Your most pressing questions answered by Dr. Isaacs and his professional staff.
Take a look at the questions below and find out answers to some of the most commonly asked questions about vein and skin therapy.
Q: Is surgery the only option
for bulging varicose veins?
A: In the past, only surgery (stripping) could
adequately expose the source of abnormal venous blood
flow under the skin that causes varicose veins. In 1987
ultrasound guided sclerotherapy was introduced as an
alternative to surgery, and in the hands of an experienced
and skilled phlebologist this method is very effective,
particularly when combined with foam sclerosant. Ultrasound
guided heat catheter treatments, including radiofrequency
(Closure®) and laser (EVLT®), were introduced between
1995 and 2000 and are extremely effective at closing
even the largest abnormal veins.
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Q: Are the results of treatment with endovenous laser or sclerotherapy just temporary?
A: While it is possible for someone with a hereditary
predisposition to develop new varicose veins after either
surgical or non-surgical treatment, modern non-surgical
treatment is extremely effective in permanently closing
off existing varicose and spider veins.
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Q: Should you wait until after you're done having children before having your veins treated?
A: While pregnancy can cause new dilated veins due to hormonal changes, treatment between pregnancies makes later pregnancies much more comfortable, improves self-image, decreases the chances of superficial phlebitis and slows the progression of new varicose veins. The recommendation made in the past that women wait to have treatment until after having all their children was based on the fact that surgery was the only treatment available.
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Q: Wouldn't closing varicose veins just redirect flow into normal veins and make them become varicose?
A: Because varicose veins have abnormal blood flow, surrounding veins are already being burdened by having to compensate. Treatment of abnormal veins actually removes this burden from the surrounding veins, thereby improving circulation. This is why symptoms improve after treatment.
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Q: Doesn't your body need all of its veins?
A: Your body hasn't used these veins effectively since they became abnormal. There is no reason to keep them.
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Q: What kind of specialist should
you see for this kind of treatment?
A: As managed care has had a greater and greater
impact on American medicine many doctors have turned
to cosmetic procedures to enhance their revenues. Consumers
face the challenge of choosing qualified specialists
from amongst the many physicians who advertise their
services. Here are some questions that may help you
choose a doctor for your vein treatment needs:
"What is your specialty?" In the past, patients
needing vein treatment were referred to vascular surgeons
because surgery was the only effective method for treating
varicose veins. As non-surgical methods have become
more effective, doctors from many backgrounds have turned
to treating veins. In 2006 the AMA recognized Phlebology
as a self-designated specialty for physicians who have
devoted their practices to vein treatment. It's a good
sign if your doctor identifies himself/herself as specializing
in Phlebology. A doctor with a different specialty may
be treating veins as a minor part of a much larger practice.
"Are you a member of either the American College
of Phlebology or the American Venous Forum?" These
are the two American specialty societies for doctors
who treat vein problems. The American College of Phlebology
is open to doctors from all backgrounds while the American
Venous Forum is open primarily to surgeons. It's an
even better sign if the doctor has served as faculty
at the meetings of one of these societies.
"How many of these procedures have you done?"
If you are contemplating ultrasound guided sclerotherapy,
endovenous laser, radiofrequency heat catheter treatment
or another invasive procedure, it is important to know
that your doctor is very experienced in this procedure.
"Where did you receive your training?" Very
few American medical schools and residency programs
teach vein treatment. Doctors must make an effort to
find adequate training before they start treating patients,
no matter what their specialty background. Make sure
your doctor has had more than a simple, brief workshop
or seminar for training.
"Are you a Fellow?" The American College
pf Phlebology awards Fellowship status to those doctors
who have made outstanding contributions to the specialty
of Phlebology. This is evidence of the highest status
of expertise currently available.
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Q: Do you need to save your saphenous vein in case you need bypass
surgery?
A: Patients who have multiple risk factors for heart disease (such as male gender, smoking, high blood lipids, hypertension, a sedentary lifestyle or a strong family history of the disease) may need to preserve one of the saphenous veins, assuming that it is not already too abnormal. By combining ligation (tying the vein at the source of abnormal flow) and sclerotherapy, varicose veins can be removed while the saphenous vein is preserved.
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Q: If you don't want full stripping can you just have the vein tied?
A: Tying (ligating) the vein temporarily solves the problem, but studies have shown that the rate of recurrence is high.
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Q: Does sclerotherapy cause stains on the skin?
A: Temporary brownish discoloration is common. It is caused by a pigment called hemosiderin that is released in the skin from veins that are in the process of disintegrating. These stains can take from several weeks to several months to fade, depending on the size of the veins, the type of skin and the individual's healing ability.
