An Alternative to Surgery

La Jolla Vein Care provides different types of non-surgical treatments for variety of vein-related conditions such as varicose veins, spider veins, and leg ulcers. Depending on the severity of the condition, we use the following procedures to treat both small and large vein problems:

• Visual Sclerotherapy
• Laser treatment
• Ultrasound Guided Sclerotherapy (Endovenous Chemical Ablation)

In addition to the aforementioned procedures, we provide:

• Vascular Studies
• – Ultrasound Examination for Venous Incompetence (Reflux)
• – Vein Mapping
• – Deep Venous Thrombosis
• Compression Therapy
• Wound Care for Venous Ulcerations

Advanced Treatments for Vein Conditions

How Treatable are Vein Problems Today?

Advancements in diagnosing and treating venous disorders make it easier than ever to manage vein conditions with minimal discomfort. By using ultrasound scanning and advanced procedures, vein care professionals are able to provide precision-based treatments that are safe, painless, and effective—all without surgery. As renowned experts in vein care, we use injection procedures to provide sophisticated treatments for a wide range of vein conditions.

Although treatment is fast, pain-free, and affordable, only 1% of Americans ever seek treatment for vein problems. Veins are not only unattractive, but can also be a sign of real disease. Too many people ignore symptoms, often rationalizing that legs naturally ache due to age or increased activity, accepting such discomfort as a part of life. The good news is that we can help people look and feel better—all without surgery or anesthesia. By specializing in treating spider veins, varicose veins, and leg ulcers with non-invasive treatments, we make beautiful and healthy legs a reality.

Treatment of Spider Veins

We treat spider veins in the legs through an injection procedure called sclerotherapy. By leveraging a state-of-the-art imaging device called Veinlite, we can pinpoint hard-to-find veins through transillumination for painless and accurate treatments. For procedures on the face, we use superficial laser obliteration to remove spider veins. For both procedures, a two-step approach is used to ensure best practices. During the first visit, the patient is carefully examined with the use of ultrasound to identify the underlying vein disease and to map out a personalized treatment plan. The Veinlite device projects an angled light that visualizes reticular veins that are not visible to the naked eye, thus allowing the simultaneous treatment of spider and reticular veins. Simultaneous treatment of spider and reticular veins provides a more thorough treatment with better cosmetic results—as opposed to just injecting the visible spider veins. The second step of the treatment occurs about four weeks later to clean up any residual veins. Most people require two to five treatments to maximize results while others discover that symptoms disappear shortly after the first injection session.

Each treatment is highly customized; some patients require repeated treatments, which ultimately results in pain-free and aesthetically more appealing legs. For other patients, chronic spider veins are a fact of life. Effective treatment of recurrent veins and good cosmetic results can be accomplished with careful follow-up and periodic treatments. Moreover, it must be remembered that spider veins are like dental cavities: properly treated they do not get worse; however, even the best treatment cannot prevent new cavities—or veins—from appearing after a certain period of time. Furthermore, there is nothing that can reverse the dominant role that heredity plays in vein disease. Given the complexities and potential risks of venous diseases, the La Jolla Vein Institute fuses the latest technologies with the most distinguished names in the field of vein care to provide patients with exceptionally high quality care and minimally invasive treatments.

Treatment of Varicose Veins

The experts at the La Jolla Vein Institute provide various options for treating varicose veins, including Sclerotherapy, Microfoam Schlerotherapy, and ultrasound-guided microfoam sclerotherapy.

Sclerotherapy

The Injection of a sclerosant medication into the vein, a procedure called sclerotherapy, is the safest, simplest, and most effective treatment method for spider veins and varicose veins. In fact, it is the gold standard for vein treatment. It is minimally invasive and almost painless. As a result, no anesthesia is necessary with treatments available at the La Jolla Vein Institute. Moreover, there is no down time; patients may resume normal daily activities right away. It has replaced painful and debilitating vein surgery as a superior and more cost-effective alternative to other procedures in the treatment of larger veins, which still require sclerotherapy to close the smaller veins that are not obliterated by laser or radiofrequency catheter ablation.

