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InterMed vein clinic - FAQ About InterMed Vein Clinic What may I expect during my initial consultation? We begin your preliminary consultation with a thorough physical examination in combination with an ultrasound to determine the extent of your varicose veins. With this information, Dr. Milne creates a personalized treatment plan designed to achieve your desired results What are your office hours? InterMed Vein Clinic is open Monday through Friday, 9:00 a.m. to 5:00 p.m. What type of medical insurance do you accept? We are participating providers for Medicare, Medi-Cal, all PPO plans, most of HMO plans and many other insurance plans. What payment options are available to patients without any insurance? We have several financing options to offer to our patients with no insurance. The terms and conditions of these financing options depend on multiple factors, including patient's credit score and income. We also accept payments by Care Credit, major credit cards, and Paypal. About Venous Disease How are arteries different from veins? Arteries are blood vessels that pump oxygen-rich blood away from the heart to different parts of body. Veins are blood vessels that return oxygen-poor blood from various parts of the body back to the heart. With respect to the legs, arteries bring the blood down to the legs, and veins return blood up the legs back to the heart. All veins have one-way valves to prevent blood from flowing in the wrong direction back toward the feet. What are the three main categories of veins in the leg? Deep veins are in the center of the leg, within the muscles and near the bones. 90% of blood from legs returns back to the heart via these deep veins. Superficial veins are just beneath the skin, above the muscles. They act as the side roads to return blood back to the heart. Perforator veins serve as connections between the deep and superficial veins. Blood flows from superficial veins into the perforator veins in order to connect with the deep veins and return to the heart. Why do varicose veins occur in the legs? Varicose veins are enlarged veins extending down the leg, or occurring in bunches, like grapes, or in snakelike curves beneath the surface of the skin. Varicose veins develop when valves in veins fail. The distance from the feet to the heart is the furthest blood has to travel in the body. Consequently, if the vein valves fail, the backflow of blood causes the surface veins in legs to be under pressure, become swollen, enlarged and distorted. Who is at risk for varicose veins? Multiple conditions contribute to varicose veins: genetics, hormonal changes at menopause, pregnancy, extended standing, injury to legs, obesity, and past vein such as thrombophlebitis (inflammation of veins) or previous history of blood clots. Women suffer from varicose veins more than men, and the incidence increases to 50% of people over age 50. What are the symptoms of varicose veins? Varicose veins may cause legs to ache, feel heavy, and tire easily. Feet and ankles may swell by the end of day. Varicose veins may itch or burn. Leg cramps can occur at any time, but more often at night. Varicose veins can get inflamed and cause redness of the skin. As skin and tissue damage progresses, ankles and feet can develop brown or black discolorations. In some cases, patients may develop ulcers and open painful sores. What can happen to varicose vein disease if left untreated? If varicose veins are left untreated, smaller abnormal veins may increase in number and are associated with worsening symptoms such as leg pain, leg cramps, swelling, fatigue, skin rash and discoloration. Phlebitis, thrombosis (severe blood clots), spontaneous bleeding and skin ulcers are complications of varicose vein disease. How are blood clots formed in varicose veins? The blood flow in varicose veins is slow enough to encourage blood to sit still and coagulate. The medical term, superficial thrombophlebitis, refers to the occurrence of blood clots in superficial veins. Superficial thrombophlebitis rarely causes death or a blood clot that travels to the lungs. However, progression of a