Non-surgical Varicose Vein Treatments Mean Quicker Recovery


One of La Jolla Vein Care’s incredible patient returned to surfing just two weeks after varicose vein treatment.

Over the past decade, advances in the treatment of vein conditions have improved the safety, efficacy, comfort and success of therapy. Newer procedures have replaced old-fashioned vein stripping surgery.  In 2008, a statement by the American College of Phlebology announced that these newer methods, called endovenous procedures are considered the ‘new standard of care,’ replacing vein stripping surgery. Modern vein treatments are performed in the office, without anesthesia, and return to normal activities is almost immediate.  The average procedure time is 60 minutes.   There are several different treatment options depending on the type of veins, extent of disease, your ultrasound findings and other factors.  Normal activities and regular walking can be resumed immediately after vein treatments, whereas, return to heavy rigorous exercise, such as running and spinning is about two weeks.


Boston Marathon Winner Finishes in Compression Socks

The first American man to win the Boston Marathon since 1983 crossed the finish line last week.  Meb Keflezighi, 38 , won the men’s division while wearing CEP compression, a line of Mediven medical compression stockings. Meb has been publicly wearing CEP compression socks for years, including as the US Olympic marathon runner.


CEP Compression

Due to the health benefits that come from compression socks, other athletes are also using compression socks to decrease muscle fatigue and improve performance and recovery. It seems as though every runner is wearing compression socks these days.  Compression is not just for athletes. Compression has been used for decades as the treatment for vein disorders. In the field of venous disease, they are the gold standard in conservative management for vein conditions such as varicose veins and venous insufficiency. For those who have jobs that require prolonged periods of standing or sitting, compression can help with occupational leg swelling and fatigue. They are also recommended during air travel to reduce the risk of deep venous thrombosis (DVT).

CEP Compression socks, like those worn by Meb Keflezighi in the Boston Marathon can be found at

How To Reduce Your Risk of DVT During Air Travel

A deep vein thrombosis (DVT) is a blood clot that develops in the deep veins of the legs. If it travels to the heart and lungs (pulmonary embolism), it can be fatal.  Blood clots, (DVTs) are a serious condition and occur in 1% of airline passengers in long haul flights greater than 8 hours.  On last night’s episode of Bravo’s TV Series, The Atlanta Housewives, actress, housewife and Dancing with the Star’s, Nene Leakes described her recent DVT and pulmonary embolism from a plane flight. She now ‘wears compression socks’ which is an important component to reduce complications of vein conditions.

The key to preventing blood clots in the veins (DVT) is knowing the risks and taking steps to minimize the danger. Here are a few important practices you can follow to help prevent a potentially dangerous blood clot and increase your comfort.

#1) Bend Your Feet While Seated


Compression stockings should be worn during travel to reduce the risk of blood clots. Blood clots in the leg veins occur in 1% of airline passengers on flights longer than 8 hours.

Increase blood flow through your legs by bending your feet up and down when you’re seated, or by getting up and moving around every hour or so.

#2) Avoid dehydration

Avoid excessive alcohol and caffeine during airline flights and drink plenty of water.  Choose water over caffeinated or alcoholic beverages

#3) Avoid crossing your legs

#4) During the flight, walk around the cabin whenever you can

#5) Consult your doctor before flying if you are pregnant or have recently given birth; use birth control or other hormone therapies; or have had a stroke or recent surgery

#6) Wear graduated compression stockings

Wear graduated compression stockings when you travel. Medical grade compression stockings can help prevent veins from stretching when your legs are bent for long periods of time and prevent pooling of blood within the veins.  Compression stockings should be worn during long periods of travel by airplane or by car or train.  Medical compression stockings for travel can be found at:


Does Insurance Cover Varicose Vein Removal?

Vein procedures are generally a covered benefit by most insurance types (including Medicare) if they are considered medically necessary. Medical necessity requirements varies by the individual policy, but in general the varicose veins must cause symptoms such as leg pain, heaviness, fatigue, aching, restless legs, swelling or skin changes such as darkening of the skin around the ankles. Sometimes varicose veins can cause  complications such as phlebitis, bleeding, ulceration or skin changes; these are considered medical conditions. If varicose veins do not cause symptoms, they are considered to be a cosmetic issue in the eyes of insurance.

An ultrasound examination is necessary to provide an overall assessment of the severity of the vein condition. This is a diagnostic study and usually covered by insurance.

