ulcers break the skin open.  Early treatment by vein specialist utilizing proven technology are the keys to a great outcome!

 

Your FREE screening includes a brief 10 minute appointment with a Dr. Paul Larson based on the physical appearance of your legs and the information you provide on the vein history form. You can often skip the screening if you have obvious signs of venous disease. You can take the quiz right now! 

 

Please wear shorts to your screening appointment.

 

If you present with numerous spider veins, bulging rope-like varicose veins, skin color changes, swelling of the ankles, or other symptoms of Venous Disease, you can skip the screening and go ahead and schedule a consultation. Insurance requirements demand a certain amount of time for conservative treatment. The initial consultation starts the conservative treatment, the vein screening does not count toward this in the insurance company’s eyes.

 

Often you will be scheduled for a Duplex Ultrasound appointment with a trained Sonographer, and a second appointment with the doctor to review the findings.  You can contact us here or give us a call at (928) 750-8975

 

 

 

The Vein Center of Arizona is a dedicated vein treatment center in Yuma, Arizona. Dr. Paul Larson and his staff will do everything in their power to provide you with the best vein treatment possible.  

 

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