Sclerotherapy in Review

Sclerotherapy is used to treat spider veins and varicose veins by injecting a sclerosing agent into the interior of the troublesome vein. This substance causes the vein walls to become sticky and seal shut. The collapsed vein is reabsorbed into local tissue and eventually disappears. There is little risk of complication, and patients often experience an immediate relief of symptoms.

Light-assisted sclerotherapy is used to treat smaller veins below the skin’s surface. These reticular veins are responsible for feeding the veins that are visible on the surface of the skin. A small, powerful light illuminates the veins and tissue directly below the patient’s skin, allowing the physician to clearly identify the source of the venous dysfunction and to perform the procedure.

Ultrasound-guided sclerotherapy is used for larger, less superficial veins that cannot be seen with transcutaneous illumination (light used to view veins near the surface). Due to proximity of some of these veins to nerves, arteries and other structures, a skilled ultrasound sonographer is critical to the success of this procedure.

After sclerotherapy, treated veins often fade within a few weeks, although it may take longer to see the full results. In some instances, several sclerotherapy treatments may be necessary.

Liquid vs. Foam

There are several kinds of liquid sclerosing agents. The most popular modern sclerosant is call polidocanol. This is a detergent by nature, and therefore, can form bubbles easily. Foam sclerotherapy is, simply put, the mixture of the liquid sclerosant with a gas to create those bubbles.

In the treatment of varicose veins, foaming the sclerosant enables it to displace the blood in larger veins, rather than just mixing with it, as a liquid sclerosant would. That means foam provider a longer contact time between the chemical longer contact time between chemical and the vein wall and is more effective on larger veins, such as the great saphenous vein (GSV) and other truncal veins. Liquid sclerosants work best on the smaller, reticular veins.

Another significant advantage of foam is that it is echogenic, which means that it is easily visible on an ultrasound, increasing the accuracy with which individual veins can be treated.

In addition, because of the efficacy of the sclerosing agent is increased with foam, a lower concentration can be given to treat varicose veins, which means having a smaller total dose of sclerosant to achieve the desired effect.

The most common method for producing foam for sclerotherapy is the “Tessari technique”, which involves manually mixing a small volume of liquid sclerosant with a volume of room air or other gas using two syringes and a three-way tap, or stopcock.

If you or someone you know is suffering from varicose or spider veins, we encourage you to visit our office for a complimentary vein screening. During this screening, we will go over your medical history, complete a visual exam, review your diagnosis and if needed, recommend a venous ultrasound, which will provide the needed results for your treatment options. Please give us a call if you have any questions or would like to schedule your free screenings.

This article was originally published in it’s entirety by Vein Healthcare News and was written by Jennifer Boggs.

Exercising and Varicose Veins

If you already have a pre-existing venous condition such as venous insufficiency or varicose veins, exercising can be painful! There are some exercises that are more likely to worsen varicose veins as well. It is important to see a specialist regarding any changes or discomfort.

Exercise is part of a healthy routine and lifestyle, so rather than avoiding exercise, be smart about how you work out. These types of exercises will help strengthen your legs without a strong risk of developing varicose veins. To learn more about Exercising and Varicose Veins, please speak with your vein specialist.

  1. Do exercises that keep your legs even or higher than your heart

    • Gravity has a huge pull on the formation of varicose veins. Keeping your legs at the same height or higher than your heart during a workout will help to take off the extra pressure that can be put on leg veins during exercising.

  2. Keep Breathing Even and Consistent

    • Many people find breathing more difficult and even strained during physical activity, especially weight lifting. Holding your breath increases your blood pressure, which is horrible for varicose veins. Full and even breaths will help keep your blood pressure more consistent, decreasing the pressure on the veins.

  3. Wear Compression Stockings

    • Next time you go for a run or hit the gym, don’t forget your compression stockings. These can help strengthen your veins and help to prevent varicose veins.

Proactive Prevention

Joe Knapp was 14 years old when he was hit head-on by a car while he was riding a bicycle. The accident fractured his left femur at the proximal one-third of the bone and put him in traction for a week. Femur rodding was a new procedure at the time, but the bone healed quickly and Knapp was able to resume sports like basketball and cross-county running.

Fast-forward about ten years. Knapp started to see varicose veins gradually forming on his left ankle and along the scar from the rodding surgery he’d had in high school. At 35, he started to wear knee-high support hose to protect his legs from long shifts as a nurse on a medical-surgical unit. But his leg got worse.

“I wore support hose for more than a decade, but as the years went on, they were less and less helpful,” said Knapp. “When I turned 50, they stopped being effective at all, and I began to notice an itching and heaviness in my legs.”

