The
condition that results from these leaky valves
is known as reflux. When the blood is refluxing
back down the legs it puts excess pressure on
the vein walls, which causes them to expand.
This expansion causes the valves to be even
more ineffective. In order to treat the varicose
veins effectively the greater saphenous vein
must be treated. If we just removed the branches,
the refluxing blood in the main tree would result
in more varicose branches.
In rare cases you may have
reflux in the greater saphenous vein that causes
spider veins on the medial thigh, knee and calf.
But for the most part spider veins are unrelated
to reflux in the saphenous vein.
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Who
should treat your Veins?
Significant venous
reflux can be the cause of varicose veins and
needs to be corrected first. Veins of any size
should be treated by a physician who understands
venous physiology and who can offer all state-of-the-art
methods of treatment. As a Board Certified Vascular
Surgeon with over 15 years experience, Dr. Bardwil
understands the underlying venous disease and
can choose among all techniques available to
decide your best course of treatment.
Dr. Bardwil will meet with
you one-on-one to perform a comprehensive screening
evaluation and will advise you on the best treatment
option for your venous disease.
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What
can be done to correct Varicose Veins?
Recent technology
has enabled saphenous vein reflux and reflux
in other veins to be treated without surgery.
Using only needle access to the vein, a catheter
can be advanced the length of the vein. The
vein is sealed using laser or radio frequency
energy as a heat source. When the vein is closed,
the pressure problem is resolved and symptoms
improve. Since the root of the problem is eliminated,
most varicose veins will subsequently become
smaller or disappear.
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What
is the Endovenous Laser (ELAS) procedure?
The ELAS procedure is
a minimally invasive treatment for superficial
venous reflux. A thin catheter is inserted into
the vein through a small opening. The catheter
delivers laser energy to the vein wall, causing
the vein to close.
What is Venous
Insufficiency?
Venous Insufficiency is the underlying pres-sure
problem created in the veins of the legs that
give rise to varicose veins and symptoms of
swelling, heaviness, fatigue and achiness in
the legs. Saphenous vein reflux, or reverse
flow, is usually the root of the problem and
may be accompanied by reflux of other veins
also. It is estimated that 25 million people
suffer from venous insufficiency. In its most
severe form, this can cause profound swelling
and skin breakdown or ulceration.
How does it
work to treat venous insufficiency?
Since valves cannot be repaired, the only alternative
is to re-route blood flow through healthy veins.
Traditionally, this has been done by surgically
removing (stripping) the troublesome vein from
your leg. The ELAS procedure provides a less-invasive
alternative to vein stripping by simply closing
the problem vein. Once the diseased vein is
closed, other healthy veins take over and empty
blood from your legs.
How is the
ELAS procedure different from vein stripping?
During a stripping procedure, the surgeon
makes an incision in your groin and ties off
the vein after which it is removed from your
leg through a second incision in your calf.
In the ELAS procedure, there is no need for
groin surgery, the vein remains in place and
is simply closed using a special laser fiber
inserted through a small skin puncture. Vein
stripping is usually performed in an operating
room, under a general anesthetic. The ELAS procedure
is performed on an outpatient basis typically
using local anesthesia.
How long does
the procedure take?
The ELAS procedure takes approximately 1 hour.
Where will
the procedure be performed?
The ELAS procedure is usually performed in our office
Is the procedure
painful?
You will be given a local anesthetic to numb
the treatment area. Patients report feeling
little if any pain during the ELAS procedure.
Will the procedure
require any anesthesia?
This procedure is well-tolerated using local
anesthesia and can be performed in the office
or in an ambulatory surgery center. Patients
report feeling little if any pain.
How quickly
can I return to my normal activities?
Many patients can resume normal activities within
1-2 days. For a few weeks following the treatment.
A regular walking regimen is recommended and
you should refrain from very strenuous (heavy
lifting for example) and prolonged periods of
standing.
How soon will
my symptoms improve?
Most patients report a noticeable improvement
in their symptoms soon after receiving the procedure.
Are there any
potential risks or complications?
As with any medical intervention, potential
risks and complications exist with the ELAS
procedure. Each patient should consult their
doctor to determine if their condition presents
any special risks. Dr. Bardwil will review potential
complications of the ELAS procedure at the consultation.
Is there any
scarring, bruising, or swelling after the treatment?
Patient’s report minimal to no scarring
following the ELAS procedure. Brusiing will
usually resolve in one to two weeks. There may
be slight tenderness or numbness during the
weeks after treatment.
Is the ELAS
procedure suitable for everyone?
Only your doctor can tell you if the procedure
is a viable option for your vein problem.
How long will
the treated vein remain shut?
Current published reports suggest that over
90% of treated veins remain closed after 2 years.
What happens
to the treated vein left behind in the leg?
The vein simply becomes a fibrous tissue after
treatment. Over time, the body will probably
re-absorb this fibrous tissue. One study reported
that the treated vein is indistinguishable from
other body tissue one year after the procedure
was performed.