In most cases, insurance companies require that conservative measures have been tried for several weeks. Conservative measures include compression stockings, leg elevation, exercise, weight loss or maintaining a healthy weight, NSAIDS or other medication and hot/cold packs.  Many insurance types REQUIRE 6 to 12 weeks of wearing medical grade compression stockings prior to being approved for treatment.

Sometimes, flexible spending accounts can be used to pay for or may reimburse for compression stockings, varicose veins and spider vein treatments.

For more insurance information and questions, email

LJVC Welcomes Hilary Black, RN


Hilary is a Registered Nurse who treats cosmetic spider vein conditions at La Jolla Vein Care’s Cosmetic Sclerotherapy Clinic.

LJVC welcomes Hilary Black, RN! Hilary has worked with LJVC for a few months now in our cosmetic spider vein clinic, helping patients get rid of unsightly spider veins on the legs.  Hilary also continues to work with Dr. Sadrian, plastic surgeon.  She  received her Bachelor of Science in Business from U.S.C. in Los Angeles prior to graduating from Maric College of Nursing in San Diego.  Hilary worked on the cardiac care (telemetry) unit immediately after graduating from nursing school before she joined the aesthetic world. Since then she has worked for over 12 years in the aesthetic arena.   Her experience includes the use of many state of the art lasers and injectibles, including those for vein treatment.   She has worked with and continues to work beside surgeons to provide specialized aesthetic treatment plans for her patients.  She has performed thousands of procedures and strives to provide a beautiful and lasting result for each patient.Hilary lives in Carmel Valley and enjoys spending time with her niece and nephews, shopping, reading, traveling and going out with friends.

To schedule an appointment with Hilary in our cosmetic spider vein clinic, please call 858-550-0330. Summer’s around the corner, and leg vein conditions  may take more than one treatment and several weeks-months for best results.

Meet La Jolla Vein Care’s Dr. Fronek, Vein Specialist

Helane Fronek MD, FACP, FACPh is one of La Jolla Vein Care’s esteemed board certified vein specialist.  Dr. Fronek _NOR1964entered the field of phlebology in 1985 and has been an integral part of the development of this new medical specialty. As the Director of the Varicose Vein Clinic at Scripps Clinic, she provided cutting edge treatment for the entire spectrum of superficial venous disorders and conducted research on venous leg ulceration, compression therapy, and emerging therapies for varicose veins. Dr. Fronek is a past president of the American College of Phlebology, the largest medical organization devoted to vein care. She is a respected speaker and educator in all aspects of diagnosis and treatment for venous disease and communication in the medical arena.

Dr. Fronek was the first recipient of the American College of Phlebology’s prestigious Leadership Award. In 2011, Dr. Fronek was honored for her contribution to the field of phlebology and named an honorary member of the ACP. This award is given to one leader in the field, amongst national and international members.

Board-certified in both Internal Medicine and Phlebology, she is also Assistant Clinical Professor of Medicine at UC-San Diego School of Medicine, where she teaches medical students the practice of physical examination and the art of medicine. Dr. Fronek has dedicated her career to providing technically excellent and compassionate care to her patients and to inspiring and teaching the next generation of phlebologists. Dr. Fronek is well known for authoring, ‘The Fundamentals of Phlebology’ which is a medical textbook used by most Phlebologists entering the field.

Dr. Fronek is accepting new patients. To make an appointment with Dr. Fronek, call 858-550-0330.


Dr. Nisha Bunke

Meet Dr.Bunke, La Jolla Vein Care Specialist

Dr. Nisha Bunke

Dr. Nisha Bunke Paquette, MD, FACPh is one of La Jolla Vein Care’s highly trained board-certified venous disease specialist.  Dr. Bunke specializes in highly advanced and minimally invasive outpatient procedures for treating a wide spectrum of venous conditions. Dr. Bunke  is one of a few southern California physicians board-certified and fellowship trained in Venous and Lymphatic Medicine. She was the first physician in the United States to complete fellowship training supported by the American College of Phebology and was mentored by world renowned vascular surgeon, Dr. John Bergan. Presently, she sees patients at La Jolla Vein Care, San Diego County’s largest dedicated vein center.  She is also a Volunteer Clinical Instructor of Surgery at the University of California San Diego (UCSD) School of Medicine, member of the Scripps Ximed Medical Group and Veteran’s (VA) Medical Center. For five years, Dr. Bunke  has run the vein clinics at the VA Medical Center, providing vein care for our veterans. From 2010 until 2012, she also directed UCSD’s Vein Clinic.

