What to Look for in a Phlebologist
Whether you are seeking life changing treatment for debilitating chronic venous insufficiency or cosmetic treatment of spider veins your phlebologist should be well-versed in all aspects of venous and lymphatic medicine.
Drs. Robin and Velis are experts in treating a wide range of conditions and treatment modalities and prescribe treatment that’s tailored to your condition and not pigeon holed to their practice. In any situation, a phlebologist should be able to offer the treatment most appropriate for your condition.
VeinCare Experts practices a highly collaborative philosophy. Our doctors work closely with ultrasound technicians, nursing staff and office staff to ensure optimal outcomes. This team approach has proven to be one of the defining characteristics of our practice.
Veteran doctors, nurses and technicians with a long history in vein care and the latest therapies will invariably result in successful treatment.
Regardless of your medical condition a doctor should thoroughly explain your condition, outline courses of treatment and seek your input into developing a plan. This collaborative approach is both patient-centered and assures that you’re treated as a person and not as a condition.
Continuing education in the latest techniques, treatments and outcomes is important in knowing that you’re receiving the best care. Your phlebologist should maintain Board Certification in his/her primary specialty.
A phlebologist who is a Diplomate of the American Board of Venous and Lymphatic Medicine (ABVLM) has demonstrated a very high level of experience and knowledge.
Ultrasound technician and/or physicians should be certified in ultrasound and vascular diagnostic techniques (RVT, RPVI, RDMS, RPhS).
Just as multiple certifications, expanded expertise and skill are indicators of a highly successful practice, it’s just as important to examine your doctor’s and staff’s curriculum vitae (CV).
A practice that can demonstrate a high-degree of practical as well as academic accomplishment illustrates how immersed they are in vein treatment. In addition, involvement and leadership in national and global medical societies is yet another indication of how a physician is judged by their peers. And finally, outcome transparency is a key in judging how well a practice treats a patient and their condition.
What is a Phlebologist?
A phlebologist is a medical specialist in the diagnosis and treatment of disorders of the veins. Phlebologists become experts in the field through experience and training and their primary specialties may be in a variety of disciplines such as surgery, vascular surgery, internal medicine, cardiology, family medicine, dermatology or interventional radiology.
Most commonly encountered conditions are related to venous disorder of the legs such as varicose and spider veins. However, the field of phlebology also incorporates venous thrombosis, inherited and acquired thrombophilia (clotting disorders), congenital venous anomalies, vascular malformations, anticoagulant drug usage, care of venous ulcers, use of imaging modalities, and lymphatic disorders to name a few.
This broader description of the field is reflected in the name change of the American Board of Phlebology to the American Board of Venous and Lymphatic Medicine (ABVLM).
A task force of experts have developed the Core Content for Training in Venous and Lymphatic Medicine which has been endorsed by the American Venous Forum and the American College of Phlebology.
Physicians who are certified as Diplomates of the American Board of Venous and Lymphatic Medicine have passed rigorous eligibility criteria and a comprehensive knowledge examination. There only are an estimated 700 designated physicians worldwide.
Conditions
As phlebologists, we evaluate and treat many conditions associated with the venous and lymphatic systems. The majority of our patients are seeking help for varicose veins and chronic venous insufficiency.
Varicose veins and chronic venous insufficiency are very common and not usually associated with more serious health issues. In fact, it is estimated that up to forty percent of the U.S. adult population has some sort of vein issue.
Varicose veins may be a cosmetic problem, an annoyance, or a more serious medical problem limiting normal daily activities and the ability to lead a healthy active lifestyle. They also may lead to more serious issues such as swelling, blood clots, phlebitis, skin changes, bleeding, and leg ulcers.
Many of our patients are concerned that they suffer from “poor circulation”. While lower extremity veins are part of the circulatory system, arterial and venous function are distinctly different. Atherosclerosis and peripheral artery disease (PAD) concerns the arterial side and are unrelated to most common venous issues.
