Definitive treatment for spider veins involves injections. Some will claim that superficial lasers or radiofrequency generators can do the job…but, in my opinion…based on experience…I would recommend starting with sclerotherapy first and use those other modalities as a last resort or to treat veins too small to enter with a needle. Sclerotherapy Centuries old, the concept of injecting solution into varicose veins in order to get them to scar down and shrink is still a mainstay in the armamentarium of phlebologists. Like thermal ablation, the goal is to achieve irreversible damage to the cells that line the walls of veins, causing local inflammation and ultimately scarring down and resorption of the vein itself. Too little, the body can ultimately heal the damage and allow blood to continue to flow through diseased veins. Too much can allow the sclerosing agent to flow into normal healthy veins and cause unwanted damage.
Long before my career as a vein doc performing varicose and spider vein treatments in the North suburbs of Chicago began, I worked a series of jobs and volunteered for many organizations around Chicagoland before and during my undergrad years: Lifeguard, delivering meals-on-wheels for the elderly, crisis hotline counselor, keyboardist in a band, operating room assistant. A pretty diverse set of experiences. Each informed and impacted upon my decision of which route to take in terms of a career choice. Starting to post on this blog has forced me to reflect on a great many things. And, just like looking at a reflection in any mirror, we not only see the image as it is in front of us, but also as we would like it to appear. This dissonance is what compels us to grab a brush…start a diet…seize the day. Looking through the retrospectoscope, I can’t say that I have always made the correct decisions…but I have always tried to operate on the premise that making the best decisions starts with having the best information at hand. In the medical world there is the concept of informed consent. This means that in order for patients to agree to procedures, they need to be informed of the risks and benefits involved. This is true for brain surgery as well as vein procedures. On the doctor side of the equation, I have to choose which treatment methods to add to my armamentarium by analyzing the evidence available from research as well as my experiences and those of my colleagues. Having sifted through the data, there is a clear winner to treat superficial venous insufficiency: endovenous ablation. But it’s not enough for me to be certain of the benefits. I need to present the information to you as clearly as I can…including the alternatives…in order for you to make an informed decision that you feel comfortable with [see my previous Vein Rant #1 blog post]. My previous treatment post described conservative treatment options. As you recall, all of them are practical, but none are definitive as they can’t fix the underlying problem of venous […]
Venous Pathophysiology, Part 1: The North Suburbs of Chicago seems an idyllic place. Great schools. Lovely parks. The beautiful state-of-the-art Rosen Vein Care office in The Professional Plaza at Northbrook Court. But despite all the local trappings and amenities, we live in an imperfect world. The second year of med school deals with learning about medical imperfection; what happens when things go wrong. Here’s a little taste of 2nd year med school for you…a discussion of venous pathophysiology. Pathophysiology is why doctors exist. Rosen Vein Care exists to fix the pathophysiology of the superficial venous system. I live and breathe the stuff. The concept is pretty easy to grasp: remember the major players of the venous system in the lower extremities: veins, valves, and pump…then realize that what can go wrong often does go wrong. The final common pathway of all the problems is an increase in the venous pressure in the extremities (venous hypertension). Let’s consider the players one-by-one: 1. Calf Muscle Pump Failure: Think of this as “congestive heart failure” of the “peripheral heart”. Decreased pump function→decreased “ejection fraction”(the amount of blood pumped out of the legs and back to the heart)→increased volume of blood remaining in the lower extremities→ INCREASED VENOUS HYPERTENSION. This can be caused by: –Neuromuscular diseases (can’t move muscles in pump) –Muscle wasting (used to pump better, now not so much) [Please resist the urge for a “that’s what she said”] –Deep fasciotomies…or surgical incisions made deep into the muscles that render them unable to be used effectively 2. Plumbing Issues: Once you start talking about vascular problems what you are really talking about are plumbing issues. Plumbing issues can be boiled down to either blockage/narrowing or leaking. If we used such simplistic terms doctors would never be taken as seriously as they expect to be taken. Therefore we’ve come up with fancy-shmancy ways of saying the same thing. We call blockage “obstruction”. We call the leakage “incompetence”. [If the plumber told us our toilets are obstructed and our faucets are incompetent he’d likely charge us double, G-d forbid] a) Obstruction: The pump is fine but […]