Sclerotherapy is a technique that must be administered by a specially trained physician. The physician uses a very fine needle to inject a safe sclerosing agent directly into the blood vessel. The specially developed medication displaces the blood in the vein, causing it to immediately appear lighter in color and sometimes vanish. Next, the solution irritates the vein lining, causing it to collapse, thus blocking it from getting more blood. The vein is then absorbed by the body and disappears. Healthier vessels nearby absorb the blood flow of the collapsed veins.

Microfoam Sclerotherapy

Microfoam sclerotherapy is today’s treatment alternative to surgery and to the injection of liquid sclerosants to eliminate varicose veins. Lasers and light sources can be used to treat some leg veins; however, under most circumstances, microfoam sclerotherapy, remains the therapeutic modality of choice because it is virtually painless, complication-free, and effective after a single session. Moreover, it is cost-effective, administered in the facility, and allows the patient to resume normal activity immediately.

Sclerotherapy with liquid sclerosants does not deliver the same result while light and laser treatments have not proven to be as effective. When administered appropriately by experienced physicians, microfoam sclerotherapy carries minimal risks and effectively treats 80% to 90% of vessels. Microfoam sclerotherapy uses a special aerated detergent-like compound that can be injected directly into the vein. The foam briefly spreads the vein, replaces the blood, and holds the solution in place against the vein walls. The vein then contracts within a couple minutes, eventually collapsing and absorbing into the body.

A major advantage to foam over liquid sclerosants is that it increases contact between the sclerosant and the vessel. Moreover, the procedure is easy to direct and control because it displaces the blood. Ultrasound monitoring prevents the spread of the foam, although it seems that the passage of small amounts into the deep veins are seldom harmful. Sclerosant foam remains stationary within the vessel and fills many of the varicose tributaries. As a result, a single injection with subsequent compression can obliterate these vessels as well.

Ultrasound-Guided Microfoam Sclerotherapy

The ultrasound-guided Microfoam technique was developed by Dr. Juan Cabrera and has been used to treat patients with vascular malformations since 1993. Dr. John Bergan, the Founder of the La Jolla Vein Institute, was the first to identify the wide spread potential of foam in treating varicose veins. Dr. Bergan pioneered the use of Microfoam sclerotherapy and Ultra-Sounded Guided Microfoam treatment techniques used at the institute today, thus setting the standard for treatment used throughout the world. Dr. Bergan best sums up the wonders of foam sclerotherapy in a recent medical publication:

Sclerotherapy: A Truly Minimally Invasive Technique by John J. Bergan, MD, The La Jolla Vein Institute, California and the Department of Surgery, University of California San Diego. Published in Perspectives in Vascular Surgery and Endovascular Therapy.2008; 20: 70-72:

‘Foam sclerotherapy offers a treatment strategy with great potential. Recently, general and vascular surgery have become less invasive; so too, has the treatment of venous disorders. Prospective randomized outcome data support the hypothesis that foam sclerotherapy is superior to liquid sclerotherapy. All published reports of varicose vein treatment with foam describe efficacy in terms of immediate and primary venous occlusion of better than 80%. Severe complications of foam sclerotherapy are rare. Recurrent varices are in the 10% to 20% range. Use of foam sclerotherapy in our experience has proven to be effective, essentially pain-free, and durable in the short term. The treatment is quick, efficient, and cost-effective.”

How many sessions will you need?

The number of treatments required varies according to the size and location of the veins. With a commitment to individual care, each patient gets a personalized treatment plan on the first visit. Each session is approximately 30 to 45 minutes. The fee is based per session, not per injection or by the amount of scleroscent, as is the case for certain non-medical offices without board certified experts.

To maximize effectiveness, it is important to complete the series of recommended treatments to ensure all of the veins are removed. Many patients quit treatment once legs begin to look better. This is problematic because venous disease is progressive and the remnants of the veins left in the legs can quickly grow into more veins. Remember, properly treated vein disease prevents regression; however, good treatment does not ensure that new or veins will not appear after a period of time.

Is sclerotherapy painful?

For most people, there is minimal pain in sclerotherapy treatments. Individual injections, however, can cause a slight burning sensation for a few seconds, similar to an insect bite. We use a sclerosant that was developed as a local anesthetic to ensure it does not sting or burn like other sclerosants. The needles we use are the smallest available, similar to the size of needle used in acupuncture or Botox injections. No pain medication or numbing cream is necessary prior to treatment.

