What is Ethical Vein Treatment?

 The 10 core components of Ethical Vein Treatment

1) Board-certified vascular experience

In practice today, there are an incredible number of untrained physicians inflating their experience as vein specialists without ever completing any vascular training or board certification.  This is especially true of many newly formed vein centers provided by pain management doctors, internists, and physiatrists.  Unknowing patients seeing pain specialists for leg pain are commonly worked up for vein disease despite a lack of clinical or physical signs of varicose veins.   An undelivered promise to cure leg pain with minimally-invasive vein treatments.

Our vein doctors all have undergone intense procedural training for minimally invasive vein procedures.  Each doctor is hand-selected based on their background training and maintenance of board certification in a vascular specific field. 

2) Full Time Employed Vascular Technologist

Many pop-up vein centers do not employ their vascular techs as a cost-saving measure.  Instead, technicians are brought in on a weekly basis as “hired-guns” incentivized to find abnormal studies.  

3) Vascular Imaging

Cardiologists, Radiologists and Vascular Surgeons are formally trained in understanding vascular imaging and providing accurate interpretation.  Vascular imaging is essential to the proper diagnosis and treatment of venous insufficiency.  It is simply outside the scope of an internist or pain management physician to interpret vascular ultrasounds. Despite any assurances that the images are sent to an independent third party for interpretation, we advise patients to approach with caution!

4) Treat The Patient, Not The Ultrasound

An ultrasound can often detect early signs of venous insufficiency even in individuals with simple spider veins.  This alone does not justify medical interventions, but assists doctors with understanding how treatment will be impacted.  However, it needs to be emphasized that spider veins are not cured or entirely prevented by medical vein treatments despite certain promises.  A vein specialist should help you navigate your options guided by your treatment goals. 

5) Continuing Medical Education & Leadership

Our talented doctors honor their commitment to providing the highest quality of care.  

6) Ethical Billing

Cosmetic sclerotherapy should not be billed to insurance and threatens the integrity of our specialty.  Sclerotherapy is covered under medical necessity for large varicose veins close to the skin or in some cases neovascularization.  It is inappropriate for use with spider vein treatment and any potential cost-savings are not likely associated with high quality treatment. 

7) Investment Into Practice Technology

We are investing regularly into technologies that aid the comfort of procedures and efficacy.  A few examples include surgical beds, latest technological devices, and emergency equipment. 

8) Dedicated Vein Centers

Our Best Vein Center is entirely dedicated to the treatment of spider veins and varicose veins.  Conversely, some non-vascular doctors have found vein treatment an opportunity to expand their services.  We feel strongly that vein treatment requires the utmost dedication and attention to achieve high quality results and patient satisfaction.  

9) Only Doctors Perform Medical Procedures

In some clinics, health extenders including Nurse Practitioners and Physician Assistants are performing vein ablations and medical sclerotherapy in place of the doctor.  Despite assurances that these procedures are supervised by the attending, this is far from the case.  Many times, the physician is at a remote location providing zero support or supervision.  The primary intention is to provide as many treatments as possible in a single day. We refer to this as “Fast-Food” medicine. Vascular procedures are not intended to be performed by health extenders and any deviation from this practice is a serious concern.

10) Anesthesia

As a minimally invasive procedure, vein ablation and varithena do not routinely require conscious sedation or anesthesia. Rarely, a patient may require conscious sedation and the risks and benefits of this approach should be discussed ahead of time.  We believe that anesthesia provides an unnecessary risk usually by inexperienced providers uncomfortable with their technique.

 

Final Thoughts:

Our mission  is to provide modern medical treatments for vein insufficiency with clinical integrity and competence with the utmost respect for each patient’s individual goals. We empower patients through knowledge to be active participants in their treatments. Regardless of the changes in the practice of medicine and the challenges presented, we are committed to ethical vein treatment.  

What is RF Vein Treatment?

 In clinical trials, RF ablation for varicose veins and spider vein treatment has proven to be safe and effective for truncal veins. More importantly, they have proven to be associated with better long term results, faster recovery and improved quality of life in comparison to older, dated methods like surgical stripping. The modern day minimally invasive techniques for vein treatments have been revolutionary.

What Are Varicose Veins?

Varicose veins are abnormal swollen veins present both on the surface and beneath the surface of the skin. In contrast, spider veins are smaller, red or purple blood vessels that are <1 mm in diameter and have a web-like appearance. Both conditions can be related to venous insufficiency prompting a visit to vein clinic

What creates Varicose Veins problems?

