1. What happens to the veins in my leg used for heart bypass surgery?

2. Are the procedures covered by my insurance?

3. Are the procedures painful?

4. What happens to the blood flow after removing the abnormal veins?

5. Why has my doctor not referred me earlier?

6. Are there any contraindications to having these procedures?

7. Which treatment method is better—Radio Frequency or Laser?

8. Can I have these procedures even though I'm on blood thinners?

9. When can I return to normal activities?

10. When can I resume routine exercising?

11. What are the causes of varicose veins?

12. What is the chance that varicose veins will recur?

13. What's the difference between vein stripping and vein ablation?

14. Why should I have vein treatment?

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1. What happens to the veins in my leg used for heart bypass surgery?

Veins which become incompetent and dilated are not suitable for heart or any artery bypass. These veins are abnormal, too large, and will clot and close within three to six months after the bypass. An abnormal saphenous vein should never be used for artery bypass of any kind. Heart surgeons now use other blood vessels for bypass, or use veins which are not abnormal.

2. Are these procedures covered by my insurance?

All vein treatments are covered by insurance with exception of treatment for spider veins. Spider veins are those 1mm or less in diameter, and are considered cosmetic treatments by insurance companies and medicare.

3. Are the procedures painful?

During the main laser surgery procedures, our patients receive a moderate sedation and usually sleep through the procedure, therefore there is no pain. After surgery, 4 of 10 of our patients report having no pain, and the remainder report pain with intensity less than 5 on a scale of 1 - 10. There is very little pain associated with the modern vein treatments for most patients.

4. What happens to the blood flow after removing the abnormal veins?

The saphenous veins are the abnormal veins most frequently eliminated by the laser surgery. The skin of the leg drains to the saphenous vein, which then flows into the deep veins. When the saphenous veins are ablated, the skin spontaneously diverts to the deep veins within a short time. The deep vein valves are always normal unless there has been a previous deep vein blood clot. Consequently, the leg vein abnormalities are instantly corrected.

5. Why has my doctor not referred me earlier?

Many doctors are not aware of modern vein treatments, nor are they aware of the abnormalities causing vein problems. We spend quite a lot of time educating other doctors about the new and greatly improved treatments available today. Our patients often take information back to their doctors, which is a good way to be sure the doctor is informed.

6. Are there any contraindications to having these procedures?

Pregnancy is the most absolute. Some patients are simply too ill and should not undergo any procedure. Some patients with extensive deep vein blood clots should not have the new procedures. Interestingly, patients with abnormal blood clot problems and on anti-coagulation can still undergo treatment with the modern laser methods. Every patient is carefully evaluated before we determine that either nothing can be done, or the treatment would not be effective.

7. Which treatment method is better—Radio Frequency or Laser?

We had the opportunity to perform more than 1000 radio-frequency closure procedures. Unfortunately, nearly 20% of the treated veins re-opened beginning about six months after surgery. The laser used in the AVVC practice has a 99.7% success rate to keep the treated veins closed forever. A recently published report comparing laser to radio-frequency and to stripping surgery showed that the laser has the far better outcome long term.

8. Can I have these procedures even though I'm on blood thinners?

Most of the time you may continue the anti-coagulation, even Coumadin. The laser energy used is very effective to close veins even if your blood has been anti-coagulated. Your doctor will advise you regarding your blood thinner and surgery.

9. When can I return to normal activities?

The only down day is the day of surgery. The following day, our patients can be walking around and some may resume work if they wish. The surgical dressing is removed the second night, and the third morning the compression hose are applied for the day. Our patients may resume work for sure on the third day, and may resume driving as well.

10. When can I resume routine exercising?

On the day after surgery, walking is encouraged. By the second day, gradual increase in the walking distance is allowed. Wait two weeks before restarting exercise program involving jogging, elliptical machine, stairstep maching, etc. The use of compression hose, especially during impact type activity, may be helpful for a period of two weeks.

11. What are the causes of varicose veins?

Heredity plays a significant role, and if one parent has this problem, the risk is 40%; if both parents have it, then the risk rises sharply to 90%. Pregnancy is a contributing force, and with one pregnancy, the risk is 26%; after four pregnancies the risk goes up to 60%. Obesity adds to the risk, and acts like being constantly pregnant. Female gender is a risk in early life, and after 55 years, males have a higher risk. Lifestyle plays a role, especially standing for long periods.

12. What are the chances varicose veins will recur?

The risk for the saphenous veins which are treated with the laser to open up again is small—3-5%. The smaller spider veins which are treated with sclerotherapy can occur in other areas of the legs, and often require maintenance treatment every 1-2 years.

13. What's the difference between vein stripping and vein ablation?

Vein stripping has been around since 1905, and has been the main procedure performed by surgeons whereby the major saphenous veins were removed by placing a device into the vein from the ankle/knee area up to the groin area. The vein is disconnected in the groin, secured to the device within the vein, and the device is pulled downward to the knee or ankle area. This is often done in the operating room under anesthesia, and the resulting bruising and pain is significantly more than the present day vein ablation. A laser fiber is used in the vein ablation, introducing it into the saphenous vein at the knee, upper calf area and positioning the tip at the groin level. Local or tumescent anesthesia is placed around the vein to be treated before sealing up the vein with the laser fiber, which is slowly pulled down the entire vein from the groin to the knee area. All of this is performed in an office setting, and the patients are awake with moderate conscious sedation. The possibility of bruising and pain for vein ablation is much lower.

14. Why should I have vein treatment?

The complications of leaky venous valves are significant. The resultant chronic venous insufficiency syndrome leaves one with lipodermatosclerosis, a scarring of the skin and underlying tissue in the ankle area, and this is painful, and can subsequently break down into ulcer formation. The brownish discoloration known as stasis dermatitis is a permanent change seen in the ankle area, and this can progress to ulcer formation. Blood clots can form in the ropy varicose veins, and bleeding can also be a complication of spider veins and varicose veins. Early treatment can help prevent these complications.

 

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