Varicose veins develop due to incompetent venous valves or defects in the vein wall that cause blood to pool in the legs. Symptoms include unsightly, swollen, twisted veins and leg heaviness. The document discusses risk factors, evaluation, and treatment options for varicose veins including compression stockings, sclerotherapy, microphlebectomy, and minimally invasive procedures like endovenous ablation.

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 <www.treatmyvaricosevein.com>

2. What is varicose vein ? 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.

3. Prevalence & Incidence of Vascular Disease Sources: American Heart Association, SCVIR, Brand et al. “The Epidemiology of Varicose Veins: The Framingham Study”

4. Who’s at risk?

5. Risk Factors Hereditary Gender Age Pregnancy

6. How do VV develop? Incompetent venous valves Inherent defects in the vein wall Associated with Heredity (alteration in vein wall collagen and/or elastin) Hormones (progesterone) Gravitational Hydrostatic Forces Postthrombotic Syndrome

7. Anatomy of the Leg VEIN SYSTEM: Deep System Superficial System Perforators

8. Presentation Unsightly veins Leg heaviness Dull achy leg Swelling aSx

9. Progression Hyperpigmentation Lipodermatosclerosis Induration Ulceration Bleeding

10. Initial Assessment Detailed History Thorough physical examination +/- ultrasound

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. The High Ligation The Vein Stripping Treatment: Vein Stripping and Ligation

13. General anesthesia Hospital setting: OR use and admission Severe post-operative pain requiring prescription drugs Severe bruising/ tenderness along the treated vein Typical recovery is between 2-4 weeks Treatment: Vein Stripping and Ligation

14. Treatment: Endovenous Ablation Local anesthesia Office/ base Outpatient No Scar Little or no pain Less bruising/ tenderness Return to normal activity immediate 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. Catheter Technique Minimally Invasive Heat causes collagen contraction and endothelium denudation Eventually develop vein fibrosis, obliteration and scarring Treatment: Endovenous Ablation Diomed 810 nm Diode Laser

16. Treatment: Endovenous Ablation Before After Before After

17. Treatment: Endovenous Ablation Before After Before After

18. Also known as stab phlebectomy or ambulatory phlebectomy Performed under local anesthesia Well tolerated in the office setting 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. Treatment: Microphlebectomy

19. ` Treatment: Sclerotherapy 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.

20. Treatment: Transluminated Sclerotherapy

21. The Varicose Vein Unit Wholistic comprehensive approach to the diagnosis and treatment of varicose veins. Consultation, diagnostic study and procedural treatment are done in one place- One stop shop system.

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. 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: treat@myvaricosevein.com

24. Reminder, Rodeo Houston is just around the corner. Better get your cowboy hat and cowboy boots… if not, just be the cow… moooo!