What is Phlebology and what is a Phlebologist?

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Phlebology is the medical specialty which is dedicated to the diagnosis and treatment of disorders of the venous system. A phlebologist is a specialist who has trained specifically to diagnose and treat all aspects of venous disorders.

Is Varicose Vein treatment just for women?

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Approximately 15 to 20% of males have varicose vein disease. Males do certainly have less involvement compared to females when it comes to varicose veins, but they’re not immune to these issues!

What Results Can I Expect After My Vein Treatment?

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We expect that all the veins that you have – that are treated appropriately, of course – are going to be gone. There’s a possibility that you would develop new veins down the line since this is a lifetime disorder which we are currently unable to cure. However, the veins that we treat with laser phlebectomy and ultrasound guided foam sclerotherapy should be gone completely, with the exception of your tendency to develop new vein issues.

How Can I Tell If My Varicose Veins are Bad Enough To Need Treatment?

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We think that YOU need to determine whether or not you wish to have something done for your vein issues. If in fact you have pain and swelling, you are certainly a candidate in the eyes of the insurance companies to have treatment which would be definitively aimed at removing them. If, on the other hand, you have spider veins, that is strictly a cosmetic concern, and the procedures to remove them would be at your expense.

Are There Any Health Risks in NOT Treating My Varicose Veins?

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Untreated varicose veins advance over time and can produce bleeding, blood clots and worst of all, ulcers. These are all potential problems if your varicose veins are untreated. Generally, however, these symptoms do not occur until much farther down the line of long-standing varicose veins. Whether or not you have treatment is based on whether you have pain and swelling and not so much the fear of having these other symptoms, unless you experience changes to your skin like dark brown pigmentation and thickening of the skin in your lower calves and ankle areas. These issues would indicate a much more advanced stage that’s referred to as “advanced venous hypertension.” This would require treatment of a more urgent nature.

How Does Pregnancy Affect Varicose Veins?

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Untreated varicose veins advance over time and can produce bleeding, blood clots and worst of all, ulcers. These are all potential problems if your varicose veins are untreated. Generally, however, these symptoms do not occur until much farther down the line of long-standing varicose veins. Whether or not you have treatment is based on whether you have pain and swelling and not so much the fear of having these other symptoms, unless you experience changes to your skin like dark brown pigmentation and thickening of the skin in your lower calves and ankle areas. These issues would indicate a much more advanced stage that’s referred to as “advanced venous hypertension.” This would require treatment of a more urgent nature.

What Are Varicose Veins?

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By definition, varicose veins are dilated tortuous veins that may or may not be visually prominent on the legs. They are often seen as ropey, dilated and often bluish-colored veins that may travel down the thigh, knee calf and sometimes around the ankle. They develop as the result of defects in the valves which are responsibly for conducting blood flow in one direction, namely toward the heart and lungs. If these valves fail, by virtue of genetic abnormalities, the flow then reverses down the leg and causes bulging varicose veins.

The other abnormality involves the vein wall. As veins walls dilate, the valve structures, which may be normal, are pulled apart. As a result of the valves parting, blood flow is then allowed to reverse direction and flow down the legs. This causes varicose veins, which are reverse-flowing, usually dilated veins that sometimes can be seen on the surface of the legs. Varicose veins are always documented with ultrasounds, which is the only definitive way of diagnosing varicosities.

Can Varicose Veins Be Cured?

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Unfortunately, there is currently no cure for varicose veins, however they are ALWAYS treatable using a variety of techniques. Modern technology has done away with the outdated and dangerous “vein stripping” procedures which Vein Center of New Mexico NEVER utilizes. We can treat your veins and get rid of your veins, but because of genetic predispositions, new veins may develop down the road. Remember, we can always manage your varicose veins to give you great relief and cosmetic improvement.

How Will Blood Get Back to My Heart After My Diseased Veins Are Removed?