The normal function of leg veins is to bring blood back to the heart. With activity, the calf muscles function as a pump, to circulate blood back from the legs toward the heart. The same blood vessels have one-way valves that protect against blood from reversing back due to gravity. If the valves are faulty, this mechanism fails and blood collects in the lower legs resulting in venous insufficiency. This abnormal flow is referred to as reflux and with time builds up pressure in the legs to cause symptoms including abnormal spider and varicose veins.

Who is at risk of Varicose Vein disease?

There are various risk factors associated with varicose veins. These dangers include a family history of varicose veins, obesity, pregnancy, hormonal adjustments at menopause, a job that requires prolonged standing or sitting, and even previous trauma.

What Is the Most Effective Varicose Vein Treatment?

The mostly commonly used device used by a phlebologist is the RF ClosureFAST by Medtronic. The ClosureFAST system is based on radiofrequency, thermal induced destruction of vein walls similar to the concept of laser treatment for spider veins.

Procedure

Radiofrequency RF vein ablation is minimally-invasive and can be performed directly in the office. The best vein clinic perform the procedure in a dedicated room that provides a sterile environment and houses the necessary equipment. In general, thermal ablation is utilized for truncal veins like the GSV and SSV or some of the tributaries.

Access for the ablation catheter is obtained by venupuncture under ultrasound guidance. Prior to access, the area of treatment should be sterilely prepped and draped per usual protocols. Lidocaine or similar local anesthetic is used to numb the region of interest. Using the modified Seldinger technique, the vein is prepared for treatment with exchange of wires for a percutaneous sheath.

In the case of the GSV access can be obtained anywhere distal to the SFJ (or in the case of the SSV, distal to the SPJ) that provides adequate treatment of the culprit vein. The ablation catheter is then advanced into its target position under careful ultrasound guidance making sure that any positioning into deep venous structures is avoided. Before the heat sources is turned ON, the saphenous sheath in the region of interest is infused with diluted tumescence anesthetic (combinations of lidocaine, saline, bicarbonate, and epinephrine). Epinephrine is used sometimes opted for by the vein specialist in the solution to minimize the vein size when treatment is performed. Tumescence has three purposes: 1) anesthetic 2) collapse the targeted vein to the size of the catheter where treatment can be more effective against the venous walls, and 3) direct collateral tissue and nerves away from the targeted region to reduce risks of injury.

Once adequately anesthetized, the vein doctor will activate the RF generator and heat the tip of the catheter. The catheter will then be withdrawn 6.5cm with each treated segment until the catheter has fully treated the targeted segment and can be withdrawn in entirety from its insertion site. The sheath is also withdrawn and hemostasis at the access site is achieved by manual pressure. Post procedure after care instructions are then provided to the patient by the vein treatment clinic per usual protocol.

At minimum, the patient will return to the vein specialist with in 1 week to rule out any unintended complications, like DVT. Thereafter, each vein clinic follow their own protocol to assess the need for additional treatments based on any continued symptoms.

Overall success rates for RF vein ablation is >90% in long term follow-up with fearsome complications like DVT or allergic reactions in the proper hands of a qualified vein specialists near me being less than 1%.

Article Source: http://spiderveintx.freeblog.biz/2021/12/15/what-is-rf-vein-treatment/

How to choose a vein doctor?

“Varicose veins are a common affliction and affects nearly 1 out 4 Americans” according to a vein specialist in New Jersey. Fortunately, most of us with varicose veins will not have any significant issues or complications. Simple at home or work measures including exercise, compression stockings, leg elevation and smoking cessation will be enough to keep symptoms at ease.

For patients with symptoms including leg pain, leg heaviness, itchy or spider veins on legs, and restless legs despite conservative measures, a new approach is needed. Many are aware that a consultation with a varicose clinic is needed, however are unsure how to find the most qualified physician. Within each major zip code, you might search and find at least 10 different vein treatment centers. As you are probably aware, not all of them are equally experienced or skilled to manage vein disease.

So let’s begin with some advice on selecting which doctor is best for you from your internet search:

1) Be certain that your vein doctor is board-certified and “trained” in vascular treatments. This is more than passing a written test, but also informs you that the vein doctor completed a formal residency or fellowship in endovascular treatments. Consider specialists with backgrounds in vascular surgery, interventional radiology or interventional cardiology.

