Sclerotherapy 101

Sclerotherapy is used to treat veins just below the skin's surface that are either invisible or difficult to see with the naked eye. In this procedure, tiny needles provide access to the vein and then a substance called a sclerosing agent is injected into the vein's interior wall. This substance causes the vein to become sticky and seal shut, and the troublesome vein disappears. Blood then finds a healthy path back to the heart. There is little risk of complication, and patients often experience an immediate relief of symptoms. 

There are two ways that providers visualize the veins during this procedure: “ultrasound guided” and “light assisted.” Ultrasound-guided sclerotherapy uses ultrasound to locate veins that are not readily visible and cannot be seen with a light. This procedure is often used to treat perforator veins, or veins that connect the superficial system (above the muscles in your leg) to the deep system (veins under and between the muscles of the leg).  

During light-assisted sclerotherapy, a small, hand-held light illuminates the veins and tissue directly below the skin, which allows the provider to clearly identify the source of the dysfunction.

The number and length of each treatment vary from patient to patient. Each session can take between 15 minutes and one hour, depending on the complexity of vein patterns and venous reflux. Most patients need multiple treatments (3-6 sessions, on average), however, there is usually improvement with each session.

Here is the question that patients ask the most: “Will it hurt?” Everyone’s experience is different, but most people describe the feeling as quick little bee stings. It is always possible to stop the procedure or take a break if someone does find it very uncomfortable, but most patients say it is very tolerable. The medicine is pH balanced and vein access is with a 27-32g needle, so it’s just a very small perceivable pinch.

Immediately following the procedure, there may be mild itching of the legs, which typically resolves within an hour. For the next few days, there may be some tenderness and bruising. About two weeks following the procedure, there may be hard bumps in the area of the treated vein, which usually disappear over the course of several months.

The most common side effects are bruising and tenderness of the treated veins. The bruising is usually fully resolved within two weeks, and the tenderness responds well to heat and elevation. Remember, patients who follow the post-procedure guidelines for care will promote the most effective healing. Compression stockings should be worn for 7-14 days after each sclerotherapy session, depending on the severity of the venous disease.

The changes that patients notice in the first two months are improvement in symptoms. Patients have reported to that their legs feel lighter or pain free! The large, lumpy veins slowly disappear, usually 2-6 months after the procedure, and the smaller veins may disappear over the following six months. It’s good to remember that as the veins resolve, there may be some color changes in the skin; legs sometimes look worse before they look better. But when they look better, they look great!

To learn more about Sclerotherapy or other vein treatments, contact us at the Vein Healthcare Center today to schedule an evaluation. Education is the first step toward healthy legs!

3 reasons why winter is a great time for vein treatment

Diagnosing and treating varicose veins (and other forms of venous disease like spider veins and leg ulcers) is a good idea any time of year. Winter, however, is an excellent time for vein treatment. 

Here are just a few reasons why:

1. Cozy Compression

With a vein procedure such as ablation, you will be required to wear medical-grade compression stockings any time you are on your feet for the first two weeks following treatment. (After sclerotherapy, you should wear compression 7-14 days when you are on your feet.) The good news is that post-procedure compression stockings will keep you warm while you recover – and it’s much more comfortable with a winter wardrobe.

2. Less Swelling, More Comfort

Heat causes blood vessels to expand, or vasodilate, which can increase swelling and discomfort in legs that are prone to varicose veins. The cold weather naturally constricts blood vessels, which can potentially reduce post-procedure swelling and makes recovery feel easier than in the summer heat.

3. Ready for Summer 

Recovery from vein treatments take time. Patients can expect some amount of bruising, swelling, and tenderness, although post-procedure discomfort is highly variable from person to person. While some patients may experience discomfort, some may feel none at all. It takes time for legs to recover from vein treatment. If you get started in the winter months, you’ll be more ready for shorts in the summer.