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The deep system of veins in your legs is the main route for returning blood flow to your heart, returning about 80% of the blood back to your heart. The superficial system returns only 15-20% of the blood. When you have varicose veins, the blood in your SUPERFICIAL system is traveling towards your feet, which is abnormal and is responsible for the symptoms you’re experiencing. MOST of this blood flow, however, does get into the DEEP system and flows back to the heart and lungs, with only a small portion flowing back down the legs. If we close down the reverse-flowing varicose vein “pipeline”, this makes sure that ALL of your blood – 100% – is now flowing in the proper direction toward your heart and lungs. This causes a significant improvement in your health, and removing diseased veins can only make you better!

What Is a Skin Ulcer?

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A skin ulcer represents an advanced stage of degenerative changes in your venous system. It implies venous hypertension, which occurs in the legs when you have a vast amount of reverse-flowing blood. This is abnormal because all flowing blood should be headed towards the heart and lungs. Over many years, patients who disregard their varicose veins and fail to recognize the fact that they are developing changes in their legs, will experience a darkening of the skin in the legs, a leather-like change in skin texture and ultimately the potential for an opening of the skin right around the inner ankle. Once developed, the ulcer, or opening, may increase in size and become a source of chronic severe pain. If this is not dealt with by way of treating the underlying varicose vein disease, the ulcer will only get worse.

There are also veins in your lower extremities that can result in bleeding. For example, a patient may emerge from a shower and rub the skin of the leg with their towel, causing an underlying varicose vein just below the surface to break the skin and begin bleeding profusely. Please know that A BLEEDING VARICOSE VEIN IS AN EMERGENCY and must be treated immediately.

What is a Duplex Ultrasound Exam?

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The Duplex Ultrasound Exam is the gold standard for diagnosing vein disease. In recent years the technology and machinery have become very sophisticated, and the technicians who perform these examinations – called “sonographers” – have mastered the skill of diagnosing vein disease.

This technique utilizes ultrasound to look “inside” the leg and is able to determine the direction of blood flow in your veins, which ideally should all be flowing toward the heart and lungs, going UP the leg. If it is found that flow is in a reverse direction – which ultrasound will detect – varicose vein disease or some form of venous hypertension is present.

What Treatment Options are Available Other Than “Vein Stripping”?

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In the last 10 to 15 years there have been two techniques used to close the main superficial veins in the body: radio frequency, and laser energy. In these situations, a laser fiber, or a fiber which will conduct radio frequency energy, is passed up the vein to the point where the reflux, or reverse flow, begins. Then this energy source is applied to the inside of the vein, which closes the vein. Over time, this vein will be re-absorbed by the body and ultimately disappear as though it were treated with vein stripping.

Another option is treating varicose veins with ultrasound guided foam sclerotherapy. In this situation, veins are identified underneath the skin and can only be seen with ultrasound. In this procedure, the vein is identified, a needle is inserted into the vein using ultrasound guidance, and a solution designed to injure the vein and make it close is injected. Over time the vein closes and is reabsorbed by the body.

Why do you recommend compression stockings?

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Compression hose or stockings are recommended to patients in their post-operative period. Many physicians feel that wearing compression stockings will aid in the closure of treated veins. Many insurance companies now REQUIRE that patients wear stockings for a given length of time BEFORE treatment to improve symptoms and to determine if a patient will truly benefit from surgery.

Patients who DO have an improvement when they wear compression stockings are really compressing their veins and lessening their symptoms. This would indicate that they can benefit from laser or ultrasound therapy to permanently remove the veins.

Compression stockings DO play an active role in the treatment of symptoms as well as aiding in recovery after surgery.

Does Vein Disease Affect Women and Men Equally?

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Vein disease does NOT affect women and men equally. Approximately 85-90% of people with vein disease are women, and men seldom – if ever – develop spider veins, which is usually the plague of many women.

Women who develop varicose veins do so because of genetic reasons. Hormone factors occurring in pregnancy as well as the pressure from the uterus on the veins can cause vein disease, and progesterone also has an effect on veins. Hormone replacement therapy and oral contraceptives also play a role in relaxing and dilating vein walls which causes them to become prone to vein disease.

Men mostly develop bulging varicose veins, which they often disregard because the symptoms they develop are not usually as strong as those in women.

What should I look for in a vein physician?

