Patients often accept painful varicose veins, swelling, and discoloration as a part of life and "getting old." Sometimes only until the problem is fully-treated do they realize that they have not been living their best life. Their gratitude upon realizing this is truly inspirational.
Have you ever wondered what venous reflux looks like in real-time? Enjoy this short but amazingly clear clip of a refluxing terminal valve at the saphenofemoral junction, the most common site of reflux in the great saphenous vein.
We RPhSs are all aware of the critical importance of properly diagnosing compression syndromes such as pelvic vein reflux and May-Thurner when performing a venous insufficiency study in preparation for ablation. These diagnoses are often the difference between a successful procedure and a hugely unsuccessful one, if the proper sequence of events is not implemented. Often, compression syndromes are only detected after the patient has become grossly symptomatic due to an increase in interstitial pressure, leading to clinical manifestations such as collateral formation. But how familiar is the average technologist with the many variations and presentations of compression syndrome? This attached link is a reminder to be aware of the lesser-known syndromes such as the several less-common variants of iliac compression, nutcracker phenomenon/anatomy, popliteal entrapment, VTOS/Paget-Schroetter presentation, and extrinsic compression when performing duplex studies. Often, the only indication which may hint to an obstruction or compression is distal PW Doppler waveform, or direct manipulation of the patient’s leg with the intent to provoke compression. No vein practice should ever fall victim to under-education and inexperience when it comes to quality patient care and satisfaction before, during, and after vein procedures.
Dr Ronald Bush, MD has been diligently instructing vein specialists in the art of successful sclerotherapy and ablation for years, both privately and at his greatly successful Aesthetic Vein Conference. I was fortunate enough to be a recipient of his expertise recently, and the tips and techniques learned were an invaluable addition to my toolbox. As always, I am hugely grateful for yet another opportunity to expand my network and to be able to share knowledge with one of the top contributors to our field. Dr Bush instructed us on the technique and importance of exit phlebectomy in preventing phlebitis of varicose veins during thermal ablation, safe sclerotherapy, and also instructed us on his flawless technique for perfect spider vein removal, every time. For my company, our patients’ confidence in the appearance of their legs is just as important as how they feel physically. Needless to say, our patients have been raving about their results and can’t wait to see what else is in store. I look forward to more up-coming learning opportunities with Dr Bush and his generous team!
Fifteen years ago, radiofrequency ablation was first performed on patients in the UK, giving physicians a much-needed alternative to vein stripping. Traditional stripping methods often caused prolonged bruising, pain, and the development of new refluxing veins. In fact, many vein stripping patients often seek our help decades after their procedures for treatment of their residual and often worsening symptoms.
Recently, a study was performed to test the long-term efficacy of radiofrequency ablation 15 years post-procedure, and the results were extremely encouraging. None of the patients in the study had significant recannalization of their previously ablated veins, and the 44% of patients that had developed new varicose veins had developed them in previously unsymptomatic areas of the leg. This development was likely due to hereditary factors over time. The most critical result? 100% of patients were pleased with their results, 98% recommend it to a friend, and 2% "might" recommend it. Not a single patient showed disinterest in recommending radio frequency ablation. These results speak for themselves, even for the earliest procedures which were performed under general anesthesia and with far inferior technology compared to the technology of today. It is no surprise that radio frequency ablation had become the NICE recommended first-line treatment of venous insufficiency since 2013. To read more about this study, click the title of this entry to be redirected.
Perforating veins are small veins which allow blood to transfer from superficial veins to the deeps veins. These veins are capable of refluxing similarly to the truncal veins, and may contribute a large part to varicose veins, trophic changes, and venous ulcers if left untreated.
Attached to this post is a great read on the ever-changing morphology and hemodynamics of calf perforator veins post-EVA, stressing the importance of reevaluation during post-ablation follow-up exams. Often we see patients come in for continued vein treatments from previous locations, only to show more signs of increased swelling and venous hypertension than when they began the treatment process. Before every procedure, it is crucial to evaluate the nature of the pathology that the patient is scheduled to treat that day in the event that the vein was not reevaluated during the follow-up exam. A situation which seems to occur quite often is that a perforating vein is previously documented as incompetent in the original reflux report, but is no longer incompetent due to the offloading triggered by previous saphenous ablations and is subject to treatment anyway. This leads to increased venous hypertension and undesirable results. Not only are previously incompetent perforating veins now potentially competent, but neovascularization may have occurred in the lateral aspect of the legs due to venous flow redirection, and new perforators are subsequently left uninvestigated.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557325/#!po=85.8696
Have you ever wondered why your patients often seem to present with new symptoms of neovascularity after GSV ablation? Dr. John Kingsley of the Alabama Vascular and Vein Center suggested a "blowout phenomenon," which describes a sudden occurrence of varicose veins along the path of the AAGSV following the ipsilateral GSV ablation. This phenomenon is due to a very common oversight by many vein procedurists. Hint: It correlates with AP diameter. You can read more about recurrent veins by clicking the above link.
I would like to welcome you to SonoMaxLLC.com. Thank you for taking your valuable time to search my company! Please sit back, relax, and peruse the site. I will be updating exciting news and events in the next several weeks, so keep checking back for more information. If you have any questions at all, please contact me through the Contact tab or at 772.485.2335 and I will respond as quickly as possible.
Sincerely,
Christina
SonoMax is a highly-qualified mobile sonographic imaging company, utilizing the latest advances in technology to bring the highest quality care to a variety of medical practices. Registered in Cardiac, Abdominal, Gynecological, Vascular, and Phlebology Sonography, SonoMax is proud to offer a wide variety of imaging modalities, as well as assistance and physician-training in endovenous ablation procedures, ambulatory phlebotomy, ultrasound-guided sclerotherapy, and cosmetic sclerotherapy. We take pride in providing quality service to all of our practices, but most importantly, in helping your patients feel valued and cared for in a positive, nurturing environment.
“Christina is a friendly, knowledgable, and enthusiastic trainer in endovenous ablation, with a great knack for patient care and satisfaction.”
