28, 8, 2023

RFA for perforator vein reflux

2023-05-24T16:56:04-07:00

Radiofrequency perforator ablation (RFA) is performed on perforator veins, short connections between your deep and superficial veins. Perforator veins can suffer the same sort of valve damage and retrograde blood flow (venous reflux) as other veins. Most patients with vein disease who experience skin changes, (that also may result in leg ulcers if left untreated) have reflux in perforator veins near their ulcers, as well as in the superficial or deep veins.

RFA

What are Perforator Veins?

Perforator veins serve as connections between the two networks of veins in the extremities, the superficial venous system and the deep venous system. Perforators connect the two parallel systems, and normally drain blood from the superficial veins to the deep veins as part of the process of returning oxygen-depleted blood to the heart.

Perforator veins have one-way valves designed to prevent backflow of blood down towards the superficial veins. When those valves no longer function properly and reflux occurs, the buildup of blood and pressure can cause not only the superficial veins but the perforators themselves to become incompetent. Perforator veins in the lower leg and ankle are particularly vulnerable to distention and incompetence, and the resultant circulatory problems create an increased likelihood of edema, skin discoloration, dermatitis and skin ulcers in the immediate area.

Your doctor may have recommended RFA treatment of your perforator vein(s) because it is contributing to:

  • Venous leg ulcers
  • Pre-ulcerative skin changes
  • Persistent or recurrent varicose veins
  • Leg pain
  • Leg swelling

“Bringing Experts Together for Unparalleled Vein and Vascular Care”

La Jolla Vein & Vascular (formerly La Jolla Vein Care) is committed to bringing experts together for unparalleled vein and vascular care. 

Nisha Bunke, MD, Sarah Lucas, MD, and Elliot DeYoung, MD are specialists who combine their experience and expertise to offer world-class vascular care. 

Our accredited center is also a nationally known teaching site and center of excellence. 

For more information on treatments and to book a consultation, please give our office a call at 858-550-0330. 

 For a deeper dive into vein and vascular care, please check out our Youtube Channel at this link, and our website https://ljvascular.com

For more information on varicose veins and eliminating underlying venous insufficiency,

Please follow our social media Instagram Profile and Tik Tok Profile for more fun videos and educational information. 

For more blogs and educational content, please check out our clinic’s blog posts

 

RFA for perforator vein reflux2023-05-24T16:56:04-07:00

3, 5, 2023

Patient Transformation: Spider Veins

2023-02-15T18:42:47-08:00

What are spider veins?

Spider veins are the fine, thread-like reddish veins at the surface of the skin. These veins are not healthy. Veins are often considered a cosmetic issue, but they can be associated with underlying feeder veins, not visible to the naked eye.  Feeder veins are the ‘blue veins’ also known as ‘reticular veins,’ that give rise to spider veins. Spider veins may also be a sign of underlying venous insufficiency. For example, spider veins located in the inner ankles and inner thighs can indicate an underlying problem with the saphenous vein. As a result, an ultrasound examination may be recommended to identify and effectively treat the underlying source of these veins.

What are the symptoms?

Vein conditions affect people differently. For some, these veins can be a painless cosmetic concern, and for others they may cause symptoms. The most common symptoms of spider veins are burning, throbbing, and localized pain. They can also feel hot and itchy and bleed.

What causes them?

Spider veins in the legs are caused by the same condition that causes varicose veins. Leaky vein valves allow blood to pool within the veins causing them to stretch and become enlarged. These veins on other areas of the body, such as the face, and chest can be caused by sun damage, hormone changes or liver disease. Hormones, such as with pregnancy, birth control or hormone replacement therapy can weaken the vein wall.

Below you can see the transformation of 3 of our patients who received vein treatment.

spider spider spider

“Bringing Experts Together for Unparalleled Vein and Vascular Care”

La Jolla Vein & Vascular (formerly La Jolla Vein Care) is committed to bringing experts together for unparalleled vein and vascular care. 

Nisha Bunke, MD, Sarah Lucas, MD, and Elliot DeYoung, MD are specialists who combine their experience and expertise to offer world-class vascular care. 

Our accredited center is also a nationally known teaching site and center of excellence. 

