treating your veins - pt -update2

ANDREW STYPEREK MD

Treating your Veins

TAMARAC

7301 N University Drive, Suite 102

Tamarac, FL 33321

Phone: 954-726-2000

Function of Peripheral Venous System

Returning blood to the heartRegulate body temperatureStore bloodRegulate cardiac output

Value ensure blood return

Valves ensure unidirectional blood return to the heart by preventing effect of gravity

Mostly in lower legs

Normal flow Abnormal

Calf muscle pump

Calf muscle drives blood return to the heart

Anatomy

There are 2 vein systems in the leg

Front View

Superficial Deep

AnatomySuperficial Deep

There are 2 vein systems in the leg

Rear View

Common symptoms of vein disease

Varicose or Spider Veins

Swelling Skin ChangesColor/Texture/Rash

Ulcers or open sores

Fatigue Cramping

Pain

Itching

Burning

Restless leg

AchingHeaviness

Other examples

Treatment

Before treating visible veins, it is important to examine the veins upstream…

What we see…

Where the problem is…

Duplex Ultrasound

Highly accurate, live, painless test of veinsProvides information about:

Anatomy Blood flow Clots Valves

12

Treatment Options

Conservative Therapies: Require consistent and daily treatment

*Exercise *Leg elevation *Compression stockings *Use of NSAIDS *Unna boot or compression wraps (for ulcers)

Heat Non-HeatSurgical

Radio-frequenc

yLaser Roto-

rooter Foam

Glue

Stripping

Compression

w/o compression w/ compression

Compression Stockings

Depending on coverage & disease severity, you will need to attempt compression for 90-180 days.

Minimum 20-30mm HgNot covered by insuranceMultiple designs, each with pros & cons

Surgical Ligation & Stripping

Surgical cutting & removal of veins, including cutting and sewing of all connections to other veins

Removal may or may not be assisted with a device

Performed for 100+ years Requires general anesthesia in

operating room 4 weeks recovery

Vein Ablation: Heat

Heat shrinks the vein wall, seals vein closed, blood rerouted to healthy veins

Symptom relief in 2 days

Resume normal activities within a few days

Vein ablation: Laser vs RF

17 Radiofrequency

Continuous Pullback Requires continuous careful pulling of

laser through vein human error due to pullback speed

Segmental Ablation Controlled heat delivery No human

error during treatment of each segment

Laser Ablation

Vein ablation: Non-heat

Cyanoacrylate Adhesive

Large amount of adhesive/ thrombus is left in the AVM as seen on MRI.

Courtesy of Dr. R. Raabe

If we can glue high-flow cerebral AVMs, why can’t we glue low-flow varicose veins?”

– Dr. R. Raabe, 2008

Benefits of non-heat therapy

No need for: Tumescent anaesthesia Post-procedure

compression Post-procedure pain &

bruising

Sclerotherapy

Sclerotherapy

Before

After

Conclusion

Heat Non-HeatSurgical

Radio-frequenc

yLaser Roto-

rooter Foam

Glue

Stripping

FAQs

Do I need these varicose veins for bypass surgery? NO. Other bypass grafts can come from radial arteries (one in

each arm) and mammary arteries (one on the left and right) in the chest that can be harvested to do bypass surgery.

Varicose veins are NOT healthy and often large (varicose) and NOT suitable for bypass grafting and likely to clot once they are in place because of the size mismatch and their inflamed (phlebitic) nature.

Finally, chances are in your lifetime that you will get a stent for blockages in your heart rather than bypass surgery.

Using them would be like putting worn tires that are about to blow onto your car before a cross-country trip.