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When searching for a physician to treat your vein disorder, make sure to look for a phlebologist: someone who is specially-trained in the treatment of venous disease. Make sure they’re board-certified in this specialty area, and that they can treat blood clots, bleeding, venous ulcers, spider veins, varicose veins… the entire spectrum. Anything less than that and you may not be as satisfied with your outcome.

What is EVLT?

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EVLT stands for Endovenous Laser Treatment. This involves placing a laser fiber inside a vein and passing it up to the source of where the reverse blood flow occurs in the vein within the superficial system. The laser is activated at this point and the laser fiber is pulled back through the course of the vein, heating up the vein wall and destroying the lining. Over time, the vein will disappear as though it had been “stripped.” This is why the outdated surgery known as “vein stripping” is no longer recommended or needed.

EVLY is applicable only in certain veins in the leg and is the treatment of choice for dealing with large varicose veins.

What is the difference between EVLT and Surface Lasers in Vein Treatment?

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Endovenous Laser Treatment, or EVLT, involves the treatment of large varicose veins, whereas a surface laser is applicable strictly for spider veins and the slightly larger veins called “reticular” veins. These are two totally different modalities – EVLT is directed entirely towards symptomatic vein disease (and covered by insurance), and surface lasers specifically treat cosmetic issues involving spider veins, which is not covered by insurance.

Does Sclerotherapy Cause any Damage or side effects?

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There are two chemical agents used in the U.S. for sclerotherapy and both are extraordinarily safe and have years of use in the hands of many physicians across the country. There ARE side effects, however, which we always enumerate for our patients, but rarely do we ever see any adverse reactions.

Side effects can occur if you are allergic to the specific drug being used, which is extremely rare. If the solution were directed into the wrong vein you could experience a loss of skin or ulceration in the area, but that also is extremely rare. It is possible that a blood clot could form from the solution flowing into a deeper vein, but again all of these are very rare and are mentioned mainly for medical and legal reasons.

Does EVLT cause any damage or side effects?

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It’s a rare day that we see any complications resulting from laser treatment. Very early in the history of EVLT in the United States there may have been reports of some skin burns at the exit site of the laser fiber, but today this is virtually a non-occurrence.

There CAN be some bruising and discomfort over the surface of the vein that has been treated with EVLT, in the post-op period, however every measure is taken to prevent this, and we routinely advise the use of Arnica gel, which is extremely effective at reducing or eliminating any bruising and discomfort after treatment.

Is recurring vein disease a serious problem?

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Recurrence of vein disease can occur in any patient. Once the original problem is treated thoroughly, we follow your progress and ask you to come back if any new veins are noted. These new veins are rarely treated, and the original veins will not come back.

The Vein Center of New Mexico recommends long-term follow up, which will assure patients that no new disease is recurring and that they are pain-free and totally satisfied with their results.

Will I need to take time off work or be hospitalized after my vein treatment?

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After vein treatment, many patients ask if they need to be hospitalized and take time off work to recover. Our answer is: absolutely not! Hospitalization after vein treatment is a thing of the past (due to the fact that vein “stripping” surgery is no longer performed).

We encourage most of our patients to return to work IMMEDIATELY after their treatments. If a patient is undergoing ultrasound guided foam sclerotherapy, they can go back to work right away. If a patient undergoes laser ablation, which requires a local anesthetic in the legs, they can usually return to work that same afternoon, unless of course they’ve had some valium to lessen their discomfort during treatment – then we ask that they wait until the next day to return to normal activity.

What Can I do to Prevent Varicose Veins?

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Assuming that you don’t already have varicose veins, we implore you to consider what may be a lifestyle change,  which involves wearing below-the-knee compression socks. These are fitted, lightweight and a prescription is not necessary. We’d also ask that you begin walking at least a mile a day, every day. This will activate an important pump in your calf called the “muscular venous pump”, which is so important that it’s actually considered to be a “second heart” by many in medical circles. This pump in your calf returns blood back to your heart, and it is ONLY activated by walking, heel-to-toe. Stair-steppers and other machines DO NOT accomplish what walking and running can do for this muscular pump in your calves.

Will Insurance Pay For My Treatment?