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Q: Can you exercise after treatment?
A: Exercise is not only permitted, it is encouraged. We find that people who use their leg muscles every day after treatment have faster healing, fewer complications and less discomfort. The simplest and most effective form of exercise for good vein function is walking.
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Q: What about radiofrequency catheter
treatment (Closure®)?
A: The VNUS company has been a pioneer in developing
an effective, catheter-based treatment for varicose
veins. We used this method, Closure®, for several years
in this office and found it to be safe and very effective
for veins within certain diameter limits. We decided
to switch to endovenous laser treatment, a different
treatment in which heat is transmitted via a laser fiber,
because we found it to be faster and to have a better
long term success rate. In both methods heat energy
is transmitted into the vein wall to cause it to shrink
and close.
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Q: Is Sotradecol® really what you
use, even though I have heard it's no longer available?
A: Sotradecol® (the brand name for sodium tetradecyl
sulfate) used to be manufactured by Wyeth Pharmaceuticals,
but it was discontinued in 2000. Another company, Bioniche,
obtained the rights to this brand name and began making
it commercially available in 2006. We use Sotradecol®
except for situations in which we need to use a dilution
that is not manufactured by Bioniche. In those instances
we use a compounded generic equivalent made from FDA
approved ingredients in a certified compounding pharmacy.
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Q: Can hand veins and veins on other
parts of the body be treated?
A: Not all vein specialists treat hand veins,
but in this office we have treated hand veins on hundreds
of patients over the years with great success. Likewise
we have treated visible and symptomatic veins on the
breasts, abdomen, and vulvar area. Dr. Isaacs regularly
receives referrals from OB/Gyn doctors whose patients
have painful post-pregnancy varicose veins in the genital
area.
Ready to schedule an appointment? Click here.
Q: Should you get spider veins treated by laser instead of going through a bunch of injections?
A: Current technology allows lasers to be very effective for treating very tiny broken capillaries like those that appear around the nose. Despite advertisements to the contrary, they are not very effective for the large spider veins that appear on the legs. In fact, laser treatment is more expensive, just as painful, and more likely to leave long-term pigmentation than
sclerotherapy.
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Q: What about Photoderm?
A: Photoderm is an intense light energy source that is not really a laser. While the theory behind it is very interesting and it may turn out to be effective over time, currently I feel it is unproven and very expensive.
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Q: Are spider veins caused by crossing your legs, working on concrete floors or gaining weight?
A: There are many myths regarding spider veins. The most important causes are thought to be hereditary predisposition (the body characteristics you inherited) and hormonal effects such as those present during puberty and pregnancy. Other factors probably contribute very little.
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Q: Does exercise hurt your veins?
A: Anything that keeps the leg muscles in good shape is probably good for your veins in that the leg muscles are the pumps that keep vein circulation going. Only very extreme activity or direct trauma would cause harm.
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Q: After treatment with hypertonic saline, will most of your veins came back after a period of years?
A: There are two factors that could be at work here. One is that while hypertonic saline is effective for very small veins, it is much less effective on the larger, blue veins that feed into the spiders (and it is also quite painful). The second possible problem is that many doctors inject spider veins directly but fail to treat the feeder veins. Ongoing pressure from these larger veins will often cause recurrences.
This is why we do not use hypertonic saline.
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Ready to schedule an appointment? Click here.
Q: Why can't surface laser be used to
treat varicose veins?
A: A laser that is applied from the surface
of the skin can only penetrate a tiny distance before
it loses its energy. External lasers can be used to
eliminate small caliber "broken capillaries"
on the surface such as those that commonly appear around
the nose, but they rarely do as well on the legs. Even
very small leg veins usually have larger feeder veins
that must be injected before the smaller veins can be
treated successfully.
However, endovenous laser involves threading a laser
fiber into the vein and treating it from the inside
rather than from the surface of the skin. This type
of laser is extremely effective for large varicose veins.
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Q: Aren't surface lasers less painful?
A: Unfortunately, surface laser often is more painful than injection treatment and usually quite a bit more expensive.
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Q: Are there different types of lasers?
A: This is a very important point. Laser is a special type of light which can be tuned to different frequencies in order to affect different targets. Vascular lasers target the pigment in blood, so that blood vessels can be destroyed without affecting surrounding skin. Pigmented lesion lasers hit brown pigment in order to get rid of skin spots without affecting blood vessels or unpigmented skin. Carbon dioxide and erbium lasers take off layers of skin in order to resurface the skin. It is extremely important that the right laser be used for the right purpose - and remember that newer is not always better.
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Ready to schedule an appointment? Click here.
If you would like any further information or wish to schedule a consultation, please call
(925) 945-8656.
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