Arteries are responsible for delivering blood and nutrients to the tissues. Veins return the blood from the tissues to the heart, and lymphatics act as a sort of scavenger system for tissue fluids.
This system depends on many factors to function normally. For the veins, there must be a path free of blockages and normal functioning valves. Calf muscles also serve as an additional “pump” to aid in return of venous blood. If any or all of these components are not functioning properly, excess pressure may build up on the venous side leading to chronic venous insufficiency (CVI) and its consequences.
The lower extremities have interconnected systems of veins. The deep veins represent the final common path back to the heart. This system may be impaired by partial or complete blockages, clots (DVT), congenital malformations, or primary valve dysfunction. These conditions are difficult to treat and fortunately less common than superficial venous insufficiency.
The superficial system includes the saphenous system (truncal veins) and its branches or tributaries. Perforator veins connect the deep and superficial systems and communicating veins connect components of the superficial system. Most patients present with problems in the superficial system. This system also may be impaired by blockages, clots (SVT), or congenital malformations, but primary valve dysfunction is the most common problem. Advances in our field have made treatment of these problems very effective and relatively simple and painless.
Varicose veins are elongated, dilated, tortuous veins most often found in the lower extremities. They may vary greatly in size, location, configuration, and symptoms, Varicose veins directly associated with the saphenous system are called truncal. As abnormal veins are located closer to the skin, they may be referred to as reticular, venulectasia, or telangiectasia (spider veins).
Because of the human erect posture, gravity causes elevated hydrostatic pressure in the veins of our legs. Inside the tubular structure of our veins, flap valves prevent backward flow and direct the blood toward the heart. Valves may become ineffective due to damage to the valve itself or to the surrounding vein segment. When a valve is damaged, there is increased pressure on the valve below, making it more susceptible to damage and creating a cascade effect. A key valve occurs at the saphenofemoral junction where the saphenous vein meets the femoral vein at the groin or upper thigh.
Many people with varicose veins have an inherited tendency toward weak valves. The condition is aggravated by several factors including aging, pregnancy, smoking, or chronic increased abdominal pressure associated with cough, constipation, or heavy lifting. Long periods of standing associated with certain occupations or activities may also play a role.
Most patients with varicose veins have some symptoms, but the severity varies greatly. Typical symptoms are heavy, tired legs, restless legs, burning, itching, tingling, and a deep aching or throbbing pain. Cramps and restless legs are also common. Symptoms are typically worse while standing or sitting for long periods and improved with leg elevation. Symptoms may also be worse in warm weather or during a woman’s menstrual period.
Aside from discomfort and appearance, venous insufficiency, if left untreated, can lead to more serious local complications such as swelling or edema, inflammatory skin changes and leg ulcers, superficial and deep vein thrombophlebitis, and hemorrhage or bleeding.
Some people have a genetic predisposition to abnormal clotting. Unexpected or recurrent clotting episodes, unusual patterns, or a family history should prompt the physician to consider blood tests for these conditions. Certain acquired conditions can also make one prone to abnormal clotting and these may be considered on an individual basis.
Sometimes, excess pressure in the venous system of the legs (ambulatory venous hypertension) is due to abnormalities in the deep system. This situation may occur primarily or as a result of prior episodes of clots with valve destruction (post-phlebitic syndrome). Compression is the mainstay of treatment of deep venous insufficiency although there are complex valve repair or transplant procedures which may he considered in rare cases.
Sometimes in the developing embryo, the venous system does not form correctly resulting in congenital venous malformations. The proper management begins with recognition. Evaluation and workup may be more complex than usual, but these conditions are often treatable or at least manageable. They may also affect soft tissue and bones and may be associated with a birthmark called a port-wine stain. The best known is Klippel-Tranaunay or K-T syndrome.