If you’re concerned about your vein health and want to schedule an appointment this winter, feel free to contact us at the Vein Healthcare Center. Our goals are to learn about your condition, help you understand how your vein health affects your overall health, and provide you with treatment options. We make taking the first step simple, comfortable, and stress-free!

Be aware of DVT and travel safely this summer

Summer may be BBQ season, but it’s also the time when people travel long distances in planes, trains, and automobiles. For us in vein healthcare, that means increased risks of Deep Vein Thombosis, or DVT.

The deep vein system carries about 80% of blood from the feet back up to the heart. Deep veins are located under the muscle and connective tissue layers in the legs. A blood clot in a deep vein can be dangerous because the high pressure in the system could cause the clot to break free from the vein wall and enter the blood stream. The DVT could then travel up through the legs into another part of the body such as the lungs, where it would become a pulmonary embolism (PE).

DVT or PE symptoms are often misinterpreted as something less serious. A blood clot in the leg may feel like a “charley horse,” shin splints, or a twisted ankle. Symptoms from PE are often attributed to a pulled muscle in the chest, costochondritis (inflammation of the joint between ribs and breast bone), asthma, or a “touch of pneumonia.”

So what are some of the signs to look for? For DVT, the leg may be warm to the touch; swelling in the leg (can also occur in the arm); leg (or arm) pain or tenderness; reddish or bluish skin discoloration.

For PE, be aware of a sudden shortness of breath; sharp, stabbing chest pain (may get worse with deep breath); rapid heart rate or breathing; feeling lightheaded or fainting; unexplained coughing, sometimes with bloody mucus.

In half of DVT and PE cases, no symptoms present at all—but both conditions are medical emergencies. Any of these symptoms should be regarded as a DVT or PE until proven otherwise, especially if someone is in a risk category (including whether there is a history of blood clots in your family).

Awareness is key-- and so is prevention. When traveling long distances, stay well hydrated, stretch legs your legs and pump your feet periodically, avoid or moderate alcohol and caffeine, and consider wearing graduated compression stockings on your trip.

To find out more about DVT and other vein issues, contact us at the Vein Healthcare Center. We will evaluate your vein health — including spider veins, varicose veins, and leg ulcers.

Compression: How To Put It On & Take It Off

At the Vein Healthcare Center, we've said it before and we'll keep on saying it: we love compression!

To help patients better understand how to put on and take off their compression stockings -- what they refer to in vein care as "donning and doffing" -- we've adapted this downloadable guide from our friends at medi-usa.

If you have any questions about compression, please contact us at 27-221-7799 or email info@veinhealthcare.com. If you're interested in taking the next step in vein care, click here to learn more.

The latest issue of Vein Health News!

We've released the latest issue of Vein Health News! 

In the cover story “Skin: Dermatological Changes & Vein Health” we explore how vein specialists use the clues in skin -- everything from color and thickness, to visible spider veins and ulcers -- to help diagnose a patient's vein disorders. 

We also take a look at "medi-spas" and how consumers can choose their aesthetic procedures and practitioners wisely -- and why they should.

In the same issue, we share updates in the world of compression and even give illustrated tips for getting compression stockings on and off with ease. 

Click here to read all this and more. If you would like more information about skin, vein health and the right treatment for you, give us a ring or drop us a line at the Vein Healthcare Center.

You can call 207-221-7799 (Monday through Friday during regular business hours), or send us an email at info@veinhealthcare.com.

Are graduated compression stockings the same as TED hose?

In a word: no. TED hose are not the same as graduated compression stockings. There are many people who do not realize there is a difference.

T.E.D. is an acronym for Thrombo Embolic Deterrent, so T.E.D. hose are "anti-embolic" stockings. They are often worn after surgery to help prevent Deep Vein Thrombosis -- also known as DVT. They work well for this purpose, but they are only 8-15mmHg of compression. As soon as someone is out of bed post surgery and is able to stand, there is more pressure on the veins and the TED hose become much less effective. 

