BLOOD THINNING MEDICATIONS PART 1: ANTICOAGULANTS: WHAT ARE THEY AND HOW ARE THEY USED?

Over the next few weeks, I want to discuss the medications that vascular surgeons may prescribe.  These medications include anticoagulants, antiplatelets, statins, and other miscellaneous agents.  This week I will discuss anticoagulants!

Anticoagulation refers to agents that STOP the clotting of blood.  The clotting of blood starts with what is known as the coagulation cascade.  The cascade refers to a series of consecutive events each involving special proteins that are needed to occur for blood to form a clot.  Different anticoagulants block specific parts of the cascade.  The main reason we usually see patients with anticoagulants are for hypercoagulable states, certain heart arrhythmias like atrial fibrillation, and deep vein thromboses otherwise known as blood clots.  Hypercoagulable states are specific genetically inherited disorders that result in the blood being more likely to clot.  Atrial fibrillation and other arrhythmias can cause blood clots to form in the heart.

 

Anticoagulant agents are given to prevent the formation of clots in the heart that can then break off and go to the brain, hands, feet, kidneys, or any other part of the body and cause problems. 

 

Deep vein thrombosis or blood clots mandate the prescription of anticoagulant therapy to ensure that more blood clot does not form.

 

Anticoagulants can be broken up by many different classification schemes.  For the purposes of this blog, I will limit our discussion here to agents that are appropriate for the OUTPATIENT (Outside of the hospital) setting.  Please speak with you private physician to answer any additional questions you may have regarding Anticoagulation medication of feel free to reach out to me directions for more information on how anticoagulation is used. Anticoagulation agents that are used during hospitalization or in the IN-PATIENT setting in patients are outside the scope of this article.

 

Up until the 2010’s the mainstay of anticoagulation therapy was with a drug called warfarin (Trade name: Coumadin).  Warfarin, though effective, requires the weekly or biweekly measurement of a specific lab for the blood called the prothrombin time.  The active monitoring of the prothrombin time facilitates modulation of dosing to always allow for safe levels of effective therapeutic anticoagulation.  Since the beginning of the 21st century new agents have come to market that require only taking one or two pills a day.  They include Xarelto or Rivaroxaban and Eliquis or apixaban.

If you have a question about how your medications may be affecting your vascular disease, please do not hesitate to call and schedule an appointment today!

South Bay Vascular Center and Vein Institute is Silicon Valley’s largest and most trusted Vascular Surgery practice.  Serving South Bay communities for over 26 years, Dr Kokinos and her Colleague, Dr Ignatius Lau are the region’s foremost experts in advanced vascular care and provide innovative care for patients suffering from circulation relation problems. At South Bay Vascular Center and Vein Institute our job is to understand the “Why” so that you have real solutions to living a healthy life. Call us today at 408-376-3626 or visit our website at www.southbayvascular.com to learn about what makes us the most referred to vascular surgery clinic in Silicon Valley.

PART 4: WHY DO MY TOES, ANKLES AND FEET HURT AT NIGHT? DIABETIC FOOT DISEASE

Over the past month, I have discussed why venous and arterial disease as well as Raynaud’s Syndrome may cause pain in the feet and toes at night. Today, I want to discuss another one of the most common causes I see in my clinic for pain in the feet at night: Diabetic foot disease.

Interestingly, diabetes mellitus has Greek etiology and literally means sweet (mellitus) urine (diabetes).  Diabetes is a condition in which the body loses its ability to limit the amount of sugar in the blood.  The high concentrations of sugar result in the formation of harmful chemicals that can hurt the eyes, kidneys, and nerves all around the body, especially in the feet.  Once the sugar levels become high enough, they overload the kidneys—the organ that creates urine—and sugar overflows into the urine, hence the Greek etiology of diabetes mellitus.

Diabetes causes pain in the feet via two main pathways: Neuropathic pain and pain from ulcers. 

Neuropathic Pain:

For neuropathic pain, the high blood sugar levels damage the small nerves in the feet responsible for sensation.  As a result, patients often complain of burning, cramping, tingling, and at the very worst end of the spectrum, numbness.  Sometimes only the toes have these symptoms, but often times the symptoms can encompass the entire foot!

Ulcerative Pain:

The way diabetes results in the formation of ulcers is multifactorial.

