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Varicose Vein Treatment [Transcript]

Jennifer Heller is the Director of the Johns Hopkins Vein Centers.
Jennifer Heller, MD, FACS, is
the Director of the Johns
Hopkins Vein Centers.
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Featuring Jennifer Heller, MD, FACS, Director of Johns Hopkins Vein Centers

Many doctors treat varicose veins – why consult with a vascular surgeon?

A very unique component of the Johns Hopkins Vein Centers is that all of our treating physicians are board-certified vascular surgeons. And that truly provides us with a very unique, expert view and perspective on causes, treatments and differential diagnoses of varicose veins. When I mean differential diagnoses, I mean that just because someone has varicose veins, doesn’t necessarily mean that the presence of varicose veins is what is causing your underlying problem. And as vascular surgeons, we are best equipped to be able to tease out those nuances and treat you appropriately and safely.

Describe compression stockings and why they are recommended.

Compression stockings really have such a terrible reputation. But in actuality, compression stocking products have greatly improved since the days of our grandmothers and great-grandmothers. And truly, compression stockings have a great deal of advantages: They are safe. They are non-invasive. And they stabilize most patients’ venous disease. And as vascular surgeons at the Johns Hopkins Vein Centers, we pride ourselves on the art of surgery. Sometimes it’s appropriate to intervene and sometimes it isn’t. Approximately 15%-20% of the patients that I see do very well with non-invasive, or conservative, management. And that’s why compression stockings are very important.

The other good news about compression stockings is that most insurance companies will cover patients for their cost.

What can I expect from new minimally invasive treatments?

Over the past ten years, the treatment of superficial venous insufficiency and varicose veins has witnessed quite a revolution. At the Johns Hopkins Vein Centers, we are able to offer our patients out-patient procedures lasting one hour or less under twilight anesthesia.

What is the treatment for spider veins?

We offer a few different types of treatments for spider veins. The first thing, however, which is most important always, is to determine if you have any possible risk factors not to pursue injection sclerotherapy or any type of spider vein treatment. Some possible conditions include chronic skin conditions or whether or not you may be on any type of blood thinning medication such as Coumadin. Injection sclerotherapy is one of the types of spider vein therapy we offer at the Johns Hopkins Vein Centers, and that involves injecting tiny little needles into the spider veins – and they are really rather painless – and schlerosant solution is used to shut down those spider veins.

We also do offer state-of-the-art technologic advances such as laser treatments, which are also used in combination with injection sclerotherapy.

What is percutaneous ablation?

Treatment of the superficial veins, such as the great saphenous vein, which runs on the inside of your leg from the groin in a straight line down to your ankle, or the small saphenous vein, which runs behind your calf muscle, are best treated with a variety of techniques called percutaneous ablation. Two different types of heat can be utilized to heat the inside of the vein: radio ablation heat or laser heat. And once this heat is applied, the vein tube then closes and the catheter is removed. The vein blood that used to sit in this ineffective vein now gets naturally redirected into the deep veins of the lower extremities or legs that are much more effective, and your circulation improves immediately.

How are venous ulcers treated?

It has been my experience that patients have been treating their vein ulcers at wound centers or with other physicians, only to find that after healing they can recur. At the Johns Hopkins Vein Centers, we pride ourselves on the ability to not only identify these ulcers as being venous in origin, but also being able to treat them and prevent them from recurring. Some of the surgical procedures that we have to treat vein ulcers do include the ablation procedures as well as the phlebectomies.

What is a phlebectomy?

A phlebectomy is a removal of a vein segment. At the Johns Hopkins Vein Centers, we offer both the conventional, or hook, phlebectomy, as well as a powered phlebectomy which is a state-of-the-art, minimally-invasive procedure, which utilizes transillumination with a light through the skin, with easy access with a receptor device to remove those vein branches. Your Johns Hopkins Vein Centers physicians will best determine which phlebectomy procedure suits you.

What is vein stripping and is it still performed?

Up until 10 years ago, vein stripping was the gold-standard surgical therapy for treatment of venous insufficiency. Thankfully, that procedure is no longer indicated and not considered first-line care for superficial venous insufficiency intervention. Occasionally, when we see complex patients, there may be a partial stripping available, however with surgeons who do operate on large volumes of venous patients, truly stripping is no longer indicated.

What are the risks or side effects of treatment of varicose veins?

I will commonly tell my patients that as soon as I pick up the scalpel, I can’t give you zero risk. And that’s why it’s very important, as we pride ourselves here at the Johns Hopkins Vein Centers that we weigh the risk-benefit ratio for each patient very carefully. Just because a patient has varicose veins does not mean that they require surgical intervention. There are a multitude of risks, although the risk incidence is extremely small of all of these procedures. And they include a 1% chance or less of development of a deep vein thrombus, less than a 0.5% chance of development of a pulmonary embolus, temporary or permanent numbness, nerve injury, and phlebitis are a few of the many possible side effects.

I do think it’s very important not to minimize these problems to patients, because before we do the surgery is the time to discuss all of the possible advantages and disadvantages. Although venous insufficiency is not a cosmetic issue, it’s very important and it is our responsibility as surgeons to be able to provide our patients with all of the information they have to make the correct decision for them.

Does insurance cover varicose vein treatment?

One of the myths that I aim to dispel before my vascular surgical career is over is that venous insufficiency and associated varicose veins are merely a cosmetic issue. And that really couldn’t be farther from the truth. Because of that, insurance companies do know that surgical intervention, when warranted, is covered. And it is our job to make sure that patients’ symptoms and course matches their needed surgical intervention.

Our first step at the Johns Hopkins Vein Centers is always to proceed with compression stockings and conservative management, which also includes elevating the legs one to two times a day. And certainly in cases where patients do not feel any type of relief from these measures, surgical intervention is clearly warranted. At that point in time, insurance companies – more often than not – cover the vast majority of these cases.

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