The dedicated vein clinic is uniquely suited to offer a wide range of aesthetic procedures . Equipment such as an IPL is required to treat telangiectasia and matting . The same instrument then is available for addressing hair removal , rosacaea , acne , aging spots and facial tightening .
Also the average vein patient with concerns re cosmesis is already looking for providers of these procedures . Botox and co2 fractional for deeper facial work can then be added whem the market allows . Because the phlebologist is familiar with lasers and frequencies of different lasers used in thse procedures it becomes easier to contemplate skin responses and possible complications .
New to the market the Vaser noninvasive body conturing instrument is efficacious and selling well. The newest laser for tattooo removal trumps previous equipment with efficacy with professional inks and most colors .
Classical liposuction is performed in some vein clinics , but ultrasound guided liposuction of the neck and face be the only areas treated .
Tuesday, May 10, 2011
Monday, April 11, 2011
SCLEROTHERAPY
Sclerotherapy involves venous injections of a detergent that acts as a chemical irritant to effct closure of a particular vein . The sclerosant can exhibit a wide range of concentrations . Foaming the liquid detergent with either room air or co2 enhaces the strength of the solution . A low concentration liquid detergent is normally utilized for telangiectasia and spider veins , with reticular veins requiring hiher strength liquid sclerosant or lower concentration foam , dependent upon diameter . Varicosities generally require foam , with co2 foam utilized by many experts at the mid thigh level or above , as the rare incidence of TIA events may be decreased further using co2 , but not necessarily prevented . Foam may wee be contrindicated in the presence of a documented patent foramen ovale . Migraines are sometimes associated with patent foramen ovale with some phlebologists seeing foam as a contraindication in these patients in the absence of a negative transesophageal echo. Recently groin and vulvar varicosities have been addressed utilizing co2 foam . The ability to image the renal veins and tributaries with ultrasound during the procedure is hepful .
Monday, March 14, 2011
Complex Vein Interventions
march 14 , 2011
Signs of advanced vein disease can include the following : corona phlebiticum ; eczema below the knee ; lipodermatosclerosis ; skin ulcers ; significant hemosiderin deposits below the knee ; very prominent veins on dorsum of foot with standing ; progressive edema ; etc .
Symptoms of advanced disease include the following : lower extremity cramping ; restless legs ; fullness with prolonged standing _sometime this symptom is immediate upon standing ; edema ; bulging varicosities , often painful that sometimes bleed ; soles of feet burning or feeling of walking on rock chips .
All patients with significant reflux into the greater sapenous vein in the thigh with concomitant symptoms are candidates for ablation of the greater saphenous vein . Mid thigh perforators that reflux toward the skin are pathologic and should be closed with ablation or foam sclerotherapy ustilizing CO2 . Dilated , refluxing short saphenous veins in posterior calf associated with symptoms , skin disease or ulcers should be ablated .Ulcers associated with SSV reflux are often located on the lateral malleolus . Dilated individual superficial veins below the knee should be injected with foam sclerotherapy . Likewise pathologic below the knee perforators should be ablated with foam .
Although controversial , very dilated , refluxing saphenous veins below the knee may require closure with foam . This situation might arise when foam injection at the ankle could lead to possible closure of multiple perforators ; further treat lymphovenous edema ; relieve foot symptoms and treat all dilated superficial veins , thereby ameliorating skin disease and ulcers . Although a potential venous conduit is lost , the combination of drug eluting stent therapy and the availability of arterial conduits for use in coronary bypass surgery negate the significant concern associated with loss of a venous conduit . However one should note this procedure is necessary in only a small percentage of patients. When utilized 40 mm compression stockings should be utilized as edema is commonly seen in the first few weeks and diuretics and elevation may be required . This problem virtually always resolves over a few weeks at which time diuretics can be stopped . Walking and calf pump exercises should be encouraged as shoul water aerobics . If prior lymphedema pumps are available as home therapy and work very well .
As previously noted , complex venous disease is best treated in a dedicated center where this case mix is commonly treated .
Signs of advanced vein disease can include the following : corona phlebiticum ; eczema below the knee ; lipodermatosclerosis ; skin ulcers ; significant hemosiderin deposits below the knee ; very prominent veins on dorsum of foot with standing ; progressive edema ; etc .
Symptoms of advanced disease include the following : lower extremity cramping ; restless legs ; fullness with prolonged standing _sometime this symptom is immediate upon standing ; edema ; bulging varicosities , often painful that sometimes bleed ; soles of feet burning or feeling of walking on rock chips .
All patients with significant reflux into the greater sapenous vein in the thigh with concomitant symptoms are candidates for ablation of the greater saphenous vein . Mid thigh perforators that reflux toward the skin are pathologic and should be closed with ablation or foam sclerotherapy ustilizing CO2 . Dilated , refluxing short saphenous veins in posterior calf associated with symptoms , skin disease or ulcers should be ablated .Ulcers associated with SSV reflux are often located on the lateral malleolus . Dilated individual superficial veins below the knee should be injected with foam sclerotherapy . Likewise pathologic below the knee perforators should be ablated with foam .
