Venous Disease Archives - Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA

Phlebectomy

Codeholic Admin — Mon, 13 Mar 2017 16:55:32 +0000

Phlebectomy

What is Phlebectomy of Varicose Veins?

Phlebectomy is a minimally invasive procedure used to remove varicose veins on the surface of the leg. This is usually done in a physician’s office using local anesthesia.

How should I prepare?

You will receive specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule.

You should wear comfortable, loose-fitting clothing to your exam. You may be given a gown to wear during the procedure.

What does the equipment look like?

A small scalpel or needle is used to make very small incisions. A phlebectomy hook is used to remove the veins. The hook is similar to a tiny crochet hook with a blunt tip and a straight shaft.

How does the procedure work?

Phlebectomy involves making tiny punctures or incisions in the skin near the varicose vein. Veins are very collapsible and even large veins can be removed through the tiny incisions used in this technique.

How is the procedure performed?

This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Please consult with your physician as to whether or not you will be admitted.

Your physician will numb the area with a local anesthetic.

Because the area is numbed, you are typically awake during the procedure.

A very small skin incision is made at the site.

After cleansing and anesthetizing the skin, a series of incisions no larger than a pencil eraser are made in the skin next to the enlarged vein. A phlebectomy hook is inserted under the surface of the skin to remove the varicose vein through the tiny incision. This procedure is usually completed between 30 minutes and one hour.

What will I experience during and after the procedure?

Patients rarely report any pain during this procedure because the area being worked on is under a local anesthetic.

The incisions made during the procedure are so small that no stitches are required.

When the procedure is complete, your leg will be wrapped in a comfortable but snug compression wrap.

You will need to wear graduated compression stockings for approximately two to three weeks following the procedure. As long as the stockings are worn, almost all activities can be done beginning the day after the surgery.

You should be able to resume daily activities within 24 hours. Strenuous activities will be limited for approximately two weeks.

Who interprets the results and how do I get them?
The interventional radiologist can advise you as to whether the procedure was a technical success when it is completed.

Your interventional radiologist may recommend a follow-up visit after your procedure or treatment is complete.

The visit may include a physical check-up, imaging procedure(s) and blood or other lab tests. During your follow-up visit, you may discuss with your doctor any changes or side effects you have experienced since your procedure or treatment.

What are the benefits vs. risks?

Benefits

No surgical incision is needed—only a small nick in the skin that does not have to be stitched.

Risks

Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
Skin pigmentation at the site of the treated varicose vein may occur but is usually temporary.

What are the limitations of Phlebectomy of Varicose Veins?

Long-term success in greater than 90 percent of patients has been observed. The long-term results of phlebectomy are excellent when the procedure is performed in patients who are good candidates.

Often, phlebectomy is used with a more comprehensive treatment plan, including additional procedures such as endovenous catheter ablation that use radiofrequency or laser energy.

Patients should discuss their individualized treatment plan with their interventional radiologist.

The above information is not all inclusive of the risks, alternatives and benefits. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion. There are complications possible with any medical procedure. Overall, minimally invasive procedures have a lower complication rate than open surgeries.

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SVC Obstruction

Codeholic Admin — Mon, 13 Mar 2017 16:55:08 +0000

SVC Obstruction

SVC obstruction is a narrowing or blockage of the superior vena cava, which is the second largest vein in the human body. The superior vena cava moves blood from the upper half of the body to the heart.

Causes

Superior vena cava (SVC) obstruction is a relatively rare condition.

It is most often caused by cancer or a tumor in the mediastinum (the area of the chest under the breastbone and between the lungs).

The types of cancer that can lead to this condition include:

Breast cancer
Lymphoma
Metastatic lung cancer (lung cancer that spreads)
Testicular cancer
Thyroid cancer
Thymus tumor

Superior vena cava obstruction can also be caused by noncancerous conditions that cause scarring. These conditions include:

Histoplasmosis (a type of fungal infection)
Inflammation of a vein (thrombophlebitis)
Lung infections (such as tuberculosis)

Other causes of superior vena cava obstruction include:

Aortic aneurysm (a widening of the artery that leaves the heart)
Blood clots in the superior vena cava
Constrictive pericarditis (tightening of the thin lining of the heart)
Effects of radiation therapy for certain medical conditions
Enlargement of the thyroid gland (goiter)
Catheters placed in the large veins of the upper arm and neck may cause blood clots in the superior vena cava.

