Selecting a Vein Doctor

“Varicose veins are a common affliction and affects nearly 1 out 4 Americans” according to vein specialist in New Jersey. Fortunately, most of us with varicose veins will not have any significant issues or complications. Simple at home or work measures including exercise, compression stockings, leg elevation and smoking cessation will be enough to keep symptoms at ease.

For patients with symptoms including leg pain, leg heaviness, itchy or spider veins on legs, and restless legs despite conservative measures, a new approach is needed. Many are aware that a consultation with a varicose clinic is needed, however are unsure how to find the most qualified physician. Within each major zip code, you might search and find at least 10 different vein treatment centers. As you are probably aware, not all of them are equally experienced or skilled to manage vein disease.

So let’s begin with some advice on selecting which doctor is best for you from your internet search:

1) Be certain that your vein doctor is board-certified and “trained” in vascular treatments. This is more than passing a written test, but also informs you that the vein doctor completed a formal residency or fellowship in endovascular treatments. Consider specialists with backgrounds in vascular surgery, interventional radiology or interventional cardiology.

2) Vein evaluation is a must! If you are asymptomatic and primarily concerned about cosmetics, you should not consider more involved procedures like EVLT or EVLA (Endovenous laser ablation). Vein ablation is best suited to manage patients who have medical necessity based on signs and symptoms of venous insufficiency. A vein specialist can rightly assess your condition and determine whether or not a medical condition exists.

3) If you are having treatment for venous insufficiency, the most advanced techniques are endovascular ablation, foam sclerotherapy, and venaseal. In some cases, MOCA or mechanochemical ablation can also be considered. Stripping is an older technique and is no longer the preferred or best treatment for underlying vein disease. It has a higher level of complications and is less effective

4) Phlebectomy is still very useful for large unsightly veins that are not suitable for ablation or sclerotherapy either due to their tortuosity or proximity to skin and other collateral tissue. Additionally, treating large protuberant veins with simple sclerotherapy can sometimes lead to longer healing periods and long lasting cosmetic skin discoloration. Phlebectomy is a fast and efficient tool to eliminate large varicose veins without any large incisions.

5) Support staff is another way to measure a clinic’s commitment to the highest standards. Check and see if your ultrasound technologist performing important reflux studies has passed his/her certification exams. They will let you know if they are RVT (registered vascular technicians) or RVS or RpHS (registered phlebololgy sonographers)

6) The above factors focus on being certain on the qualifications of your vein doctor and the breadth of their skills to offer various treatment solutions tailored to your symptoms, anatomy, and vein presentation. The other qualities are more abstract and are the individual feeling you get about your interaction with the staff and vein doctor. Being given appropriate time and patience to your questions and concerns reflects on how much value the vein clinic places on the individuals care. Don’t fall prey to high volume centers that emphasize procedural volume over outcomes and quality. If you feel less than satisfied with your initial consultation, it’s very reasonable to consider a different vein clinic even if you have to travel some extra miles.

Just remember if you can’t get the time and answers to your questions, what is the likelihood you will see the time and commitment given to your vein treatment. Getting high level care is difficult because the experience of vein doctor is so variable and due to financial constraints, much of vein treatment near me today are trying to fit as many cases in a limited daily schedule. Something has to give and that generally is quality. The final results will make the extra commute worthwhile and that level of expertise can only be delivered by the very best centers committed to continuing education, investment into new technology, and you the patient for time.

Article Source: https://njveinwellness.bcz.com/2022/01/18/how-to-choose-the-right-vein-dr/

Foam Sclerotherapy

 The gold standard of varicose vein treatment in New Jersey is non-surgical treatments including endovenous laser vein ablation and endovenous radiofrequency ablation. Both forms of treatment are catheter based technologies performed using ultrasound guided percutaneous entry. However, ablation is not suitable for all patients due to variable presentations of vein disease and anatomical considerations. In fact, contra-indications to catheter based treatment include:

•  superficial veins close to the skin
•  proximal nerves or arterial circulation
•  tortuous veins.

In these instances, a more suitable treatment is microfoam delivery of polidocanol, otherwise known as foam sclerotherapy. According to experts, the difference between foam sclerotherapy and the more common and well-known sclerotherapy is the compounding of the sclerosant with mixture of air (nitrogen, oxygen, and carbon dioxide). The elements are in variable concentrations and allow for the liquid sclerosant to be compounded into a foam mixture that adheres better to target vessel walls. This is important for larger targets like varicose veins and in some cases reticular veins. Vein specialists will use either foam or liquid sclerotherapy for spider vein treatment  depending on the condition being treated.

• Truncual reflux–best suited for RF ablation or EVLT
• Truncal varicosities–foam sclerotherapy or ambulatory phlebectomy
• Perforating veins–targeted ablation or foam sclerotherapy or phlebectomy
• Reticular veins–foam sclerotherapy
• Spider veins–liquid sclerotherapy or laser treatment of spider veins

Foam sclerotherapy can be aided by ultrasound in certain situations prescribed for varicose vein treatment. In most vein clinics, the preferred solution is now polidocanol given its efficacy and safety profile. There is also the FDA-approved Varithena that is ideal for large varicose veins, perforators and neovascularization. Varithena comes in 1% polidocanol pre-packaged, but is unique from physician compounded foam sclerotherapy because it is pre-packaged as a low-nitrogen microfoam that clinically has proven to be safer and more efficacious. It can be used on the upper and lower portions of the leg. However, despite the increased safety profile ,the medication should only be administered by qualified vein doctors near me that understand the mechanism of action and appropriate use criteria.

In general, foam sclerotherapy is administered following direct cannulation of the target vein. With polidocanol, the preferred concentration is 0.5%-1.0% depending on the size of the target vein. With generic polidocanol, the liquid sclerosant is mixed with an air-filled syringe in 3:1 or 4:1 ratios until a foam is created. The injected foam has an immediate action on the vein walls inducing chemical ablation; this process continues for months to years as the vein is slow reabsorbed by the body. It is important to inform patients of the possibilities to feel tenderness or lumpy nodules after treatment that may look worse for a period of time, but will heal with good effect. Follow up is important post procedure as per the protocol and is standardized in most vein centers. The post procedure care after sclerotherapy follow up will include a duplex ultrasound to evaluate vein treatment effect and any complications post sclerotherapy.

Article Source: https://nycvaricoseveinclinic.weebly.com/nyc-vein-treatment-blog/archives/12-2021