Although controversial , very dilated , refluxing saphenous veins below the knee may require closure with foam . This situation might arise when foam injection at the ankle could lead to possible closure of multiple perforators ; further treat lymphovenous edema ; relieve foot symptoms and treat all dilated superficial veins , thereby ameliorating skin disease and ulcers . Although a potential venous conduit is lost , the combination of drug eluting stent therapy and the availability of arterial conduits for use in coronary bypass surgery negate the significant concern associated with loss of a venous conduit . However one should note this procedure is necessary in only a small percentage of patients. When utilized 40 mm compression stockings should be utilized as edema is commonly seen in the first few weeks and diuretics and elevation may be required . This problem virtually always resolves over a few weeks at which time diuretics can be stopped . Walking and calf pump exercises should be encouraged as shoul water aerobics . If prior lymphedema pumps are available as home therapy and work very well .
As previously noted , complex venous disease is best treated in a dedicated center where this case mix is commonly treated .
Saturday, January 2, 2010
Symptoms of Chronic Venous Insufficiency.....
Like the public, physicians think of venous disease as only varicose veins. However, the most commom indications for endovenous ablation relate to the symptoms of nocturnal cramps; restless legs syndrome; early fatigue of lower extremities; difficulty in standing in one position ; chronic skin changes; edema, with the lower extremities feeling more comfortable when elevated. However, all patients will have some external stigmata of venous insufficiency, such as: spider veins, telangiectasia; or reticular veins. A small percentage only will exhibit frank varicose veins.
Venous insufficiency (venous reflux) is verified by supine or standing measurement of the superficial veins, and doppler assessment of the greater saphenous vein for reflux. A proximal saphenous vein diameter at the groin of greater than 6mm is abnormal and predicts reflux.
Cool Touch Laser EVLT is a preferred modality to close the greater saphenous vein and the anterior accessory vein. Venous blood is forced to flow proximally through the femoural/ iliac veins and IVC to the heart with no avenue of reflux present.
If one has restless leg syndrome and concomitant venous insufficiency a fifty percent cure rate is possible with EVLT, and another 25% of patients will have symptoms ameliorated. Similar results are possible in patients with nocturnal cramps. All patients with these two syndromes should have routine screening, even if diabetic or with a known history of neuropathy.
In patients that do have bulging varicosities, microphlebectomy is performed with a near perfect cosmetic result. In patients with other asthetic vein issues, all procedures are self pay, and include the following: sclerotherapy for spider and reticular veins; cutaneous laser treatment for very small spider veins; matting sometimes seen after sclerotherapy and for telangiectasia.
Some final points. Some patients have very advanced venous insuffiency in the thighs and the calves. Large perforator veins usually will be closed with ultrasound guided sclerotherapy. Patients with far advanced disease may present with lipodermatosclerosis. This condition presents usually as a very large area over the entire pretibular area that appears dark gray or black that is very tender and represents an emergency. This condition usually requires multiple procedures by an experienced phlebologist. All care of these patiens should be directed through an experienced vein center.
Please address questions or concerns to wooddeming@yahoo.com.
More will come on different relevant topics on veins and etc.
Venous insufficiency (venous reflux) is verified by supine or standing measurement of the superficial veins, and doppler assessment of the greater saphenous vein for reflux. A proximal saphenous vein diameter at the groin of greater than 6mm is abnormal and predicts reflux.
Cool Touch Laser EVLT is a preferred modality to close the greater saphenous vein and the anterior accessory vein. Venous blood is forced to flow proximally through the femoural/ iliac veins and IVC to the heart with no avenue of reflux present.
If one has restless leg syndrome and concomitant venous insufficiency a fifty percent cure rate is possible with EVLT, and another 25% of patients will have symptoms ameliorated. Similar results are possible in patients with nocturnal cramps. All patients with these two syndromes should have routine screening, even if diabetic or with a known history of neuropathy.
In patients that do have bulging varicosities, microphlebectomy is performed with a near perfect cosmetic result. In patients with other asthetic vein issues, all procedures are self pay, and include the following: sclerotherapy for spider and reticular veins; cutaneous laser treatment for very small spider veins; matting sometimes seen after sclerotherapy and for telangiectasia.
Some final points. Some patients have very advanced venous insuffiency in the thighs and the calves. Large perforator veins usually will be closed with ultrasound guided sclerotherapy. Patients with far advanced disease may present with lipodermatosclerosis. This condition presents usually as a very large area over the entire pretibular area that appears dark gray or black that is very tender and represents an emergency. This condition usually requires multiple procedures by an experienced phlebologist. All care of these patiens should be directed through an experienced vein center.
Please address questions or concerns to wooddeming@yahoo.com.
More will come on different relevant topics on veins and etc.
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