superficial phlebitis to involve the deep veins may have fatal consequences. What are spider veins? While varicose veins are located deeper under the skin in fat, spider veins are hair-thin, much smaller and superficial and are located in the skin. They may be blue or red color and frequently look like a spider. They may or may not be associated with other underlying vein disease, such as varicose veins. Therefore, an ultrasound exam may be advised since unrecognized underlying vein disease is the most common reason for unsatisfactory results. This is why even spider veins should be treated by a physician with formal expertise in vein disease. What are venous leg ulcers? A skin ulcer is caused by a venous reflux disorder or chronic leg venous hypertension that is not treated. Venous stasis ulcer or sores are areas of the lower leg where the skin has opened and exposed the flesh beneath. Early signs that a venous stasis ulcer may develop include darkening of the skin in the area of the ankle. Gradually, the skin may become leathery or waxy in appearance. Without treatment of the venous disease, the skin may breakdown and bleeding may occur. Ulcers can differ in size or appearance. They are painful, odorous open wounds which weep fluid and can last for months or even years. Most leg ulcers occur when vein disease is left untreated. They are most common among older people but can also affect individuals as young as 18. About Venous Disease Treatment How can varicose veins be treated? Since vein valves cannot be easily or effectively repaired, the only alternative is to re-route blood flow through healthy veins. Traditionally, this has been done by surgically removing (stripping) the troublesome vein from legs. The endovenous ablation procedures (VNUS and EVLT) provide less invasive alternatives to vein stripping by simply closing the problem vein instead of stripping it. Once the diseased vein is closed, other healthy veins take over and empty blood from legs. What is the conservative treatment for varicose veins? Exercise, compression stockings, and elevation of legs during rest may improve symptoms. However, these regimens will not treat varicose veins or the underlying disease (venous reflux) and will not prevent varicose veins from worsening. At best, they may slow the advances of the complications of chronic vein disease, but will not reverse them. How are spider veins treated? Before treating surface spider veins, any underlying vein disease must be evaluated and treated first. Sclerotherapy is used to treat spider veins. This involves using a tiny needle to inject a small quantity of a solution that will shut down the vein. It is nearly painless, and even patients who are afraid of needles do very well with treatment. First, larger varicose veins are treated. Second, medium size surface feeder veins (called reticular veins) which are connected to spider veins are treated. Lastly, spider veins are treated within a few weeks. After treatment sessions, a compression stocking is worn for four weeks during the day. Injection sites may initially appear bruised or red. Within a few weeks, once the healing process in complete, most spider veins look better, although, continued improvement usually occurs over many months. Depending on the size and surface area of spider veins, multiple treatment sessions may be necessary. What is phlebectomy? Phlebectomy is a surgical procedure used for the treatment of varicose veins. Multiple small incisions are made along the varicose vein and veins are pulled and removed from the leg using surgical hooks or forceps. The procedure is done under local or regional anesthesia, in an operating room or an office 'procedure room.' At InterMed Vein Clinic we avoid phlebectomy by using less invasive treatment methods. What is vein stripping? Vein stripping is a surgical procedure used for the treatment of varicose veins. This is a more extensive procedure than phlebectomy and is used in treatment of larger surface veins. Under general anesthesia, all or part of the vein is tied off and pulled out. The legs are bandaged after the surgery, however, swelling, bruising, and pain can last