Clots in the deep veins are a more serious issue and may spread to the blood vessels in the lungs (pulmonary embolus or PE) and may lead to post-phlebitic syndrome with leg swelling, skin changes, and even ulcers. Diagnosis is usually readily made with some ultrasound and sometimes blood tests, venography, and lung imaging tests. Depending on the duration, location, extent, and precipitating factors, treatment may consist of a combination of blood thinners or anticoagulation, compression, and sometimes clot dissolution or clot removal.
Clot formation in the superficial veins of the lower extremity is called superficial venous thrombosis, and may present with warmth, tenderness, palpable cord, redness and swelling. Patients usually have varicose veins with stagnant flow and may have had a recent period of immobility such as lengthy travel or local trauma. Diagnosis is usually readily made with physical examination. Ultrasound should be performed to evaluate the extent and rule out associated clot in the deep veins. Underlying conditions such as hereditary thrombophilia or malignancy may make patients more prone but are rarely implicated, particularly in the absence of other signs or history. Treatment is primarily directed at the symptoms although anticoagulation, or blood thinners may be used in extensive cases.
Lymphedema is fluid retention and swelling of the tissues due to a compromised lymphatic system. The condition may be secondary to injury to or blockage of the lymphatic system from things such as tumors, surgery, radiation, accidental injury, or infection. The condition may also develop in the setting of long standing venous edema. More frequently, it is primary, with no apparent cause. Limbs with chronic lymphedema are at increased risk for infection. Lymphedema is categorized according to stage and grade, or severity. Primary lymphedema is also categorized based on time of onset, such as from birth or later in life. Although microsurgical, low level laser therapy, and suction assisted lipectomy techniques have been used in refractory cases, the mainstay of therapy is exercise and compression using garments, wraps and pumps.
Leg ulcers or sores may occur with long standing chronic venous insufficiency. Especially with todays minimally invasive techniques, the condition is readily treated. Initial treated is with exercise, leg elevation, compression, and topical wound care. Management is then directed at the cause of the chronic venous insufficiency.
Treatments
General Principles
Your individualized treatment plan will be developed based upon your history, physical examination, diagnostic ultrasound results, response to conservative measures, and goals of therapy. Treatment is tailored to the individual’s anatomic and physiologic abnormalities.
In general, the most prominent sources of high venous pressure, commonly the great and small saphenous veins, are addressed first. Treatment of the more surface varicose veins follows. We treat from “biggest to smallest” and “inside to outside”.
The truncal veins, if abnormal, are treated first, most commonly with office based endovenous radiofrequency or laser ablation. Remaining branches are then treated with a combination of sclerotherapy and/or microphlebectomy, all office based procedures.
Treatment of deep venous insufficiency, superficial and deep thrombophlebitis, congenital venous malformations, pelvic congestion syndromes, and other less common entities is highly individualized and should be discussed with your Northwest VeinCare physician.
Endovenous Thermal Ablation
These minimally invasive procedures procedures are forms of endovenous thermal ablation, and are most commonly used to treat abnormal truncal veins of the lower extremity. Each applies heat in a controlled fashion to the inside of the diseased vein, using radiofrequency (RF) or laser as an energy source. The targeted vein is sealed shut and, over time, is absorbed by the body.
The procedures are similar in how they are performed. For RF, energy is transferred and heat applied by direct contact with the collagen of the vein wall. For laser, a specific wavelength of amplified light is used to target the water in the tissue of the vein wall.
Using ultrasound guidance, your physician will position a catheter and treatment fiber into the diseased vein through a small puncture in the skin, similar to placing an IV catheter. With the catheter in place, a solution is injected around the vein to provide local anesthesia and to prevent damage to surrounding tissues. Heat energy using laser or radiofrequency as a source is then precisely applied to the diseased vein using ultrasound guidance. After the targeted vein is closed, blood is redirected to other healthy veins to return to the heart.
There are no incisions, no scarring, minimal or no pain, bruising, or swelling, and complications are extremely rare. Best of all, there is no down time. Normal daily activities may be resumed immediately. Functional and cosmetic results are excellent, with the treated diseased vein remaining shut in approximately 95% of cases. The procedure is performed in the office and takes less than an hour.
