Vein Specialty Center
Vein problems are very common. Normally veins from the legs carry blood back to the heart. This requires valves to keep the blood from flowing back into your legs with gravity. If these veins and valves become damaged, a variety of common vein disorders can occur, including varicose and spider veins . In many patients, this can cause symptoms, such as leg heaviness, swelling, aches and pains, as well as skin itching along the veins that can make getting through the day uncomfortable. In others, serious complications can ensue.
The Inovia Vein Specialty Center is dedicated to providing you with a premium vein care experience in a warm and friendly specialty office setting. Our focus is to bring the latest and most innovative treatments together in one place for our patients. While in the past people with vein disorders were appropriately reluctant to even consider older techniques such as vein stripping and ligation, the good news is that there are a variety of newer office based evaluation and treatment options that can help you address these issues in an outpatient setting.
At Inovia, it all starts with an evaluation by one of our vein experts, Dr. Boyle, or Dr. Jones. When indicated, they will employ non invasive specialty diagnostic modalities right in the office, such as ultrasound, to pin point the problem. Once we pin point the problem we can start working on the solution.
Drs. Boyle and Jones are experienced in the latest techniques to address vein problems, including EVLT, Ambulatory Phlebectomy, Sclerotherapy and surface laser. In addition to evaluating and treating patients who have never seen a doctor for varicose veins, we also see patients for RVAS, or recurrent veins after previous veins surgery. Compression therapy is not uncommonly a feature of vein treatments. We offer a variety of compression products and will be happy to help you find the best fit.
Patients often ask if insurance will cover their treatments? This generally depends if the procedure is done for cosmetic or medical purposes. It also depends on your insurance policy. We accept most types of insurance and Medicare and will work with your insurance carrier to seek preauthorization assessments when indicated.
Normal Vein Function
The function of veins in to bring blood back to the heart. Because the veins often work against gravity, 
they contain one-way valves to prevent the blood from flowing backwards as it travels back to the heart. If the one-way valve becomes weak, some of the blood can leak back into the vein, causing the veins to become congested or clogged. This causes what is know as vein reflux. Venous reflux is a condition that develops when the valves that usually keep blood flowing out of your legs become damaged or diseased. When this occurs in the superficial veins, this congestion will cause the veins to abnormally enlarge, which in turn leads to either varicose veins and/or spider veins. When this happens over the long term, complications such as thrombophlebitis, DVT, chronic venous stasis disease and venous stasis ulcers can occur.
For more information:American Venous Forum
Varicose Veins
Varicose veins are swollen bulging veins under the surface of the skin that can be dark purple or blue in color. Although varicose veins can occur anywhere in the legs, they most often on the backs of the calves and behind the knees. Varicose veins are often due to incompetent valves in the veins which allows the blood to pool and stretch out the veins below. While many varicose veins are asymptomatic, patients with bulging veins often complain that their legs feel heavy, or ache, and often they throb or feel more uncomfortable as the day goes on. It is thought that these symptoms are due to a stretching of the veins as the blood abnormally pools in the leg vessels when the patient is standing.
For more information: American Venous Forum
Complications of varicose veins
If the veins problems become severe and long standing, they can cause a number of symptoms. Common symptoms include
- A heavy sensation in the legs when standing
- Easy leg fatique
- Aching Pain
- Itching and skin irritation along the swollen veins.
- Throbbing sensation along the veins
- Restless Legs
Patients tend to find that the longer they are up and on their feet, the worse the symptoms they experience.
Beyond the symptoms, patients can have complications when varicose veins persist and go untreated. In a number of cases long-standing venous insufficiency can occur, which is a condition that occurs when the blood in the veins pools and stretches out the veins, resulting in chronic leg swelling. This causes a stretch on the veins and skin that can lead to subsequent complcations. This problem can be particularly severe in patients who have had previous deep venous thrombosis, a condition known as the post thrombotic syndrome.
One of the first complications seen are at the skin level, often at the ankle. Patients can develop:
- Ankle hyperpigmentation (increased skin color)
- Lipodermatosclerosis (hard, plaque-like painful areas affecting the skin and the tissues under the skin)
- Atrophie blanche (white scar tissue)
Because the skin tissue around the varicose veins, especially at the ankle level, may not receive enough nourishment when the venous pressures are high, sores or skin ulcers may develop. Without treating the superficial venous insufficiency, these ulcers can be very difficult to heal and can be very disabling.
Another potentially severe condition is called superficial venous thrombophlebitis, which can occur in the superficial veins or deep veins. Superficial venous thrombophlebitis is inflammation in addition to a blood clot, in a superficial vein or veins that lie above the muscles of the leg and in the fatty tissue just under the skin. This process can further damage the valves, contributing to worsening vein problems. This condition can also progress to problems like a deep-vein thrombosis (blood clot) which can be very dangerous because of the possibility of it traveling from the leg veins to the lungs, known as a pulmonary embolism, where it may block the heart and lungs from functioning.
Occasionally, the skin over the veins become so thin that the skin breaks open and bleeding ensues.
Expert Diagnostics
For many patients, an office evaluation by a vein specialist is all that is needed to determine the extent of the varicose and spider veins, and to develop an initial treatment plan.
In other patients, however, when there is evidence that some of the larger superficial veins might be incompetent and contributing to the visible varicose veins. When this is suspected a detailed examination using a sophisticated Duplex Doppler ultrasound scanner is done to 'map' the points of venous insufficiency and characterize the size and location vessels.
