What is Varithena?

 

Let’s break it down. We use Varithena (polidocanol injectable foam) in sclerotherapy, a procedure that treats veins just below the skin's surface. With sclerotherapy, 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. Patients often experience an immediate relief of symptoms, and there is little risk of complication.

Varithena is the only FDA-approved foam sclerosant. Foam sclerotherapy has been used widely in the phlebology (vein specialty) community for more 15 years. The "Tessari method," the practice of adding a gas to a liquid to create bubbles, has been the most common technique for producing foam for use in sclerotherapy. This technique involves manually mixing a small volume of liquid sclerosant with a volume of room air or other gas using two syringes and a three-way tap, or stopcock. Preparations created this way are referred to as "physician-compounded foam," and they are illegal.

 

While physician-compounded, non-proprietary foam is inexpensive to make, medical experts caution that there are risks: there have been a number of published cases of air emboli (small bubbles of gas in the bloodstream) from so-called "homemade foam" leading to neurological events in patients, including migraines, vision changes, strokes, and death. No physician-compounded foam has been approved by the U.S. Food and Drug Administration.

 

Technically speaking

Varithena is a proprietary foam preparation that was approved by the FDA in 2013 after rigorous safety testing on thousands of people. It is a chemical foam solution indicated to close the Great Saphenous Vein (GSV) and related tributaries. It is a proprietary mixture of 1% polidocanol, 65% oxygen, 35% carbon dioxide, and less than .8% of nitrogen.

 

When a physician creates their own foam, they use room air, which can contain as much as 78% nitrogen. While oxygen and carbon dioxide are rapidly absorbed into the blood stream, nitrogen is very slowly absorbed, and those bubbles can persist and possibly cause a gas embolism and obstruct an important blood vessel. In comparison, Varithena has extremely low nitrogen.

 

Varithena's primary safety feature is the consistency of its bubbles: each one is between 100-500 microns, with uniform density and stability. The standardized compound is much more predictable for vein doctors to use on their patients and there have been no strokes or air embolisms associated with Varithena treatment.

 

If you have questions about Varithena, sclerotherapy, or other vein treatments, please contact us at the Vein Healthcare Center!

No need to fear spider veins!

 

Telangiectasia is the technical term, but most people know them as “spider veins.” The small blue or purple veins that occur just under the surface of the skin may appear as short fine lines, clusters, or in a spider web shape. Spider veins can cause physical discomfort, and because of their appearance, can also be a source of embarrassment or self-consciousness for some. 

According to Dr. Cindy Asbjornsen, spider veins can be an indication of early-stage vein disease— the “tip of the iceberg,” if you will. Vein health is a continuum, so while spider veins may appear minimal, there could be a larger vein “leaking” underneath. 

In the past, treating spider veins was often considered cosmetic, but today we know that leaving venous issues untreated can eventually lead to larger health problems.

The classification used by most physicians to describe venous disease is called the CEAP scale. The C stands for “clinical severity.” On the CEAP scale, spider veins are classified as C1.

So how do you treat spider veins? 

Sclerotherapy is frequently used to treat spider veins and smaller veins. In this procedure, providers use microscopic needles to inject a medicine (called a sclerosing agent) into the vein's interior wall. This substance causes the vein to become sticky and seal shut, which makes the troublesome vein to disappear. Blood then finds a healthy path back to the heart.

With modern sclerosants, there is little risk of complication, and patients often experience an immediate relief of symptoms. Most patients can return to their regular activities after the procedure is over.

Treating spider veins can improve appearance but more importantly, treatment can help stop the progression of venous disease at its source. 

To find out more about spider veins, sclerotherapy, and other vein treatments, contact us at the Vein Healthcare Center. We’re happy to schedule an evaluation with you! 

Elevate! Elevation Tips to Relieve Vein Disease Symptoms

There are a variety of vein treatments for varicose veins and other venous diseases. In some cases, elevating your legs can alleviate the pain and/or swelling that comes from early-stage vein disease. 

So, what is elevation and how do you do it? Leg elevation means raising the legs above heart level. The ideal position is to lie on a couch with your back on the cushions and feet up on the armrest, so your feet are at a slight angle higher than the heart. Lying down with your legs resting on three or four pillows also works well. 