Symptoms

Symptoms occur when something blocks the blood flowing back to the heart. They may begin suddenly or gradually, and may worsen when you bend over or lie down.

Early signs include:

Swelling around the eye
Swelling of the face
Swelling of the whites of the eyes
The swelling will most likely be worse in the early morning hours and go away by mid-morning.

The most common symptoms are shortness of breath (dyspnea) and swelling of the face, neck, trunk, and arms.

Other possible symptoms include:

Decreased alertness
Dizziness
Fainting
Headache
Reddish face or cheeks
Reddish palms
Reddish mucus membranes (inside the nose, mouth, and other places)
Redness changing to blueness later
Sensation of head or ear “fullness”
Vision changes

Exams and Tests

An examination may show enlarged veins of the face, neck, and upper chest. Blood pressure is often high in the arms and low in the legs.

A bronchoscopy (a lighted tube placed through the mouth into the windpipe and lungs) may be performed if lung cancer is suspected.

Blockage of the SVC may be visible on:

Chest x-ray
CT scan of the chest or MRI of chest
Coronary angiography (a heart blood vessel study)
Doppler ultrasound (sound wave test of the blood vessels)
Radionuclide ventriculography (nuclear study of heart motion)

This disease may also affect the results of the following tests:

Abdominal MRI or CT scan
Liver scan

Treatment

The goal of treatment is to relieve the blockage.

Diuretics (water pills) or steroids may be used to temporarily relieve swelling.

Other treatment options may include radiation or chemotherapy to shrink the tumor, or surgery to remove the tumors. A minimally invasive option is placement of a stent to open up the SVC. This is performed by a vascular and interventional radiologist. Surgery to bypass the obstruction is rarely performed.

Outlook (Prognosis)

The outcome varies, depending on the cause and the amount of blockage.

SVC syndrome caused by a tumor is a sign that the tumor has spread, and it indicates a poorer long-term outlook.

Possible Complications
The throat could become blocked, which can block the airways.

Increased pressure may develop in the brain, leading to changed levels of consciousness, nausea, vomiting, or vision changes.

When to Contact a Medical Professional
Call your health care provider if you develop symptoms of SVC obstruction. Complications are serious and can sometimes be fatal.

Prevention

Prompt treatment of other medical disorders may reduce the risk of developing SVC obstruction.

Alternative Names
Superior vena cava obstruction; Superior vena cava syndrome

References

Rice TW, Rodriguez MR, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore). 2006;85;1:37-42. PMID: 16523051 www.ncbi.nlm.nih.gov/pubmed/16523051.

Ugras-Rey SS. Selected oncologic emergencies. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 123.

Wilson LD, Detterbeck FC, Yahalom J. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356:1862-9. PMID: 17476012 www.ncbi.nlm.nih.gov/pubmed/17476012.

Review Date 1/13/2015
Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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May-Thurner Syndrome

Codeholic Admin — Mon, 13 Mar 2017 16:54:49 +0000

May-Thurner Syndrome

May-Thurner syndrome is a rare vascular condition that affects a vein in the pelvis.

It occurs when a nearby artery compresses the left iliac vein. This vein brings blood from your pelvis and legs back up to your heart.

The compression prevents blood from flowing properly, leading to narrowing and scarring.

In some cases, an artery can compress the right iliac vein, or both veins.

Complications

Some people with May-Thurner syndrome have no symptoms, but over time, this condition can lead to:

Leg swelling.

Chronic venous insufficiency, in which blood pools in your veins. This causes swelling, pressure, skin changes, and venous ulcers or sores that don’t heal.