What are the concerns with sclerotherapy?

No medical therapy has a 100% cure rate or is performed with zero risk; however, complications are uncommon and relatively minor. Sclerotherapy is safe for most people of all ages when performed by a specialist. The agents used in sclerotherapy are commonly used, safe, and produce excellent results in both larger and smaller blood vessels.

Possible side effects include temporary redness and swelling on the injection site, which go away in a day or two. For some patients, brown lines or spots might appear on the site where larger veins were treated, which generally disappear within a year. Moreover, there can be temporary bruising or a mild allergic reaction to the sclerosant, but this is quite rare. Lumps can appear in injected vessels. These lumps are coagulated blood and are not dangerous—although they should be examined soon after a patient notices them. For individuals experiencing these symptoms, it is important to call the La Jolla Vein Institute office to see a doctor with specialized training for a quick and painless procedure to remove the trapped blood.

Patients who cannot walk are not good candidates for vein treatment. Moreover, new mothers should wait three months after pregnancy. Discussion with a physician about existing conditions and recent surgeries help determine an individualized plan of treatment to address specific concerns.

Patients may fly 24-hours after sclerotherapy, but only while the wearing compression stockings prescribed for the treatment. It is important to inform the treating physician if there are plans to travel after the treatment.

How do you prepare for sclerotherapy treatment?

Patients must avoid certain medications prior to sclerotherapy. Tetracycline or Minocin, both antibiotics, might possibly cause a staining of the skin if taken 7 to 10 days before or after sclerotherapy. Ask your doctor about other medications you may take. Do not take aspirin, ibuprofen (i.e., Advil and Nuprin), or other anti-inflammatory medications for 48-hours before and after sclerotherapy unless you are taking aspirin for a heart condition. Tylenol is permitted. Prednisone also has anti-inflammatory properties and decreases the effectiveness of the sclerosing agent. Herbal medications that increase bleeding such as Gingko Biloba and vitamin E may cause easy bruising.

Ask the doctor who prescribed the medication to see if it can be safely discontinued for 48-hours before the sclerotherapy procedure. No lotion is to be applied to the legs before or after sclerotherapy. Also, do not use self-tanning cream before or after treatment because tanning is accumulation of pigment (melanin) in the skin and could stain injection sites. If you have compression hosiery from previous treatments, please bring them with you to ensure they will provide adequate support after the sclerotherapy procedure.

What can you do after sclerotherapy treatment?

You will be able to drive yourself home. You may resume your regular activities and are encouraged to walk 30 minutes a day. Avoid prolonged sitting or standing. Immediately after the procedure, a pair thigh-high compression stocking is applied to each treated leg and is worn for 72-hours continuously to promote healing and keep the blood from collecting under the skin. After 72-hours, you may remove the hose and take a warm shower. The injection sites may be washed with a mild soap. Wear the compression hose for the next 2-3 weeks during the day. For large vein treatments, tighter compression is worn for a longer time period. Based on your specific circumstances, a trained specialist at the institute will instruct you on what to do to promote healing after treatment.

After the procedure, avoid aspirin, ibuprofen, and other anti-inflammatory medications for at least 48 hours. Tylenol may be used if needed. Do not take hot baths, sit in a whirlpool or sauna, or apply hot compresses or any form of heat to the injected areas for 48 hours after treatment. In addition, avoid direct exposure to sunlight (sun bathing, tanning beds, jogging, high-impact aerobics, and swimming for two weeks after the procedure must be avoided).