Here are more tips on how to get the most out of this accessible therapy: 

• Elevating at intervals throughout the day can encourage blood flow from the legs and decrease the pooling of blood.  
• Legs should be elevated as often as possible, for as long as 30 minutes or as briefly as three minutes. 
• The morning is a good time to elevate. 
• The best time to elevate is after a hot shower, or after standing for a long time. A good way to remember to elevate is to pair it with your meals or snacks. 

A vein specialist can guide patients on the most effective elevation techniques. “For someone with venous disease, elevation is so important that at the Vein Healthcare Center we have recliners and ottomans in the reception area, so patients can elevate while they wait,” said Dr. Asbjornsen.  

To understand how elevation provides relief, here is a brief review of how veins work. Veins carry blood from the legs and arms back to the heart. The blood in the legs travels up against gravity, so when the valves in the veins become damaged, blood “leaks” back into the legs and creates a “pooling” effect. 

Effective treatment begins with a thorough evaluation from a qualified phlebologist who will look for the source of the problem: the leaky vein valve or valves. Once that is identified, the physician can recommend the next best options for treatment. 

Elevation is a simple, yet powerful, tool that can help improve blood circulation in the veins and provide some relief to venous symptoms. 

To learn more about vein treatments, contact us at the Vein Healthcare Center today to schedule an evaluation!

August 21 is Senior Citizens Day!

The U.S. observance was established in honor of older adults who have made positive contributions in their communities. The day is also a time to bring awareness of social and health issues that affect senior citizens – like veins!

Paying attention to venous health is an important aspect of successful aging – and one that has historically gone untreated. Many seniors have been told that heavy, aching legs are a normal part of aging, but that’s often not the case. There are solutions for venous insufficiency that make people feel better, no matter what their age

Venous insufficiency occurs when healthy veins become damaged and allow the backward flow of blood into the lower extremities. This pooling of blood can lead to a feeling of heaviness, aching, and can cause skin changes, such as spider veins or a brown, woody appearance of the lower legs.
 
Older people’s veins respond differently to everyday stress compared to that of a younger person’s because vein walls are primarily made of collagen. As the body ages, a decrease in the production of collagen causes the veins to become more brittle and the valves more likely to fail, especially in the superficial veins. Thus, there is a higher incidence of varicose veins in the elderly population.
 
The skin also begins to lose its elasticity and doesn’t respond to stress the way it once did. And because skin is the “end organ” of venous disease, leg ulcers can occur as a result of damaged veins.
 
Breakthroughs in phlebology (the study of venous disease) and new approaches to treatment involve less time, less pain, and can be done in an outpatient setting. Treatments today are overwhelmingly successful over the long term when performed by a Board-certified vein specialist.
 
The risk-benefit ratio makes vein treatment an ideal option for seniors. Although seniors have a 50% greater chance of suffering from vein disease, they have the same success with modern treatment options as anyone else! 
 
To learn more about vein treatments options, contact us at the Vein Healthcare Center today to schedule an evaluation. 

Endovenous Treatment Options

What does endovenous mean? Endovenous is a medical term that means within or inside a vein. Endovenous treatments can be divided into two categories:

1. Thermal treatments that use laser energy or radio frequency waves to treat the vein and tumescent anesthesia to protect tissues surrounding the vein during the procedure.

2. Non-thermal, non-tumescent (NTNT) treatments, which are procedures that do not require the use of heat or tumescent anesthesia.

In this post, we’ll look at thermal endovenous treatments include endovenous laser ablation (EVLA), also called endovenous laser therapy (EVLT™) and radio frequency ablation (RFA). These are minimally invasive treatments used to address specific large varicose veins in the legs. It is considered the gold standard in treatment of named veins, such as the great and small saphenous veins. It has largely replaced previous, more invasive standards of care, such as vein stripping.

Endothermal ablation has opened the door for many patients with venous disorders to eliminate symptoms and improve their appearance with minimal time investment or pain. Endothermal ablation is an outpatient procedure performed with local anesthetic.

The procedure begins when the provider places a tiny access port directly into the problematic vein. Don’t worry, before the placement, we numb the skin with a small amount of local anesthetic. Once access is established, a very thin laser fiber is threaded into the vein up to the place “where health meets disease,” as Dr. Asbjornsen likes to say!