TED hose do not help with the symptoms of venous disease, nor do they halt the progression of venous disease.   

A graduated compression stocking prescribed for chronic superficial venous insufficiency is generally 20-30 mmHg, which means there is approximately 30mmHg of pressure at the ankle, 25 mmHg in the mid-calf, 20 around the knee, 15mmHg in the lower thigh, 10 mmHg in the mid thigh, and 5 mmHg in the upper thigh. This graduation encourages good venous return. Another difference is that, in general, compression stockings are much more tolerable to wear on a daily basis. 

Though compression stockings are much easier to put on than TED hose, they can still be difficult to put on. So if you are prescribed to wear either compression stockings or TED hose, ask your provider for tips -- or even coaching -- for how to put them on and take them off. (That's called "donning" and "doffing" in the compression business.) There are lots of online resources to guide you.

If you have any questions about compression therapy or T.E.D. hose, contact us at the Vein Healthcare Center. We're here to help!

We love compression!

At the Vein Healthcare Center, we talk about graduated compression. A lot. 


In fact, Dr. Asbjornsen wears 20-30mmHg socks or stockings almost every day. Doctors are always on their feet, and graduated compression fights—and beats—gravity, keeping the blood circulating from the legs back up to the heart.


In our last issue of Vein Health News, the cover story was all about caring for your legs and feet when you’re constantly using them. Our colleague Tom Musone from the compression company Juzo gave us six tips about how to use compression to make your legs feel better:

1. Wearing compression every day can prevent edema (leg swelling), alleviate venous symptoms, and make your legs feel better overall.

2. Make sure you wear graduated compression stockings. That means the pressure is highest at the foot and ankle and gradually decreases as the garment rises up the leg. This pressure gradient makes it easier for the body to pump blood up towards the heart and more difficult for gravity to pull blood downward.

3. Compression also increases the pressure in the subcutaneous tissue, which helps to reduce and prevent swelling by moving excess fluid back into the capillaries.

4. Gradient compression is expressed in millimeters of mercury, or mmHg. Unless otherwise directed by a medical professional, look for 15-20 mmHg or 20-30 mmHg.

5. Current evidence supports wearing either knee-high or thigh-high style compression stockings when standing for prolonged periods. A good fit is the most important factor.

6. Get fitted by a certified fitter to find the brand, product, and style that’s right for you. These days there are dozens to choose from.


Dr. Asbjornsen swears that even if she weren’t a vein specialist prescribing compression stockings to patients, she would still tout the benefits of wearing it, because her legs feel so good at the end of the day!


If you have any questions about graduated compression for venous relief, prevention, or both, contact us at the Vein Healthcare Center. We’re happy to educate about the benefits of compression.

Standing on the job

Do you work at the kind of job where you’re on your feet all day? (Nurses, teachers, and restaurant workers, we're talking to you!)

In our latest issue of Vein Health News, we look at the risks of being on your feet all day at work, as well as the role that veins may play in causing leg pain or discomfort after prolonged standing. The article explains the symptoms that indicate that leg pain may be due to vein disorders— symptoms that are often mistaken for something else.

Of course, the article also explores modes of treatment and prevention. We offer tips from experts in podiatry, pedorthics, compression, and even a nail technician. Read on to find out more about what you can do to take care of your feet so that they can keep you healthy and moving forward!

To learn more about this and other current topics in vein healthcare, click here. And if you’d like to take the next step in your vein health, click here.

Happy National Nurses Week!

May 6-12 is National Nurses Week, sponsored by the American Nurses Foundation. This

year's theme is "Year of the Healthy Nurse."

To celebrate and support nurses everywhere, we offer some healthy leg tips for nurses who are on their feet all day.

Did you know that varicose veins can be an occupational hazard for nurses? One tried and true way to reduce the effects of vein disease -- and in some cases, prevent symptoms -- is graduated compression. 

