This page is contains the most current information of the treatment and management of varicose veins and other venous disorders. Please check this site often as we are continuing to add information. If you don't find what you are looking for please ask us.

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Diagnosing venous disorders

Compression Stockings Can Prevent Post Thrombotic Syndrome

Vein Forum Newsletter, August 2009 

Vein Forum Newsletter , April 2008

After the physical exam is completed the physician will decide if any additional tests are needed to evaluate the venous system and the vein valves. The standard test for this is a duplex ultrasound imaging. Most Phlebologists have the equipment and the expertise to perform this test in their office. If not, the patient may be referred to another facility for the test.

At the completion of the visit the physician will explain all the treatment options to the patient. The patient should ask questions about the cost, complications, advantages and disadvantages of all the treatments. The patient should also ask questions concerning the physician’s qualifications to perform any treatment procedures. Treatment of varicose veins and venous diseases include the conservative treatment of wearing compression stockings. Other treatments include sclerotherapy, surgery, and endovenous laser procedures.  

Post thrombotic syndrome is a long term complication of DVT that is experienced by 1 out of 3 patients. The symptoms include pain, swelling, cramping, numbness, tingling, and itching of the affected leg. The skin on the lower part of the leg may harden and darken. PTS symptoms may last for years. PTS may affect 50% of patients with DVT after 2 years.

The American College of Clinical Pharmacy recommends the use of compression stockings after the onset of a DVT. They recommend that patients wear the compression stockings for at least two years after initial onset of DVT. Below knee compression stockings with a compression level of 30-40 mmHg should be routinely prescribed to all patients in this group. With more patients with DVT is being treated on an outpatient basis by emergency department physicians and family practioners, it is imperative that patients are prescribed knee high compression stockings upon discharge. Compression stockings are not contraindicated in combination of anticoagulant medication.

 The positive clinical outcomes of wearing compression stockings are dependent on patient compliance. This is true for all medical indications of stocking use. A recent study on patient compliance by C.L. Morgan, et al, University of Missouri, concluded that patients with detailed instructions and education about compression therapy become more compliant with the prescribed treatment. It is important for the prescribing physician to educate the patient on where to find this detailed information or present it them personally. This web site can adequately supply the patient with all the detailed information and education needed for upmost compliance.

You should refer your patients to this site for all the information they need.Compression stockings are widely available today. They come in many colors and styles for everyday use. One of the best places to buy compression stockings is from the premium online retailers such as www.thelaserveincenter.com. There you can find a variety of styles of colors of stockings at a reduced price.  Shipping is fast and affordable and the prices are usually less than the pharmacies or health care stores. At www.thelaserveincenter.com patients can also find useful information about compression stocking information such as how to measure their leg for stocking size, how to don stockings, how to care for stockings, and much more.

For more information on the various scientific studies that confirm that the use of compression stockings can reduce post thrombotic syndrome in patients who experience DVT visit the American College of Phlebology at www.phelbology.org or consult your local plebologist.

 Vein Forum Newsletter, August 2009

Laser Vein Center for Excellence

Anhtai H. Nguyen, M.D., M.B.A., FACS

Active Physician Member of American College of Phlebology

Dear colleagues,

We sincerely hope you enjoy this issue of Vein Forum. This newsletter is published with the intention to keep you abreast on the latest developments and advancements in the world of contemporary vein care and management. Our mission underpins the practice's dedication to the provision of modern, comprehensive, and evidence-based management of venous pathology. We offer an amalgam of services based on the patients' presentations and symptoms. These include ultrasonic applications to assist in the diagnosis and intervention, compression therapy, endovenous ablation, microphlebectomy, as well foam sclerotherapy.

In the United States, the treatment of varicose veins has been a part of many surgical practices. The old dogma has been to perform surgical removal or stripping and ligation of varicose veins. Despite its inherent risks and complications, many physicians have remained steadfast to this option. However, this paradigm has begun to shift with the introduction of endovenous laser ablation in 1999. FDA recognizes the efficacy and safety of this procedure by granting its approval in 2002. Since then, endovenous laser ablation has been widely accepted to effectively treat superficial venous reflux with minimal side effects. Our office has applied this technique for several years. This is an outpatient procedure, utilizing tumescent anesthesia that is performed in our facility. With our extensive experience, we are able to perform this procedure proficiently which has translated into improved tolerance associated with a rapid return to normal activities for all of our patients. Our success rates have remained in congruence with those in the literature.

Another option which we offer to our patients is foam sclerotherapy. This is distinct from liquid sclerotherapy which has been described extensively in the literature with mixed results. It is applied to treat secondary varicosities, reticular veins, and telangiectasias. In addition, it has been used as a first line treatment for chronic venous insufficiency without truncal reflux as well as an adjuvant therapy after successful venous ablation. Initial applications of liquid sclerotherapy were associated with a high rate of recurrences. Thus, foam sclerotherapy was developed in the 1990's and has proven to be a superior technique. This is an approach where a detergent agent is mixed in appropriate portions with room air and then injected directly into a vein. This process disrupts the endothelial cells and eventually leads to cell death and the intended local thrombosis. This procedure is quite effective if executed correctly. Contemporary studies are being performed to examine its effectiveness in treating truncal reflux as an alternative to endovenous ablation. Further, it is paramount that this procedure is performed properly to mitigate potential complications that can include DVT, thrombophlebitis, allergic reactions, visual disturbances, chest discomfort as well as a severe headache. We have employed this technique for several years under the appropriate indications and the results have been very encouraging. As always, we are firmly dedicated to the quality and safety of care for all of our patients.