Dr. Bunke is a physician and scientist, actively leading clinical research studies. In 2009, Dr. Bunke  was awarded the Internationale Union of Phlebologie Research Fellowship and the Best Young Presenter Award in Monaco. Collectively, Dr. Bunke  and Dr. Bergan were awarded the 2008 JOBST Research Award for the Advancement of Phlebology for their research on Inflammatory Bio-Markers of Venous Insufficiency. Moreover, Dr. Bunke-Paquette is a member of The Clinical and Translational Research Institute (CTRI) of the University of California San Diego (UCSD), the American Medical Association (AMA), San Diego County Medical Society, Society for Vascular Medicine, American College of Phlebology (ACP), American Venous Forum (AVF) and the Society for Vascular Ultrasound (SVU).  She has published chapters in several medical textbooks, academic journals and most recently co-edited the second edition of the Vein Book, along with John Bergan.

To make an appointment to see Dr. Bunke, call 858-550-0330. 065_NOR2320


Spider Vein Sclerotherapy: Before & After Photos

Before and after pictures of spider veins that were treated with sclerotherapy.

Before and after pictures of spider veins that were treated with sclerotherapy. This patient had spider veins behind the knees, which is a common location for spider veins and larger blue, ‘reticular veins.’

Spider vein patient treated at La Jolla Vein Care with sclerotherapy.

Spider vein patient treated at La Jolla Vein Care with sclerotherapy. Notice the presence of a blue ‘feeder vein’ that gives rise to the spider veins. It is important to treat ‘feeder veins’ to successfully eliminate the spider veins. It is similar to ‘pulling the root’ of a weed rather than clipping the weed to eliminate it.

Spider vein patient treated at La Jolla Vein Care with sclerotherapy. Note that spider veins can vary in size, location and severity. Depending on the severity of the condition, multiple treatment sessions may be required for optimal
Note that spider veins can vary in size, location and severity. This patient had a large cluster of spider veins that appear as a bluish-purple discoloration on the outside of the knee. This patient has bruising after treatment which will fade over several weeks.


New Cosmetic Spider Vein Clinic

While the doctors at La Jolla Vein Care are committed to advancing vein care through medicine, education and research (Dr. Bunke just published the 2nd edition of the Vein Book and Dr. Fronek remains an integral part of the American College of Phlebology), we are pleased to offer our new RN/ PA (Registered Nurse/ Physician Assistant) cosmetic sclerotherapy clinic for simple spider vein conditions offered on Mondays and Tuesdays.  Simple spider vein conditions are those that are cosmetic and can be treated with liquid sclerotherapy.  This does not include foam sclerotherapy for larger varicose veins, which is administered by the doctor.

The cost is based on how much solution is used, so it is a cost efficient means of treating that ‘stubborn patch of veins’ or ‘clean up’ of small spider veins after larger varicose vein removal.  The cost is $100 for the first syringe (2cc) and $75 for each additional syringe.

spider veins

Spider veins can come in different sizes and severity. Depending on the severity of the spider veins, multiple sclerotherapy treatments may be required.

New patients or patients not seen within two years will be required a physician consultation first.  For more information or to schedule your consultation, call 858-550-0330.

Dr. Fronek teaches primary care doctors to care for patients with vein problems

Dr. Fronek was recently invited to discuss vein disorders with the Family Medicine Residency Program at Scripps Chula Vista.  The doctors-in-training were excited  to learn about the variety of problems that patients have with their veins – including  spider veins,  varicose veins,  blood clots, and leg ulcers.  Primary care doctors see patients with vein disorders every day, and yet very few medical schools or residency training programs include any information about these common problems.  Dr. Fronek and Dr. Bunke-Pacquette are committed to sharing their expertise with colleagues and are frequently asked to speak at medical meetings.  Primary care doctors, in particular, can often start patients with vein disorders on conservative treatment, including graduated compression stockings and regular exercise (walking is usually the best exercise for vein disorders), as well as certain supplements such as horse chestnut seed extract, that can alleviate the symptoms that many patients with vein disease suffer from.  Informed primary care doctors can also refer patients to a vein specialist when symptoms aren’t diminished with conservative treatment, if the varicose veins worsen while a patient is using compression and exercise, or if the patient suffers from a venous leg ulcer.