Please note that so-called "support hose" does not have to be ugly! Not today, with the many styles and colors that are available. 

Another remedy for aching legs is to elevate them periodically and at the end of the day. This post explains how to properly elevate legs. Lastly, nurses should remember to care for their feet. Here are some tips from the blog RN Central.

Happy National Nurses Week to all of the nurses out there. Thank you for all you do!

Visit the Vein Healthcare Center in South Portland, Maine, or learn more about Dr. Cindy Asbjornsen.

Compression After Laser Treatment

In our last post we discussed the value of graduated compression stockings before an EVLA procedure. Now we turn to the use of compression after vein treatment. 

Graduated compression after EVLA has been proven to decrease swelling, a common outcome associated with the procedure. Additional benefits for the patient are decreased discomfort, potentially decreased risk of blood clots, and potentially decreased risk of pigmentation, or staining of the skin.

Immediately following an EVLA procedure, patients are asked to put on their compression stockings. Vein specialists will ask patients to wear compression stockings for the first two weeks following EVLA treatment, any time the patient is on her or his feet. (Compression stockings are also prescribed following sclerotherapy treatment, usually for between five days and two weeks.) Graduated compression stockings should never be worn to bed.

Compression is critical for the most efficient and effective healing process.

Compression Before Laser Treatment

For years, patients suffering from varicose veins and other vein conditions had few options for treatment. Now, endovenous ablation, or EVLA for short, is considered the gold standard in vein treatment. EVLA is minimally invasive procedure that is done on an outpatient basis, and recovery time for most people is very quick.

Graduated compression stockings play an essential role before and after vein treatments, including EVLA. Anyone that undergoes EVLA, sclerotherapy or other treatments for venous insufficiency must wear graduated compression stockings immediately following the procedure and during the recovery period. What some may not realize is that there are reasons to wear compression before treatment too.

Before a vein procedure, wearing compression stockings gives a person a snapshot of what vein health feels like. Since compression alleviates symptoms, it becomes easier for a phlebologist (vein specialist) to tease out, or confirm whether the leg pain is due to muscular-skeletal issues, the nervous system, or venous disease. Another benefit to wearing compression prior to treatment is that it’s good to confirm that the patient can tolerate stockings, and/or that the stockings fit properly. (After the procedure is the worst time to discover that the stockings don’t fit!)

Alternatively, many who think that they could never tolerate compression stockings try on a modern stocking and find them quite bearable. Since compression prevents the progression of vein disease and controls symptoms, some people may even decide to take a more conservative approach, rather than proceed with definitive treatment.

Vein Health News, a resource for patients and doctors

Dr. Cindy Asbjornsen of the Vein Healthcare Center in Portland, Maine is passionate about educating people about vein health. That’s why three years ago she started Vein Health News for primary care physicians in Maine and New England. Although the magazine was originally intended for physicians, we've found that patients really like it too.

Vein Health News covers such topics as: minimally invasive treatments for varicose veins, modern compression, leg ulcers, deep vein thrombosis, and more. Plus, the regular column “One Patient’s Perspective” explores vein care from a patient’s point of view. If you’re interested in a free subscription to Vein Health News, just click here.

Are you a Physician? 

Primary care doctors are on the front lines of reducing the growing number of people suffering with symptoms of venous disease. Vein Health News serves as a resource for well-researched meaningful information that you can pass on to your patients. If you would like the publication delivered to your office, click here to subscribe.

Education is an important first step toward better vein health and an improved quality of life.

Fashionable...compression?

Graduated compression stockings are ugly, beige, and only for “old people,” right?

Wrong. In the past several years, compression companies, such as Juzo, SIGVARIS, Carolon and Jobst, have been developing stockings and socks in styles, patterns, finishes, and colors that look more like fashion accessories than medical devices (while still being clinically effective when purchased and put on correctly.)

