What is tumescent anesthesia?

Before we explain what tumescent anesthesia is, let’s talk about when it would be used in vein care.

Endovenous thermal ablation (using laser or radio frequency) is considered the gold standard in treatment of the great and small saphenous veins, two veins that are often the source of varicose veins in the lower leg.

Endovenous laser ablation (EVLA) uses laser energy to create an intense localized thermal reaction in the incompetent vein. The thermal energy causes vein to seal shut, stopping the healthy blood flow from entering the damaged vein. This keeps the blood flowing toward the heart, not allowing it to change directions and return to the feet. The body will reabsorb the damaged and treated vein, forcing the blood to be diverted to healthy veins in the leg.

EVLA is an outpatient, minimally invasive procedure performed with local anesthetic.

Part of the treatment involves tumescent anesthesia, a technique in which a high volume of a dilute local anesthetic is infiltrated around the vein. Tumescent anesthesia serves three purposes during thermal ablation. First, the fluid causes the vein walls to collapse around the thermal fiber maximizing contact. Second, the fluid creates an insulating ring around the vein and thermal energy source. This protects all surrounding tissues, including nerves and muscles, thus stopping any type of collateral damage. The third function is as an anesthetic, keeping the patient comfortable during the procedure. 

The introduction of tumescent anesthesia into the body should not be painful but can be when administered by some physicians. Thus, before any vein treatment, consult with a board certified phlebologist who can provide a full understanding of all aspects of the procedure.

To learn more about this and other current topics in vein healthcare, click here. And if you’re interested in a free subscription to Vein Health News, just click here.

One of our patients says: it’s definitely worth it

It’s that time of year when many of us review the things we’re grateful for. One of our patients is thankful for the advances in vein treatment – and for the way her quality of life has improved since her own treatment.

“About 15 years ago I had my varicose veins stripped the old way – surgery. That doctor made an incision from my thigh all the way down to my ankle. It required many stitches and a long recovery. Back then they didn’t have the nice compression hose or knee-highs that they do now; the hoses were thick, rubber and so uncomfortable I stopped wearing them.

After I had my children, a varicose vein formed in the middle of my right leg, and then a big varicosity starting forming on my knee. Every time summer came I always made sure to wear capri-length pants, and I hated wearing bathing suits.

I was reluctant to get my veins treated again because of my experience with the surgery 15 years ago, but I did my research and found Dr. Asbjornsen and the Vein Healthcare Center. I went in to talk to Dr. Cindy, and she and her ultrasound technician took an hour to find out where the source of the problem was. They took the time to find the source of why the varicose vein recurred in my right leg.

I went ahead and did the EVLA and was amazed at how fast it was – only an hour to stop the leak at the upper groin area. I had a pretty big bruise, but I used the Arnicare they gave me and wore my compression stockings. My thigh recovered so quickly!

Before the treatment you could actually feel the heat of the vein through my clothes. You could see the outline of the vein when I wore leggings, it was that bad. Now I can wear anything I want, even shorts. It would hurt at night too, but not anymore.

I have before and after pictures on my phone that I show to everyone! I tell people: Hey, just do it. It’s easy. Yeah, you have to wear stockings for a little while, but it’s definitely worth it.

I would absolutely recommend VHC. The whole practice was professional. They were very understanding about making appointments and worked with me the whole way. The doctor and her staff took a lot of time to explain the problem to me, and how they would resolve it. I think Dr. Cindy is a really good doctor. I felt very comfortable with her and never, ever felt rushed.”

-- Deanna B., 54, Old Orchard Beach, ME

We’re grateful for patients who are willing to share their experiences. To read more of our patients’ stories click here. Thank you for reading the @VHC blog – and have a happy and healthy holiday season!

Seeing is believing

Understandably, sometimes the easiest way for people to decide to get their vein problems treated is for them to see with their own eyes what is possible. We invite you to take a look at the results experienced by several patients of the VeinHealthcare Center in our new e-booklet Perspectives.

In addition to sharing the true stories of people with vein disease, you’ll see the treatment results of eight different patients—with before and after pictures, of course. Click here to see for yourself.

Using ultrasound for vein treatment

Ultrasound is an essential tool in vein care, as well as non-invasive and comfortable for the patient. In addition to mapping a patient’s veins and diagnosing vein disorders, ultrasound is used throughout the treatment of veins, acting like the physician’s “eyes inside the leg.”

After a diagnostic ultrasound is performed and the doctor establishes a treatment plan to fix the problem, ultrasound may be used. In endovenous laser ablation for example, seeing where the healthy vein connects with the unhealthy vein is very important; ultrasound is the best modality to visualize this area.