  • First, the damage to the nerves can result in numbness or lack of sensation.  Thus, when a person injures their foot, that person does not feel it and protects it from further injury.
  • Second, in addition to damaging the nerves responsible for sensation, diabetes also damages the nerves that innervate muscles responsible for moving.  The damage to the muscle nerves occurs in such a way that irregular contractions of muscles within the foot push the bones of the foot outward creating pressure points that ulcerate easily.  Once the ulcer is formed, infection of the ulcer or exposure of the raw tissues beneath the skin can cause pain.  In patients who otherwise have numb feet, an infection can spread to an area that does have sensation and cause pain there.

Given that diabetes is so common, patient education is vitally important to those impacted by this disease.  If you or anyone you love suffers from diabetes, my hope is that this blog will help you to better understand some of the underlying factors that may be contributing to your foot pain at night.  As a rule of thumb, always remember to share with your primary care physicians all symptoms of pain that you experience during your regularly scheduled appointments and if you think your condition may be getting worse, please do not hesitate to call my office to schedule an appointment for a second opinion! We can help.

408-376-3626

Dr. Ignatius H. Lau

Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

To see what our patients are saying about us, follow the link below to read our reviews.

https://www.google.com/search?q=south+bay+vasculr&rlz=1C1CHBD_enUS878US878&oq=&aqs=chrome.0.69i59i450l8.2997409j0j7&sourceid=chrome&ie=UTF-8#lrd=0x808e34eecfbc0653:0xb9aa2de7f50ba6a5,1,,,

 

PART 1: WHY DO MY TOES, ANKLE, AND FEET HURT AT NIGHT? VENOUS DISEASE

One of the many questions I receive as a vascular surgeon is why do my feet hurt at night?  Though this question may seem simple, every person is different. Before I can provide you with “real” solutions to what’s causing this pain and what can be done to stop it, I need to evaluate multiple factors to understand “Why” this pain exists.  Over the next few weeks, I am going to explore the most common reasons for foot pain at night and why people can have pain in their feet at night caused by venous disease.

For the majority of patients Raynaud’s syndrome, Arterial disease, and Diabetic foot disease explain most of the reasons why people experience pain in their feet at night.  Though pain from problems with bones and muscle can play a role, pain due to these causes usually worsens during the day and with use, not when a patient is resting or lying flat.

In part one of this four-part series, I am going to discuss pain at night caused by VENOUS DISEASE.

Let’s start with a refresher on our bodies “plumbing” (Specifically, how does blood circulate around my body.)

  • Veins are blood vessels that bring blood BACK from the feet to the heart.
  • Arteries on the other hand are the blood vessels that bring blood FROM the heart to the feet.

Veins have specialized structures called one-way valves that allow blood to go up towards the heart but not back down towards the feet.  As we age, veins become dilated (start to leak) because the valves no longer seal properly. These leaky valves allow blood to fall back towards one’s feet which results in an increase in pressure within the veins at the ankle and just above the legs. Gravity tugs on the blood in our veins bringing it down to our feet which causes this increase in pressure

Interestingly, because of the curve that the veins take at the level of the ankle to enter the foot, the increase in pressure is not transmitted directly to the foot and toes.  The increase in venous pressure at the ankle typically results in

  • Varicose veins,
  • Swelling,
  • Dark skin discoloration from the leaking of red blood cells into the skin, and, in the worst cases
  • Ulceration.

Even without ulceration, however, the pain related to swelling and discoloration can be very severe.

People during their normal daily lives spend most of their days either standing or sitting.  Because of this, during the day gravity works in both positions to facilitate the pooling of blood around one’s ankles.  When patients come to me with pain in their feet, I always ask specifically if the pain is localized in the calves and ankles.  When pain is localized to the calves and ankles, I confirm a venous etiology by performing a physical exam and finding varicose veins, swelling, dark skin discoloration and/or ulcers between the ankle and the knee.

Pain that is reported in the foot and/or toes without the physical exam findings of varicose veins, swelling, dark skin discoloration, and/or ulcers between the ankle and the knee is NOT likely to be from a venous cause!  Though vein problems may sound or seem like a rare disease for those who have never had venous disease, patients with vein problems are one of the most common consults I see as a vascular surgeon.  Does foot pain wake you up at night? If you have any of the symptoms or appearance of the leg that I described above, please do not hesitate to call our office on 408-376-3626 to schedule an appointment.

One Final Note:

Though causes from the bones and muscles can play a role, foot pain that worsens at night is rarely due to these causes.  Often pain related to problems with bones and muscles worsen during the day and with use, not when any given patient is resting or lying flat.

