2, 3, 2022

The Best Treatment for Saphenous Vein Reflux

2022-03-17T10:11:22-07:00

The best treatment for Saphenous Vein Reflux is tailored to the individual 

 

Fortunately, there are a variety of non-surgical treatment options for saphenous vein reflux, the underlying cause for varicose veins and it’s symptoms. Because vein treatment is not, ‘one treatment fits all,’ the treatment plan should be customized to the patient. Non-surgical options include, laser vein ablation, radiofrequency vein ablation, varithena foam, venaseal an mechanical-chemical ablation, also known as clarivein. This article will specifically discuss features about Clarivein which make it a good option for some patients.

Mechanical-Chemical Ablation (Clarivein) for Saphenous Vein Reflux 

The ClariVein procedure for treatment of backwards flow (or reflux) in your saphenous veins. The great and small saphenous veins are the two main superficial veins of the leg. They run along the inner leg and the back of the leg. This minimally invasive procedure can be performed in the office in less than an hour. This offers patients the benefit of being able to return to their usual level of activity the same day. 

 

How does the treatment work?

The skin is numbed with lidocaine, then the ClariVein catheter is placed into the unhealthy vein. The catheter closes the vein painlessly by delivering two treatments: 

 

  1. Mechanical treatment with a tiny rotating wire. 
  2. Chemical treatment with polidocanol. 

 

This technique is highly effective in closing the vein and only requires one skin puncture, similar to placing an iv. 

 

What should I expect on the day of treatment? 

The procedure is performed with local anesthesia, but many patients elect to use a mild oral sedative (Valium), which is taken after checking in and completing all paperwork. The patient will change into a gown and leave underwear on. Depending on the vein to be treated, the patient will lay on the back or on the belly. We do our best to make special accommodations (for example, if the patient cannot lie flat or cannot bend a knee very well) with body positioning and using pillows. We will do our best to make the patient comfortable. Then, we will give the option of watching a movie on Netflix or listen to music. Once the patient is comfortable, the leg will be prepped with a cleansing solution for the sterile procedure. The doctor will perform an ultrasound to map the vein to be treated. Then, a numbing agent (lidocaine) will be injected into the skin. In the numb area of the skin, a tiny puncture is made to pass the ClariVein catheter. Once the catheter and rotating wire are in place, the doctor will start the treatment. It is common to feel a tickling or vibrating sensation as the doctor treats the vein. Patients usually have minimal to no pain during this procedure. Once the vein has been treated, the patient will wear compression stockings for 72 hours continuously. The benefits of wearing compression stockings during post surgical recovery are mentioned here

 

What should I do after treatment? 

You should walk 30 minutes twice daily after treatment and move your legs frequently throughout the day with short walks and/or calf exercises. This will alleviate discomfort and avoid pooling of blood in the legs. It is normal to have aching in the treated veins. This responds well to walking, ice packs, and anti-inflammatory medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve). Compression stockings are recommended for after treatment. 

 

What should I avoid after treatment? 

 

For at least two weeks after treatment, you should avoid strenuous exercise (anything more than a brisk walk), heavy lifting, saunas or hot tubs, and leg massages. All of these dilate the superficial veins and interfere with their healing. You should also avoid airline travel for two weeks after treatment. 

 

What are the possible adverse effects? 

Expect some bruising over the puncture site, which fades over about two weeks. The skin overlying larger varicose veins may also develop some temporary inflammation and/or brownish hyperpigmentation as the blood products within those veins are absorbed by the body. An uncommon complication is a blood clot within a deep vein. 

Videos of the treatment, as well as after care instructions can be found on our website or our Youtube Channel.

The Best Treatment for Saphenous Vein Reflux2022-03-17T10:11:22-07:00

21, 1, 2022

La Jolla Vein Care Doctors Make History, First to Use Live Stream Teaching in San Diego

2022-01-21T12:17:28-08:00

On Tuesday, January 18, 2022, La Jolla Vein Care doctors were the first in the region to utilize a special type of live streaming technology to teach other physicians. Over a hundred physicians around the globe dialed in to watch Dr. Armin Foghi of La Jolla Vein Care perform endovenous laser ablation (EVLA) procedures using Avail technology to livestream the procedure. Dr. Nisha Bunke of La Jolla Vein Care was the moderator. The live cases included EVLA of a great saphenous vein and of a perforator vein on patients who consented to participate. In addition to teaching, Avail, technology can be used to facilitate collaboration during procedures in real time with other physicians, sharing knowledge about surgical techniques all while bringing together the medical community to advance care for all.

avail

Dr. Armin Foghi demonstrates EVLA procedure on a perforator vein while physicians around the globe observe the case. Dr. Nisha Bunke is the moderator.

La Jolla Vein Care Doctors Make History, First to Use Live Stream Teaching in San Diego2022-01-21T12:17:28-08:00

5, 11, 2014

Dr. Fronek to Speak at ACP Annual Congress in Phoenix

2021-11-04T15:52:12-07:00
Dr. Fronek

Dr. Helane Fronek to speak at the ACP Annual Congress in Phoenix.