Newer brands like REJUVA and ITEM m6 (a spin-off of compression manufactuer medi) are also taking compression trends to the streets. Both companies were mentioned in an article about compression in the NYTimes Style section!

Read more about how compression has evolved in Healthy Style: Compression Steps Up, the latest cover story in Vein Health News. Just click here to read the story.

Preventing leg ulcers

It's not easy to live with leg ulcers. Open wounds can be painful, difficult to heal, and the likelihood of recurrence is significant. But prevention is possible.

One warning sign that you may be developing a venous ulcer is noticeable skin changes in the lower legs, such as dryness or thickening. Another sign of ulceration may be discoloration of the legs, typically dark red, purplish, or a brown, woody appearance. Other possible indications are aches or pains in the legs, especially when standing or sitting for prolonged periods.

Varicose veins are another possible warning sign. Varicose veins, as with any form of venous disease, are often hereditary. If you have varicose veins—or a family history of varicose veins— consider getting evaluated and treated for them before they lead to ulceration.

Risk factors for venous ulcers include older age, a history of deep vein thrombosis (DVT), venous insufficiency, and previous ulcers or leg injury. Though you can’t change your genetics, you can modify other things. If you have a job where you’re on your feet all day, wear graduated compression stockings.

There is often a misconception among patients and physicians alike that there is nothing you can do for venous ulcers. The fact is wound care specialists use a variety of modalities to heal patients’ wounds, including aggressive compression therapy, skin grafting and “low-tech” therapies like elevation.

It is important to remember that although wound care specialists can treat and even heal wounds, unless the underlying cause is addressed, it will only reoccur. If the wound is identified as a venous ulcer, then treating the incompetent vein valves that contribute to venous ulcers is key for lasting results.

Experts agree that the earlier the intervention and treatment, the better chance a wound has to heal and stay closed. And, of course, patients with venous ulcers are best managed by a multi-disciplinary team of primary care physicians, wound care centers, and professionals who specialize in venous care.

Welcome back, snowbirds!

For years, New Englanders have spent the winter months in warmer climates and then travel north when the snow stops flying. Summer can be a good time for people with vein problems — including “snowbirds”— to think about treatment.

During the warmer summer months, the heat can dilate veins and cause symptoms to worsen— which can inspire people to seek treatment. All venous procedures require compression stockings post-treatment, and because many seniors already wear compression stockings regularly, this may be less of a barrier.

Most snowbirds check in with their primary care doctor when they get to Maine or before they leave. If this is something you do, this doctor visit is a good time to discuss any achiness or pain in your legs, or ask about vein disease, such as varicose veins or venous ulcers.

In any case, vein evaluations can take place in either the patient’s summer or winter home. Phlebologists who are certified by the American Board of Phlebology (ABPh) can be found on the ABPh web page: www.americanboardofphlebology.org.

Finally, good communication between primary care physicans and specialists is essential to receiving good patient care. Phlebologists, too, should keep every patient’s family doctor abreast of all vein procedures and interventions, even if one doctor is in Florida and the other is in Maine. 

Varicose vein treatment in the summer, Part 2

In our last post we discussed some of the treatments available for venous disease, including varicose veins. Now we frankly discuss one possible drawback to seeking treatment for vein problems in the summer.

Following every vein procedure, patients must wear graduated compression stockings. The length of time that patients are prescribed compression stockings is highly variable, depending upon the patient and the procedure. It could be as short as three days for some light-assisted sclerotherapy, or as long as two weeks for endovenous laser ablations or ambulatory phlebectomies. The lighter, sheerer stockings are better tolerated during the summer months, but tend to be less durable than some of the thicker options often work in the winter.

Although some people choose to delay treatment until after summer is over, others prefer to seek treatment as soon as possible. For those who choose not to undergo a vein procedure during the summer, it is still a good time to think about vein health.

It can take several months or more for the complete resolution of veins that have undergone treatments, so people can plan for next summer by scheduling an evaluation now. Whether or not one decides to pursue intervention for varicose veins or other venous issues, here are tips for vein relief in the summer.