Fortunately, Knapp had some training in wound care and knew that all venous ulcers start somewhere, often with symptoms of itching and swelling. In addition, there was a history of lymphedema in Knapp’s family. His mother had Milroy’s disease, a condition characterized by lymphedema in the legs and caused by congenital abnormalities in the lymphatic system. Knapp’s sister also developed swollen ankles in her 30’s, and he also has ankles that swell easily.

Knapp’s family history of lymphedema, combined with years of working on a hospital cement tile floors, motivated him to investigate further. And his 2 1/2 years of wound care convinced him to do something about it before it got worse.

“I’ve seen what can happen when some people don’t do anything to address the problem,” said Knapp. “The varicose vein can eventually become a venous ulcer, a wound- and wound healing can turn into a long, arduous process.” He added that once the tissue “has had an assault on the system,” it becomes more difficult to repair as the person ages. The presence of varicosities, or even swelling, can exacerbate it.

In Knapp’s case, awareness led to action. He went to a board-certified phlebologist for a physical exam and diagnostic ultrasound. Together they decided to pursue sclerotherapy, a procedure that Knapp described as “smooth and virtually painless.” He had five sclerotherapy treatments on his legs and the results were immediately apparent. His legs stopped itching and felt lighter, and according to Knapp “they looked much better too.”

Now, three years later, Knapp is a nurse in a private practice. Because of his vein experience and the care he received, he expresses his concern to the doctor whenever he sees varicose veins or other venous issues, in an effort to treat the problem early and prevent further problems, such as venous ulcers, infections, superficial thromboses and potential bleeding.

“Just the idea that I could get an ulcer before I turn 60, no thanks!” Knapp stressed. “These kinds of problems don’t go away on their own- you need to do something about it.”

If you, a friend or a family member suspects varicose veins or other venous issues, we encourage you to come in for a free screening. Proactive Prevention is the best way to keep venous issues under control.

4 Reasons to Ask your Physician About Veins

  1. Legs Often Feel Tired or Heavy– These are two of the most common (and early) symptoms of a vein problem. Intense leg fatigue at the end of the day is a sign. Heaviness is usually a result of mild swelling due to poor venous return (blood flow back up to the heart). These symptoms can easily be treated with compression stockings or other minimally invasive therapies.
  2. Varicose Veins– Many people discount their bulging veins because they’ve been told for years that varicose veins are cosmetic and not covered by insurance. In 1999, the FDA approval of the endovenous approach to vein care changes this dramatically. Today, there are many modern procedures available and, when performed by a skilled phebologist, there is minimal discomfort and great long-term success.
  3. “Bad Veins” Run in the Family– Approximately 60% of people who have one first-degree relative with venous issues will also have issues. That statistic shoots to almost 90% if someone has two first-degree relatives with vein problems. If someone has a family history he/she should be proactive about vein disease prevention and consider going to a vein specialist for a baseline evaluation. We offer free vein screenings.
  4. Open Sore on One or Both Legs– Though some people suffer from arterial ulcers on diabetic ulcers, the vast majority of leg ulcers have a venous component. Today, more leg ulcers are closer and stay closed because of more effective and focused venous procedures.

Healthy Veins for Winter

Varicose vein and spider vein treatments tend to be more prominent in the winter months. Winter tends to be a better time of year for those who experience problems with venous disease as the heat of summer typically causes the veins to dilate and stretch. This will generally increase the symptoms associated with varicose and/or spider veins.

Compression Therapy

In the winter months, vein patients are much more likely to wear compression stockings or socks, having them act as another layer of insulation. Compression stockings will not completely cure vein issues, but they are able to improve the symptoms and keep the issue from getting worse.

The concept of compression therapy is based on a simple and efficient mechanical principle consisting of applying an elastic garment around the leg. By compressing the limb with graduated compression (strongest at the ankle and decreasing going up the leg), the compression stocking acts as a layer of muscle by gently squeezing the stretched vein walls together, allowing the valves to close. The cavity of the vein is reduced, thereby restoring blood flow to a normal state and aiding overall circulation.

There are two common types of compression therapy:

  • Compression Stockings: The usual first line of therapy (especially per most insurance companies) is entirely non-invasive. When applied, high-pressure stockings may prohibit veins, closer to the surface, from pooling.
  • Unna Boot: Unna Boots are useful in healing leg wounds and ulcers. These ‘boots’ are compression gauze that contains zinc oxide paste to further aid the healing process.