Deep vein thrombosis (DVT), a blood clot in a vein deep below your skin. If a blood clot breaks free and travels to your lungs, heart, or brain, it can lead to serious, even life-threatening issues like: Pulmonary embolism, a blood clot in your lung, Heart attack or Stroke.

Symptoms

Swelling, heaviness, or fullness in your leg or foot.
Venous ulcers or sores that do not heal on your leg.
Varicose veins in your leg.
In some cases, May-Thurner syndrome has no symptoms and patients go undiagnosed until they develop deep vein thrombosis (DVT).

Symptoms of DVT can include:

Leg swelling.
Leg pain and tenderness.
Redness or other changes in skin color.
Skin that feels warm.

Diagnosis

To diagnose May-Thurner syndrome, your doctor will:

Perform a physical exam.
Ask about your medical history and symptoms.
Use an imaging test — like an ultrasound, MRI, or venogram — to confirm your diagnosis.

Treatment

If symptoms are severe, this would warrant placement of a stent in the affected vein which would displace the pressure that caused the narrowing. This is performed by a vascular & interventional radiologist.

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Non-Healing Venous Ulcer

Codeholic Admin — Mon, 13 Mar 2017 16:54:24 +0000

Non-Healing Venous Ulcer

Non-Healing Ulcer

Venous ulcers, also referred to as stasis, insufficiency or varicose ulcers, are the result of malfunctioning venous valves causing pressure in the veins to increase. These typically occur along the medial or lateral distal (lower) leg. The resulting venous hypertension causes blood pooling when it is not as efficiently pumped back towards the heart, otherwise known as venous insufficiency. In addition, the increase in pressure stretches the vein walls, allowing proteins in the blood and blood cells to leach resulting in swelling.

The above along with poor oxygenation in turn lead to necrosis and ulceration.

Risk Factors

Diabetes mellitus
Congestive heart failure
Peripheral vascular disease
Deep vein thrombosis
Pregnancy
Obesity

Complications

One of the most typical complications associated with venous insufficiency ulcers is infection of the affected tissue.

Treatment

In addition to treating the superficial wound and edema, the secondary goal in treating venous ulcers is to alleviate the underlying condition. One of the most common treatments is compression therapy , which serves to decrease blood vessel diameter and pressure, increasing effectiveness and in turn preventing venous reflux. The second therapy would be to treat the underlying abnormal veins. This requires an experienced interventional radiologist. Our physician uses ultrasound guided to find and treat the veins with the abnormal veins by means of sclerotherapy or ablation. These methods use heat or medication to close the abnormal veins down.

References

Cleveland Clinic. Leg and Foot Ulcers. Cleveland Clinic. http://my.clevelandclinic.org/heart/disorders/vascular/legfootulcer.aspx. Accessed July 12, 2017.

Gabriel A. Vascular Ulcers. Medscape Reference. http://emedicine.medscape.com/article/1298345-overview. Updated Mar 16, 2016. Accessed July 12, 2017.

Healthwise, Inc. Venous Skin Ulcer – Topic Overview. WebMD. http://www.webmd.com/skin-problems-and-treatments/tc/venous-skin-ulcer-t…. Updated August 21, 2015. Accessed July 12, 2017.

London Health Sciences Centre. Venous Stasis & Arterial Ulcer Comparison. London Health Sciences Centre. http://www.lhsc.on.ca/Health_Professionals/Wound_Care/venous.htm. Updated February 1, 2009. Accessed July 12, 2017.

Ngan V. Leg ulcers. DermNet NZ. http://dermnetnz.org/site-age-specific/leg-ulcers.html. Accessed July 12, 2017.

Takahashi P. Chronic Ischemic, Venous, and Neuropathic Ulcers in Long-Term Care. Annals of Long-Term Care. http://www.annalsoflongtermcare.com/article/5980. Published September 5, 2008. Accessed July 12, 2017.

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Deep Venous Thrombosis (DVT)

Codeholic Admin — Mon, 13 Mar 2017 16:53:56 +0000

Deep Venous Thrombosis (DVT)

Deep Vein Thrombosis

Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the body. Blood clots occur when blood thickens and clumps together.

