3, 6, 2020

Blood Vessel Diseases that can be Diagnosed with Duplex Ultrasound


Duplex ultrasound combines Doppler flow information and conventional imaging information, sometimes called B-mode, to allow physicians to see the structure of your blood vessels. Duplex ultrasound uses sound waves to get images of your blood vessels. It also helps determine how fast blood moves through the vessels. It can also be useful to estimate the diameter of a blood vessel as well as the amount of obstruction, if any, in the blood vessel. Using duplex ultrasound technology, the structure of your blood vessels, the valve function, the movement of your red blood cells and direction of blood flow through the vessels, and any blockages or blood clots can be seen.

Diseases of the blood vessels can affect both veins and arteries.

Vascular refers to the blood vessels in the body. There are two main types of blood vessels; the arteries and veins. Arteries bring oxygen-rich blood from the heart to every inch of the body; vein return the blood back to the heart and lungs for more oxygen. Vascular disease is when the blood vessels are no longer healthy.

Common types of vein disease include:

  • Varicose veins
  • Chronic venous insufficiency
  • Deep venous thrombosis

Common types of artery disease includes:

  • Carotid artery disease and stroke (TIA or Stroke)*
  • Lower extremity arterial disease (PAD)**
  • Upper extremity arterial disease
  • Abdominal aortic aneurysm (AAA)
Blood Vessel Diseases that can be Diagnosed with Duplex Ultrasound2020-09-18T18:19:53-07:00

21, 5, 2020

Leaky Vein Valve Disease and Varicose Veins


Venous reflux disease refers to ‘leaky valves in the veins of the legs. Reflux may occur in the deep and/or superficial leg veins. The deep veins are those within the muscle; they bring at least 80-90% of the blood from the legs back to the heart. The superficial veins are outside of the muscle and under the skin. The main superficial veins are the Great Saphenous Vein that courses up the middle of the thigh and calf and the small saphenous vein, which courses up 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. Symptoms include leg heaviness, leg fatigue, leg pain, ankle swelling, phlebitis (inflamed and painful veins) restless legs at night, and night cramps. Venous reflux disease is progressive and worsens over time. Skin changes may also develop, including darkening of the skin around the ankles. The darkening of the skin is sometimes referred to as venous stasis skin changes. The skin can become dry and itchy (venous eczema). Eventually, the skin can break down causing a wound, called a venous leg ulcer.

Leaky Vein Valve Disease and Varicose Veins

Leaky Vein Valve Disease and Varicose Veins2021-11-05T10:56:55-07:00

21, 4, 2020

Night Cramps Commonly Caused by Varicose Veins


Leg cramps occurring at night (nocturnal leg cramps) are a common symptom of venous disease. In fact, in the San Diego Population Study, leg cramps were the second most common symptom in people with the venous disease with a prevalence of 14.3%. Leg aching (17.7%) was the most common complaint and tired and swollen legs were also predominant symptoms.

Healthy veins collect the de-oxygenated blood from the tissues. The venous blood, which is low in oxygen and high in waste products is returned to the heart and lungs where it is replenished with oxygen and nutrients.  In diseased veins, the blood circulates poorly, allowing blood to pool and become stagnant. The exact mechanism that causes cramping in the legs is uncertain.  But, when the cramping is caused by poorly functioning veins, the symptoms are often alleviated by correcting the underlying problem.  Conservative measures, such as elevating the legs, walking regularly, and wearing compression therapy may reduce the frequency of night cramps. Treating the underlying venous insufficiency may be curative.

There are many causes for leg cramps and if you suffer from night cramps it is important to be properly evaluated to determine the cause.  Cramps that occur with exercise are more likely to be associated with a more serious condition. If your muscles cramp with walking for a short time and recover with rest this may indicate arterial disease.  Other causes for leg cramps include muscle injury, thyroid conditions, pregnancy, electrolyte imbalance, dehydration or other causes.

To help identify the cause, it may be helpful to keep a log of daily activities, or change in activities; for example, heavy exertion may indicate a muscular cause or long periods of standing or sitting may favor the venous disease.  A recent study showed that prolonged standing at work may be an important risk factor for varicose veins and nocturnal leg cramps.