from days to weeks. Vein stripping should be regarded as a procedure of the past. It carries higher risk, greater pain, greater disability, longer recovery, greater cost, and less effective results than minimally invasive procedures such as VNUS or EVLT. Vein stripping causes a lot more bruising and pain which results from tearing the side branch veins while the saphenous vein is pulled out. What are alternative treatment methods to surgery? Two alternative minimally-invasive methods called endovenous ablation procedures are available and allow to treat veins without surgery: VNUS Closure and EVLT. VNUS Closure is based on radiofrequency energy and EVLT is based on laser energy. Both are new revolutionary treatments used instead of vein stripping. These methods eliminate venous reflux and treat varicose veins without physically removing the vein. It is performed as an outpatient same-day procedure in the office with local anesthesia. A special catheter is inserted into varicose veins and caused the vein to close off and empty blood. These methods eliminate the pain, bruising and extended recovery time of traditional vein stripping surgery. Like other procedures, VNUS Closure and EVLT involve risks and potential complications, but risks are much less likely and results are more effective than with traditional surgery and vein stripping. What are the effects of varicose vein treatment on blood flow? Patients at times are concerned that the loss of the varicose veins will have a negative effect on their circulation. They ask: 'How will the blood get back to my heart if these veins are gone?' The answer is that varicose veins are non-functional and do not help the circulation. Blood does not flow effectively through varicose veins back to the heart and instead, sits in the legs. Varicose veins can actually harm the body. Their treatment improves circulation by allowing blood to pass through the remaining normal functioning veins back to the heart. Will my varicose veins return after treatment? Effective treatment using VNUS Closure, EVLT and/or Sclerotherapy, is typically long-lasting. The results show more than 96% of veins treated remain in reflux-free and symptom-free at five years. With all treatment methods, new veins may appear over time. Varicose veins are rarely "cured" but treatment brings significant symptomatic relief and desired cosmetic results. How long does endovenous ablation procedure take? The procedure typically takes about 45-60 minutes, including the normal pre-procedure preparation and post-treatment evaluation. Is endovenous ablation painful? Patients report feeling little, if any, pain during the procedure. Local or regional anesthetic will be administered to numb the treatment area. How quickly after ablation procedure can I return to normal activities? Many patients can resume normal activities immediately. For few weeks following the treatment, we recommend our patients to take regular walks and to avoid strenuous activities (for example, heavy lifting) or prolonged periods of standing. Is there any scarring, bruising, or swelling after VNUS Closure or EVLT? Patients report minimal to no scarring, bruising, or swelling following the procedure. Is endovenous ablation procedure suitable for everyone? Experience has shown that many patients at any age with superficial venous reflux can be treated with the endovenous procedure. Is age an important consideration for an ablation procedure? The most important step to determine if an endovenous ablation procedure is appropriate is to complete ultrasound examination by a qualified clinician. Age alone is not a factor. Ablation procedures have been used to treat patients across a wide range of ages. Is treatment covered by insurance? Many insurance companies pay for the treatment. The coverage is determined based on medical necessity. We can discuss your insurance coverage further at the time of consultation. Are patients happy with ablation procedures? 96% of patients who have undergone the VNUS Closure or EVLT procedures are willing to recommend it to a friend or family member with similar leg vein problems.