Most deep vein blood clots occur in the lower leg or thigh. They also can occur in other parts of the body.

A blood clot in a deep vein can break off and travel through the bloodstream. The loose clot is called an embolus. It can travel to an artery in the lungs and block blood flow. This condition is called pulmonary embolism, or PE.

PE is a very serious condition. It can damage the lungs and other organs in the body and cause death.

Blood clots in the thighs are more likely to break off and cause PE than blood clots in the lower legs or other parts of the body. Blood clots also can form in veins closer to the skin’s surface. However, these clots won’t break off and cause PE.

Diagnosis

DVT in the legs and arms can easily and quickly be diagnosed by ultrasound. Pulmonary embolism is readily detected by a CT angiogram of the lungs.

Symptoms

Symptoms of DVT in the leg include:

Swelling
Pain
Redness
Warmth to the touch
Worsening pain when bending the foot
Leg cramps (especially at night and/or in the calf)
Discoloration of skin

Treatment

Treatment of DVT in the leg is individualized for each patient. Usually, anticoagulation or blood-thinning medication is prescribed to prevent further clot formation and to minimize the risk that part of the blood clot will break off and travel to the lung.

When symptoms are severe and there is a large amount of thrombus, treatment may include placement of an IVC filter. This filter prevent blood clots from traveling to the lung. Additionally, an interventional radiologist can perform thrombectomy or thrombolysis. This minimally invasive procedure removes the clot or uses medications to break it down.

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Varicose Veins

Codeholic Admin — Mon, 13 Mar 2017 16:53:33 +0000

Varicose Veins

Varicose veins are gnarled, enlarged veins. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That’s because standing and walking upright increases the pressure in the veins of your lower body.

For many people, varicose veins and spider veins — a common, mild variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems.

Varicose veins may also signal a higher risk of other circulatory problems. Treatment may involve self-care measures or procedures by your doctor to close or remove veins.

Symptoms

Varicose veins often cause symptoms in the legs including swelling, itching, throbbing, restlessness, aching, burning, cramping, tiredness and varicose eczema. They can bleed, especially in the elderly, after relatively minor trauma. The increased pressure often causes skin damage and, in some patients, actual ulceration of the skin occurs which can take months to heal without appropriate treatment.

Diagnosis

The only way to accurately determine the underlying cause of your varicose and thread veins is by having a colour duplex ultrasound scan performed on your legs. Without this full and detailed scan, it is impossible to properly assess your veins or determine the exact treatment you require. This is performed by our vascular and interventional radiologist who is a board certified imaging specialist.

Treatment

There are three main reasons not to ignore varicose veins and to get the underlying problem which is causing the increased pressure treated:

Varicose veins are unattractive. Many people are seriously affected by the looks of their veins. They will not show their legs in public and indeed often even to their partner. This has an adverse effect on sport participation and enjoyment of holidays and other leisure activities. In some it can affect their careers and we have seen many actors and models (both sexes!) who “needed” their legs to look better. Most patients are delighted with the appearance of their legs after our treatments.
Varicose veins hurt. As mentioned above it isn’t actually the varicose veins that normally cause the symptoms but the increased pressure. Nevertheless, most patients with varicose veins suffer from various symptoms which can also affect lifestyle. Common symptoms are tired legs, itchiness, throbbing, restless legs, and aching. These symptoms usually resolve very quickly after EVLA and RFA.
Varicose veins can lead to serious skin damage and ulcers. Although most patients with varicose veins don’t get ulceration most leg ulcers are associated with varicose veins and caused by the same problem that causes varicose veins. Treating the varicose veins properly removes this cause and dramatically reduces the risk of leg ulcers.

The modern varicose veins treatment recommended to fix the underlying cause of varicose vein problems is either using Ablation or Foam Sclerotherapy. These are minimally invasive techniques performed under local anaesthetic on an outpatient basis that causes the abnormal veins to close.

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