Treatment Of Venous Leg Ulcers

Treatment begins with an accurate diagnosis through clinical examination, history review, and duplex ultrasound examination. Collectively, these will identify the cause of the ulcer and show the specific veins that are malfunctioning. Treatment of the underlying problem is the most crucial step in healing a venous leg ulcer. As a result, antibiotics or commonly prescribed creams never heal a venous ulcer. At the La Jolla Vein institute, experts discovered that foam sclerotherapy treatment to be extraordinarily effective in treating severe leg ulcers. The institute’s studies have shown that most venous ulcers heal within weeks of sclerotherapy treatment; however, these injections are targeted specifically to the underlying problem and must be performed by a vein specialist. This is done in the office with ultrasound guidance—all without surgery or anesthesia. It is quick and painless. Treatment for all leg ulcers is coupled by carefully prescribed elastic stockings or rigid leg coverings known as Unna Boots. With specific diagnosis and aggressive correction, more than half of leg ulcers can be healed well enough to prevent recurrence.The institute also uses newly developed synthetic skin grafts, which can be most helpful in venous ulcer wound healing when used in conjunction with sclerptherapy.

Treatment Of Deep Venous Thrombosis (DVT)

Blood clots that involve the deep veins in the calf are frequent and are silent most of the time. If they involve the veins of the groin and above, they can give rise to embolisms in the lungs more than 50% of the time and pose a risk to health and life. Early diagnosis and intense treatment with medications to limit the growth of the clots is key to treatment. Fortunately, there are excellent medications called anticoagulants to limit the growth of the blood clots (there are certain medications that can even melt clots). The use of these anticoagulants prevents pulmonary embolisms and save countless lives. In some patients, removal of the blood clot by thrombectomy or dissolving it with thrombolysis to prevent future problems may be an option.
The most important message about blood clots is to diagnose them early and treat them aggressively because this will limit the danger of embolism and minimize the damage to the deep veins that causes late swelling, pain, and disability.

Treatment Of Superficial Thrombophlebitis (STP)

Management of superficial phlebitis when the cause is known is actually quite simple. It involves the use of anti-inflammatory medication, heating pads, compression stockings. This is likely to take four to six weeks to resolve and must be observed to sure it does not extend too close to the groin or develop in the deep veins.

Additional Services

At the La Jolla Vein Institute, there are a variety of techniques to enhance the diagnostic process and provide post-treatment support.

Duplex Ultrasound Examination

The Duplex Ultrasound exam is a non-invasive and painless study used to evaluate the following:

Venous Reflux Exam with Vein Mapping

The Duplex Ultrasound examination is used to both identify the veins that have faulty valves and to map the anatomy of the veins, thus creating a roadmap. This is necessary to make an accurate assessment of the cause and extent of the varicose veins, as well as to formulate the best treatment plan. This should be done for any individual being evaluated for varicose veins.

Deep Venous Thrombosis Screening

A DVT can be diagnosed by an experienced ultrasonographer with a Duplex ultrasound examination. A DVT study is performed when a person has signs and symptoms of a lower extremity DVT. It is a painless study and takes about 30 minutes.

Ankle-Brachial index

The ankle-brachial index is a screening test for peripheral arterial disease (atherosclerosis in the legs). The test is painless and uses blood pressure cuffs to obtain pressure readings at the arm and ankle levels. The test takes less than 30 minutes. If the screening test shows evidence of arterial disease, the patient will be advised to follow-up with his or her health care provider for a more detailed study called a segmental pressure study.

Wound Care of Venous Leg Ulcers

We provide comprehensive wound care of the venous leg ulcer, which encompasses Unna boots, multi-layer bandages, skin substitutes, and topical wound care.

Compression Stockings

We order prescription stockings on behalf of our patients to maximize recovery and added convenience. With a wide range of colors from which to choose, patients get to select a fashionable style based on individual preferences.

Vein Care in Pregnancy

Nearly 50% of pregnant women suffer from varicose veins, which make the legs feel more swollen, heavy, and painful throughout pregnancy. While the varicose veins cannot be eliminated during pregnancy, the symptoms can be reduced with special vein care. The physicians at the La Jolla Vein Institute encourage pregnant women who suffer with vein problems to visit the office for evaluation, fitting for special garments to alleviate symptoms, and a discussion of treatment options after pregnancy. A personalized plan can be designed while custom compression garments can be ordered to reduce the painful symptoms often associated with pregnancy.

Continuing Care

Vein problems are often chronic. As a result, good vein health requires life long care. Our patients are encouraged to have complimentary annual check-ups for on-going leg care. It is best to treat new vein problems as soon as possible because issues that might be visible to the skilled medical professional might not be noticeable by the naked eye.