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Oboljenja vena Venski sistem u nogama sastoji se od površinskih i dubokih vena. Površinske vene smještene su u potkožnom masnom tkivu i one imaju ulogu skupljanja „potrošene“ krvi, dakle krvi koja je bogata otrovnim ugljendioksidom, i tu krv usmeravaju i vode u duboke vene. Duboke vene nalaze se u dubinskim slojevima organa između mišića, u blizini zglobova. Upravo su duboke vene odgovorne za hemodinamiku, odnosno najveći dio venske krvi se transportuje u srce upravo preko dubokih vena. Oboljenje površinskih vena ispoljava se slikom proširenih vena, koje nazivamo varices, odnosno varikoziteti vena. Bolovi u nogama često su povezani upravo s proširenim venama, a simptomi mogu uključivati i zamor nogu, svrb, crvenilo ili pak osećaj težine u nogama. Proširene površinske vene (Varices), ukoliko se ne liječe, mogu dovesti u pitanje ishranu kože hranjivim sastojcima i uzrokovati mnogobrojne direktne i indirektne komplikacije, a to mogu biti: – Upala površinskih vena – THROMBOPHLEBITIS – Formiranje otvorenih rana – ULCUS VENOSUM – Krvarenje iz tortuoznih vena – HAEMORRHAGIA – Tromboza dubokih vena – PHLEBOTHROMBOSIS Oboljenja površinskih vena nisu uvijek vidljiva okom, i zbog toga su u prepoznavanju oboljenja i lečenju izuzetno važne tehnike i metode kojima se mogu s velikom sigurnošću dijagnostikovati uzroci i stepen problema. Obzirom da se najveći deo krvi u venskom sistemu kod čovjeka prenosi dubokim venama, uklanjanje površinskih vena ne utiče na hemodinamiku jer duboke vene koriguju gubitak tako što mogu varirati kapacitet transporta krvi i prema potrebi prenijeti veću količinu krvi. Za razliku od oboljenja površinskih vena, oboljenje dubokih vena dovodi do smetnji u protoku venske krvi. U slučaju prekida toka venske krvi u dubokim venama, odnosno ako se dogodi ugrušak u dubokoj veni, to nazivamo Phlebothrombosis. U ranom stadiju stvaranja ugruška u dubokoj veni postoji mogućnost da se dio ugruška odvoji, i začepi plućnu venu što dovodi do veoma teškog stanja koje nazivamo Plućna embolija. U daljnjem toku razvoja flebotromboze, kao kasna posljedica razvijaju se kronične promjene koje se očituju u promjeni boje kože i stvaranju otvorenih rana (Ulcus venosum). Izuzetno je važno napomenuti da oboljenja vena, ukoliko se ne liječe, mogu imati fatalne posljedice. Proširene vene i prošireni kapilari nisu ista stvar. Prošireni kapilari su minijaturna venska proširenja, koje su za razliku od Površinskih i Dubokih vena, smještene u najpovršnijem dijelu kože, tzv. epidermisu. Također, nastanak, tegobe i načini liječenja nisu jednaki, tako da su dijagnostički postupci od iznimne važnosti kako bi se točno identifikovala vrsta oboljenja a u skladu s tim odabrala i najbolja metoda liječenja. Simptomi i dijagnostika Pravovremeni pregled može otkriti eventualno oštećenje venskih zalistaka i što je još važnije, uputiti na odgovarajuće liječenje. Za Vaš prvi dolazak na pregled vena nisu potrebne nikakve pripreme: pregled vena Doppler sonografijom (ultrazvuk vena) potpuno je bezbolan i za organizam neškodljiv postupak. Pored opisanih dijagnostičkih postupaka, uz razgovor s lekarom, celokupni pregled traje otprilike 30 minuta, a nalazi i dijagnoza su dostupni neposredno nakon tog pregleda, i na rezultate ispitivanja ne trebate čekati. Nakon razgovora , pri čemu posebno treba obratiti pažnju na porodicnu anamnezu, na raspolaganju su savremeni dijagnostički postupci, koji su bezbolni i učinkoviti: Ultrasonografija Duplex sonografija Flebografija Komplikacije – Thrombophlebitis – slobodno možemo reći da je upala površinskih vena sa stvaranjem tromba prva i najlakša komplikacija koju srećemo kod osoba s proširenim venama. Očituje se crvenilom kože, otokom i bolovima na tom mjestu. – Ulcus venosum – ili „otvorena rana“, pojavljuje se kod osoba s dugogodišnjim oboljenjem proširenih vena. Nastaje kao rezultat slabosti dubokog venskog sustava zbog proširenih površinskih vena. – Treća komplikacija je krvarenje iz jako tortuozne vene, što se naziva Aneurizma. To je balonasto proširenje vene, najčešće na mjestu oštećenog venskog zalistka. Površna trauma, a ponekada i spontano, može doći do veoma jakog krvarenja s neizvjesnim