Clues that can guide me as a vascular surgeon to the cause include throbbing and aching pain versus numbness and tingling associated with tenderness or pain located in the toes versus pain located in the ankle or just above the ankle in the leg.

 

Dr. Ignatius H. Lau

Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

FIXING BLOCKED ARTERIES

The most common disease that I treat as a vascular surgeon is a medical problem called peripheral vascular disease.  Specifically, peripheral refers to the legs, and vascular disease refers to blockages of the arteries.

Because peripheral vascular disease is the most common disease that I treat, I want to talk today about what I can do as a vascular surgeon to fix these kinds of blockages in the arteries!

First though, let me explain why blockages to the arteries of the legs are bad.  When not enough blood flow reaches the legs, patients can have pain in their calves or buttocks that limits their ability to walk longer than a city block.  When the blockages are very severe, they can also have pain in their feet and toes even when they are not moving or develop non-healing ulcers and gangrene.  When I open blockages in patients’ legs, I allow them to walk again, or I give them the ability to heal their ulcers and gangrene pain free.  The improvement in patient lives is the most exciting aspect of my job!

There are two main approaches to performing what we call revascularization. Revascularization refers to the opening of old passageways or creation of new passageways to bring blood directly from the heart to the foot without any obstruction.

  • Open Surgery: In the early decades of vascular surgery, namely the 1980s and 1990s the primary way to treat peripheral vascular disease was to perform an open surgical bypass.  If there was a blockage in the thigh, I would surgically expose above and below the blockage and take a synthetic tube or the patient’s own vein and then sew it above and below the blockage.  This would allow the flow of blood to bypass the blocked segment, hence, the reason we call this surgery a bypass!  Though this procedure does produce robust flow, it necessitates large surgical incisions that cause significant pain and are susceptible to poor wound healing and/or infection.

 

  • Endovascular Surgery: In the 2000s, an innovative approach called endovascular surgery started to become more widely used and is now actually standard of care today.  Indeed, I prefer to treat patients with peripheral vascular disease with endovascular surgery whenever possible.  We access the arterial system of the leg with a needle in the groin.  Through that needle we put in a strong wire and over that wire we can then advance several different instruments over catheters.  In general, there are three different techniques I can employ in my efforts to re-establish blood flow to an area that is no longer receiving blood due to some type of arterial blockage.
    • Balloons: The most basic instrument is a balloon that expands and breaks up the narrowing or blockage.
    • Stents: If the balloon does not work, we can use a self-expanding tube called a stent.
    • Atherectomy: If the stent does not work, we can use a special device called atherectomy.  Atherectomy involves the use of a device that can literally cut the plaque out of the artery and aspirate all the debris.

 

These three technologies allow the reopening of arteries from the toes to the pelvis and only necessitate a 2 mm puncture site in the skin of the groin to be used.  There is little to no risk of infection and the procedure can be performed several times over the course of the patient’s life.  On the other hand, surgical bypass can only be performed twice—three times—during the patient’s life due to the development of dense scar tissue after each operation.

 

If you have trouble walking because of pain in your buttocks or calves or have pain in your feet and toes or ulcers that will not heal, please do not hesitate to call my office today at 408-376-3626 to schedule an appointment.  The chances are that I will be able to help take your pain and ulcers away! We Can Help

www.southbayvascular.com

WHAT IS “ENDOVASCULAR” SURGERY?

As a vascular surgeon, I perform two very different types of surgery: Open Surgery and Endovascular Surgery.

  • Open surgery is just as you might think!  It involves making an incision with a scalpel and using various tools like forceps, scissors, electrocautery, and needle drivers to expose and then repair specific structures.  Since the beginning of surgery itself, all surgeons, not just vascular surgeons, have been practicing open surgery.
  • Endovascular surgery is a recent development that only began in the 1990s.  Motivated by the desire to perform minimally invasive and less harmful interventions on the most sick and highest risk patients, pioneers in vascular surgery developed endovascular techniques.

Though the concept is simple, endovascular surgery now allows vascular surgeons to solve a multitude of problems with blood vessels very differently than they have in the past. Using advanced minimally invasive surgical techniques, vascular surgeons can treat many forms of vascular disease without the need to “cut-open” their patients to treat extraordinarily complex and in some cases life threatening diseases.

Endovascular surgical techniques utilize ultrasound (sound waves) to place the tip of a hollow needle into a blood vessel.  Once these hollow needles have been placed through the needle, we place a very stiff wire that allows us to advance large tubes called catheters into the vessel.  Catheters have many different functions depending on the situation and are used to re-establish blood flow in vessels that are diseased and or blocked.