This non invasive test performed in the office setting allows the treating physician to better characterize the extent of the problem and develop a treatment plan that will minimize the chance of recurrence and maximize the potential to obtain the best results. Ultrasound is also used after treatments to monitor progress, rule out complications, and assure optimal results. All this is performed on site in our vascular laboratory.
Compression Therapy
Wearing compression stockings is often the first approach to try before moving on to other treatments. Compression stockings are worn all day long. Gradient compression delivers a squeezing to the leg that is tightest at the ankle. The degree of squeezing or compression gradually decreases up the leg. They steadily squeeze your legs, helping veins and leg muscles move blood toward the heart more efficiently. The amount of compression varies by type and brand. We have a wide variety of brands, sizes and colors available to choose from in the office.
EVLT
Endovenous Laser Treatment is an alternative to surgical stripping of certain underlying veins that are the source of surface varicose veins. Endovenous Laser Treatment is done in-office under local anesthesia. It works by heating the inside of the vein, which causes it to seal shut and disappear.
This technique requires that a very thin laser fiber be inserted into the damaged underlying vein. 
To perform the procedure, the doctor uses an ultrasound machine to map the vein, and then injects the area with local anesthesia. The doctor places a needle into the lower end of the diseased vein, through which a small sheath is put into the vein. The laser fiber is then placed through the sheath and advanced to the upper end of the diseased vein. Local anesthesia is then delivered to the entire vein. The laser fiber heats the inside of the vein as it is slowly withdrawn back down the vein. Again, after the endovenous laser treatment, any remaining residual surface varicose veins may be treated with either sclerotherapy or ambulatory phlebectomy.
While less invasive than than traditional open ligation and vein stripping, the results are comparable and may even be better in terms of the incidence of long term recurrence.
Ambulatory Phlebectomy
Medium-sized and larger varicose veins can be removed by a procedure called stab avulsion or phlebectomy. This procedure can be performed using local anesthesia, at the same time as the EVLT procedure. Small punctures are made in the skin to allow a tool to be placed through the skin to hook the vein and pull it out through the skin incision. The vein is then pulled until it breaks, causing the varicose vein to disappear. The blood is then diverted to healthier veins.
For more information
The Old Approach: Vein Stripping and Ligation
There are a number of options available for patients who need treatment of their varicose veins. Until recently, vein ligation and stripping was the standard for treating venous reflux in larger varicose veins.
These veins were treated by making an incision over the vein and tying off the vein. To strip a vein, incisions are made at the groin and near the knee and the vein is grasped and removed. Some common side effects from vein stripping and ligation surgery may include temporary pain or discomfort, bruising, hematoma, numbness, and less frequently wound infection. While vein ligation and stripping are out patient procedures, they are not usually done in the office setting since a general anesthetic is utilized. Since an incision is required in the groin, with dissection of the sapheno-femoral junction this is an operation that needs to be done in a formal operating room where vascular surgery can be performed if there are any difficulties with the dissection of the femoral vein. Recovery time is significantly longer for vein compared to the newer techniques, such as EVLT.
In recent years, physicians and companies have developed new techniques that are less invasive and that can be done in the outpatient setting. The two best known are the Laser technique (EVLT) and the radiofrequency ablation technique (the VNUS Closure Procedure). There is some suggestion that the rate of varicose vein recurrence is significantly less with endovenous ablation of the saphenous vein, such as EVLT, compared to traditional vein ligation and stripping.
Recurrent Varicosities After Surgery (RVAS)
In our practice we frequently see patients who have had previous vein stripping or ligation. Most are patients who were treated many years prior. Recurrences of varicose veins are common after previous vein ligation stripping and avulsion. Current theories of why veins recur after previous vein ligation and stripping relate to the concept of neovascularization. This is especially common after a formal saphenofemoral junction dissection and ligation, a technique that was common until recently. Neovascularization occurs when the veins from the abdomen and pelvis are dilated with gravity and ultimately coalesce to form new, large varicose veins in the legs. While early studies suggest that the newer endovenous approaches to obliterating the saphenous vein lead to significantly less or neovascularization because the saphenofemoral junction is left intact, long term studies are not yet available to prove this assumption. Vascular Ultrasound is an excellent way to assess these often complex patterns, and both ambulatory phlebectomy and ultrasound guided sclerotherapy can be very effective forms of treatment for recurrent veins.
Are these treatments covered by insurance?
This depends on your policy and specific coverage provided by your insurnace carrier. In general, most insurance providers have two categories under which vein treatments may fall:
- Cosmetic Procedures
- Medically Necessary Procedure
Some vein treatments will fall under the category of cosmetic procedure, and as such, will not be covered by most insurance providers. This is commonly the case for asymptomatic spider veins.
In certain circumstances, however insurance companies may deem varicose veins and other disorders medical necessary and thus will offer varying degrees of coverage depending on their contracts with the patient and the doctor. Insurance companies use varying criteria in order to determine if vein treatment is to be considered "medically necessary." These criteria may include one or more of the following:
- Lifestyle Disruption: the daily activities of the patient must be disrupted significantly.
- Pain: The patient must be experiencing pain as a result of their vein disorder.
- Failure of Conservative Measures: Other methods of treatment, such as compression hose, have failed to provide adequate relief.
- Vein Size: Bulging veins larger than 4 mm are often considered medically significant.
- Complications: Complications, such as phlebitis, bleeding veins, leg swelling and leg ulceration make it more likely an insurance company will consider treatment medically necessary.
A trial of conservative management is sometimes required prior to providing coverage for varicose vein treatments. This includes a number of features, and often includes compressive therapy, rest, elevation and other maneuvers. It is best to check with your insurance carrier if you have any questions about your coverage.