Another example is ultrasound-guided sclerotherapy, which uses the guidance of ultrasound to find leaking veins that are not visible and can’t be seen with a hand-held light used to view veins near the surface (transcutaneous illumination). Ultrasound-guided sclerotherapy is often used to treat perforator veins, or veins that connect the superficial system (above the muscles in the leg) to the deep system (veins under and between the muscles of the leg).     

After the vein treatment and a designated amount of time for healing, the physician will use ultrasound again to assess the effectiveness of the treatment plan.

What is ultrasound mapping?

Vein disease, which often manifests as varicose veins, is defined as the impairment of blood flow towards your heart. Oxygenated blood is constantly being pumped from the heart to the rest of our bodies through arteries. It is the job of our veins to carry deoxygenated blood back up to the heart.

Healthy veins have valves that open and close to assist the return of blood to the heart. Vein disease occurs when these valves become damaged, allowing the backward flow of blood in the legs where it can pool, leading to a feeling of heaviness and fatigue and causing varicose veins or other skin changes.

Ultrasound is a tool used to diagnose if and where a vein valve (or multiple valves) in the legs is damaged. High-frequency sound waves are used to create images that allow the doctor to see which veins have flow going in which direction—like a road map for the venous system.

A healthy vein will only allow flow from the feet towards the heart. Faulty veins are often connected, so finding the “source” of the problem is a complicated, but critical, step in establishing where exactly treatment should start.

Ultrasound is the gold standard for evaluation of chronic venous disease, and it is important to have a qualified sonographer perform the mapping in order to have accurate diagnostic results. To learn more about what to expect at a vein evaluation, visit our previous post on the topic.

Knowledge is Power

If you’ve thought about “doing something” about your varicose veins or heavy, achy legs but aren’t sure what exactly to do, here’s a suggestion: learn more vein disease and the available options for treatment. By reading this blog you’re on your way, and in this post we’re going to get more specific. After all, knowledge is power!

When researching on the Web, go to trusted sites that specialize in phlebology (the study of vein disease and vein healthcare), such as the American College of Phlebology (www.phlebology.org) and the American Venous Forum (www.veinforum.org). The Vein Healthcare Center website also provides reliable information for both patients and physicians (www.veinhealthcare.com).

If you prefer reading books to screens, then check out our previous post about vein health books.

Gathering information is important, but don’t worry yourself needlessly because of too many visits to WebMD! If you really want to understand the root of your vein problems—and possible treatments—then a visit to a Board-certified vein specialist is best.

What women can do about varicose veins (and free eArticle)

It is a common misconception that only women experience troublesome veins. In the U.S. one in three people— including men— has some form of venous disease. Still, gender does make a difference. Why?

A woman has three potential “high risk” times in her life that men do not. Significant hormonal fluctuations typically happen during menarche (menstruation), pregnancy, and menopause. Surges in the hormone progesterone, in particular, can cause veins to stretch, sometimes enough for vein valves to tear and fail to do their job. Women who have venous insufficiency may notice that their symptoms worsen during menstruation.

Even after menopause, when most hormone fluctuations have stopped, a woman’s risk of vein disease continues to increase with age. There is a higher incidence of varicose veins in older women, because as the body ages, it produces less collagen, which causes the veins (and vein valves) to become weaker.

With the right information, women have the ability to reduce their risk of developing venous disease and/or decrease its severity. Preventative measures include: wearing graduated compression stockings; living an active lifestyle; and maintaining a healthy weight.

There are also a number of effective, minimally invasive treatments available for varicose veins and other symptoms of vein disease. If you’d like to learn more about how women can improve their vein health, read our latest eArticle “Women and Vein Treatments.” Click here to download your free copy.

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.

3 reasons to visit a vein specialist this year

At the start of a new year, many people schedule visits to their family doctor, dentist and other physicians, but who should plan to visit a vein doctor, and why? People often discount their bulging or uncomfortable veins because they’ve been told for years that such issues are merely cosmetic and never covered by insurance. Not true!

Today, venous disease and its accompanying symptoms— including, but not limited to, varicose veins— are recognized for the health issues they truly are. Improving one’s quality of life also shouldn’t be underestimated, so here are just three reasons to consider an evaluation with an experienced, board-certified phlebologist:

1. You’re embarrassed to show your legs – Whether you have thick, ropy varicose veins, or spindly spider veins, there are modern, minimally invasive procedures to treat an array of vein disorders. While varicose veins can hinder confidence and the ability to participate fully in life’s activities, venous disease is never simply cosmetic. It is a progressive disease that can lead to incapacitating symptoms, heightened pain, and intensified health concerns.

2. Your legs often feel tired or heavy – These are two of the most common (and early) symptoms of a vein problem. Intense leg fatigue at the end of the day is a sign. Heaviness is usually a result of mild swelling due to poor venous return (blood flow back up to the heart). These symptoms can be easily treated with compression stockings or other minimally invasive therapies.