Your VeinCare physicians are amongst the most skilled and experienced in these procedures, having performed thousands in a comfortable and convenient office setting.
Venaseal (Cyanoacrylate Ablation)
Venaseal is a non-thermal ablation procedure used to treat the truncal veins of the lower extremity. Tumescent local anesthesia is unnecessary so there is only one needle stick (at the catheter insertion site). Small dabs of cyanoacrylate medical adhesive are injected while pressure is applied over the vein. There is no down time and no need to wear compression afterward. The procedure is very effective, with results similar to thermal ablation.
Your Veincare Experts physicians are skilled and experienced in this procedure and were amongst the first in the Chicagoland area to perform Venaseal ablation.
Sclerotherapy (Endovenous Chemical Ablation)
After truncal veins are satisfactorily addressed, or if they are not an issue, then branches or tributaries are treated, most commonly with sclerotherapy. An FDA approved sclerosing agent is injected into the vein, destroying its lining and prompting the vein to close shut. Sodium Tetradecyl Sulfate or Polidocanol are commonly used, either as a liquid or a foam. As with the truncal veins, blood is routed to more efficient routes. Unlike treatment of truncal veins, sclerotherapy for tributaries usually requires a series of shorter appointments. At each session, several injections are performed at key locations using a very small needle. The injection is guided by direct vision, palpation, or by duplex ultrasound imaging. A compression dressing is worn for several days afterwards.
Sclerotherapy has also been used for truncal veins, but more effective treatments are usually used today. Sclerotherapy is also used for spider veins, and is very efficient, although other modalities are available.
Treatments are virtually painless except for tiny needle sticks, there is no scarring, complications are extremely rare, and there is no down time. Your Northwest VeinCare physicians have performed these treatments countless times with excellent cosmetic and functional results.
In this procedure, veins are actually removed, but unlike conventional stripping, tiny (1-3 mm) punctures are made with a fine scalpel or needle tip and the diseased veins removed using tumescent anesthesia and a special hook shaped dissecting instrument. The configuration and location of diseased veins determines when this procedure may be recommended. The procedure may be performed in the office or out patient operating room, depending on how extensive the diseased veins are. Scars are tiny, there is minimal pain, and no down time. Dr. Robin is expert at this procedure and has performed several hundred.
Conventional surgical stripping, has, for the most part, been abandoned in favor of less invasive procedures.
This minimally invasive videoscopic procedure allows the surgeon to divide abnormal perforator veins in the lower leg. The videoscope and dissecting instruments are inserted through very small incisions just below the knee. It is performed in the operating room using regional or general anesthesia, and is usually reserved for patients with severe skin changes or ulcers. Dr. Robin was one of the first in the Chicago area to perform this procedure. It is used infrequently today since perforator veins can now be addressed by even less invasive percutaneous laser, radiofrequency, or sclerotherapy procedures.
Glossary
Accessory Saphenous Vein: A special tributary of the saphenous vein which often runs parallel to the saphenous vein, superficial to it, and towards the front (anterior) or back (posterior) of the thigh and terminates near the saphenofemoral junction at the groin.
Acute: An acute condition or acute stage of a condition refers to rapid onset, short course, or both. In medicine, it is usually a measure of time scale of a condition.
Ambulatory Microphlebectomy: The removal of varicose veins on an outpatient basis, usually done in the office using local anesthesia. Unlike traditional vein stripping, the procedure is done with a minimally invasive technique using a special dissecting hook and a series of 2-3 mm. (1/10th inch) skin punctures. Usually no sutures are required. It is also known as stab avulsion phlebectomy.
Anterior: The front of the body or body part.
Artery: The blood vessels of the circulatory system that carry oxygen rich blood away from the heart to the tissues.
Baker Cyst: A collection of fluid behind the knee joint associated with conditions if the joint such as arthritis or injury, relevant to phlebology only in that it may be noted incidentally during ultrasound examination.
Blood Vessel: An artery or vein that is part of the circulatory system.
