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UNDERSTANDING VEIN DISEASE

Why are my legs veins dark and visible?  Is it something I did?  Does it run in families?  Can they be fixed?  Is it expensive?

These are everyday questions in a vein care office.  A great deal more is known about vein disease now than when most physicians did their training, and most patients are pretty frustrated by the lack of information they receive from their primary doctor.

Modern Phlebology (the study of vein disease) is a rapidly changing specialty, with tremendous advances in understanding and treatment over the past decade . . . even the past year.  Effective and safe procedures are now available to correct most vein problems.  Most of these corrective procedures are routinely performed in the office setting, and the cost is quite reasonable.  Even huge bulging varicose veins can be eliminated in the office!

Our Approach to Your Care

Dr. Owens has been a vein care specialist since 1994. He is a member of the American College of Phlebology, the largest professional organization of vein care physicians. He takes pride in thoughtful, well chosen, compassionate and gentle care, and is honored to include Medicare patients in his practice. He was the first physician in Wisconsin or Minnesota to perform modern endovenous ablation treatment of saphenous vein varicosities, in early 2000, recognizing the opportunity to spare his patients from painful and unreliable vein stripping surgery.

At Minor Procedures, we offer the full spectrum of vein care, from the tiniest cosmetic spider vein, to severe advanced disease. We strive to provide the highest quality and the most affordable care. Please contact us with your questions!

1.     Careful Diagnosis

The nature of the problem must be understood, if the treatment is to work well.

2.     Selection of Treatment

Match the problem with the solution that's right for you.
What Can Be Done
Selecting the Right Treatment

3.     ALL OF THESE TREATMENTS ARE PERFORMED IN THE OFFICE, USING LOCAL ANESTHESIA. THERE IS NO NEED TO MISS WORK FOR RECOVERY. PATIENTS CAN WALK IMMEDIATELY, AND USUALLY DRIVE THEMSELVES HOME.

4.     Follow-up Care

Normal appearance and function can be achieved in most cases, and maintained for many years.

Follow-up Care

Be sure to ask Dr. Owens any questions you have about the disease, the diagnosis, or the treatment.

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NORMAL CIRCULATION

Blood vessels called arteries carry blood from the pumping chamber of the heart to tissues throughout our bodies. Arteries have strong, muscular walls, and carry bright red, oxygen-rich blood at fairly high pressure to maintain the flow of nutrients to all body parts continuously. The larger arteries branch repeatedly into smaller and smaller arteries, ending in tiny tubes called capillaries, which release the oxygen and nutrients to the individual organs and cells. After passing through the capillaries, the depleted blood flows back to the heart and lungs through the venous system. Tiny venules empty into larger and larger veins, joining the return flow from other organ systems as more and more branches join the stream. Veins carry oxygen-depleted, bluish blood at low pressure, and have thin walls compared to the arteries.

HOW PROBLEMS DEVELOP

As we age, and as the veins respond to the influence of hormones and heredity, and to other factors such as straining or prolonged standing, the veins tend to dilate to a larger diameter, which can trigger a series of permanent changes in the vessels and surrounding tissues. Normally, the blood in the veins can only flow in one direction (toward the heart) because of a series of one-way valves built into the vein walls. If the vein becomes too dilated, these valves can no longer function to prevent backflow, and then certain areas of the body no longer enjoy normal venous drainage. This is especially common in leg veins, because the difference in altitude between the legs and the heart makes gravity work against normal blood return.

Certain veins, called perforators, communicate between the shallow veins just beneath the skin, and the deep veins, protected beneath the tough envelope which surrounds muscles. If the perforators become dilated, and their valves fail, then the full pressure of muscle contraction is transmitted to the more fragile shallow veins.

The abnormal high pressure leaking from the deep vein system strongly affects the thin walls of these shallow veins. They gradually enlarge in diameter and also stretch in length in response to the extra pressure. This causes bulging and coiling in small veins (spiders) and in larger veins (varicosities). These vessels become permanently damaged, and carry blood very inefficiently. They become more of a hindrance than a help to the circulation of your blood.

Left untreated, the larger varicose veins (greater than 3-4 mm diameter) can develop spontaneous phlebitis or blood clots, with a risk of possible pulmonary embolism (blood clots which break free and are pumped into the lungs.) Also, untreated venous insufficiency can inflame and damage nearby skin and tissue and cause swelling, skin breakdown and open sores with ulceration and scarring.