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Generally, insurance will cover the treatment of large vein disease, or varicose veins. This is considered a medical problem by most insurance companies and they will pay according to whatever percentage the patient is responsible for. Our office will make every effort to obtain the best insurance rates for you by dealing directly with your insurance company after we perform a full evaluation in our office.

Insurance will NOT cover the cosmetic aspect, which is the treatment of spider veins.

What Causes Varicose Veins?

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Varicose veins are an evolvement of the superficial venous system which is responsible for returning approximately 10-15% of the blood flow back to your heart and lungs. The deep system handles everything else, and this deep system is never a problem with varicose veins. With varicose veins, a valve somewhere along this superficial venous system fails. As the valve is a one-way “gate”, its failure allows blood to flow towards the feet, causing enlarged, “tortuous” veins to develop over time. Without treatment, more serious issues can develop such as ulcers, bleeding and extensive skin discoloration.

Why Do I Need an Ultrasound for Spider Veins?

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It’s been determined that approximately 25% of patients who have spider veins are in fact plagued with larger, deeper underlying veins (varicose veins) which feed into the spider veins.   It is only through doing a complete vein evaluation – primarily utilizing ultrasound – that we can determine whether or not large veins ARE responsible for the high pressure producing these surface, or spider veins. In most cases a complete evaluation is mandatory to determine the reason or cause of spider veins.

Do Spider Veins Come Back After Treatment?

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New spider veins CAN develop over time – they are simply the result of the same preconditions that resulted in the initial spider veins. However, generally the first treatment takes care of those that ARE treated. Just keep in mind that new spider veins MAY develop in the future.

How Long Will My Vein Treatment Take?

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The length of your treatment will be contingent upon what we find at the time of your evaluation. Treating large vein disease may possibly involve laser ablation, it could involve removing veins via ambulatory phlebectomy, or ultrasound guided sclerotherapy. On the other hand if you don’t have large vein disease and we’re treating spider or reticular veins, the usual session is about 20-30 minutes long.

How Do I Begin Treatment for my Vein Condition?

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We begin with an initial consultation in our office, at which time we’ll examine your legs, map them, then we’ll use ultrasound to determine where the areas of abnormal flow originate. Then we’ll talk with you and discuss a treatment plan, outlining for you exactly what to expect, the appropriate costs and we’ll recommend with conservative management or, if you wish, a procedure which will remove your damaged veins via surgery or sclerotherapy.

Are There Activity Restrictions After I've Been Treated for Vein Disease?

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After treatment we recommend that patients walk a mile a day for at least three weeks. We also recommend that you not perform any physical exercises such as weightlifting or related activities to avoid putting excessive pressure on the venous system. Ordinarily you can do most anything you want after two weeks after being treated for large vein disease or after cosmetic sclerotherapy.

What is Sclerotherapy?

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Sclerotherapy is the treatment of spider and reticular veins (the slightly larger thread-like veins). Ideally Sclerotherapy would be the best treatment, which is a solution designed to collapse the vein and make them close. The solution may sting a bit – it’s very similar to having a mosquito bite – but generally VERY thin needles are used and most patients are quite comfortable during the procedure.

What is the Difference Between Varicose and Spider Veins?

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Varicose veins are dilated, tortuous veins that usually involve the thigh and the calf. They are the result of valve failure, usually beginning at the groin or behind the knee. As a result of these valves failing, blood flow travels down the leg towards the feet as opposed to traveling upwards to the heart.

Spider  veins are bluish or reddish in color, thinly distributed veins on the thigh or the calf. They are completely separate from varicose veins and are treated by injections or surface or cosmetic Sclerotherapy.

Do Varicose Veins Come Back?

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Varicose veins, unfortunately, are a lifetime disorder. If you do suffer a recurrence of varicose veins, we can readily treat them using the latest technology. Varicose veins the recur are NEW veins, not old ones coming back. Remember, any vein issues you have can always be treated, and the veins we do treat will be obliterated.

Can Additional Veins Be Removed Safely Even After Having Prior Surgery?

