New Product: The Scat Belt Becoming a Favorite Exercise Companion

Exercise is an important component of good vein health.  Exercise empties the veins of the legs and is beneficial to the cardiovascular system.  As a result, regular exercise, even a walking routine is beneficial to the leg veins and can help reduce leg symptoms.  A new product was developed that keeps you safe during outdoor exercise, such as going on evening walks or hiking in areas that are less populated. The Scat Urban Belt, allows you to carry pepper spray, a super loud alarm, a smarthphone and even a bottle of water!  For more information, go to


The SCAT URBAN Belt is lightweight, comfortable and provides peace of mind because you’re prepared and protected. The Urban comes in three great colors and two adjustable sizes for optimal fit.

Access pepper spray, an ear-piercing personal alarm and smartphone within seconds – also carry a bottle of water.

8 Warning Signs of Vein Disease: #2 Discoloration of the Skin


Discoloration of the Skin

venous leg ulcers

Chronic venous insufficiency (CVI) can cause the skin to become discolored, usually around the ankles. Over time, ulcerations or skin wounds may develop.

Over time, leakage of the blood into the area surrounding the veins can cause tissue to die. The resulting pooling of blood in the tissue causes a darkening of the skin. It is at this stage that the skin is actually stained by your own blood.  This is also known as venous stasis skin changes, skin hyperpigmentation or venous stasis dermatitis because the skin is often inflamed, itchy and eczema-like.  This is most frequently caused by venous reflux, an underlying condition that can be treated. When skin changes like these are present, the condition is termed chronic venous insufficiency.  Over time, the skin condition may worsen and the skin may become darker, firm to touch, scaly and itchy, and the skin may break down causing a venous leg ulcer.

8 Warning Signs of Vein Disease: #1Tired, Heavy Legs

Tired, heavy-feeling legs

One of the first signs of vein disease- your legs feeling chronically tired and heavy. This is a clear indication that the return flow of blood from the legs to the heart is impaired. The result is oxygen depletion in your legs and pooling of blood, increasing the pressure in your legs, giving you that tired, heavy feeling.

varicose veins

Varicose veins most frequently cause the legs to become heavy, achy and tired. But, these symptoms can be present even in the absence of varicose veins. Venous insufficiency, the underlying cause for varicose veins can cause leg heaviness, tiredness and swelling even before bulging veins are visible.

Many people think it is normal to have tired, heavy legs or that it is a part of aging. It is not. If you or someone you know, suffers from these symptoms, especially legs that become tired and heavy toward the end of the day, causing you go slow down your activities to sit and elevate the legs, you should get checked out for venous insufficiency.

What are Vein Valves?


In healthy veins, the valves close after the blood flows towards the heart, preventing back flow.
When veins become dilated, the valves cannot close properly, allowing blood to flow back towards the ankle.

Vein valves play a critical role in helping blood flow through the veins back to the heart. Like swinging doors, valves open to allow blood to flow toward the heart and flap closed again to prevent the flow of blood back down the legs. If the veins become dilated, the flap-like valves cannot completely close, making them incapable of preventing the back flow of blood. This ‘back flow’ of blood through dysfunctional valves is called venous reflux or venous insufficiency.

Dr. Bunke Trains Doctors Using Vein Simulator

Dr. Bunke Paquette instructed doctors on advanced techniques of sclerotherapy last week at a workshop hosted by the Society for Vascular Medicine. Dr. Bunke used a special training model, called a ‘sclerotrainer,’ which allows educators to teach vein injection techniques on a lifelike model that includes veins filled with fluid that is the same viscosity as blood, of varying sizes and depth and veins .  This device made it possible for many clinicians to perfect different injection techniques for tiny telangiectatic and reticular veins.


La Jolla Vein Care’s Dr. Bunke Paquette instructs doctors on techniques for sclerotherapy of telangiectasias and reticular veins on a life-like model of veins.


The Sclerotrainer is a lifelike model that includes veins filled with fluid that is the same viscosity as blood, of varying sizes and depth and veins. This allows educators to teach vein injection techniques for the treatment of small spider and reticular veins.

The La Jolla Vein Care staff also helped out with the lesson and shared their expertise with the physicians.

7 Signs of Venous Disease

#1 A feeling of heaviness or fullness in the legs that gets worse as the day progresses.

#2 Leg fatigue and tiredness in the legs, that also becomes worse by the end of the day and after prolonged standing or sitting. Some patients describes their legs as being ‘full of energy’ in the morning but are tired by the evening. For example, after a long day at work, disney land or the grociery store, you may feel like you need to run to a chair to recline and elevate the legs.