For more information on treatments and to book a consultation, please give our office a call at 858-550-0330. 

 

For a deeper dive into vein and vascular care, please check out our Youtube Channel at this link.

 

For more information on varicose veins and eliminating underlying venous insufficiency, check this link out full of resources. 

Please follow our social media Instagram Profile and Tik Tok Profile for more fun videos and educational information. 


Patient Transformation: Spider Veins2023-02-15T18:42:47-08:00

3, 1, 2023

Meet our team of vein & vascular specialists: Dr Bunke

2022-12-26T10:53:06-08:00

Our vein specialists are not your average doctors.  They train and teach other doctors, medical students, physician assistants, and empower and educate patients everyday with knowledge and choices.  They lead clinical research studies and contribute to scientific journal and textbook publications.  Our recent research made the cover of the “Journal for Vascular Ultrasound” in March, 2018.  Our doctors continuously strive to elevate the standard in vein care- they are fellowship-trained, board certified in venous and lymphatic disease, and earned additional credentials in ultrasound interpretation to provide comprehensive vein care for all patients.

 

Nisha Bunke, MD FACPh, RPhS

Venous Disease Interventionist, Vein Clinic Medical Director

vein

Dr. Nisha Bunke was the first physician in the United States to complete fellowship training supported by the American Vein and Lymphatic Society (formerly known as the American College of Phlebology) in 2008 and is a diplomate of the American Board of Venous and Lymphatic Medicine. Over the past decade, Dr. Bunke has dedicated her career to treating patients with venous and lymphatic conditions and advancing the field of vein care.

Being inspired by her mentor, world-renowned vascular surgeon, Dr. John Bergan, who emphasized that venous disease is a special condition that requires specialized care, she founded La Jolla Vein Care in 2010. Under her leadership, La Jolla Vein Care was awarded accreditation in Vein Clinic and Vascular Testing by the Intersocietal Accreditation Commission (IAC). La Jolla Vein Care is the first dedicated vein care facility in the region to earn this distinction.

Prior to turning her complete attention to La Jolla Vein Care, she has held appointments as a Volunteer Clinical Instructor of Surgery at the University of California San Diego (UCSD) School of Medicine, and Veterans (VA) Medical Center.  In addition to these duties, for five years, Dr. Bunke managed the vein clinics at the VA Medical Center La Jolla, providing vein care for our veterans.  She was also a physician at UCSD Healthcare System’s Department of Vascular Surgery, where she evaluated and treated patients with venous disease.

Dr. Bunke is a physician and scientist, actively leading clinical research studies.  In 2009, Dr. Bunke was awarded the International 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 Biomarkers of Venous Insufficiency. Dr. Bunke also developed Recova, a post-surgery recovery cream.

Dr. Bunke has been named as a finalist by the San Diego Business Journal’s Women Who Mean Business Award and San Diego Magazine’s Woman of the Year award.  In 2018, she was named as the top 25  Women of the Year by the San Diego Business Journal.

Dr. Bunke’s Affiliations

Moreover, Dr. Bunke is a member of the Scripps Ximed Medical Group, 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 Vein and Lymphatic Society, American Venous Forum (AVF) and the Society for Vascular Ultrasound (SVU). Dr. Bunke has numerous publications in both scientific journals and medical textbooks.

Dr. Bunke is co-editor of the most widely used textbook for vascular physicians, “The Vein Book”

vein

Books/ Book Chapters: Dr. Nisha Bunke

Bergan, JJ, Bunke, N. “Outcome Measures in Venous Disease.” In:  Fast Facts- Vascular and Endovascular Surgery Highlights 2008-09.  Davies, A., Mitchell, A. M. Health Press UK

Bergan, JJ. Bunke, N.  “Varicose Veins and Chronic Venous Insufficiency.” In: Total Endovascular Series Venous Diseases Contemporary Management.’ Lumsden, A, Davies, M.

Bergan, JJ, Bunke, N.  “Venous Disorders.”  In:  Educational Review Manual in General Surgery. 8th Edition. Castle Connolly Graduate Medical Publishing.

Bergan, JJ, Bunke, N. “Pathophysiology of Chronic Venous Disease.”  In:  The European Venous Course Book.

