Serving Okaloosa, Walton, Santa Rosa, Bay, & Escambia Counties
The following information is for Large Varicose Veins (bulging veins or “grape-like” clusters).
Step 1
Call the Destin Vein Center at 850-654-5222 or toll free 866-701-7088 to schedule a 15 minute complimentary consultation with Dr. Grisoli. By Dr. Grisoli’s request, you will be asked for a convenient time at which his assistant can call you.
Step 2
Expect a phone call, at your convenience, by Dr. Grisoli’s assistant prior to your consult to answer any questions you may have. Arrive at your consult with a pair of shorts or loose clothing to change into so that you are comfortable and able to demonstrate to Dr. Grisoli your areas of concern.
Step 3
At your consult you will be given an evaluation which addresses the medical significance and cosmetic concerns of your leg vein problems. After the initial exam is complete, Dr. Grisoli may decide that further testing is in order. These tests often include duplex ultrasound and/or Doppler exams of the legs. These non-invasive procedures use sound waves to evaluate the function of the valves in the veins of the leg. These tests are very important in diagnosis, and can improve the effectiveness of any treatment.
At this point, we will discuss treatment options with you. You should feel free to ask any questions about costs, complications, and potential benefits as well as side effects of treatment
Treatment of Large Varicose Veins 1. Endovenous Ablation
Endovenous laser treatment is a minimally invasive, in-office treatment alternative to surgical stripping of the great saphenous vein. Instead of removing the saphenous vein, it is sealed closed in place. The skin on the inside of the knee is anesthetized and a laser fiber is inserted through a needle stick in to the saphenous vein. As the fiber is withdrawn, the laser is fired causing the vein to collapse and seal shut. Following the procedure, a compression stocking is worn for seven days. Patients are able to walk immediately after the procedure and most individuals are able to return to work the next day. Endovenous laser treatment is FDA approved.
Possible complications of endovenous laser treatment are thermal skin burns and transient numbness.
2. Ultrasound Guided Foam Sclerotherapy
Echo-Sclerotherapy is an in-office treatment alternative to surgical stripping. Ultrasound imaging is used to guide a needle into the abnormal vein and deliver medication to destroy the lining of the blood vessel and seal it shut. Ultrasound guided sclerotherapy is primarily used to treat large veins beneath the surface of the skin.
3. Ambulatory Phlebectomy
Ambulatory phlebectomy is usually performed in a doctor’s office using local anesthesia. The area surrounding the varicose vein clusters is flooded with anesthetic fluid. A needle is then used to make a puncture next to the varicose vein and a small hook is inserted into the needle hole and the varicose vein is grasped and removed. Ambulatory phlebectomy is often performed in conjunction with minimally invasive endovenous catheter procedures.
Large vein insurance issues
Larger veins that require endovenous ablation, ultrasound guided sclerotherapy, or ambulatory phlebectomy will usually be covered by insurance. Our office will seek prior authorization from your insurance company for your treatment. Insurance companies usually require the results of duplex scans, documentation of the size of veins, failure of conservative management along with pain, bleeding, or ulcer formation in order to be covered. When authorization has been received, we will plan your treatment.
Anterior Lateral branch of the Greater Saphenous Vein
Greater Saphenous Vein insufficiency extending into the calf
WHAT CAN HAPPEN IF I DON'T TREAT MY VARICOSE VEINS? There are several adverse consequences of untreated varicose veins, and their severity will vary from person to person depending on the circumstances. Many people who don't treat their varicose veins will experience continued symptoms of pain, fatigue and swelling of the legs or ankles. More advanced medical problems may include hyperpigmentation, lipodermosclerosis, venous leg ulcers, spontaneous bleeding, superficial thrombophlebitis, and a potentially life-threatening condition called deep vein thrombosis.
Blood that pools in the varicose veins is depleted of oxygen and nutrients. The veins also do not tolerate high pressure well and begin to allow red blood cells and fluid to leak into the tissues of the leg. The fluid leak causes ankle swelling. The red blood cells in the tissues cause chronic inflammation and the skin becomes dark and discolored. The medical term for the dark discoloration is hyperpigmentation. When the skin and the fat under the skin are inflamed for years, the tissues become woody and firm. The medical term for this woody, hard tissue is lipodermosclerosis.
A condition that may occur over time, when there is chronic venous insufficiency, is a venous leg ulcer. The ulcers due to varicose veins are painful and difficult to heal. Sometimes the ulcers cannot be healed until the backward blood flow in the veins is corrected.
Another possible consequence of untreated varicose veins is spontaneous bleeding from the varicose veins. As the skin over the veins becomes thin, eventually the vein can be exposed to the outside world and be easily injured by clothing, bedding, etc. The blood loss can be significant and is painless.
Superficial thrombophlebitis (ST) is an inflammation of a vein just below the surface of the skin. The cause of inflammation is not an infection. Rather, inflammation is due to decreased blood flow through the vein, damage to the vein and blood clotting. The features of ST include redness to the skin and a firm, tender, warm vein. Localized leg pain and swelling may occur as well.
Treatment of ST is directed towards reducing the inflammation. Aspirin or Ibuprofen are the drugs of choice. Compression with graduated support hosiery is important as well. Fortunately, ST is usually a benign and short-term condition. Symptoms generally improve in one to two weeks although the firmness of the vein may persist longer.
Deep vein thrombosis (DVT), unlike ST, can be associated with significant and serious medical problems. DVT is often first noticed as a "pulling" sensation in the calf of the lower leg, and it can be quite painful. Symptoms also include associated warmth, redness and swelling. The swelling often extends to above the knee.
CONSERVATIVE TREATMENTS
Conservative treatments include compression stockings.
Graduated compression stockings are a mainstay of initial/conservative management of venous disease. Graduated compression stockings are tighter around the foot and ankle and the compression decreases as it goes up the leg. This "graduated compression" promotes the normal flow of blood up the leg. Possible complications of graduated compression stockings are obstruction of venous or arterial blood flow due to improper sizing or undiagnosed peripheral vascular disease