Regular Activity

Many people prefer to stay inside during the colder months. A lifestyle with less activity and more sitting around could increase the symptoms associated with the varicose or spider veins. Excessive sitting increases the pressure in the legs and can cause the blood in unhealthy veins to pool more quickly. Keep the legs active as much as possible during the winter months by:

  • Getting up and walking around the house/office multiple times a day
  • Mall walking around the holidays
  • Riding a stationary bike
  • Elevating your legs if you have to sit/lay for an extended period of time
  • Don’t cross your legs while sitting, if necessary cross your legs at the ankles

Each patient’s condition is unique. For this reason, we offer an initial complimentary* vein screening to evaluate each patients condition so that we can recommend the appropriate treatment protocol. The following is reviewed in the initial complimentary* vein screening:

  • Medical History
  • Visual Exam
  • Recommendation for Venous Ultrasound (if needed)
  • Review of Diagnosis
  • Treatment Options (will depend on Ultrasound results)

*Additional diagnostic ultrasound testing may be required, which will be billed to the insurance carrier.

Call our office or visit our website to learn more and schedule a free screening today!

Peripheral Arterial Disease affects over 40% of Adults over 40

More than 40 percent of Americans aged 40 and older have experienced one or more of the most common symptoms of peripheral arterial disease (PAD). However, the majorities are unfamiliar with the disease and relatively few who experience symptoms see a doctor, according to a recent online awareness survey conducted by Harris Poll.

The Covidien-sponsored survey of more than 2,000 U.S. adults in September highlights the need for greater awareness of PAD, a disease affecting approximately 202 million worldwide and 8 to 12 million people in the United States.

Specific findings of the survey included:

43 percent of Americans ages 40 and older have experienced one or more of the most common symptoms of PAD;
63 percent of adults ages 40 and older have never heard of PAD;
Only 34 percent of those who have experienced symptoms of PAD have spoken to their doctor.
shutterstock_79761805 Additionally, the most commons symptoms of PAD that were experienced by Americans ages 40 and older included: fatigue when walking or climbing stairs (20 percent); pain that disturbs their sleep (16 percent), and pain when walking or climbing stairs (17 percent). In 42 percent of Americans ages 40 or older, the symptoms impacted their daily life, including not being able to exercise as much/at all (27 percent), having to stay home more (17 percent) and weight gain (15 percent).

“PAD can be difficult to recognize and diagnose, and adults often dismiss symptoms of PAD as normal signs of aging,” said Mark Turco, M.D., chief medical officer, Vascular Therapies, Covidien. “However, it is important for individuals to talk to their doctor about the symptoms and risks of PAD. PAD is usually also associated with other cardiovascular diseases, and if left undiagnosed, can lead to major health issues.”

PAD is one of the most common vascular diseases. It occurs when arteries in the legs become narrowed or blocked by plaque, and it can cause severe pain, limited physical mobility and non-healing leg ulcers. PAD can also result in serious health consequences such as amputation, cardiovascular disease and death. In fact, people with PAD are six times more likely to die from cardiovascular disease within 10 years than people without PAD.

There are a number of risk factors associated with PAD, some of which are controllable and include smoking, diabetes, high cholesterol, and high blood pressure. In fact, one in three people ages 50 and older with diabetes are likely to have PAD and more than 80 percent of patients with PAD are current or former smokers.

Advancing age also increases an individual’s risk for PAD. Up to 20 percent of individuals 65 and older have PAD. In fact, the survey found adults aged 55 and older were more likely to experience the most common symptoms of PAD.

Methodology of the Survey: This survey was conducted online within the United States by Harris Poll on behalf of Covidien from September 2-4, 2014 among 2,017 adults ages 18 and older, among which 1,393 are age 40+. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated. Article adapted by Medical News Today from original press release.

Q&A: Compression Hose for Travel?

Q: Which type of compression stocking should be worn for travel and by someone who has postural tachycardia syndrome? I am taking a long haul flight that is about 15 hours. I have postural tachycardia syndrome (POTS) and would like to wear a comfortable and effective compression stocking on the flight. Should I opt for knee-high, thigh-high, or panty hose? Also, what grade?

A: 15-20 mm Hg stockings should suffice, and the knee-highs are all that is required. Just get up and move about during the flight every 30 minutes and exercise your calf muscles at your seat every now and then.

Q&A: Leg Falls Asleep After Ablation

question1Q: The leg that was treated with endovenous laser ablation falls asleep soon after sitting down, is this normal? I am two weeks out from endovenous laser ablation (EVLA) and have had several complications that my physician has seen me for. A blood clot was ruled out but now the leg that had the procedure falls asleep very soon after sitting down. Is this normal?

A: This should resolve with time, especially if you still have some leg swelling. I would give it up to 6-8 weeks to resolve, assuming this is your only complaint, but you should always stay in close follow-up with your treating physician.

