The Varicose Vein Clinic


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  • Notes: Ten times more patients suffer from venous insufficiency than peripheral arterial disease in the U.S. Market research indicates that over 2 million work days are lost annually in the US and $1.4 billion is spent each year on this common medical condition
  • The Varicose Vein Clinic

    1. 1. M ANAGEMENT OF V ARICOSE V EINS Martin Anthony A. Villa, M.D., P.S.V.S Varicose Vein Clinic N.L. Villa Memorial Medical Center <>
    2. 2. <ul><li>What is varicose vein ? </li></ul><ul><ul><li>Varicose veins are gnarled, enlarged veins. The word &quot;varicose&quot; comes from the Latin root &quot; varix ,&quot; which means &quot;twisted.&quot; Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins in your lower body. </li></ul></ul>
    3. 3. Prevalence & Incidence of Vascular Disease Sources: American Heart Association, SCVIR, Brand et al. “The Epidemiology of Varicose Veins: The Framingham Study”
    4. 4. Who’s at risk?
    5. 5. Risk Factors <ul><li>Hereditary </li></ul><ul><li>Gender </li></ul><ul><li>Age </li></ul><ul><li>Pregnancy </li></ul>
    6. 6. How do VV develop? <ul><li>Incompetent venous valves </li></ul><ul><li>Inherent defects in the vein wall </li></ul><ul><li>Associated with </li></ul><ul><ul><ul><li>Heredity (alteration in vein wall collagen and/or elastin) </li></ul></ul></ul><ul><ul><ul><li>Hormones (progesterone) </li></ul></ul></ul><ul><ul><ul><li>Gravitational Hydrostatic Forces </li></ul></ul></ul><ul><ul><ul><li>Postthrombotic Syndrome </li></ul></ul></ul>
    7. 7. Anatomy of the Leg VEIN SYSTEM: Deep System Superficial System Perforators
    8. 8. Presentation <ul><ul><li>Unsightly veins </li></ul></ul><ul><ul><li>Leg heaviness </li></ul></ul><ul><ul><li>Dull achy leg </li></ul></ul><ul><ul><li>Swelling </li></ul></ul><ul><ul><li>aSx </li></ul></ul>
    9. 9. Progression <ul><ul><li>Hyperpigmentation </li></ul></ul><ul><ul><li>Lipodermatosclerosis </li></ul></ul><ul><ul><li>Induration </li></ul></ul><ul><ul><li>Ulceration </li></ul></ul><ul><ul><li>Bleeding </li></ul></ul>
    10. 10. Initial Assessment <ul><li>Detailed History </li></ul><ul><li>Thorough physical examination </li></ul><ul><li>+/- ultrasound </li></ul>
    11. 11. M ANAGEMENT OF V ARICOSE V EINS Medical Treatment Weight control Compression stockings Leg elevation Leg elevation Avoid very tight garment Interventional treatment Endovenous ablation Microphlebectomy Sclerotherapy Vein stripping Superficial laser beam
    12. 12. The High Ligation The Vein Stripping Treatment: Vein Stripping and Ligation
    13. 13. <ul><li>General anesthesia </li></ul><ul><li>Hospital setting: OR use and admission </li></ul><ul><li>Severe post-operative pain requiring prescription drugs </li></ul><ul><li>Severe bruising/ tenderness along the treated vein </li></ul><ul><li>Typical recovery is between 2-4 weeks </li></ul>Treatment: Vein Stripping and Ligation
    14. 14. Treatment: Endovenous Ablation <ul><li>Local anesthesia </li></ul><ul><li>Office/ base </li></ul><ul><li>Outpatient </li></ul><ul><li>No Scar </li></ul><ul><li>Little or no pain </li></ul><ul><li>Less bruising/ tenderness </li></ul><ul><li>Return to normal activity immediate </li></ul>Under local anesthesia, a catheter is inserted into the vein. The laser/ RF fiber is passed through the catheter to the top of the vein. The fiber is fired, and the catheter is withdrawn back out of the small puncture site. LASER RF
    15. 15. <ul><li>Catheter Technique </li></ul><ul><li>Minimally Invasive </li></ul><ul><li>Heat causes collagen contraction and endothelium denudation </li></ul><ul><li>Eventually develop vein fibrosis, obliteration and scarring </li></ul>Treatment: Endovenous Ablation Diomed 810 nm Diode Laser
    16. 16. Treatment: Endovenous Ablation Before After Before After
    17. 17. Treatment: Endovenous Ablation Before After Before After
    18. 18. <ul><ul><li>Also known as stab phlebectomy or ambulatory phlebectomy </li></ul></ul><ul><ul><li>Performed under local anesthesia </li></ul></ul><ul><ul><li>Well tolerated in the office setting </li></ul></ul><ul><ul><li>A fine phlebectomy instrument is inserted through the 2-3 mm incision to grasp the vein. This vein is teased from the surround tissues and removed. </li></ul></ul>Treatment: Microphlebectomy
    19. 19. ` Treatment: Sclerotherapy <ul><li>Intravenous injection of a medical solution into the reticular vein, telangectasia or spider vein causing an irritation to the vein wall. These lead to the obliteration of the vein lumen. </li></ul>
    20. 20. Treatment: Transluminated Sclerotherapy
    21. 21. The Varicose Vein Unit <ul><li>Wholistic comprehensive approach to the diagnosis and treatment of varicose veins. </li></ul><ul><li>Consultation, diagnostic study and procedural treatment are done in one place- One stop shop system. </li></ul>
    22. 22. Medical Treatment Services Offered Interventional treatment Endovenous ablation Microphlebectomy Sclerotherapy Vein stripping Superficial laser beam Initial Evaluation Conservative Tx H & P Ultrasound study P800 ++ P7000++ P59,000++/session P3,500++/session P50-70,000++ P15,000++/session
    23. 23. Varicose Vein Unit 2 nd Floor, N.L. Villa Memorial Medical Center Felix Manalo St., Lipa City Wednesday and Sundays 10:00- 300 pm For appointment/ inquiry: 043-756-1217, 043-756-4871 to 73 Email:
    24. 24. Reminder, Rodeo Houston is just around the corner. Better get your cowboy hat and cowboy boots… if not, just be the cow… moooo!