Bergan JJ, Bunke, N. “Endovenous Procedures in Venous Disease.”  In:  Peripheral Endovascular Interventions.  White, R, Fogarty, T.  3rd Ed.

Bergan, JJ, Pascarella, L, Bunke, N. “Venous Anatomy, Physiology and Pathophysiology.”  In: Treatment of Leg Veins, 2nd ed.  Alam, M., Silapunt, S. Martin Mellor Publishing Ltd. UK

Bergan, J. Lee, BB, Bunke N.  “Lymphatic Disease.”  In: Clinical Review of Vascular Surgery. Edited by Sapan Desai, MD, PhD and Cynthia Shortell, MD.

Bergan, J. and Bunke, N. General Considerations. In: Lymphedema: A Concise Compendium of Theory and Practice. Edited by Byung-Boong Lee, John Bergan, Stanley G. Rockson 2011.

Bergan, JJ, Bunke-Paquette, N, editors. The Vein Book, 2nd edition. Oxford University Press, New York, NY USA. 2014

Bunke-Paquette, N. “Complications of Liquid Sclerotherapy.” In: The Vein Book, 2nd ed. Bergan, JJ, Bunke-Paquette, N. Oxford University Press, New York, NY USA. 2014

Loerzel, N, Ratcliff V, Bunke-Paquette, N, et al. “Ultrasound Examination of the Patient with Primary Venous Insufficiency.” In: The Vein Book, 2nd ed. Bergan, JJ, Bunke-Paquette, N. Oxford University Press, New York, NY USA. 2014

Bunke-Paquette, N, Loerzel, N, Bergan, JJ. “Ultrasound-Guided Catheter and Foam Therapy for Venous Insufficiency.’ In: The Vein Book, 2nd ed. Bergan, JJ, Bunke- Paquette, N. Oxford University Press, New York, NY USA. 2014

Bergan, JJ, Pascarella, L, Bunke-Paquette, N. “Perforating Veins.” In: The Vein Book, 2nd ed. Bergan, JJ, Bunke-Paquette, N. Oxford University Press, New York, NY USA. 2014

Bunke-Paquette, N. Russell, T, Broder, K, Li, A. “Medical Management of the Venous Leg Ulcer.” In: The Vein Book, 2nd ed. Bergan, JJ, Bunke-Paquette, N. Oxford University Press, New York, NY USA. 2014

Peer-Reviewed Journals

Bunke N, Brown K, Bergan J. Foam sclerotherapy: techniques and uses. Perspect Vasc Surg Endovasc Ther. 2009 Jun;21(2):91-3

Bunke N, Brown K, Bergan J. Phlebolymphemeda: usually unrecognized, often poorly treated. Perspect Vasc Surg Endovasc Ther. 2009 Jun;21(2):65

B.B. Lee, M. Andrade, P.L. Antignani,F. Boccardo, N. Bunke, et. al. Guidelines: Diagnosis and treatment of primary lymphedema consensus document of the international union of phlebology (IUP)-2013. International Angiology. 2013 Dec: (32): 541-574

“Bringing Experts Together for Unparalleled Vein and Vascular Care”

 

La Jolla Vein & Vascular (formerly La Jolla Vein Care) is committed to bringing experts together for unparalleled vein and vascular care. 

 

Nisha Bunke, MD, Sarah Lucas, MD, and Elliot DeYoung, MD are specialists who combine their experience and expertise to offer world-class vascular care. 

 

Our accredited center is also a nationally known teaching site and center of excellence. 

For more information on treatments and to book a consultation, please give our office a call at 858-550-0330. 

 

For a deeper dive into vein and vascular care, please check out our Youtube Channel at this link.

 

For more information on varicose veins and eliminating underlying venous insufficiency, check this link out full of resources. 

Please follow our social media Instagram Profile and Tik Tok Profile for more fun videos and educational information. 


Meet our team of vein & vascular specialists: Dr Bunke2022-12-26T10:53:06-08:00

25, 8, 2022

What you need to know about varicose veins and pregnancy

2022-12-13T13:19:49-08:00

It’s important to know about your vein health during pregnancy.

