ANDREW STYPEREK MD
Treating your Veins
TAMARAC
7301 N University Drive, Suite 102
Tamarac, FL 33321
Phone: 954-726-2000
Function of Peripheral Venous System
Returning blood to the heartRegulate body temperatureStore bloodRegulate cardiac output
Value ensure blood return
Valves ensure unidirectional blood return to the heart by preventing effect of gravity
Mostly in lower legs
Normal flow Abnormal
Calf muscle pump
Calf muscle drives blood return to the heart
Anatomy
There are 2 vein systems in the leg
Front View
Superficial Deep
AnatomySuperficial Deep
There are 2 vein systems in the leg
Rear View
Common symptoms of vein disease
Varicose or Spider Veins
Swelling Skin ChangesColor/Texture/Rash
Ulcers or open sores
Fatigue Cramping
Pain
Itching
Burning
Restless leg
AchingHeaviness
Other examples
Treatment
Before treating visible veins, it is important to examine the veins upstream…
What we see…
Where the problem is…
Duplex Ultrasound
Highly accurate, live, painless test of veinsProvides information about:
Anatomy Blood flow Clots Valves
12
Treatment Options
Conservative Therapies: Require consistent and daily treatment
*Exercise *Leg elevation *Compression stockings *Use of NSAIDS *Unna boot or compression wraps (for ulcers)
Heat Non-HeatSurgical
Radio-frequenc
yLaser Roto-
rooter Foam
Glue
Stripping
Compression
w/o compression w/ compression
Compression Stockings
Depending on coverage & disease severity, you will need to attempt compression for 90-180 days.
Minimum 20-30mm HgNot covered by insuranceMultiple designs, each with pros & cons
Surgical Ligation & Stripping
Surgical cutting & removal of veins, including cutting and sewing of all connections to other veins
Removal may or may not be assisted with a device
Performed for 100+ years Requires general anesthesia in
operating room 4 weeks recovery
Vein Ablation: Heat
Heat shrinks the vein wall, seals vein closed, blood rerouted to healthy veins
Symptom relief in 2 days
Resume normal activities within a few days
Vein ablation: Laser vs RF
17 Radiofrequency
Continuous Pullback Requires continuous careful pulling of
laser through vein human error due to pullback speed
Segmental Ablation Controlled heat delivery No human
error during treatment of each segment
Laser Ablation
Vein ablation: Non-heat
Cyanoacrylate Adhesive
Large amount of adhesive/ thrombus is left in the AVM as seen on MRI.
Courtesy of Dr. R. Raabe
If we can glue high-flow cerebral AVMs, why can’t we glue low-flow varicose veins?”
– Dr. R. Raabe, 2008
Benefits of non-heat therapy
No need for: Tumescent anaesthesia Post-procedure
compression Post-procedure pain &
bruising
Sclerotherapy
Sclerotherapy
Before
After
Conclusion
Heat Non-HeatSurgical
Radio-frequenc
yLaser Roto-
rooter Foam
Glue
Stripping
FAQs
Do I need these varicose veins for bypass surgery? NO. Other bypass grafts can come from radial arteries (one in
each arm) and mammary arteries (one on the left and right) in the chest that can be harvested to do bypass surgery.
Varicose veins are NOT healthy and often large (varicose) and NOT suitable for bypass grafting and likely to clot once they are in place because of the size mismatch and their inflamed (phlebitic) nature.
Finally, chances are in your lifetime that you will get a stent for blockages in your heart rather than bypass surgery.
Using them would be like putting worn tires that are about to blow onto your car before a cross-country trip.