No matter what the season, finding a qualified vein specialist can lead to an improved quality of life and better overall health. 

After EVLA

As with any medical procedure, if you’ve undergone Endovenous Laser Ablation Therapy, or EVLA, it is important to know what to expect after the procedure— and to understand any recommendations or restrictions the doctor gives you.

Because EVLA is minimally invasive and almost always performed in an outpatient setting, there is usually minimal down time, if any. In most cases, those who undergo EVLA treatment can return to their regular daily activities immediately. In fact, many patients may return to work the day after your appointment, provided the job is not physically strenuous.

Recommendations

Immediately after the EVLA is performed, your leg will be washed and you will be asked to put on your compression stockings. Compression stockings should be worn for the first two weeks following treatment any time you are on your feet. (They do not need to be worn during sleep.) This is an important requirement and can make a big difference in your recovery.

Following EVLA, the treated leg may drain fluid for the first 24 hours, making the compression stocking feel damp. Patients can expect a moderate amount of bruising, swelling, and discomfort. Post-procedure discomfort is highly variable from patient to patient, and while some patients may experience pain, some may feel no discomfort at all following the procedure. Elevating your legs as much as possible, applying heat, and taking ibuprofen as needed are all effective ways to ease most post-operative pain.

Another important recommendation is to walk for 30 minutes each day for the first two weeks after your procedure. Walking can be done in short increments throughout the day adding up to 30 minutes, or it can be done all at once, whatever works best for your schedule.

Restrictions 

Post-procedure restrictions include no heavy lifting and no strenuous physical activity while standing. However, patients should feel free to exercise as long as their feet remain at, or above, the level of their heart (e.g. swimming or floor exercises, ideally with feet on an exercise ball).

The main reason for these restrictions is that those activities increase pressure by tightening the core or abdominal muscles— which then increases pressure downward into the legs. That pressure can cause irritation of the treated vein, which may lead to swelling. It's possile that the swelling could develop into phleblitis. The closed vein likely won’t open, but phlebitis can be quite uncomfortable.

Hot tubs are also restricted while you are healing. Even though doctors sometimes suggest patients use heating pads post-procedure, in a hot tub all of the veins in the legs above and below the treated area become dilated. This can actually cause pain.

           

Follow up

Finally, and most importantly: schedule a follow-up visit to the phlebologist within a week following the procedure to ensure that everything is healing properly. 

How to prepare for an EVLA

In a previous post we described the outpatient procedure called EVLA, or endovenous laser ablation. Now we’ll discuss what to do to prepare for an EVLA appointment. Being fully prepared for your appointment and following recommendations for care before your appointment will help ensure successful, comfortable treatment.

Most vein specialists offer patients pre-operative instructions. Read— and heed— all of the guidelines as part of preparing for the appointment. Common EVLA preparations include:

1. Compression stockings should be purchased and worn prior to your appointment to be sure they are comfortable. You should bring them with you the day of the procedure, as you will use them immediately following treatment and during the following two weeks.

2. Refrain from shaving your legs the morning of the procedure. This will reduce the risk of razor burn irritation from the sterilizing wash.

2. Take all regular medications the day of the procedure.

3. You will be prescribed a muscle relaxer to help keep the muscles in your leg loose, and a pain medicine. Take both medications 1 hour before the procedure or as directed by your physician.

4. Fasting is not required— eat a normal breakfast or lunch.

5. Prepare to bring or wear high-cut underwear that you are willing to have stained by iodine solution. You will likely want a second pair to change into after the procedure is over.

6. Bring an iPod or headset if you'd like to listen to music during the procedure.

It’s important to remember that while endovenous laser ablation (EVLA) is the gold standard for venous care, you and your vein doctor, together, may decide on a different course. Call the Vein Healthcare Center to schedule an educational visit and learn about what options may be right for you.