It’s estimated that 70% to 80% of pregnant women develop varicose veins during the first trimester. Pregnancy causes an increase in blood volume; however, it’s the hormonal changes that cause the veins to enlarge. Elevated levels of progesterone, which the body produces to stabilize the uterus, allow the veins to dilate. Later, the uterus enlarges and causes increased pressure on the veins in the pelvic area. While varicose veins often disappear after delivery, the venous valves are damaged. When varicose veins are still visible after three months, it’s time to contact a vein specialist. It’s important you look good, feel good, and remain healthy—particularly after pregnancy. Here is some helpful information to better understand varicose veins. 

 

Varicose Veins and Venous Reflux Disease

Varicose veins are the twisted, bulging veins just beneath the surface of the skin. Varicose veins are swollen, twisted veins that you can see just under the surface of the skin. These veins usually occur in the legs, but they also can form in other parts of the body. Varicose veins are a common condition.

What causes varicose veins?

Varicose veins are caused by leaky vein valves, which allow blood to pool within the veins causing them to stretch and become enlarged. Varicose veins can be an isolated finding, but the majority of the time, they are caused by underlying venous reflux disease. Venous reflux disease is also known as venous stasis, venous insufficiency or venous incompetence. Reflux may occur in the deep and/or superficial leg veins.

In our study, led by Dr. Nisha Bunke and published in the Journal of Vascular Ultrasound in 2018, we studied over 1,000 legs with varicose veins. Over 90% of the time, the source of the varicose veins were the great and small saphenous veins. The Great Saphenous Vein (GSV) courses up the middle of the thigh and calf and the small saphenous vein (SSV), which courses along the back of the calf. Normally, there are one-way valves within the leg veins, which help blood flow in one direction: toward the heart. This means blood is traveling against gravity. The calf muscle also helps move blood toward the heart. When vein valves are leaky, blood flows backward (reflux) towards the feet. Blood pools in the lower legs, causing bulging veins at the surface.

What are the symptoms of varicose veins and venous reflux disease?

The symptoms can include:

  • Aching, tenderness
  • Heaviness, fatigue
  • General restlessness in the legs
  • Burning pain
  • Throbbing pain
  • Itching
  • Leg cramps, particularly at night
  • Ankle swelling
  • Skin discoloration at the ankle
  • Skin ulcers above the ankle

Over time, complications can develop from untreated veins. These include:

  • Superficial phlebitis (painful inflammation of the vein)
  • Superficial thrombophlebitis (blood clots within the varicose veins)
  • Spontaneous vein hemorrhage (the vein can rupture spontaneously)
  • Skin discoloration and eczema around the ankle (venous eczema)
  • Skin sores or ulcers usually near the ankle

If you experience any vein disease symptoms, please call our office at (858)-550-0330 to schedule a consultation with one of our knowledgeable doctors at La Jolla Vein and Vascular. 

 

For more information on vein health please check out our Youtube Channel or visit our helpful guide of resources. 

 

What you need to know about varicose veins and pregnancy2022-12-13T13:19:49-08:00

What you need to know about compression stockings

2022-07-20T13:10:20-07:00

At La Jolla Vein and Vascular, we suggest patients use compression stockings for better vein health. There are a few different types to choose from listed below. But first, knowing the benefits of using compression stockings for your vein health empowers you to decide with your physician which type is best for you. 

Benefits of compression stockings for vein and vascular health: 

  1. Wearing compression stockings or socks places pressure on the veins in the lower legs.
  2. The pressure helps improve blood flow
  3. The pressure helps prevent further spider veins and varicose veins
  4. Compression stockings also relieve leg swelling
  5. Reduces the risk of blood clots in the legs

 

Anti-embolism stockings, also known as TED hoses, are designed specifically for non-mobile patients or those confined to a bed. These are the white stockings used for hospital patients. They are low-cost temporary solutions commonly used for patients in nursing homes and post-surgery to prevent deep vein thrombosis (DVT).

 

Graduated compression therapy provides external support to the vein walls and works in conjunction with the calf muscle pump. Compression stockings improve circulation while helping to minimize and control leg and ankle swelling.

However, for ambulatory (walking patients who are not bed-bound), TED hoses do not offer sufficient support to counter the effects of gravity.  They have not graduated compression and only offer about 8-18mmhg compression. TED hose does not help the symptoms of venous disease and varicose veins. TED hose cannot be used for vein treatment and should not be used for daily support in walking patients.