Veins and Feet: A Direct Connection

Whether you’re standing still, running to your next appointment, or dancing the salsa, think about how much time you spend on your feet. Most Americans log 75,000 miles on their feet before they reach age 50, according to the American Medical Podiatric Association (APMA). It’s no wonder that Dr. Sunny Raleigh, a primary care physician at True North Health Center in Falmouth, Maine, says that feet are a vital component to overall health.

“From an osteopathic perspective, we see the feet as our foundation,” said Dr. Raleigh. “When you consider and examine the feet, you can usually unwind many physiological concerns in the rest of the body.”

The fascial, musculoskeletal, nervous, lymphatic, and venous systems in the feet all have intimate feedback connections to the rest of the body, so paying attention to the feet allows Dr. Raleigh to “see the whole person” and assess if something else may be contributing to a problem. She emphasizes the importance of addressing, not just the physical manifestations or symptoms, but also the underlying issues. Her approach is to look upstream for the causes of the downstream diagnosis, continually seeking answers to the question: what is the systemic breakdown that we need to try to repair?

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Veins & Feet:

Problems in the feet can be manifestations of arterial or venous concerns. Peripheral arterial disease (PAD) and other related disorders are important to consider when examining the foot. However, the close correlations between foot issues and venous disease- the impairment of blood flow back up towards the heart- also deserve attention.

If venous return is impeded due to damaged valves in the venous system, then the backward flow of blood can pool in the legs and feet. The vein insufficiency, or venous reflux, can cause leg pain and fatigue, spider veins or varicose veins. If left untreated, it can lead to edema, corona phlebectasia and ultimately, ulcers.

Predominantly, most vein issues will present in the medial ankle or anterior shin area. If veins aren’t functioning properly, then edema will often occur. Edema is the venous symptom that is most frequently encountered. People with mild edema in their feet and legs don’t always realize it, but over the years it can create chronic reactions in the skin, such as hemosiderin staining, which is a brown or rusty discoloration of the lower legs. When vein valves fail, regurgitated blood forces red blood cells out from capillaries; those dead cells then release iron, which gets stored in the tissues as a hemosiderin.

The onset of edema can be a prelude to other more serious issues, as the skin becomes susceptible to breakdown and venous ulceration.

“Venous ulcers are always very challenging, and sometimes impossible, to heal,” said Dr. Maisak, a doctor of Podiatric Medicine at Portland Foot & Ankle in Portland, Maine. “Early detection and control of edema will reduce those chronic changes of the skin, greatly lowering the risk of long-term effects.”

According to Dr. Dwight Blease of Casco Bay Podiatry in Brunswick, Maine, some of those long-term effects may include bacterial skin infections or infection of the bone, as well as “all the morbidity associated with those conditions.”

There are a number of minimally invasive treatments of venous disease available, including endovenous laser ablation and sclerotherapy. (North Shore Vein Center Treatments)

Dr. Raleigh suggests that there may also be a role for osteopathic manipulative medicine in treating vascular and venous insufficiency. A 2012 study showed that adding myofascial manipulation to venous treatment increased venous return in post-menopausal women (when compared to direct venous treatment alone).

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Making the Connection:

Because the primary care physician is typically the first encounter a patient with complaints around venous disease and related diseases will have, that initial contact can set the stage for a treatment plan.

According to Dr. Raleigh, a good diagnostic exam often leads to a referral for further studies and intimate care with specialists: “We all have our role to play in supporting the overall health of each patient, with the PCP acting as QB, making sure the plays are going off as desired. It’s our priority to make sure that the patient is getting the best possible care by using specialists and adjunct providers optimally.”

Dr. Blease has been practicing podiatry for more than 25 years. He explains that when he was in podiatry school there was an emphasis on the arterial system, with little study of the venous system. He also recalls having a patient who was told she could never have surgery done on her foot because she’d had her veins stripped and the potential for severe swelling and delayed healing were great.

“Now with these newer techniques in vein treatment, our patients heal quicker and we get an improved functional result,” Dr. Blease said. “We can now see how phlebologists’ skills are expertise can help us do our job better.”

Dr. Masiak concurs. If he sees that a patient has venous insufficiency, he will consult a vein specialist for possible treatment. Vein insufficiency (often accompanied by edema) may be a contradiction to surgery, because of the likelihood that the skin will have trouble healing. He also recognizes that podiatrists can play a role in early detection for venous or vascular issues.

“We see a lot of lower extremities, so we can be a good source for identifying vein-related problems,” said Dr. Maisak.