ishodom. – I konačno najteža komplikacija, koja se javlja čak 85% češće kod osoba s proširenim venama je tzv. Flebotromboza, a to je stvaranje krvnog ugruška u dubokoj veni. To često dovodi do plućne embolije, što je veoma ozbiljno stanje. Lečenje proširenih vena Najvažniji cilj lečenja kod oboljenja vena je: – Ukloniti venski zastoj – Ubrzati protok venske krvi Za lečenje oboljenja vena postoji više mogućnosti: Hirurško liječenje, odnosno uklanjanje mjesta nastanka proširenih vena, kao i uklanjanje proširenih i izvijuganih površinskih vena jedina je metoda koja nudi mogućnost izliječenja. Medikamentozna terapija na bazi bilja pomaže da se smanje tegobe, odnosno simptomi, kao što su otekline ili osjećaj težine u nogama, ali svakako da ne može izlečiti. Kompresiona terapija elastičnim zavojima ili čarapama potpomaže fiziološko usmjeravanje venske krvi od površinskih prema dubokim venama. Ono poboljšava vensku drenažu i olakšava vraćanje tecnosti iz tkiva u krv, što rezultira smanjenjem otoka i sprječava stvaranje novih. Druga prednost kompresione terapije je mogućnost dugotrajnog lečenja, jer ne postoje nuspojave. Sklerozacija proširenih vena je postupak kod kojega se u proširenu venu ubrizgava substanca koja izaziva upalu zida vene, što dovodi do zatvaranja vene. Neposredno nakon sklerozacije efekt je zadovoljavajući, jer nestaju proširenja, ali se uvijek i u 100% slučajeva ponovno jave proširene vene, zato što je mjesto nastanka proširenih vena jedno od dva ušća glavnih površinskih vena, a to je prepona ili iza koljena. Na tim mjestima se nikada i ne smije izvoditi sklerozacija jer bi moglo doći do tromboze dubokih vena. Danas se ova metoda lečenja postepeno napušta i uglavnom se izvodi kod manjih sporednih proširenja tzv. Retikularnih površinskih vena. Hirurško lečenje proširenih vena Hirurško liječenje oboljenja proširenih vena jedina je metoda koja nudi mogućnost izliječenja, jer podrazumijeva uklanjanje mjesta nastanka proširenih vena, kao i uklanjanje proširenih i izvijuganih površinskih vena. U našoj bolnici uklanjanje proširenih vena obavlja se prema metodama i procedurama vodećih europskih klinika za flebologiju pri čemu se posebno vodi računa o minimalnom riziku samog zahvata, kao i o brzom oporavku i ozdravljenju. Zajedničko svim metodama kirurškog liječenja oboljenja vena je to da se rijetko ponovno javljaju proširene vene (recidivi), zahvat je minimalno invazivan a ožiljci nestaju nakon nekog vremena u potpunosti Savremena klasična operacija vena Zahvat se izvodi ambulantno u lokalnoj (tumescentnoj) anesteziji i ne traje više od sat i pol. Već nakon 15 do 20 minuta nakon operacije odlazite kući bez da vam je potrebna nečija pomoć, a ležanje se ne preporučuje. Suvremena klasična operacija vena u pravilu se sastoji iz tri faze: Najvažniji dio operativnog zahvata jest precizna i temeljita krosektomija (crossectomia) – izvodi se kroz rez u preponi gdje se nalazi ušće glavne površinske vene (vena saphena magna) u duboku venu. hirurg odvaja venu safenu od duboke vene te odstranjuje još pet vena koje se ulijevaju u glavnu venu na tom ušću. Osobita važnost krosektomije je u tome da ako se ona ne napravi, proširene vene će se ponovno vratiti unatoč uklanjanju površinskih vena – dobili smo recidiv. Općenito, ušće je naša “slaba točka” – u preponi je hidrostatski tlak najjače izražen pa se zalisci na tom mjestu prvi oštećuju. Sledeća je faza striping (stripping) pri čemu se vadi dio glavne površinske vene i to od prepone do ispod koljena. Danas se u suvremenim flebološkim ustanovama striping izvodi potpuno novim sondama koje štede okolno tkivo, a krvarenje je minimalno. Pritom se vena izvlači kao kad se čarapa izvrne na drugu stranu. I na kraju, posljednja faza operacije je mikroflebektomija u kojoj se vade sve preostale proširene vene na nozi specijalnim kukicama kroz minijaturne otvore na koži (1-2 mm) koji se ne šivaju i ne ostavljaju vidljive ožiljke na nogama, tako da postižemo iznimne rezultate i u smislu estetike. Ako se zahvat izvede na opisani način, mogućnost recidiva smanjena je na najmanju moguću mjeru – u praksi će se proširene vene ponovno pojaviti u manje od 2% operisanih pacijenata.