In comparison, graduated compression stockings are medically therapeutic and designed for people who are mobile. Graduated compression means that they are tightest around the ankle and gradually ease as they go up. These can help reduce the risk of DVT in patients who travel by plane or car and reduce symptoms such as leg swelling (edema), aching, heaviness, fatigue, pain from varicose veins, and useful for pregnant women to reduce pain from varicose veins.

 

 For more information and to book a consultation, please give our office a call at 858-550-0330. 

 

For more information please check out our Youtube Channel at this link.

 

For more information on varicose veins and eliminating underlying venous insufficiency, check this link out full of resources. 

 

What you need to know about compression stockings2022-07-20T13:10:20-07:00

28, 7, 2022

Varicose Vein Patient Transformation

2022-06-25T16:29:05-07:00

Varicose Veins: Patient Transformations 

What are varicose veins?

They are the twisted, bulging veins just beneath the surface of the skin. These veins are swollen, twisted veins that you can see just under the surface of the skin. These veins usually occur in the legs, but they also can form in other parts of the body. Varicose veins are a common condition.

What causes them?

Varicose veins are caused by leaky vein valves, which allow blood to pool within the veins causing them to stretch and become enlarged. These veins can be an isolated finding, but the majority of the time, they are caused by underlying venous reflux disease. Venous reflux disease is also known as venous stasis, venous insufficiency or venous incompetence. Reflux may occur in the deep and/or superficial leg veins.

In our study, led by Dr. Nisha Bunke and published in the Journal of Vascular Ultrasound in 2018, we studied over 1,000 legs with varicose veins. Over 90% of the time, the source of the varicose veins were the great and small saphenous veins. The Great Saphenous Vein (GSV) courses up the middle of the thigh and calf and the small saphenous vein (SSV), which courses along the back of the calf. Normally, there are one-way valves within the leg veins, which help blood flow in one direction: toward the heart. This means blood is traveling against gravity. The calf muscle also helps move blood toward the heart. When vein valves are leaky, blood flows backward (reflux) towards the feet. Blood pools in the lower legs, causing bulging veins at the surface. 

As you can see below, these patient transformations after varicose vein treatment are remarkable! 

varicose veinsvaricose veinsvaricose veins

 

La Jolla Vein Care Before and After Transformations:

 

At La Jolla Vein Care, we are here for our patients from beginning to the end. We love seeing the transformations that take place. Below are a few cases from our patient transformations from before varicose vein treatment to after varicose vein treatment. 

 

If you experience any vein disease symptoms, please call our office at (858)-434-5998 to schedule a consultation with one of our knowledgeable doctors at La Jolla Vein and Vascular. 

 

For more information on vein health please check out our Youtube Channel or visit our helpful guide of resources. 

 

 

Varicose Vein Patient Transformation2022-06-25T16:29:05-07:00

What could be causing your varicose veins?

2022-12-13T14:16:03-08:00

What are varicose veins? 

Varicose veins are the twisted, bulging veins just beneath the surface of the skin. Varicose veins are swollen, twisted veins that you can see just under the surface of the skin. These veins usually occur in the legs, but they also can form in other parts of the body. Varicose veins are a common condition.

Who gets them and why.

Both women and men can develop vein disorders at any age.  It can affect the healthiest of individuals, but there are some conditions that increase your risk of developing varicose veins.  They are mostly inherited; if both of your parents had varicose veins, you have a 90% chance of also having them.  Other factors that increase your chance of developing vein disorders include being female, hormonal changes, pregnancy, getting older, having a job that requires many hours standing or sitting, being overweight, and history of leg injuries. Some of the causes of varicose veins are listed below: 