Even the APMA, the leading professional organization for podiatrists in the U.S., has acknowledged the link between podiatry and phlebology. In 2013, the APMA joined the “Rethink Varicose Veins” campaign to raise awareness of venous disease diagnosis and treatment.

Dr. Blease see the “Rethink” campaign as a step in the right direction. He believes this is an issue that goes undiagnosed and untreated in many situations, and he encourages all physicians to learn more about it: “We all share the same goal- keeping our patients active, independent, working and enjoying their favorite things in life.”

Vein Health News originally published this article by Jennifer Boggs. The article has been edited for space, but the full article can be viewed here:




Laser Treatment Best Option for Varicose Veins

When treating varicose veins, laser therapy remains the best option, a new study says.


Researchers in the study examined 798 participants who had varicose veins and were treated at 11 vascular surgery centers in the United Kingdom, between November 2008 and October 2012. The participants underwent one of three types of treatments: closing off the veins with a laser, injecting a drug “foam” into the vein or surgically removing the vein.

After six months, the researchers compared the outcomes, looking at how well the treatments worked and at their complication rates, as well as how the participants rated the change in their quality of life since their treatments.

“The main findings indicated that laser therapy was the preferred treatment for varicose veins,” said study author Dr. Julie Brittenden, a professor in vascular surgery at the University of Aberdeen in Scotland. “We found that all three treatments reduced symptoms associated with varicose veins, but there were fewer complications after laser treatment.”

What causes varicose veins?

Varicose veins are blood vessels that have become swollen, enlarged and twisted. Improperly working valves in the veins cause the disorder, Brittenden explained. In people who have this condition, blood returns up to the heart from the veins in the legs because of the contraction of the calf muscles, she said. Normally, valves in these veins prevent blood from flowing backwards, down towards the feet.

“People with varicose veins have leaky valves, which means that some blood flows backward and pools in the veins, causing them to become enlarged,” she said.

The procedure called endovenous laser ablation, or laser therapy, uses heat generated by laser energy to seal off faulty blood vessels, diverting blood flow immediately to nearby healthy veins.

Foam treatment involves injecting drugs into a blood vessel. The medicines, when mixed with air, cause the vessel wall to thicken, which also helps to seal off blood flow. The recent study showed that foam was less likely than the other treatments to completely close a vein that had leaky valves, which may increase the likelihood that a patient will need future treatment, Brittenden said.

In the study, about 1 percent of patients who underwent treatment with a laser experienced complications such as lumpiness, skin staining and numbness. About 6 percent of those who received the foam treatment, and 7 percent of those who underwent surgery experienced such complications, according to the study.

The researchers also found that successful ablation of the great saphenous vein occurred in 83 percent of those who received the laser treatment and 84.4 percent of the participants who underwent surgery.  These numbers were significantly higher than the 54.6 percent who had such successful ablation after the foam treatment. The great saphenous vein, the longest in the body, runs along the length of the leg.

The study appears in today’s (September 24) issue of the New England Journal of Medicine.

Dr. Kevin McMullen, a vascular surgeon at Surgical Hospital of Oklahoma who was not involved with the study, said he agreed with Brittenden’s conclusion. “Laser is preferred over surgery or foam due to higher success rates with the least amount of complications,” he said.

Laser therapy works better than foam on larger veins, as the success rates for foam treatments worsens with increasing vein size, McMullen said. However, surgery may be the best choice for patients who have previously had vein procedures, or who have anatomical issues, such as veins that are very close to the skin or are larger than three-quarters of an inch (20 millimeters) in diameter, he said.

Can varicose veins be prevented?

Varicose vein treatment is not done just for cosmetic reasons, Brittenden said. “People with varicose veins often suffer from aches and discomfort,” she told Live Science. “The condition can also cause swelling of the ankles, skin changes and sometimes ulcers.”

Both men and women get varicose veins, she said. The condition is more common in pregnant women, older patients, overweight people and those who stand for long periods. It is also more prevalent in people who have a family history of varicose veins.

People can’t prevent varicose veins from forming, but may be able to delay their formation or prevent existing varicose veins from getting worse, according to the National Institutes of Health. The NIH recommends that people avoid standing or sitting for a long time without taking breaks; avoid crossing their legs when sitting; and keep their legs raised when sitting, resting or sleeping.

Losing weight and doing exercise that works the leg muscles can also help, the NIH said.

This article was originally posted by LiveScience. To view the article go to:

The doctor at North Shore Vein Center will perform a full evaluation on every patient to determine the best method of treatment on an individual basis. Laser treatment is a proven method, but there are other procedures available that may better suit a specific patient’s needs. This article is purely informational.


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