2) Vein evaluation is a must! If you are asymptomatic and primarily concerned about cosmetics, you should not consider more involved procedures like EVLT or EVLA (Endovenous laser ablation). Vein ablation is best suited to manage patients who have medical necessity based on signs and symptoms of venous insufficiency. A vein specialist can rightly assess your condition and determine whether or not a medical condition exists.

3) If you are having treatment for venous insufficiency, the most advanced techniques are endovascular ablation, foam sclerotherapy, and venaseal. In some cases, MOCA or mechanochemical ablation can also be considered. Stripping is an older technique and is no longer the preferred or best treatment for underlying vein disease. It has a higher level of complications and is less effective

4) Phlebectomy is still very useful for large unsightly veins that are not suitable for ablation or sclerotherapy either due to their tortuosity or proximity to skin and other collateral tissue. Additionally, treating large protuberant veins with simple sclerotherapy can sometimes lead to longer healing periods and long lasting cosmetic skin discoloration. Phlebectomy is a fast and efficient tool to eliminate large varicose veins without any large incisions.

5) Support staff is another way to measure a clinic’s commitment to the highest standards. Check and see if your ultrasound technologist performing important reflux studies has passed his/her certification exams. They will let you know if they are RVT (registered vascular technicians) or RVS or RpHS (registered phlebololgy sonographers)

6) The above factors focus on being certain on the qualifications of your vein doctor and the breadth of their skills to offer various treatment solutions tailored to your symptoms, anatomy, and vein presentation. The other qualities are more abstract and are the individual feeling you get about your interaction with the staff and vein doctor. Being given appropriate time and patience to your questions and concerns reflects on how much value the vein clinic places on the individuals care. Don’t fall prey to high volume centers that emphasize procedural volume over outcomes and quality. If you feel less than satisfied with your initial consultation, it’s very reasonable to consider a different vein clinic even if you have to travel some extra miles.

Just remember if you can’t get the time and answers to your questions, what is the likelihood you will see the time and commitment given to your vein treatment. Getting high level care is difficult because the experience of vein doctor is so variable and due to financial constraints, much of vein treatment near me today are trying to fit as many cases in a limited daily schedule. Something has to give and that generally is quality. The final results will make the extra commute worthwhile and that level of expertise can only be delivered by the very best centers committed to continuing education, investment into new technology, and you the patient for time.

Article Source: https://njveinwellness.bcz.com/2022/01/18/how-to-choose-the-right-vein-dr/

Breast Veins

 A woman's chest is something that she wants to be proud of. Regardless of the size, if you want to look good at the pool or in a sexy dress, you don't want unsightly veins popping out. There are several causes of visible veins on the breasts:

Hormones - as women know well, they experience hormone changes throughout the month and throughout their lives. These fluctuations can cause veins to sometimes appear on the surface of the skin, and even bulge out at times. Hormonal vein changes are usually temporary. Weight change - both weight gain and weight loss can affect your veins and your breasts.

Weight gain - can stretch your skin, making the veins more visible. While weight loss, can decrease the fat layer that usually hides your veins. Pregnancy - a woman's body is very busy during pregnancy, so much so that the blood volume in the body increases by 20-40%. All this extra blood can leave the body, especially the breasts looking veiny. This decreases after breastfeeding is done.

Breast surgery - breast augmentation is meant to make a woman look sexier, but one unsexy side effect is increasing the visible veins. Breast implants push veins up towards the skin, and can make them more apparent.

Age - as we age, our skin becomes more transparent. Also, with aging the fat on the breasts decreases because of decreasing hormone levels. This combination can lead to more visible veins on the aging breasts.

Other health conditions - while rare, there are certain health conditions that can also increase the visibility of veins on the breast. These conditions can include, mastitis, mondor's disease, and inflammatory breast cancer.

If you suspect any of these reasons, see a doctor immediately. Once you figure out what is causing your "blue boobs", there are good options for treatment. In some cases a quick fix can be exercising regularly to stimulate blood flow or changing the size or style of your bra. A tight fitting bra can constrict the circulation to the breasts, and cause the veins to swell. If these solutions don't work, a top vein doctor can help.