  • Increasing age. As you get older, the valves in your veins may weaken and not work as well.
  • Heredity. Being born with weak vein valves increases your risk. Having family members with vein problems also increases your risk. About half of all people who have these this type of venous reflux disease have a family member who has them too.
  • Hormonal changes. These occur during puberty, pregnancy, and menopause. Taking birth control pills and other medicines containing estrogen and progesterone also may contribute to the forming of varicose or spider veins.
  • Pregnancy. The hormones during pregnancy greatly influence the leg veins. These veins can even be a symptom of pregnancy and can show up during the first trimester. As pregnancy progresses, there is a huge increase in the amount of blood in the body. This can cause veins to enlarge. The growing uterus also puts pressure on the veins. Varicose veins usually improve within 3 months after delivery. More varicose veins and spider veins usually appear with each additional pregnancy.
  • Obesity. Being overweight or obese can put extra pressure on your veins. This can lead to varicose veins.
  • Lack of movement. Sitting or standing for a long time may force your veins to work harder to pump blood to your heart. This may be a bigger problem if you sit with your legs bent or crossed.
  • Leg Injuries

If you experience any vein disease symptoms, please call our office at (858)-550-0330 to schedule a consultation with one of our knowledgeable doctors at La Jolla Vein and Vascular.

For more information on vein health please check out our Youtube Channel. 

What could be causing your varicose veins?2022-12-13T14:16:03-08:00

9, 2, 2022

How to Earn Vein Center Accreditation by IAC in 2022

2022-02-11T17:53:26-08:00

How to earn vein center accreditation by IAC in 2022

More than one half of Americans age 50 and older are affected by varicose veins. Varicose veins occur when the valves in the leg veins no longer function, causing blood to pool in the legs. In some cases, this condition progresses to a more serious form of venous disease called chronic venous insufficiency (CVI). Whether to relieve symptoms and/or improve appearance, treating varicose veins can be performed by vein centers that specialize in the evaluation and management of superficial venous disorders. Through vein center accreditation, one can feel confident in choosing the best providers and treatments for their vein disease.

There are many factors that contribute to an accurate vein treatment and management. The training and experience of the vein specialist performing the procedure, the type of equipment used and the quality assessment metrics each facility is required to measure, all contribute to a positive patient outcome. IAC accreditation is a “seal of approval” that patients can rely on as an indicator of consistent quality care and a dedication to continuous improvement.

La Jolla Vein Care located in La Jolla, CA has been granted vein center accreditation by the Intersocietal Accreditation Commission (IAC) in the area of Superficial Venous Treatment and Management.

This latest accreditation awarded to La Jolla Vein Care demonstrates the facility’s ongoing commitment to providing quality patient care in vein treatment and management.

How to earn vein center accreditation:

Accreditation by the IAC indicates that La Jolla Vein Care has undergone an intensive application and review process and is found to be in compliance with the published Standards, thus demonstrating a commitment to quality patient care in vein treatment and management.

  • A detailed self-evaluation
  • Followed by a thorough review by a panel of medical experts

The IAC accreditation process enables both the critical operational and technical components of the applicant facility to be assessed, including representative case studies and their corresponding final reports.

About IAC

IAC provides accreditation programs for vascular testing, echocardiography, nuclear/PET, MRI, diagnostic CT, dental CT, carotid stenting, vein treatment and management and cardiac electrophysiology.

The IAC programs for accreditation are dedicated to ensuring quality patient care and promoting health care and all support one common mission:

Improving health care through accreditation®. IAC accreditation is widely respected within the medical community, as illustrated by the support of the national medical societies related to venous disorders, which include physicians, physician extenders, nurses and ultrasound technologists. To date, the IAC accrediting divisions have granted accreditation to more than 14,000 sites throughout the United States, Canada and Puerto Rico.

How to Earn Vein Center Accreditation by IAC in 20222022-02-11T17:53:26-08:00

7, 7, 2018

La Jolla Vein Care Earns Vein Center and Venous Testing Accreditation

2020-12-19T04:16:45-08:00

LJVC IAC Vascular-webSan Diego’s First Accredited Dedicated Vein CenterLJVC IAC Vein-web

La Jolla Vein Care is the only dedicated vein center in San Diego that is accredited by the Intersocietal Accreditation Commission (IAC). IAC accreditation is a “seal of approval” that patients can rely on as an indication that the facility has been carefully critiqued on all aspects of its operations considered relevant by medical experts in the field of Vascular Testing and as a Vein Center.

La Jolla Vein Care Earns Vein Center and Venous Testing Accreditation2020-12-19T04:16:45-08:00
Go to Top