Venous Ulcers & Varicose Veins
What causes venous ulcers?
There are two components to the venous drainage of the legs. A deep system and a superficial system. Blood typically flows from the superficial to the deep system through small connecting veins called perforators. The perforators have valves that prevent the blood from flowing back to the surface. In the unfortunate patients who develop venous stasis ulcers, these perforator valves are nonfunctioning or incompetent and allow blood to flow back to the surface. This makes the legs swell up, the patient experiences discomfort and sometimes pain, and ultimately, because of the increased pressure on the skin, there is breakdown and ulcer formation.
How do you treat venous ulcers?
The mainstay of treatment for venous stasis ulcers is compression stockings. the stockings force blood from the superficial to the deep system, reduce the swelling and allow the ulcers to heal. Unfortunately, even with stockings, the majority of patients have a recurrence of their ulcers. Our physicians offer an array of minimally invasive and surgical options that can be helpful in the treatment of venous ulcers. Some of the options available are vein surgery, radiofrequency ablation, medical adhesive closure, and sclerotherapy.
In addition to vein procedures, our physicians are Board Certified Surgeons who can assist with General Surgery, Vascular Surgery, And Thoracic Surgery needs. Please click here to learn more about their expertise.
Chronic venous insufficiency (CVI) is a serious condition that often manifests as varicose veins. CVI and varicose veins affect more than 190 million people globally and more than 30 million Americans. Despite its prevalence, many times CVI goes undiagnosed or is undertreated. In fact, less than 10 percent of men and women seek treatment. Why? Many people with varicose veins believe their condition to be a cosmetic issue. However, if left untreated, varicose veins can progress to CVI, a serious disease that can cause leg pain, swelling, restlessness, skin damage and ulcers. As a progressive disease, it is important for patients to evaluate treatment options for CVI that demonstrate long-term effectiveness of the procedure, given the chance of reoccurrence. For patients here in Sarasota and Charlotte County, there are treatment options available, including minimally invasive procedures that have clinically demonstrated strong closure rates out to five years.
What are varicose veins?
Varicose veins are large, visible veins that are close to the surface of the skin that causes bulging beneath the surface. They often look like either strand of knotted rope or clusters of grapes as opposed to actual veins.
Do varicose veins cause health risks?
Although many people with varicose veins complain of discomfort, these symptoms usually are not harmful to your health.
What symptoms are associated with varicose veins?
Patients with varicose veins can experience any of the following:
- Discomfort in the legs
- Aching, tingling, numbness or swelling
- Cramps at night and restlessness
- Phlebitis – a condition that causes the veins to become hot, red, and swollen
When close to the skin, it’s possible for varicose veins to break and cause bleeding but this is rare.
Can varicose veins be removed?
Yes, with a minor procedure they can be removed.
The ClosureFast™ procedure utilizes radiofrequency energy to provide consistent and controlled heat to contract the collagen in the vein walls, causing them to collapse and seal. Once a leg vein is closed, blood flow is redirected to healthy veins. With very little discomfort and generally no scarring, this procedure is a great option for patients.
The British Journal of Surgery published the results of a study evaluating the long-term results of patients with chronic venous insufficiency being treated using our method with the ClosureFast™ system. The results of the study demonstrated strong closure rates of the diseased vein and minimal treatment side effects at five years.
How long does the ClosureFast™ procedure take?
The ClosureFast™ procedure takes approximately 45-60 minutes. Most patients typically spend one to two hours at our facility due to normal pre- and post-treatment procedures.
Does the ClosureFast™ procedure require anesthesia?
The ClosureFast™ procedure can be performed under local, regional or general anesthesia. It is generally performed using local anesthesia in our vein specialist’s office.
After the ClosureFast™ procedure, how quickly can I return to normal activities?
Many patients experience a quick return to normal activities, typically within a few days. For a few weeks following the treatment, our vein specialist may recommend a regular walking regimen and suggest you refrain from very strenuous activities (i.e., heavy lifting) or prolonged periods of standing.
How soon will my symptoms improve after the ClosureFast™ procedure?
Most patients report a noticeable improvement in their symptoms within one to two weeks following the procedure. For any cosmetic symptoms that are not completely resolved following the procedure, you may consider adjunctive treatment including sclerotherapy (small chemical injections) or micro phlebectomy (removal of varicose veins through small skin punctures under local anesthesia).
What potential risks and complications are associated with the ClosureFast™ procedure? Can I expect any pain, bruising or tenderness after the ClosureFast™ procedure?
As with any medical intervention, potential risks and complications exist with the ClosureFast™ procedure. Our vein specialist will have a consultation with you to determine if your conditions present any special risks. They will also review with you potential complications associated with the ClosureFast™ procedure, which can include but not limited to the following: adjacent nerve injury, hematoma, pulmonary embolism, thrombosis, infection, phlebitis, skin burn or discoloration, or vessel perforation. Patients report minimal to no scarring, bruising or swelling following the ClosureFast™ procedure.
Is the ClosureFast™ procedure suitable for everyone?
A vein specialist can tell you if the ClosureFast™ procedure is the right option for your vein problem. Experience has shown that many patients with chronic venous insufficiency can be treated with the ClosureFast™ procedure.
What happens to the treated vein left behind in the leg? Don’t I need it?