Check with your primary care physician to rule out other causes for leg cramps. Blood tests can check for thyroid, kidney and electrolyte conditions.  You may also have undiagnosed venous reflux.

At La Jolla Vein Care, our vascular imaging scanners help us detect vascular causes of leg pain. For example, we can utilize one of our three duplex ultrasound imaging systems to scan for blood clots in the leg veins (deep venous thrombosis), venous insufficiency and identify significant problems in the arterial circulation.


Call us for more information about our vascular imaging services at 858-550-0330.

Night Cramps Commonly Caused by Varicose Veins2021-12-31T12:29:50-08:00

29, 3, 2020

Vein Care Telemedicine during COVID


We’re here for you!

telemedicine from home

talk to our board certified doctors, vein specialist from the convenience of your home.

Connect with one of our board certified physicians at the convenience of your home.

While we remain focused on providing exceptional care, we feel it is in everyone’s best interest to move to a contact-free environment. Effective March 19th, 2020  and with a tentative ending on April 26th,  2020, the office will be closed. However, physicians will be available to patients by phone or via video conference (telemedicine) during normal business hours.

Did you know you can start your conservative management now?

Have you had concerns about your legs you have always wanted to discuss or ask about?

Now is the time. You can text us pictures of areas of concern on your leg/s ahead of time.

How to reach us:

To schedule a phone or telemedicine visit with our physicians, or any questions please call us at (858) 550-0330 or email anna@lajollaveincare.com.

Alternatively, you can reach us with the chat function below or text (858) 295-3347.

We are available between the hours of 8am to 5pm, Monday through Friday.

Vein Care Telemedicine during COVID2020-08-18T22:51:01-07:00

6, 5, 2016

Common Misconceptions… Do I have spider veins or varicose veins?


Common Misconceptions… Do I have spider veins or varicose veins?


photo of spider veins on back of thighs

spider veins on back of thighs


There is a common misconception of what varicose and spider veins really are. It may be embarrassing for some to admit that they have varicose veins or they simply just think that they have spider veins. Although spider veins can be fed from varicose veins, they are simply not the same. Let’s start with spider veins… What are they? Spider veins are typically purple web-like veins that appear either scattered all over the leg or in clusters. Although they can be symptomatic, they are usually painless and are considered cosmetic. They lie almost, if not, flat on the skin and are often described as “unsightly.” Varicose veins on the other hand are bulgy. People describe them as snake or rope like or even like a little brain. Varicose veins protrude from the skin and are not considered a cosmetic condition, but rather a medical condition. They can also be either symptomatic or asymptomatic. To properly diagnose patients with either spider veins or varicose veins, a thorough consultation should be done to examine the patient’s legs and areas of concern. Sometimes, certain patterns of spider veins indicate that there may be an underlying vein condition. An ultrasound examination can be done to properly diagnose varicose veins and underlying vein conditions.

Common Misconceptions… Do I have spider veins or varicose veins?2020-12-19T01:54:10-08:00

21, 7, 2014

Varicose Veins vs. Spider Veins


What is the difference between varicose veins and spider veins?  Are they the same thing? Spider veins and varicose veins both refer to dysfunctional, dilated leg veins but the main difference is the size of the veins. Spider veins are small, thread-like veins at the surface of the skin. They often appear in clusters or can have a ‘starburst’ or spider-like pattern. Varicose veins are larger veins that appear swollen, twisted cordlike veins that ‘bulge’ at the surface.

Both spider veins and varicose veins can cause pain and other symptoms like burning, aching, and throbbing. Both can be treated without surgery.

Slide 4_2

This image describes the difference between spider veins and varicose veins. Both are manifestations of unhealthy veins. Spider veins are essential, tiny varicose veins.

Varicose Veins vs. Spider Veins2021-11-05T13:08:51-07:00

19, 6, 2014

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, which also becomes worse by the end of the day and after prolonged standing or sitting. Some patients describe 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 grocery store, you may feel like you need to run to a chair to recline and elevate your 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


7 Signs of Venous Disease2021-11-05T11:14:23-07:00

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, 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



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.

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