For peripheral vascular disease, there are blockages in the legs of a patient that prevent blood flow from reaching the foot.  For peripheral vascular disease we can use balloons on the end of the catheter that are inflated to open a blockage.  If balloons do not work, then we can put a self-expanding metal mesh tube on the end of a catheter and then deploy it inside the blockage, thereby keeping it open.  There is also a technology called atherectomy which literally means cutting out plaque.  The atherectomy device has a cutting edge that sands down the plaque and then a suction function that removes all the debris.

For aneurysms, which are dilations of a blood vessel that can rupture, we use stent grafts, which are self-expanding metal mesh tubes that are lined with an impermeable fabric.  We place the stent graft above and below the aneurysm, thereby sealing it from the pressure created by the heart and preventing rupture.

At the end of these endovascular cases, the patient only has one or two 1 mm in size punctures over the arteries that were accessed.  Contrast this to the classic open surgeries where patients could have incisions up to 10 to 20 cm!  As a contemporary vascular surgeon, I take pride and joy in being able to offer both types of surgical interventions to my patients.  If you or your loved one may be suffering from vascular disease, please do not hesitate to call our office at 408-376-3626 to schedule an appointment today!

TRANSCAROTID ARTERY REVASCULARIZATION: THE FUTURE OF CAROTID SURGERY

One of the most gratifying problems we help treat for patients is carotid artery disease.  The carotid arteries supply the brain with blood.  In patients with high blood pressure, high cholesterol, diabetes, and a history of smoking, the carotid arteries can become narrowed and form blood clots that then go into the brain and cause strokes.  Traditionally, vascular surgeons have fixed this carotid artery narrowing’s with a surgery called a carotid endarterectomy.  The carotid artery is dissected out and cut open.  The plaque is then removed, and the carotid artery is sewn back together.

Over the past five years, however, I have had the opportunity to perform a new technique involving carotid stenting called trans carotid artery revascularization or TCAR.  Stents are self-expanding metal tubes that we can use in the carotid artery to stop clots from forming in narrowed areas.  TCAR uses a suction machine to reverse flow in the carotid artery during the placement of a stent to minimize the risk of inadvertent stroke during the procedure itself.  After having performed over 20 of these procedures in the past two years, I can say with confidence that the flow reversal and stenting that TCAR provides is a highly safe and successful way to treat carotid artery disease.  Furthermore, the length of the incision, postoperative pain, and risk of nerve damage and bleeding are all much less with TCAR than with CEA.

I am so happy to be able to offer this revolutionary, safe, and effective therapy to all my patients at South Bay Vascular Center.  Should you or anyone you know have any problems with your carotid arteries or a stroke, please do not hesitate to call us today at 408-376-3626 to schedule a consultation.

https://youtu.be/O32nDoovMPY]

VARICOSE VEIN DOCTORS

Type “Varicose Vein Doctor” into your Google search and in seconds, you’re overwhelmed by results.

Each link points to a different website.  Each site claims their “Vein Doctor” is the “best” and every practitioner claims to have the “bona-fides” to back-up these claims. Credentials span the continuum from Academic Institution Affiliations, (claiming to be X, Y or Z University Affiliated); to Chair-Personships (they “chaired’ this or that medical departments in the “Big Box” health care systems they came from (i.e. Kaiser, PAMF, or Sutter) to Medical Journal Publications…all this in an apparent attempt to equate administrative responsibilities with clinical excellence. Some of the bolder in the group even claim they trained at the best medical schools hoping to convince potential patients that by attending a great medical school they are the best physician for the procedure.

 

AN ESPECIALLY CONCERNING TREND IS A PHYSICIAN’S USE OF GOOGLE ADWORDS TO ADVANCE THEIR MESSAGE

 

If a vein doctor’s website shows up in your Google Search and you see that the listing starts with the word “AD” …be careful. It means that the owner of this practice is paying Google a special Advertising fee to get their name to the top of the search results. This is an attempt by this physician to “BUY LEGITIMACY”.  Businesses PAYING google to display their ads above the practitioners who have EARNED this privilege is a great way for Google to make money. Unfortunately, it can be deceiving to people who think that because a doctor’s website pops up at the top of the search results that they must be the best. (On a separate note…If a physician’s website DOES show up at the top of the search results and DOES NOT have the word “AD” in front of it, IT IS a sign that this physician has many website visitors and that they have been around for a long time…Especially if this listing is followed by a large number of Google Reviews.)  It also means that this physician has EARNED their reputation, and NOT purchased their website ranking. A word of warning to patients searching for an experienced vein care professionals. Anyone can pay to elevate their search rankings on Google; regardless of their experience.