#3 Leg swelling, mostly affecting the ankles. Your legs may be normal in the morning but you notice swelling or that your shoes are tight by the end of the day.

#4 Leg pain. This can occur generally, or along a varicose vein, especially those that run on the outside of the leg or behind the knees. Some patients report localized pain along the vein that feels like burning or throbbing. Leg pain that is worse during exercise may indicate a different problem.

#5 Night cramps. These are cramps usually in the calf or thighs that occur only at night.

#6 Restless Legs: a feeling of restlessness during the night, that may interrupt sleep. You may have to get out of bed to walk around and move your legs.

#7 Noticeable bulging, twisted veins called varicose veins


Dr. Bunke Presents at SVM Scientific Sessions


Dr Nisha Bunke Paquette presents at the SVM Annual Scientific Meeting in La Jolla, Torrey Pines Hilton June, 2014.

La Jolla Vein Care’s Dr. Nisha Bunke presented a talk about the ‘Management of Non-healing wounds in venous disease’ at the Society for Vascular Medicine’s Annual Scientific Sessions this past weekend. She spoke about venous leg ulcers, which she described as being the most common type of chronic leg ulcer, how to make the correct diagnosis and how to heal the venous leg ulcers.

Other topics at the meeting included venous thromboembolism (DVT), diagnosing and treatments for DVT, atypical wounds, phlebectomy, managment of the diabetic wound, duplex evaluation of the lower extremities for DVT, doppler evaluation of the arterial system, lymphedema, lipedema and many other venous, arterial and lymphatic system topics.

History of Foam Sclerotherapy Treatment of Varicose Veins


Foamed sclerosant inside a vein: Once foam is introduced into the vein, it is hyperechogenic on ultrasound. In this picture, a La Jolla Vein Care doctor points to the foamed medication inside the vein. Notice it appears ‘white.’


Foamed sclerosant used for sclerotherapy has a ‘foam’ or frothy-like appearance.

In 1994 and 1950, E.J. Orbach introduced the concept of a macro bubble air-block technique to enhance the properties of sclerosant in performing macrosclerotherapy.  Apparently, few vascular surgeons were interested in the subject and the technique languished.  The work of Juan Cabrera and colleagues in Spain attracted attention of some vein specialists and interest in the use of foam technology in treating venous insufficiency was reawakened. Administration of foamed sclerosant was reintroduced in the early 1990s by Cabrerra, who summarized a broad experience in 1997. By the 1990’s, broad use of diagnostic ultrasound imaging made it possible to monitor foam distribution with ultrasound scanning. Some 40 years earlier, and before the development of ultrasound scanning, foam had been used in Germany to treat varicose veins.  At that time, foam was made by special syringes and its distribution was assessed by touch, instead of ultrasound scanning. Tessari , prior to the year 2000 developed an easy way of making liquid sclerosant into foam using two syringes and a three-way stop cock.   By 2000, Sica was able to report a three-year experience using foamed sclerosant in treating saphenous varices.  Since that time, foam has appeared increasingly in general use. Around 2000, Dr. John Bergan began describing the utility and success of foam treatment to physicians in the United States and can be attributed to bringing its awareness to North America. Over the past decade foam has gained world-wide popularity for the treatment of varicose vein tributaries in place of surgery. Varithena foam was recently FDA approved to treat the great saphenous vein with foam sclerotherapy.  Dr. Bergan predicted that microfoam sclerotherapy will eventually replace all other methods.  Presently, it is most commonly used as an adjunct to endovenous ablation of the great and small saphenous veins or as a sole treatment for surface varicose veins.

We Mourn the Loss of Dr. John Bergan, Founder of the Vein Institute of La Jolla

This last week, we mourn the loss of a famed vascular surgeon and incredible human being. Dr. John Bergan, world renowned vascular surgeon who founded the Vein Institute of La Jolla passed on Wednesday June 10. Dr. Bunke trained under Dr. John Bergan and has said, ‘he was a great human being, compassionate doctor, a dear friend.  I couldn’t have been more fortunate to have had Dr. Bergan as my mentor.  We miss him dearly.’

His obituary read:

‘A vascular surgeon who gained national and international acclaim as one of the pioneers in organ transplantation has died at the age of 87.

Dr. John J. Bergan died Wednesday in Chicago, 50 years after he performed the first kidney transplant at what is now Northwestern Memorial Hospital. He founded the Division of Vascular Surgery at Northwestern University’s medical school and wrote what is considered one of the most authoritative books on the circulatory system.