Selecting the right vascular specialist should focus on board certification, vascular experience, online reviews, and treatment options. We recommend performing this online research focusing on the vein clinic and doctor credentials:

#1-The Vein Doctor

No item is as important as the physician who will be managing your condition. A vein specialist should have expertise in the diagnosis and management of both simple and complex vein conditions. This includes patients presenting not only for cosmetic veins, but also symptoms consistent with venous insufficiency. On site venous ultrasonography is what separates vein clinics from pop-up spider vein treatment centers. A quality study is the most important factor in determining your health condition related to spider and varicose veins.

# 2 Board-certification

Besides experience, we trust vein doctors who possess board-certification in vascular medicine. This includes vascular surgery, cardiology and interventional radiology. These training programs provide the necessary exposure for the diagnosis and treatment of vein conditions. Do you really trust any doctor who's training was less than an entire residency or fellowship? Unfortunately, vein treatment has no specific board certification and so it's not uncommon to find less experienced doctors from various backgrounds including internal medicine, pain management, and family medicine performing vascular procedures.

# 3 The facilities

Don't judge a book by its cover is true in most instances. However, with vein treatment, we cannot over-emphasize the importance of maintaining a clean and up to date look. Vein treatment centers engaged in keeping their practice modern will spend the extra dollars to re-invest in their technology and maintaining their site to the highest standards.

A vein doctor can determine the best course of action for you as an individual. One of the leading treatments for breast veins is sclerotherapy. Sclerotherapy is a formulated liquid that is injected into the vein. The chemical begins to then irritate the walls of the targeted veins causing them to collapse and eventually be absorbed and "disappear" on the surface of the skin.

For more information on causes and treatment of breast veins, visit a dermatologist or vascular specialist in your region.

Article Source: https://nycvaricoseveins.webgarden.com/nyc-veins/blog

Orthopedic Vein Disease

Leg pain is one of the most common issues patients face and it’s not surprising to learn that orthopedic issues and vein disease can be seen together. In fact, both conditions affecting one patient can be quite common as the 2 conditions are seen frequently in individuals over age 40. Some have coined the term “orthovenous” disease and the impact of vein disease can be quiet significant for patients considering orthopedic surgery. This includes patients who have not only undergone previous knee or hip surgery, but also considering procedures in the future. It’s important for both the varicose vein clinic near me  and orthopedic surgeon to be aware of the signs and symptoms of venous insufficiency.

 
Orthopedic patients suffering from leg swelling, visible or tender varicose veins in feet, leg cramps, charley horses, and restless legs likely have underlying vein disease. These patients should consider a venous evaluation prior to any major orthopedic surgery. Post-operatively, if swelling continues beyond the typical expected period, a similar evaluation would be recommended.
 
Although there is a lack of abundant literature regarding the treatment of venous disease prior to orthopedic surgery, the available research has shown that patients who have their venous problems addressed prior to knee replacement or arthroscopy have a better outcome. Patients were noted to lessen the risk of leg swelling and deep vein thrombosis post- operatively when venous disease was managed prior to surgery. Similarly, the decreased swelling has been observed to improve wound healing and physical therapy.
 
Vein treatment by closing defective veins is minimally invasive, taking approximately one hour with rapid recovery times. While anyone suffering from vein disease will likely benefit from a vein evaluation, patients undergoing orthopedic surgery may be a special population that should seek earlier treatment Additional research is needed to verify some of the earlier findings and beliefs within the orthopedic and vascular community.
 
If you have leg pain and are under orthopedic evaluation, be sure to consider your vein health also. If you have concerns about varicose veins,  itchy veins, swelling, leg heaviness or skin discoloration – request a vein center near me to evaluate your leg pain. Remember, untreated vein disease can improve how you feel and recover after orthopedic surgery.

Article Source: https://southjerseyveinclinic.weebly.com/blog/orthopedic-vein-disease

Foam Vein Treatment

 The gold standard of treatment for spider veins clinics in NJ is non-surgical treatments including endovenous laser vein ablation and endovenous radiofrequency ablation.  Both forms of treatment are catheter based technologies performed using ultrasound guided percutaneous entry.  However, ablation is not suitable for all patients due to variable presentations of vein disease and anatomical considerations.  In fact, contra-indications to catheter based treatment include: 1) superficial veins close to the skin 2) proximal nerves or arterial circulation 3) tortuous veins. 