 

IGNORE websites with paid “AD’s”, especially if they don’t have any verified Google reviews. 

 

To make things even more difficult, it can be very confusing just trying to figure out what kind of doctor actually does varicose vein procedures. Some doctors call themselves “Vein Specialists”. Others call themselves “Vein Experts”. You’ll also see the labels “Phlebologist” and “Vascular Expert”. Finally, there is the “Vascular Surgeon”. You ask yourself, do all of these physicians fix varicose veins? If so, what’s the difference? (Learn more by clicking on the following link). https://www.southbayvascular.com/blog/vascular-surgeon-vs-phlebologist-vs-vein-specialist/ Every one of these “Vein Doctors” promises to rid you of your ugly, painful veins, leg swelling and non-healing ulcers. Every one of them posts photos showing off their work to prove their point.

Let’s face it, it’s confusing. All you really want is to get your veins “fixed” so that next time you get invited to a pool party you can wear shorts or a skirt again without being “mortified” by how bad your legs look. So, what’s next?

Lost in this hype, finding the right doctor to treat your varicose veins might seem impossible. Choosing the best doctor for your specific vein condition is a difficult decision and not one that you should take lightly.  Only after serious consideration of the available options should this decision be made and in the best of all worlds, it should be made in consultation with your primary care physician…and this is the probably the most important message in this post.

LISTEN TO YOUR PRIMARY CARE DOCTOR

They’ve been in this community a long time and they know who is good and who is not. Their referral should be your number one reason to make an appointment with a Varicose Vein Doctor.

In the best of scenarios, patients should visit as many doctors as they can; interview them and question them about everything relating to their condition and their ability to help you…but remember, your primary care doctor has been doing this for a long time. They’ve got the benefit of having seen the results from different doctors and on the strength of their recommendation, you should have the confidence to know that you are making the right choice.

Here are a few things varicose vein patients should keep in mind:

  1. Remember, these are your legs. You deserve the best and you deserve to “Love Your Legs Again”.
  2. Don’t be frightened to ask your doctor tough questions.
    • Don’t just ask your vein doctor how long they have been in practice, ask them how long they have been doing these specific kinds of vein procedures. Ask them how many of these procedures they’ve done.
    • If your doctor is in private practice, ask them how long they have owned their own practice. This is important because getting things done right in a private practice is significantly more difficult than getting work done in a University Hospital or Big Box Medical System.
    • How many of these procedures have you done RECENTLY….if they do less than 25-30/ month, you might want to seriously consider finding another option
    • What kind of complications might you expect…every person is different and if your doctor says your legs will look as good as they did when you were 20, you might want to consider seeing someone else.
    • Who does your ultrasounds…are your ultrasound techs RVT’s (Registered Vascular Technologists?) Are they done “in-house” by full time Vascular ultrasonographers or are they done by “travelling” ultrasonographers who just work in their office a few times a week and who are not full time employees of the medical office.
    • Most importantly, is your Vascular lab IAC Accredited? This is especially important as your doctor will make their diagnosis on the basis of your ultrasound report and an IAC accreditation guarantees the best of the best studies are being done at that particular lab.
    • Who reads the ultrasounds….is it an RPVI registered physician, not simply a radiologist… as the two physicians will look for vastly different signs relating to vascular disease and health. Keep in mind if the study isn’t read correctly, the procedure can go poorly.
  3. Finally, ask your “Vein Specialist” about what happens if you have a complication Ask your provider if they have “Admitting privileges” at the local hospital in the event something goes wrong during the procedure and what their plan is if their procedure fails.

 

EXPERIENCE COUNTS WHEN IT COMES TO YOUR HEALTH!

 

South Bay Vascular Center and Vein Institute brings 24 years and 20,000 vein procedures to you as our patients. As the leading independent Vascular Surgery practice in the San Francisco Bay Area, more local independent physicians refer their vein patients to Dr Kokinos than to any other vascular surgeon in the greater Silicon Valley Region.

WE OFFER HOPE WHEN OTHER SAYS THERE IS NONE!

Call us today at 408-376-3626 to schedule your vein consultation

IMPROVING THE LIVES OF OUR PATIENTS

Improving the lives of our patients is the foundation of everything that we do. In pursuit of this goal we strive to provide the most advanced vascular treatments available and to care for our patients in a compassionate and respectful manner.