La Jolla Vein Care’s Dr. Helane Fronek was invited to speak to her peers at the upcoming, American College of Phlebology (ACP) Annual Congress in Phoenix.  This congress is the country’s largest peer-education forum dedicated to the diagnosis and treatment of venous and lymphatic disease. Attended by hundreds of vein care specialists, from physicians to nurses to researchers, the Annual Congress is one of the best opportunities to learn directly from experts in the field and connect with other medical professionals in the field of vein care. Each year, approximately 900 vein care specialists from across the globe come together at our Annual Congress. Participants come from all areas of the medical profession–physicians, nurse practitioners, ultrasound technologists, and researchers attend the Annual Congress to discuss the latest technology, treatments and advances from  experts in the field of venous and lymphatic disease.

Dr. Fronek is a past president of the ACP and an active member. She will be speaking about various topics on venous disease.

Dr. Fronek to Speak at ACP Annual Congress in Phoenix2021-11-04T15:52:12-07:00

13, 8, 2014

Dr. Fronek Featured in National Vein Magazine

2021-11-04T15:42:23-07:00

Past ACP President and La Jolla Vein Care’s Dr. Helane Fronek, MD, FACPh, FACP was featured in this summer’s Vein Magazine. The 5-page interview with Dr. Fronek discusses topics such as her career and perspectives in the fields of venous disease and medicine. She is described as:

‘Professionally, Dr. Froenk sees patients at La Jolla Vein Care, educates medical students as an assistant clinical professor at the UC San Diego School of Medicien, is the author of the Fundamentals of Phlebology, is a past President of the American College of Phlebology (ACP), is the first recipient of the ACP’s Leadership Award and is recognized as an Honorary Memeber of the organization……..she is also a blogger on The Huffington Post and has recently added Life Coach to her distinguished resume…’

Vein magazine

Past ACP President and La Jolla Vein Care’s Dr. Helane Fronek, MD, FACPh, FACP was featured in this summer’s Vein Magazine. The 5-page interview with Dr. Fronek discusses topics such as her career and perspectives in the fields of venous disease and medicine.

Dr. Fronek

Dr. Helane Fronek, MD, FACPh, FACP is a Past ACP President, author of the Fundamentals of Phlebology, Assistant Clinical Professor at UCSD School of Medicine and presently sees patients at La Jolla Vein Care, located at the Scripps Memorial Campus.

La Jolla Vein Care is grateful to have such a talented doctor on our staff. You can read Dr. Fronek’s blog  at helanefronekmd.wordpress.com.

 

Dr. Fronek Featured in National Vein Magazine2021-11-04T15:42:23-07:00

24, 6, 2014

Dr. Bunke Trains Doctors Using Vein Simulator

2021-11-05T11:34:45-07:00

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.

scleroworkshop

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.

scleroworkshop3

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.

Dr. Bunke Trains Doctors Using Vein Simulator2021-11-05T11:34:45-07:00

Dr. Bunke Presents at SVM Scientific Sessions

2021-11-05T11:10:02-07:00
NBSVMMEETING

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, management 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.

Dr. Bunke Presents at SVM Scientific Sessions2021-11-05T11:10:02-07:00

History of Foam Sclerotherapy Treatment of Varicose Veins

2021-11-05T10:56:45-07:00
foam

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.’

foam03*

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.

History of Foam Sclerotherapy Treatment of Varicose Veins2021-11-05T10:56:45-07:00

28, 1, 2014

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

2022-01-04T05:17:54-08:00

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.

Dr. Fronek teaches primary care doctors to care for patients with vein problems2022-01-04T05:17:54-08:00

Oxford University Press releases The Vein Book

2014-01-24T22:49:10-08:00

The second edition of The Vein Book, edited by Dr. Nisha Bunke Paquette and Dr. John Bergan will be released on January 30th, 2014 by the Oxford University Press.

Since its initial publication nearly a decade ago, The Vein Book continues to serves as the ultimate comprehensive resource on venous disease. Upholding its reputation as the go-to reference for complete, authoritative, and up-to-date information about venous function and dysfunction, this second edition effectively bridges the gap between clinical medicine and basic science, suitable both for the seasoned surgeon as well as the medical student.

La Jolla Vein Care's Dr. Bunke releases The Vein Book

La Jolla Vein Care’s Dr. Bunke releases The Vein Book

The book is divided into five essential sections: basic considerations, primary superficial venous insufficiency, venous thromboembolism, chronic venous insufficiency, and congenital venous malformations. The book covers the entire spectrum of venous conditions from clarification of the pathophysiology of venous insufficiency, molecular mechanisms in the cause of varicose veins, new treatment options for varicose veins and spider veins, startling new treatment for venous thromboembolic disease, and effective treatment for leg ulcers.

More user-friendly and encyclopedic than ever, The Vein Book is still a must-have for vascular surgeons, phlebologists, interventional radiologists, research scientists, epidemiologists, and surgeons at all levels.  It is available for pre-order at Amazon.com.

Oxford University Press releases The Vein Book2014-01-24T22:49:10-08:00
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