We hope you find this newsletter informative. If you or your patients suffer from varicose veins, we are here to help. Thank you for your continuing support. To learn more about the treatment options, please call the Laser Vein Center for Excellence of Washington Surgical Group at (301) 745-4500.

A.H. NGUYEN, M.D., M.B.A., FACS

www.TheLaserVeinCenter.com

 Vein Forum Newsletter

Dear colleagues,

We sincerely hope you enjoy this issue of Vein Forum, a newsletter we will publish regularly to update you on the latest developments in the world for contemporary vein care and management. Our practice is dedicated to the modern, comprehensive, evidence-based management of venous pathology. We offer a variety of services based on patients’ needs and presentations including: endovenous ablation, microphlebectomy, sclerotherapy, and ultrasonic applications to assist in diagnosis and intervention.

For decades, the only method for treating symptomatic varicosities involved ligation and stripping. This process removes abnormal veins by ripping them out of the leg through multiple incisions. In addition, it requires general or spinal anesthesia and results in post surgical edema, pain, and prolonged ecchymosis. Furthermore, it is not uncommon for patients to experience paraesthesia along the medial aspect of the lower extremity for months postoperatively. This is secondary to the damage of sensory nerve that occurs during stripping.

Our office utilizes endovenous laser ablation technique. This is an outpatient procedure, which is performed in our facility. By delivering the exact wavelength of laser energy, the diseased vein is eliminated. After the damaged veins are treated, the body automatically routes the blood return to other healthy veins. Our center has accumulated several years of experience with this procedure. Initially, this procedure took approximately one hour to perform. With our extensive experience, we are able to perform this procedure in under forty minutes. Most patients agree that the procedure is not painful. They are up and walking as soon as the ablation is completed, and able to return to full normal activity as tolerated. There is no cutting involved, thus no scarring. We follow our patients post ablation at regular intervals and monitor them with venous duplex. To date, our success rate has been 100%. This compares quite favorably with reported 97% short-term success in the literature.

The application of laser technology eliminates the risk associated with surgery. Endovenous laser ablation is a minimally invasive procedure. The entry point is extremely minute and the risk of infection is extremely minimal. Many insurance companies will cover the expense of this exciting new option.

We hope you enjoy this issue of Vein Forum and find is informative. If you or your patients suffer from varicose veins, we can help. Thank you for your continued support. We are extremely appreciative.

To learn more about varicose vein treatment options, please call Laser Vein Center for Excellence at (301) 745-4500.

A.   H. Nguyen, MD, FACS

We sincerely hope you enjoy this issue of Vein Forum.  This newsletter is published with the intention to keep you abreast on the latest developments and advancements in the world of contemporary vein care and management.  Our mission underpins the practice’s dedication to the provision of modern, comprehensive, and evidence-based management of venous pathology.  We offer an amalgam of services based on the patients’ presentations and symptoms.  These include ultrasonic applications to assist in the diagnosis and intervention, compression therapy, endovenous ablation, microphlebectomy, as well as foam sclerotherapy.             

In the United States, the treatment of varicose veins has been a part of many surgical practices.  The old dogma has been to perform surgical removal or stripping and ligation of varicose veins.  Despite its inherent risks and complications, many physicians have remained steadfast to this option.  However, this paradigm has begun to shift with the introduction of endovenous laser ablation in 1999.  FDA recognizes the efficacy and safety of this procedure by granting its approval in 2002.  Since then, endovenous laser ablation has been widely accepted to effectively treat superficial venous reflux with minimal side effects.  Our office has applied this technique for several years.  This is an outpatient procedure, utilizing tumescent anesthesia, which is performed in our facility.  With our extensive experience, we are able to perform this procedure proficiently which has translated into improved tolerance associated with a rapid return to normal activities for all of our patients.  Our success rates have remained in congruence with those in the literature.           

Another option which we offer to our patients is foam sclerotherapy.   This is a process where a detergent agent is injected directly into a vein to damage the lining which then leads to localized thrombosis.   This procedure is quite effective for secondary varicosities, reticular veins, and telangiectasias if executed correctly.  Currently, studies are being performed to examine its effectiveness in treating truncal reflux as an alternative to endovenous ablation.           

Varicose veins management is a rapidly progressing discipline.  Our minimally invasive approaches have clearly benefited the patients that we have treated to date.  We remain firmly dedicated to the contemporary advancements for the care of all our patients.           

We hope you find this newsletter informative.  If you or your patients suffer from varicose veins, we are here to help.  Thank you for your continuing support.  To learn more about the treatment options, please call the Laser Vein Center for Excellence at (301) 745-4500. 

A.H. NGUYEN, MD, FACS

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