3. “Bad veins” run in the family – Approximately 60% of people who have one first-degree relative with venous issues will also have issues. That statistic shoots to almost 90% if someone has two first-degree relatives with vein problems. Many bleeding and blood clotting disorders are also hereditary. If someone has a family history, s/he should be proactive about vein disease prevention and consider going to a vein specialist for a baseline evaluation.

If you have any questions about problem veins, or just don't know where to begin, give us a call at the Vein Healthcare Center. We'll work with you understand venous disease and what your options for treatment may be.

Is it time to get a second opinion?

One way to take control of your own vein health (and overall health) is to seek a second opinion.

Second opinions are common in the field of medicine, including the area of vein health. In fact, second opinions are an essential part of effective diagnosis and treatment of venous disease.

In recent years, there have been many new developments in the treatment of varicose veins and other vein problems, and some doctors may not be familiar with minimally invasive treatment options, such as ultrasound-guided sclerotherapy, or endovenous laser ablation (EVLA).

If you have been told that there is no treatment for your venous symptoms-- or, if you have been told that your venous condition will resolve itself without any intervention-- you may be a good candidate for a second opinion.

Learn more about second opinions and some of the treatment options available, and take control of your vein health!

Considering Treatment for Varicose Veins and Vein Disease? Here’s What to Expect

For those suffering from the effects of vein disease, including varicose veins, the dog days of summer are the perfect time to consider treatment.

Summer is often full of activities and busy schedules, but there is never a good reason to procrastinate when it comes to good health. Plus, if the appearance of varicose veins is a concern, scheduling an evaluation with a certified phlebologist now can allow plenty of time to learn about venous issues and review options for treatment so you’ll be able to show off your legs next summer.

Getting Started With Vein Care

A venous evaluation starts with a medical history,
physical exam, and ultrasound assessment 

Dr. Cindy Asbjornsen, founder of the Maine Phlebology Association is certified by the American Board of Phlebology and treats patients at the Vein Healthcare Center in South Portland, Maine where she cares for all levels of venous disease, including spider veins, varicose veins and venous stasis ulcers. According to Dr. Asbjornsen, proper treatment of insufficient veins starts with the first consultation: a history, physical exam, and ultrasound assessment. “Every part of the evaluation is critical to effective vein treatment,” said Dr. Asbjornsen. “I’m treating the whole patient, not just his or her legs, so it’s important to get the whole picture.”

If you are considering taking the next step toward better vein health, here’s what you can expect from your first visit:

1. Health history. Patients are asked to describe the current state of their veins, what makes their veins feel better, and how their quality of life is affected. Board certified phlebologists don’t just stop at the legs but rather review all of the patient’s systems from head to toe.

2. Other considerations. Past medical, family, and surgical histories are also taken into account, as well as a social history. Details about lifestyle— whether or not a patient smokes, runs marathons, or stands for his/her job all day, for example— are all relevant to good venous care.

3. Physical exam. The specialist will take a patient’s vital signs, then look closely at the patient’s legs and feet. The doctor will rate the patient’s level of disease and health on universal standardized scales. Vein specialists use the “CEAP classification,” which helps us categorize disease. (CEAP stands for: clinical severity, etiology or cause, anatomy, and pathophysiology.)

4. Ultrasound mapping. The veins of the lower legs are evaluated using ultrasound waves to see which veins have flow going in which direction. A healthy vein will only allow flow from the feet towards the heart. Faulty veins are often connected, and finding the “source” of the problem is a complicated, but critical, step in establishing the site where treatment should start.

5. The whole picture. Once the evaluation is complete, the whole picture should be taken into account before determining the best treatment for the patient. The doctor will present the patient with all of the potential options, including conservative treatments[http://veinhealthcarecenter.com/treatment-options.php?Other-4]. In the end, the patient decides how he/she wants to proceed.

6. Timing.  Consultations generally take between 45 to 90 minutes, depending upon the extent of the problem and whether or not an ultrasound occurs in the same visit.

7. Pre-visit paperwork. New patients can prepare for their first consultation by filling out any required paperwork ahead of time; filling it out at the office will just delay their appointment— and other patients too.

8. Removing socks and shoes. Patients should also know that they will be asked to wear a short garment and to take off socks and shoes. Doctors need to visually inspect the patient’s legs and feet, so they must be adequately exposed.

9. Drink water. It’s also helpful for patients to drink water before the exam; hydration can cause the veins to bulge, making it easier to see the problem.

While full consultations are not free, they are partially or completely covered by most insurance companies, especially if the policy covers specialist visits. Those with Medicare and supplemental coverage usually pay no out-of-pocket expenses. So, if you’ve been considering an evaluation from a certified phlebologist, don’t wait. It’s always the right time to improve your vein health.