What Are Venous Ulcers?

Venous Ulcers are painful wounds usually located by the ankles that are caused by abnormal pressure from diseased veins that cannot adequately transport blood back to the heart. Venous reflux is found in deep venous insufficiency
or superficial venous insufficiency. They are the major causes of chronic wounds occurring in 70%-90% of patients with chronic wounds. If an ulcer is part or completely due to superficial venous insufficiency, treating the underlying superficial venous insufficiency can reduce the pressure and cure the ulcer. This can also prevent recurrences. Other treatments include frequent wound cleansing, anti-inflammatory medication and wound dressings.
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Visual vs. Duplex Guided Sclerotherapy

Visual Sclerotherapy is injection of sclerosants or solutions into smaller surface varicose veins. These are veins seen by the naked eye such as your spider and reticular veins. Duplex-Guided Sclerotherapy is the injection of sclerosants
into the larger diseased superficial veins not seen on the surface such as your trunk veins and their tributaries. All sclerosants work by irritating the lining of the vein wall. In response, the veins collapse and are reabsorbed by the immune system.
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Best Laser Treatments for Varicose Veins

For large truncal vein insufficiencies (Greater Saphenous, Small Saphenous and Anterior Accessory Saphenous Veins), the Endovenous Laser Treatment (EVLT), generally works the best. For small or medium sized veins, sclerotherapy is our
treatment of choice. For spider and telangiectatic veins that are too tiny for sclerotherapy needles to enter, (often seen on face, chest and back), we see the fastest and best results using the Vein Gogh Ohmic Thermolysis system which uses a hair thin probe to coagulate the blood causing its collapse and total destruction. Unlike a laser, it can be used on any type skin and has fewer complications and side effects.
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Endovenous Laser Treatment (EVLT)

The EVLT is a laser that uses light energy to close main superficial trunk veins. With the laser fiber, which is a thin wire, it is placed in a truncal vein and local anesthesia is placed. The laser energy, which is heat, is used to seal
the vein closed. It takes less than 45 minutes to perform; it is done in our office with a 98% success rate with usual relief of symptoms and return to normal activity immediately. Walking is encouraged. There may be bruising and mild soreness post treatment but this is usually relieved by compression stockings and over-the-counter pain medications. This procedure is often covered by medical insurance when medically necessary.
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What are Compression Stockings?

Compression stockings are elastic garments worn around the leg, compressing the limb, exerting pressure against the leg reducing the diameter of the distended veins causing an increase in deep venous blood flow velocity and valve
effectiveness. Compression stockings help decrease venous pressure preventing and helping with venous stagnation, swelling and pain. The main indication would be tired, achy legs, leg swelling from chronic peripheral venous insufficiency or lymphedema, leg ulcers, superficial venous thrombosis or deep venous thrombosis. Possible contraindications are moderate to severe peripheral obstructive arterial disease, congestive heart failure, cellulitis, draining dermatitis and advanced peripheral neuropathy.
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What to Expect After Treatment

Often veins look worse after a sclerotherapy treatment. Sometimes the day following the injections and up to two to fourteen days or longer, veins appear mosquito bitten and bruised. They may itch and have some initial tenderness with
signs of inflammation. This inflammation is what occludes and actually causes the disappearance of these veins. Larger veins can feel like a cord under the skin. This cord can be tender and knots can be felt. Often the vein can feel tight along its course. These are all expected signs and symptoms and can be managed by using compression stockings, ice, Tylenol and walking. Generally, there is no down time after sclerotherapy and often can be done over your lunch hour. You will be wearing compression therapy for 2 – 3 hours so you may want to wear long pants or a skirt to cover the bandages. After your first treatment, you may notice that many of the veins haven’t disappeared. This is normal and does not mean you are not responding to the therapy.
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Treatment & Blood Circulation

The backward flow of blood in the larger superficial veins actually interferes with the normal venous return. Removal of these diseased veins through stripping, lasers or sclerotherapy will improve the circulation of the blood back
to the heart. The numerous normal veins with normal valves function better if blood is not shunted to the abnormal veins where the blood is almost stagnant due to insufficient valve function.
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Spider Veins: Causes & Treatment

For some people, Spider Veins are more than just a cosmetic eye sore. Spider veins are rarely a serious health problem, but they can and often do cause aching, cramping, itching, throbbing, burning, tingling and heaviness. Spider veins can
also be a sign of deeper venous insufficiency, (veins beneath the skin surface with poor functioning valves causing more severe problems like swelling, skin thickening, discoloration and ulcerations).
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Duplex Ultrasound for Varicose Veins

Duplex Ultrasound is used to see the anatomy, check the direction of blood flow and determine any blockages in the veins below the surface not seen with the naked eye. It can also be used as an adjunct to sclerotherapy by locating the
diseased vein underneath the surface. The needle can then be seen entering the vein and the sclerosant is injected directly into the vein with full visualization.
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