DIAGNOSIS OF THE PROBLEM

During your initial evaluation at MINOR PROCEDURES, you will receive a focused physical examination and may have special diagnostic tests to help determine the nature of your vein disease, which allows us to choose the most appropriate way to treat the damaged veins and prevent further deterioration of both function and appearance.

These painless tests (called noninvasive venous hemodynamics tests) can identify potentially serious problems with the deep vein system, as well as pinpointing specific perforating veins or vein junctions which have malfunctioning flow valves.

WHAT CAN BE DONE

A variety of treatments can be used to treat the damaged veins. A conservative approach seeks to preserve the present status through use of compression stockings and avoidance of standing or sitting for prolonged periods. Sclerotherapy Injections can be used to close off the dilated and visible veins, and Microincision Surgery can be used to interrupt and/or remove large bulging varicosities. If there is leaking of the main valves in the groin area into the saphenous veins, minimally invasive EVLT laser [or VNUS Closure radiowave catheter] may be needed to eliminate back flow at that site.

SELECTING THE RIGHT TREATMENT FOR YOU

Depending on your history, the results of the physical exam and hemodynamic testing, you may be advised to have your vein problem treated by injection sclerotherapy, microincision surgery, or by a conservative approach of compression hose only.

Reflux (backflow) of the major flow valves in the upper thigh/groin area may require a minimally invasive catheter closure of the saphenous vein (an office procedure which replaces old-fashioned vein stripping surgery).

Usually you will be asked to wear gradient compression stockings for at least part of the treatment since success rates are higher with appropriate use of these hose.

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FOLLOW-UP CARE

Vein disease is a progressive problem, but with appropriate treatment, normal function and appearance can be achieved in most cases. Periodic examinations after the initial treatment sequence can allow you to avoid most if not all of the long-term consequences of chronic venous insufficiency.

Lifestyle factors may be of great influence in avoiding further deterioration of your condition. Smoking retards tissue healing, reduces the oxygen carrying capacity of blood, and makes dangerous blood clots much more likely. Significant obesity puts additional stress on the veins and worsens varicosis. Sedentary lifestyle is also a negative influence, as calf muscle contraction works as a venous pump to help empty the leg veins; regular, frequent exercise (especially walking) is very beneficial. Use of the compression stockings during periods of unusual stress (prolonged sitting or standing, pregnancy, etc.) can also protect you against worsening of your veins.  Certain dietary supplements such as horse chestnut seed extract may be very useful for some patients.

NEW TREATMENTS FOR BULGING VEINS

The cornerstone of correcting the problems caused by dilated veins is to eliminate the cause of the vein problem.  Large bulging surface veins are usually caused by a failed valve in the upper thigh.  When this valve stops working properly, pressure from the deep veins is transmitted to the surface of the leg, stretching and damaging the veins near the surface.

Eliminating backflow into the shallow veins may require closure of the saphenous vein in the thigh.  This has been done for nearly one hundred years by means of vein stripping surgery.  Unfortunately, this surgery has many drawbacks: high cost, the risk of general anesthesia, the need to miss work for postoperative recovery, and the apprehension many patients feel about having surgery.

Since 1999, new minimally invasive procedures have emerged to take the place of the stripping surgery.  Using ultrasound imaging, a radiowave catheter [or laser fiber] is introduced into the saphenous vein near the knee by a small incision using local anesthetic and advanced gently to the upper thigh location of the failed valve, allowing safe and effective closure of the vein.

The enormous advantage of the VNUS Closure or the EVLT laser procedure is obvious.  It works immediately, there is very little discomfort involved, and the patient can return to normal activities the same day.  There is no need to miss work for recovery in most cases.

The cost of these minimally invasive procedures is vastly less than for stripping surgery.  They are typically covered by most insurances, as they are well documented to be safe and effective.

MINOR PROCEDURES in Madison was the first location in Wisconsin or Minnesota to offer this revolutionary improvement in the care of bulging veins.  Since April of 2000, we have performed several hundred minimally invasive endovenous closures of saphenous veins in the office setting, saving several hundred thousand dollars in surgical and operating room charges on behalf of our patients, as well as preventing several years of unneeded time off work for recovery.  This benefits patients, employers and third party payers alike, with improved results, fewer complications, and vastly less discomfort and inconvenience.

For further information, visit http://www.vnus.com/, or http://www.evlt.com/evlt.jsp or call us at
608-251-6060

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