Catheter: A thin tube made from medical grade materials which can be inserted into a body cavity or blood vessel to inject or drain substances. In phlebology, catheters are often used in veins to perform minimally invasive ablation treatments for varicose veins.
Chronic: A measure of time or scale of a condition, lasting a longer time, as opposed to acute.
Chronic Venous Insufficiency (CVI); Also known as Chronic Venous Disorder (CVD): A progressive medical condition that may worsen over time. Vein walls and valves are weakened and damaged, leading to a high pressure system in the vessels which carry blood back to the heart. Symptoms and signs include pain, swelling, and fatigue of the legs, and skin damage and ulcers, or sores, may occur. CVI is often preceded by varicose veins.
Circulation: The movement of fluid through the body in a regular or circuitous course. The circulatory system, composed of the heart and blood vessels, functions to deliver with oxygen and nutrients to the tissues, and then return it to the heart and lungs for another cycle. The venous circulation involves the return pathway.
Competent Vein: A vein in which blood flow occurs in the proper direction back to the heart, without excess pressure (also referred to as having “normal flow” or “no reflux”).
Compression Pump: An automated device using intermittent pneumatic compression, which aids in the treatment of edema. It may also be used to prevent clotting, for example, during surgery.
Compression Stockings: Also known as compression hose, these garments are used to treat chronic venous insufficiency and are often worn following varicose vein treatments. They may be prescribed by a physician and are individually fitted to the patient. They come in knee-high, thigh-high, and pantyhose styles and can help alleviate the swelling and pain associated with varicose veins. Some lower weight compression stockings can be purchased over the counter or online from specialty stores.
Congenital Venous Anomaly: Sometimes the venous system fails to develop normally, resulting in abnormalities termed congenital venous anomalies or malformations. Those affecting the lower extremities may be familial (inherited), or sporadic (a consequence of chance abnormal development), and may be associated with other findings elsewhere. The most common syndrome affecting the lower extremities is known as Klippel-Trenaunay syndrome.
Continuous Wave Doppler: An older form of diagnostic evaluation using a hand-held device that generates ultrasound waves and emits an audible signal indicating the velocity of blood flow. It has largely been replaced by more sophisticated techniques.
Deep Veins: Veins that lie within the groups of muscles or their lining, close to the bones, and carry blood back to the heart.
Deep Vein Thrombosis (DVT) (Thrombophlebitis): A condition that occurs when a blood clot forms in a deep vein, usually of the leg. It may become life threatening if the clot breaks off and moves to the lungs. A chronic condition affecting the legs known as post-phlebitic syndrome may also result as a consequence. DVT typically occurs with extended periods of inactivity such as after surgery or extended travel such as a long flight. One may also be predisposed to DVT by inherited conditions, injury, trauma and cancer, and certain medications.
Duplex Ultrasound Test: Currently, this is the mainstay of diagnostic tests for venous disorders. It uses ultrasound waves to measure directional speed of blood flow and also produces an image of structures. In this way, it provides the doctor with a map of the veins as well as an indication of valve competency, obstruction, clot, or other conditions that may be causing a venous disorder. It is also used as a guide during the performance of procedures such as endovenous ablation and ultrasound guided sclerotherapy.
Edema: The accumulation of fluid in the tissues, which may be seen in the lower legs of patients with varicose veins and chronic venous insufficiency, as well as other medical conditions.
Endovenous: Within a vein.
Endovenous Ablation: Closure of a vein from the inside, most often referring to the truncal (saphenous) veins of the lower extremity. A catheter is inserted into the vein and energy (most commonly thermal energy using laser or radiofrequency) is precisely applied to seal it shut. Blood is rerouted to more properly functioning veins. The treated vein dries up, shrinks, and is absorbed by the body. Sclerotherapy is also a form of endovenous ablation where a chemical is used to destroy the vein lining and cause it to shut down.