After treatment, the affected vein simply becomes fibrous tissue. Over time, the vein will be completely absorbed into surrounding tissue. Faulty valves interfere with the normal return of blood through the venous system. Closing these diseased veins helps to re-route the blood, improving circulation and relieving most symptoms.
Is the ClosureFast™ procedure covered by insurance?
Many insurance companies pay for the ClosureFast™ procedure in part or in full. The ClosureFast™ procedure has coverage policies with major health insurers. A vein specialist can discuss your insurance coverage further at the time of consultation.
The VenaSeal™ closure system treats the diseased saphenous veins, without traditional heating or stripping the vein out of the leg. During the procedure, a trained clinician fills a syringe with the medical adhesive, which is inserted into a dispensing gun that is attached to a catheter. The catheter is advanced into the diseased vein under ultrasound guidance. The catheter is placed in specific areas along the diseased vein and the clinician conducts a series of trigger pulls to deliver the medical adhesive. The adhesive closes the vein and blood is rerouted through nearby healthy veins. Compression is applied to the leg during the procedure. The VenaSeal™ closure system is designed to minimize patient discomfort and reduce recovery time.
How does the VenaSeal™ closure system differ from thermal energy procedures?
The VenaSeal™ closure system uses a small amount of specially formulated medical adhesive to close the vein. Thermal energy uses heat to close the vein. The intense heat requires a dilute numbing medicine, which is injected through multiple needlesticks. The injections may cause pain and bruising after the procedure. The VenaSeal™ closure system also eliminates the risk of burning or nerve injury associated with thermal based procedures8 and may not require the use of compression stockings post procedure.
How quickly can patients return to normal activities post procedure?
The VenaSeal™ closure system procedure is designed to minimize patient discomfort and reduce recovery time. After the procedure, a small bandage will be placed at the access site. Patients are able to rapidly return to normal activities. Additionally, patients have reported minimal bruising following the VenaSeal™ closure system procedure.
Is treatment with the VenaSeal™ closure system suitable for everyone?
The VenaSeal™ closure system should not be used in patients who have a known hypersensitivity to the VenaSeal™ closure system’s adhesive, acute inflammation of the veins due to blood clots, or acute whole-body infection. Adverse events observed in the VenaSeal™ closure system trials—and generally associated with treatments of this condition—included vein inflammation (phlebitis) and burning or tingling (paresthesia) in the treatment zone. Our vein specialist can tell you if the VenaSeal™ closure system is the right option for your situation.
What happens to the treated vein left behind in the leg? Don’t I need it?
Faulty valves interfere with the normal return of blood through the venous system. Closing these diseased veins helps to re-route the blood through nearby veins, improving circulation and relieving most symptoms. The adhesive was designed to remain permanently in the GSV and is eventually encapsulated by chronic fibrotic growth for vein closure.
Is the VenaSeal™ closure system procedure covered by insurance?
As with any procedure, insurance coverage may vary. Those interested in the VenaSeal™ closure system should contact their insurance provider for more information.
How does the procedure work?
Phlebectomy involves making tiny punctures or incisions in the skin near the varicose vein. Veins are very collapsible and even large veins can be removed through the tiny incisions used in this technique.
What do the instruments look like?
A small scalpel or needle is used to make very small incisions close to the vein. A phlebectomy hook is used to remove the veins. The hook looks similar to a tiny crochet hook with a straight shaft and a blunt tip.
How is the procedure performed?
This procedure is generally done on an outpatient basis at our office.
After cleansing and numbing the skin, a series of small incisions (no larger than a pencil eraser) are made in the skin next to the enlarged vein. A phlebectomy hook is inserted under the surface of the skin to remove the varicose vein through the tiny incision. This procedure is usually completed in 30-60 minutes.
What will I experience during and after the procedure?
Patients rarely report any pain during this procedure because the area being worked on is under a local anesthetic.
The incisions made during the procedure are so small that no stitches are required. A small dressing is applied to cover the incisions.
When the procedure is complete, your leg will be wrapped in a comfortable but snug compression wrap.
You will need to wear graduated compression stockings for approximately two to three weeks following your procedure. As long as the stockings are worn, almost all activities can be resumed beginning the day after the procedure.
You should be able to resume daily activities within 24 hours.
What are the benefits vs. risks?
- No surgical incision is needed—only a small nick in the skin that does not have to be stitched.
- Any procedure where the skin is penetrated carries a risk of infection, however this risk for a phlebectomy is very slight.
- Skin pigmentation at the site of the treated varicose vein may occur but is usually temporary.
What are the limitations of Phlebectomy of Varicose Veins?
The long-term results of phlebectomy are excellent when the procedure is performed in patients who are good candidates.
Occasionally, we use phlebectomy with a more comprehensive treatment plan, including additional procedures such as thermal or non-thermal ablation.
Patients should discuss their individualized treatment plan with their surgeon.
Sclerotherapy is the “gold standard” in the treatment of spider veins. Sclerotherapy involves injecting a sclerosing (drying) agent into the vein. This causes damage to the vein wall and causes the vessel to close.
When will I see results?
Most patients will require more than one treatment to obtain the best results. Typically, the appearance of the unsightly veins is significantly improved after several treatments. The exact number of treatments may vary, depending on the extent of your spider vein.