In these instances, a more suitable treatment is microfoam delivery  of polidocanol, otherwise known as foam sclerotherapy.  The difference between foam sclerotherapy and the more common and well-known sclerotherapy is the compounding of the sclerosant with mixture of air (nitrogen, oxygen, and carbon dioxide).  The elements are in variable concentrations and allow for the liquid sclerosant to be compounded into a foam mixture that adheres better to target vessel walls.  This is important for larger targets like varicose veins and in some cases reticular veins.   Vein specialists will use either foam or liquid sclerotherapy for spider vein treatment NJ depending on the condition being treated.  

• Truncual reflux–best suited for RF ablation or EVLT
• Truncal varicosities–foam sclerotherapy or ambulatory phlebectomy
• Perforating veins–targeted ablation or foam sclerotherapy or phlebectomy
• Reticular veins–foam sclerotherapy
• Spider veins–liquid sclerotherapy or laser treatment of spider veins

Foam sclerotherapy can be aided by ultrasound in certain situations prescribed by the vein doctor.  In most vein clinics, the preferred solution is now polidocanol given its efficacy and safety profile.   There is also the FDA-approved Varithena that is ideal for large varicose veins, perforators and neovascularization.  Varithena comes in 1% polidocanol pre-packaged, but is unique from physician compounded foam sclerotherapy because it is pre-packaged as a low-nitrogen microfoam that clinically has proven to be safer and more efficacious.  It can be used on the upper and lower portions of the leg.  However, despite the increased safety profile ,the medication should only be administered by qualified vein doctors near me that understand the mechanism of action and appropriate use criteria.



In general, foam sclerotherapy is administered following direct cannulation of the target vein.  With polidocanol, the preferred concentration is 0.5%-1.0% depending on the size of the target vein.   With generic polidocanol, the liquid sclerosant is mixed with an air-filled syringe in 3:1 or 4:1 ratios until a foam is created.  The injected foam has an immediate action on the vein walls inducing chemical ablation; this process continues for months to years as the vein is slow reabsorbed by the body.   It is important to inform patients of the possibilities to feel tenderness or lumpy nodules after treatment that may look worse for a period of time, but will heal with good effect.    Follow up is important post procedure as per the protocol and is standardized in most  vein centers. The post procedure care after sclerotherapy follow up will include a duplex ultrasound to evaluate vein treatment effect and any complications post sclerotherapy.

Article Source: https://centralnjveinclinic.weebly.com/blog/foam-vein-treatment

When to Visit the Vein Doctor?

 Spider veins and varicose veins are quite common.  In fact, it's estimated that up to 80% of females have some presentation of vein disease including spider veins. In most cases, the presence of spider or varicose veins is not a reason for concern.  However, whether it's for cosmetic reasons or medical reasons, you will want to make sure you are getting the right advice. 

 

 

In this article, we review some of the top reasons patients seek out expert advice for spider and varicose vein treatment.

 

1) Spider Veins

Spider veins are fine red or purple vessels on the skin and have the appearance of spider webs. They represent the most common reason females seek out vein treatment.  Genetics, venous insufficiency, and hormonal factors are the most common cause.

 

2) Varicose veins

Protuberant, larger veins on the surface of the skin.  They are tortuous and associated with a greater degree of symptoms. The primary cause is often venous insufficiency and genetic factors.

 

3) Restless Leg Syndrome

Venous insufficiency is surprisingly a common cause of restless legs. While every patient may not have pain from varicose veins, the involuntary contractions from restless legs during the night-time can be very disturbing. A simple duplex ultrasond can help make the diagnosis.

 

4) Leg Swelling

Edema or leg swelling is more concerning symptom with venous insufficiency and results from higher venous pressures. Swelling in vein disease is an indication for treatment, however alternative causes should also be excluded.  

 

5) Leg Pain

Leg pain in venous insuffiency occurs as blood pools in the legs and causes aching and heaviness. The saphenous veins are often involved and can be diagnosed with with venous reflux study.

 

 

 

 

Making a decision about vein treatment is often guided by the symptoms you experience.  Leg pain, restless legs, and swelling are indications of medical venous disease. 

Treatment is guided by venous reflux studies to help elucidate the culprti vein.  Greather saphenous disease accounts for approximately 80% of venous insufficiency and can be relieved with simple measures including vein ablation, venaseal and varithena in appropriate candidates.

 

For more information, consider visiting www.veinspecialistcenters.com for detailed questions about vein disease and vein treatment.

Article Source: https://healthandwellnessnj.puzl.com/_news/Who-Visits-the-Vein-Doctor/291645