Foam/Foam Sclerotherapy: Sclerotherapy performed with a mixture of liquid and gas to create foam resulting in greater surface area and longer contact time with the inside lining of the affected vein.
Femoral Vein: The major deep vein of the lower extremity from the knee to the groin.
Great Saphenous Vein: A long vein that travels along the inside of the leg from the ankle to the thigh and empties into the femoral vein at the groin. It is a common source of valvular incompetence and venous insufficiency.
Hyperpigmentation: Skin discoloration, usually brownish, in the lower legs, which may be associated with chronic venous insufficiency.
Incompetent Vein: A vein with poorly functioning valves, so that blood flows in the wrong direction, or excess pressure is required for blood to proceed to the heart; also referred to as a vein that has reflux.
Inflammatory Skin Changes: Skin changes, usually in the lower leg and ankle, associated with long standing chronic venous insufficiency and frequently preceding venous ulcers.
Laser: A powerful beam of light that is used in some types of surgery to cut or destroy tissue. In endovenous ablation, it is used to direct energy very precisely to destroy the lining of veins and close them down.
Laser Ablation: A minimally invasive procedure delivers laser energy to the inside of the vein, which ultimately causes the diseased vein to seal off. Laser devices used in this procedure have frequencies that range from 810-1470 nm. The procedure is most often used to “close off” poorly functioning truncal veins of the lower extremity.
Leg: The part of the lower extremity below the knee.
Local Anesthesia: Local anesthesia involves numbing a specific part of the body to prevent feeling of pain during a procedure.
Lower Extremity: The entire lower limb, from the hip through the foot. In popular usage it is commonly referred to as the leg, although in medical terminology, the leg refers to the portion of the lower extremity from the knee to the foot.
Lymphedema: A condition of lymph fluid building up in the soft tissue. It may occur as a result of destruction, obstruction, or abnormal flow in the lymphatics, and may occur sporadically or as a consequence of surgery, injury, infection, or other precipitating event. Lymphedema is often distinguished from venous edema by physical examination. It is also classified according to age of onset, and may be inherited, acquired, or sporadic.
Micro-Phlebectomy: See Ambulatory Phlebectomy.
Mutation (with respect to Thrombophilia): An inherited condition affecting the clotting system which may result in a tendency to form clots.
Perforating Veins: Veins that connect the superficial and deep venous systems and usually perforate, or pierce the fascial layer.
Phlebectomy: See Ambulatory Phlebectomy.
Plethysmography: A testing method using a series of air cuffs which are inflated and deflated at set intervals to allow measurements of changes in blood flow. It is used infrequently in the assessment of chronic venous insufficiency.
Popliteal Vein: The deep vein located behind the knee.
Radiofrequency Ablation: A minimally invasive procedure that uses radiofrequency energy in bursts to provide heat to contract the collagen in the vein walls, causing them to collapse and seal off. It is used to “close off” poorly functioning veins of the lower extremity. It is also known by the proprietary name of “Closure” or “Venefit” procedure.
Reflux: The valves in the veins close just as blood begins to flow backwards. If the valves do not close properly, the blood , for a period of time, may flow backwards, or retrograde, resulting in high pressure in the system and potential damage to valves upstream, and setting up a cascade effect for more vein damage. The veins themselves may become tortuous and dilated varicose veins, and the tissues may suffer from high venous pressure.
Saphenous Vein: The great and small saphenous veins serve as the principal veins running superficially up the leg, eventually joining the deep vein system to return blood to the heart. The great saphenous vein goes fro the inside of the ankle all the way up to the groin. The small saphenous vein runs from the outside of the ankle and terminates in the space behind the knee. They are considered truncal veins of the superficial system.
Sclerosant: A chemical in liquid or foam form injected into a vein to destroy the lining cells and prompt the body to close down the vein.
Sclerotherapy: A simple procedure involves injecting a liquid or foam solution into the veins using a very fine needle. The chemical irritates the lining of the vein, causing it to scar down and fade away, as it is absorbed by the body. Blood flow shifts to nearby healthy veins. Sclerotherapy is used to treat varicose veins and spider veins.