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Recurring varicose veins are not uncommon. We’ve seen patients who have been treated elsewhere who come in for further treatment because their condition has recurred. This can happen. This is a lifetime disorder which we cannot cure, but which we can always control. By removing these recurrent veins your circulation will only improve, decreasing the workload on the deep venous system and reducing your symptoms greatly. You’ll generally feel much better overall, and of course your legs will look better!

If You Remove My Diseased Veins, I Won't Have any Veins Left if I Need a Heart Bypass!

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On the contrary, the veins we’re removing are abnormal veins. They’re dilated, tortuous, have reverse-flowing blood, and they are no longer suitable for use in any bypass surgery. By removing these veins we’ll be improving the condition and health of your legs by removing all of the reverse-flowing blood which can cause a variety of symptoms throughout the body if left untreated.

My Doctor Says My Vein Problems Are Just "Cosmetic"

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We find that this claim is very common among many doctors in private practices. However, many of them are not aware of all the current developments and changes in the ever-evolving field of phlebology, or the treatment of venous disorders. We are. We use only the latest technology to treat vein disorders, and those include laser ablation, ambulatory phlebectomy, and ultrasound guided foam sclerotherapy. Vein “stripping” is an outmoded, barbaric and dangerous practice which we do NOT recommend to anyone.

How Are Varicose Veins Treated?

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Firstly, varicose veins are diagnosed using ultrasound guidance. Generally, if you have large, straight veins that are flowing the wrong way (i.e., “refluxing”) the best treatment is laser ablation or other modalities. The second procedure is called ambulatory phlebectomy, which involves making very tiny incisions in the legs and removing the veins through those incisions. This will remove those bulging veins and also the symptoms that go along with them. Finally, there are other veins that may be under the surface and that can only be seen with ultrasound. The only way to treat these types of veins is with ultrasound guided sclerotherapy.

Does Crossing Legs Cause Varicose Veins?

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This is a tale passed down through generations, which is simply untrue. A study published by a Canadian phlebologist who is a specialist in vein disease, determined that crossing your legs has absolutely NO effect on the development of varicose veins. So, feel free to cross your legs as much as you like!

How Is Your Treatment Different from Vein "Stripping"?

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Vein stripping is a thing of the past. We believe it is a barbaric and often dangerous procedure that no longer belongs in anyone’s vein treatment plan, period. Vein stripping was performed without the benefit of ultrasound, which is now mandatory in the treatment of all vein disorders. Vein stripping involved putting a “Stripper” down inside the leg and pulling the vein out, without even knowing for sure where the tributaries or abnormal vein branches were located in the leg! You also would have been hospitalized for several days after the procedure, experiencing a very slow return to normal, and feeling a lot of pain and swelling.

With new technology, ultrasound helps us determine exactly where new veins have developed or where old veins still reside, and that allows us to tailor a strategy and plan for your specific situation. In most cases you will experience an immediate return to normal activity, with no hospitalization required as with vein stripping.

What Happens If My Varicose Veins Are Not Treated?

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Deciding not to treat your varicose veins is a valid alternative in a conservative management plan, provided you wear compression stockings and adopt an active lifestyle of walking at least a mile a day.

However, if left untreated, over time varicose veins will simply get larger and possibly discolor the skin (hyper-pigmentation), cause bleeding or venous ulcers. We recommend getting your veins treated IF you are symptomatic (i.e., have pain or swelling or other symptoms). We do NOT treat patients who have no symptoms whatsoever.

Should I Have My Vein Disease Treated Before or After Pregnancy?

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We believe that you SHOULD treat your varicose veins before a pregnancy is initiated or completed. The problem is that your veins are going to really “blossom” during your pregnancy, and by treating them before you’re pregnant, we can minimize all of the symptoms that would inevitably experience otherwise, such as bulging veins, heaviness, throbbing, burning, etc.

You could decide to wear compression stockings, but many women find them very tedious when pregnant.

Will Removing My Varicose Veins Affect My Blood Circulation?

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The veins that we remove no longer perform any normal function as far as returning blood to your heart and lungs. They’re actually sending blood flow to your feet, which increases the burden on your deep venous system. Once these abnormal veins are eliminated, all of your blood flow will go in the correct direction (back to your heart), and your system will be operating much more efficiently.

Is there a question we can answer for you?