His son-in-law, Drew Davis, announced his death Friday. He says Dr. Bergan died from complications of a neurological illness.

A longtime Northwestern colleague called Dr. Bergan a “pioneer and a visionary vascular surgeon.” Dr. William Pearce added it’s unlikely any vascular surgeon in the United States does not know of Dr. Bergan’s contributions to medicine.’


Dr. John J. Bergan

More about Dr. John Bergan:


HON., F.R.C.S. (ENG,), FACPh



Dr. John Bergan is a clinical vascular surgeon and respected teacher of vascular surgery.  He serves as Professor of Surgery at the University of California, San Diego and at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.  His office for the private practice of vascular surgery is in La Jolla, California, and there he is on the staff of the Scripps Memorial Hospital.


Dr. Bergan completed his secondary education in South Bend, Indiana, attended Yale University and received his medical degree from the Indiana University School of Medicine.  He was influenced by the pioneering vascular surgery of Dr. Harris Shumacker during internship and then completed his surgical residency at the Northwestern University Medical School under the guidance of Dr. Walter Maddock, one of the founders of the Society for Vascular Surgery.

At Northwestern,  he pursued a career in arterial surgery and organ transplantation. The Post Graduate Vascular training program there became the model for subsequent Fellowships approved by the American Board of Surgery.


After 1972, Dr. Bergan assisted Dr. James Yao in development of the noninvasive laboratory at Northwestern University Medical School. He was the principle founder of the Midwestern Vascular Surgery Society and the American Venous Forum.  His teaching of vascular surgery was rewarded by the Rovsing Silver Medal of the Danish Surgical Society, the Hach Silver medal of the German Phlebologic Society and honorary memberships in the Royal College of Surgeons in England, the Vascular Society of Great Britain & Ireland, the Vascular Surgery Section of the Royal Australasian College of Surgeons, and many others.


In Southern California, Dr. Bergan has confined his clinical and research interests to the venous system. He discovered that deep venous reflux disappeared after correction of superficial venous incompetence and  his recent clinical work has emphasized  chemical ablation of incompetent veins using intravenous foam.  His basic science investigations with Professor Geert Schmid Schönbein have uncovered a fundamental cause of venous dysfunction, which has potential for pharmacologic manipulation.


Academically, Dr. Bergan founded the Venous Digest, a monthly newsletter containing abstracts and commentary delivered by e-mail monthly and the International Venous Digest by Fax which is translated into 9 languages and delivered worldwide weekly.

Dr. Bergan has served as President of the Society for Vascular Surgery, the European‑American Venous Symposium, the American Venous Forum, the International Association of Vascular Surgeons, the Chicago Surgical Society, the Gulf Coast Vascular Society, and the Southern California Vascular Surgical Society.  He is current President of the American College of Phlebology and has served as a member of the editorial boards of all of the major surgical and vascular journals such as the Journal of Vascular Surgery, Annals of Vascular Surgery, Surgery and the British Journal of Surgery. He has published over 700 papers and has edited or co-edited 34 books on Vascular Topics nine of which deal with venous problems. His latest contribution, The Vein Book  has appeared  in the Winter of 2014.


Society for Vascular Medicine Meeting To Be Held in La Jolla

The Society for Vascular Medicine’s 25th Anniversary and Scientific Sessions 2014 are going to be held in La Jolla this week. La Jolla Vein Care’s Dr. Bunke was asked to speak on venous topics.  The keynote speaker will be Dr. Jonathan Woodson, MD, U.S. Department of Defense, Assistant Secretary of Defense (Health Affairs). There will be several scientific topics and research discussed over several.  Some of the topics include:

Venous disease

Lymphatic disease

Anticoagulants, thrombolytic therapy

PAD/endovascular therapy
Carotid arterial disease/endovascular therapy

Management of the non-healing wound in venous disease
Management of the diabetic wound
What do the guidelines recommend?

 Sclerotherapy, laser, endovenous approaches, liquid sclerotherapy
Foam sclerotherapy
Endovenous laser and instruction for access
Endovenous RF and instruction for access
Chronic Venous Disease
Epidemiology and pathophysiology including molecular insights into venous ulcer formation
Medical management: Compression therapy, novel herbal agents (horse chestnut and others)
Endovascular therapy: Ablation, radiofrequency, laser (superficial vs. deep incompetency)
Treatment of chronic venous occlusions svmlogo