Patients can't feel the laser fiber because the inner walls of the veins do not have sensor receptors. Once in position, more numbing medicine is added to the outside of the vein; it should not be more uncomfortable than the first pinch when access was established.

Once the leg is numb, the heat source is turned on or "fired," sealing the vein shut from the inside out. The vein eventually is reabsorbed by the body and will no longer be visible on the surface of the leg. Blood is diverted to the many other healthy veins in the leg, and there is no ill effect from the loss of the troublesome vein. Patients can return to work the next day with very limited restrictions.

What is Tumescent Anesthesia?


The thermal endovenous treatments involve 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:

1. The fluid is an anesthetic, keeping the patient comfortable during the procedure.

2. It 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.

3. It causes the vein walls to collapse around the thermal fiber, maximizing contact and increasing the effectiveness of the procedure.

The tumescent fluid can be administered in many ways, but with a trained and proficient physician, the process is comfortable and painless.

To learn more about vein treatments options, contact us at the Vein Healthcare Center today to schedule an evaluation! 

Men & Vein Health: June 15-21 is International Men’s Health Week!

June is Men’s Health Month! Throughout June, Men’s Health Network shares education, amplifies awareness, and distributes free resources to improve the health of men, boys, and the families who care about them.

At the Vein Healthcare Center, we know that vein health is an important part of everyone’s overall health and wellbeing. According to epidemiologic studies of the 1960s and 70s, women are more likely than men to have venous disease, including varicose veins and spider veins. More recent research shows, however, that this may not be the case. We also know that men are more likely to suffer from vein issues and tend to present with the worst vein problems, such as ulcers. Why is this the case?

 

Phlebologists have often observed that women tend to get help for their vein issues right away, while men will often wait until the problem becomes too painful to ignore. The result is, often, leg ulcers that are difficult to heal. Even men who are athletic are susceptible to venous disease. Sometimes men with vein problems misinterpret their symptoms, mistaking the pains of venous disease for a strained or pulled muscle.

 

The important thing for patients with vein issues is to seek help as soon as symptoms present themselves, regardless of his or her gender. Venous conditions like varicose veins get worse with time, and the longer one waits, the more extensive the condition could become—and often, the treatment. Anatomically, men's leg veins are no different from women's veins. Looking at a leg ultrasound, one would be hard-pressed to tell the difference between a man's and a woman's legs.

 

The key for male patients is to get evaluated as soon as the symptoms become apparent. Common symptoms of venous disease include:

• LEG FATIGUE OR HEAVINESS: When legs feel good upon waking but are intensely tired or heavy at the end of the day, this is an early warning sign.
• SWELLING: Swelling can be caused by many things but also serves as a very early warning sign for vein problems. In any case, legs that frequently swell shouldn't be ignored.
• SKIN CHANGES: Redness, skin thickening or other color changes on the legs and/or ankles is a common (and commonly overlooked) symptom. Other skin changes, such as dermatitis, cellulitis, dry or scaly skin, or brown "stains" on the skin can be signs of advanced venous disease and should be evaluated by a physician.
• SPIDER VEINS: Spider veins are blue or purple-colored veins that occur under the skin but are close enough to be seen on the surface. Treating them can improve appearance, as well as stop the progression of venous disease at its source.
• VARICOSE VEINS: Another sign of early-stage venous disease, varicose veins are visible veins in the leg that bulge, often protruding through the skin.
• ULCERS: An open wound on the leg or ankle that fails to heal can be the result of ongoing venous disease. In fact, "venous ulcers" in the leg are often an indication that venous disease has reached an advanced stage.

Venous disease is a progressive disease that is not curable, but for most people, even debilitating symptoms are completely treatable. Today's vein treatments are done on an outpatient basis and are minimally invasive and nearly pain-free. Treatment can stop the progression of venous disease and its complications for those in all stages of the disease; however, early intervention is generally best-tolerated and provides the most improved quality of life. For those struggling with late-stage symptoms, it is still possible to restore health.

 

To learn more about vein treatments for venous ulcers or other vein issues, contact us at the Vein Healthcare Center today to schedule an evaluation. Our goal is to help your legs feel better!

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!