At South Bay Vascular Center, we give our patients hope when others say there is none. By providing the most advanced vascular care available in our own state of the art angiography suite, South Bay Vascular has grown into the leading center for amputation prevention in Northern California. When other physicians say an amputation is necessary, our physicians perform diagnostic testing few, if any other centers in the area can provide. As a result, our physicians save more legs than any other doctors in the region.

Dr. Kokinos and Dr. Pineda perform more lower leg re-vascularization procedures than any other vascular surgeons in the area. Each year we save hundreds of patients from below knee and above knee amputations by performing specialized procedures that few other surgeons in the area are trained to perform.

Additionally, we work tirelessly to spread the word that patients facing amputation should always ask what else can be done to save their limb before going ahead with their amputations. Our goal is to educate anyone being told they need an amputation that they need a second opinion from a board certified Vascular Surgeon. When their doctors can’t answer the simple question of what does the inside of their artery look like, it’s time to ask for a second opinion.

 

But we can’t do this alone! We need everyone’s help to spread this message. There is hope for many patients facing diabetic amputation but, every week we see patients who have tragically already undergone an amputation without getting an informed second opinion from a Vascular Surgeon. For these patients, it’s too late.

We invite everyone to use the immense power of the social network to help spread the word that there is Hope for many of these patients. Reach out to everyone you know and let them know that if they or anyone they known is facing a potential lower limb amputation they need to call our office for a second opinion.

Our goal is to stop unnecessary amputations. Please Help!

Spread the word to everyone you know. Like us on Facebook, tweet this message to your friends, share this story over a drink… snap chat and Instagram the message that the physicians and staff at South Bay Vascular can Help!

Call us at 408-376-3626 to schedule an appointment or visit our website www.southbayvascular.com to learn more about what can be done to stop unnecessary amputations. Join us today and

Take A Stand Against Amputation!!

WHAT IS ENDOVENOUS LASER THERAPY?

Endovenous Laser Ablation (EVLT), a treatment for varicose veins, is an advanced, highly effective treatment for varicose veins. EVLT works by using targeted laser energy to close off problem veins, thus relieving the symptoms and appearance of varicose veins and restoring healthy, attractive legs. This treatment is ideal for large varicose veins, including the greater saphenous veins.

The EVLT™ Procedure is minimally-invasive and virtually pain-free. While surgical vein treatment methods can cause scarring and other side effects, the laser energy used in EVLT minimizes risks and complications. Laser energy is delivered directly to the target vein to shrink the walls, which eventually causes the vein to close. Blood flow is diverted to other, healthy veins, eliminating the varicose vein bulging, discoloration, and pain.

EVLT is performed as an outpatient procedure, usually in less than an hour, with only local anesthesia. This means that recovery time is dramatically reduced. Most patients can resume normal activities immediately following treatment, while enjoying superior clinical and aesthetic results.

WHAT IS VASCULAR ULTRASOUND*

The medical specialty of vascular technology utilizes diagnostic ultrasound to generate images of blood flow within the veins and arteries. Ultrasound uses high frequency sound waves, similar to the sonar that a ship uses to detect structures beneath the surface of the water. Vascular ultrasound can also be known as a Doppler or duplex study. For example, if your physician wants to make sure that you do not have a blood clot in your leg, he or she might order a venous duplex or venous Doppler examination.

Vascular ultrasound procedures are noninvasive, meaning they do not require the use of needles, dyes, radiation or anesthesia and are, therefore, relatively painless and harmless.

The information obtained through vascular ultrasound examinations is extremely helpful to physicians in diagnosing a variety of conditions related to cardiovascular disease, disorders of the heart and blood vessels. Early detection of life-threatening vascular diseases is possible through the use of noninvasive vascular testing techniques performed within vascular facilities.

Vascular ultrasound’s reliability in diagnosing conditions related to heart disease and stroke is encouraging as we strive for ways to reduce the more than 500,000 lives lost in the United States each year to these disorders. However, it is critical that the public realizes there are many facets that contribute to an accurate diagnosis based on vascular ultrasound examinations. These factors include the skill of the technologist/sonographer performing the examination, the type of equipment used, the background and knowledge of the interpreting physician and quality assurance measures. In fact, poor ultrasound examinations often lead to inconvenient, redundant studies, misdiagnosis and even unnecessary tests or surgery.

*Taken from the Intersocietal Accreditation Commission Website