Is the ELAS
treatment covered by my insurance?
Insurance coverage is determined on a per case
basis. Most insurance companies determine coverage
for all treatments, including the ELAS procedure,
based on medical necessity. Dr. Bardwil’s
staff will discuss your insurance coverage further
at the time of consultation.
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What
is the Endovenous Radio Frequency (Closure®)
procedure?
The Closure procedure is a minimally invasive
treatment for superficial venous reflux.
What is Venous
Insufficiency?
Venous Insufficiency is the underlying pres-sure
problem created in the veins of the legs that
give rise to varicose veins and symptoms of
swelling, heaviness, fatigue and achiness in
the legs. Saphenous vein reflux, or reverse
flow, is usually the root of the problem and
may be accompanied by reflux of other veins
also. It is estimated that 25 million people
suffer from venous insufficiency. In its most
severe form, this can cause profound swelling
and skin breakdown or ulceration.
How does it
work to treat venous insufficiency?
Since valves can’t be repaired, the only
alternative is to re-route blood flow through
healthy veins. Traditionally, this has been
done by surgically removing (stripping) the
troublesome vein from your leg. The Closure
procedure provides a less-invasive alternative
to vein stripping by simply closing the problem
vein. Once the diseased vein is closed, other
healthy veins take over and empty blood from
your legs.
How is the
Closure procedure different than vein stripping?
During a stripping procedure, the surgeon makes
an incision in your groin and ties off the vein
after which it is removed from your leg through
a second incision in your calf. In the Closure
procedure, there is no need for groin surgery.
The vein remains in place and is simply closed
using a special (Closure) catheter inserted
through a small skin puncture.
How long does
the procedure take?
The Closure procedure takes approximately one
hour.
Where will
the procedure be performed?
The Closure procedure is performed
in surgical centers as an outpatient (day surgery)
procedure.
How quickly
can I return to my normal activities?
Many patients can resume normal activities within
1 -2 days. For a few weeks following the treatment,
Dr. Bardwil may recommend a regular walking
regimen and suggest that you refrain from very
strenuous activities activities (heavy lifting
for example) or prolonged periods of standing.
How soon will
my symptoms improve?
Most patients report a noticeable improvement
in their symptoms soon after receiving the procedure.
Are there any
potential risks or complications?
As with any medical intervention, potential
risks and complications exist with the Closure
procedure. Each patient should consult their
doctor to determine if their condition presents
any special risks. Dr. Bardwil will review potential
complications of the Closure procedure at the
consultation.
Is there any
scarring, bruising, or swelling after the treatment?
Patients report minimal to no scarring, bruising,
or swelling following the Closure procedure.
On occasion, there may be slight tenderness
or numbness during the weeks after treatment.
How long will
the treated vein remain shut?
Current published reports suggest at the 2 year
follow up, 90% of treated veins remain closed.
What happens
to the treated vein left behind in the leg?
The vein simply becomes a fibrous tissue after
treatment. Over time, the body will probably
re-absorb this fibrous tissue. One study reported
that the treated vein is indistinguishable from
other body tissue one year after the Closure
procedure was performed.
Is the Closure
treatment covered by my insurance?
Insurance coverage is determined on a per case
basis. Most insurance companies determine coverage
for all treatments, including the Closure procedure,
based on medical necessity. Dr. Bardwil can
discuss your insurance coverage further at the
time of consultation.
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What
is Ultrasound Guided Sclerotherapy?
Ultrasound Guided Sclerotherapy
is a very effective method of treating varicose
veins. Utilizing ultrasound the varicose vein
is visualized on a screen and Dr. Bardwil uses
this technology to guide the placement a needle
directly into the diseased vein. A sclerosing
agent is injected into the veins. This causes
an irritation to the inner lining of the vein
resulting in closure of the vein. The injections
are done along the course of the vessel, as
needed, usually 4-5 injections per leg. The
number of treatments varies depending on the
severity of your condition.
The majority of persons who
have Ultrasound Guided Sclerotherapy performed
have satisfying results. Dr. Bardwil will determine
if this procedure will be effective and safe
for you.
The
majority of persons who have Ultrasound Guided
Sclerotherapy performed have satisfying results.
Dr. Bardwil will determine if this procedure
will be appropriate for you.
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What
are Venous Stasis Ulcers?
When reflux is
left untreated over many years, the constant
pressure backup may cause a leaking of the blood
into the tissues. This leaking causes brown
stains on the skin. This is known as stasis
skin changes and can become serious.
In cases where the stasis
is severe, a breakdown of the tissue may result
in a chronic venous stasis ulcer. Venous stasis
ulcers are very difficult to treat and are chronic
in nature with the ulcer reopening just when
you thought it was healed.
Venous stasis ulcers do not
occur in all patients with varicose veins. Unfortunately,
we cannot definitively predict who will go on
to develop this complication. When skin changes
begin to appear, the likelihood of an ulcer
increases.
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