SEPS: Subfascial Endoscopic Perforator Surgery is a videoscopic operative procedure used to treat incompetent perforator veins; those short veins that communicate between the deep and superficial vein systems. It is less invasive than older operations, but more invasive than percutaneous office based procedures. It may be useful in selected cases.
Small Saphenous Vein: Also known as Lesser Saphenous Vein (see Saphenous Vein).
Spider Veins: Spider veins are very small veins in or just under the skin which are not raised above the surface. They look like tiny branches or webs of blue, purple or red. Although spider veins may be associated with varicose veins and chronic venous insufficiency they may exist independently and treatment is usually considered cosmetic.
Stasis Dermatitis: See Inflammatory Skin Changes
Stripping: A surgical procedure to treat varicose veins. The abnormal saphenous vein is “stripped” from groin to lower leg by making an incision in each location, dissecting out the vein, ligating or tying it at each end, passing a flexible device through it, and avulsing the segment of vein. Tributaries, or branches, may be removed through a series of small incisions. This stripping method has been used since the 1950s but has largely been replaced by less invasive office procedures.
Superficial Thrombophlebitis: A blood clot with associated inflammation in a superficial vein. This condition can be very uncomfortable, but is usually not in and of itself, dangerous. However, it is often a sign of underlying venous insufficiency and also can be associated with concomitant deep vein thrombophlebitis, so it should prompt evaluation by a vein care expert.
Superficial Veins: Veins of the lower extremity that lie above the deep fascia and muscles, closer to the skin than deep veins. In the lower extremity, the saphenous veins are the main, or truncal, superficial veins.
Telangiectasia: The condition commonly known as spider veins.
Thigh: The part of the lower extremity above the knee.
Thrombophilia: A systemic condition, inherited or acquired, which makes one more likely to form clots.
Trivex Powered Phlebectomy: A method of stripping tributaries using fewer incisions, transillumination, tumescence, and a powered device to destroy affected non-truncal veins, usually performed in the operating room with anesthesia.
Truncal Veins: The major superficial veins of the lower extremity; great saphenous, accessory saphenous, and small saphenous veins
Tumescent Anesthesia: A technique used involving infiltration of large amounts of local anesthetic in the subcutaneous tissue. Its use in phlebology is different than when it may be used in cosmetic procedures such as liposuction. Dosages delivered for phlebology are under potentially toxic limits and the solution is precisely delivered around the vein to be treated, also acting as a heat sink during endovenous thermal ablations.
Varethena: A proprietary system using foam sclerotherapy to ablate truncal veins.
Varicose Veins: Bulging, weakened and tortuous or twisted veins primarily found in the lower extremity, or leg. These veins have lost their elasticity and contain ineffective valves. Blood pools and pressure builds up in these veins, leading to uncomfortable symptoms, swelling, and changes in surrounding tissues and skin.
Vein Valve: Healthy leg veins contain valves comprised of delicate flaps of tissue which open and close to promote flow towards the heart and prevent pressure from building up in the legs. They are designed to overcome the effect of gravity on the venous blood in the legs. Weakened, poorly functioning or destroyed valves are associated with varicose veins and chronic venous insufficiency.
Venefit: Formerly known as VNUS Closure, this minimally invasive procedure is similar to Laser Ablation for truncal veins, but uses radiofrequency energy to heat and shrink the affected vein in a controlled manner.
Venous Reflux: A term that describes what happens when the valves in the veins become weak or damaged and lose the ability to regulate the direction of blood flow. When blood “leaks” down past a bad valve, it is called reflux. Reflux allows blood to pool in the legs as opposed to moving upward toward the heart.
Venous Stasis Ulcer: If chronic venous insufficiency is left untreated, the skin may break down resulting in a wound in the leg. These ulcers usually appear near the ankles or lower leg and indicate a more severe and progressive state of disease. They may appear spontaneously or may follow seemingly minor trauma.