The dedicated vein clinic is uniquely suited to offer a wide range of aesthetic procedures . Equipment such as an IPL is required to treat telangiectasia and matting . The same instrument then is available for addressing hair removal , rosacaea , acne , aging spots and facial tightening .
Also the average vein patient with concerns re cosmesis is already looking for providers of these procedures . Botox and co2 fractional for deeper facial work can then be added whem the market allows . Because the phlebologist is familiar with lasers and frequencies of different lasers used in thse procedures it becomes easier to contemplate skin responses and possible complications .
New to the market the Vaser noninvasive body conturing instrument is efficacious and selling well. The newest laser for tattooo removal trumps previous equipment with efficacy with professional inks and most colors .
Classical liposuction is performed in some vein clinics , but ultrasound guided liposuction of the neck and face be the only areas treated .
Tuesday, May 10, 2011
Monday, April 11, 2011
SCLEROTHERAPY
Sclerotherapy involves venous injections of a detergent that acts as a chemical irritant to effct closure of a particular vein . The sclerosant can exhibit a wide range of concentrations . Foaming the liquid detergent with either room air or co2 enhaces the strength of the solution . A low concentration liquid detergent is normally utilized for telangiectasia and spider veins , with reticular veins requiring hiher strength liquid sclerosant or lower concentration foam , dependent upon diameter . Varicosities generally require foam , with co2 foam utilized by many experts at the mid thigh level or above , as the rare incidence of TIA events may be decreased further using co2 , but not necessarily prevented . Foam may wee be contrindicated in the presence of a documented patent foramen ovale . Migraines are sometimes associated with patent foramen ovale with some phlebologists seeing foam as a contraindication in these patients in the absence of a negative transesophageal echo. Recently groin and vulvar varicosities have been addressed utilizing co2 foam . The ability to image the renal veins and tributaries with ultrasound during the procedure is hepful .
Monday, March 14, 2011
Complex Vein Interventions
march 14 , 2011
Signs of advanced vein disease can include the following : corona phlebiticum ; eczema below the knee ; lipodermatosclerosis ; skin ulcers ; significant hemosiderin deposits below the knee ; very prominent veins on dorsum of foot with standing ; progressive edema ; etc .
Symptoms of advanced disease include the following : lower extremity cramping ; restless legs ; fullness with prolonged standing _sometime this symptom is immediate upon standing ; edema ; bulging varicosities , often painful that sometimes bleed ; soles of feet burning or feeling of walking on rock chips .
All patients with significant reflux into the greater sapenous vein in the thigh with concomitant symptoms are candidates for ablation of the greater saphenous vein . Mid thigh perforators that reflux toward the skin are pathologic and should be closed with ablation or foam sclerotherapy ustilizing CO2 . Dilated , refluxing short saphenous veins in posterior calf associated with symptoms , skin disease or ulcers should be ablated .Ulcers associated with SSV reflux are often located on the lateral malleolus . Dilated individual superficial veins below the knee should be injected with foam sclerotherapy . Likewise pathologic below the knee perforators should be ablated with foam .
Although controversial , very dilated , refluxing saphenous veins below the knee may require closure with foam . This situation might arise when foam injection at the ankle could lead to possible closure of multiple perforators ; further treat lymphovenous edema ; relieve foot symptoms and treat all dilated superficial veins , thereby ameliorating skin disease and ulcers . Although a potential venous conduit is lost , the combination of drug eluting stent therapy and the availability of arterial conduits for use in coronary bypass surgery negate the significant concern associated with loss of a venous conduit . However one should note this procedure is necessary in only a small percentage of patients. When utilized 40 mm compression stockings should be utilized as edema is commonly seen in the first few weeks and diuretics and elevation may be required . This problem virtually always resolves over a few weeks at which time diuretics can be stopped . Walking and calf pump exercises should be encouraged as shoul water aerobics . If prior lymphedema pumps are available as home therapy and work very well .
As previously noted , complex venous disease is best treated in a dedicated center where this case mix is commonly treated .
Signs of advanced vein disease can include the following : corona phlebiticum ; eczema below the knee ; lipodermatosclerosis ; skin ulcers ; significant hemosiderin deposits below the knee ; very prominent veins on dorsum of foot with standing ; progressive edema ; etc .
Symptoms of advanced disease include the following : lower extremity cramping ; restless legs ; fullness with prolonged standing _sometime this symptom is immediate upon standing ; edema ; bulging varicosities , often painful that sometimes bleed ; soles of feet burning or feeling of walking on rock chips .
All patients with significant reflux into the greater sapenous vein in the thigh with concomitant symptoms are candidates for ablation of the greater saphenous vein . Mid thigh perforators that reflux toward the skin are pathologic and should be closed with ablation or foam sclerotherapy ustilizing CO2 . Dilated , refluxing short saphenous veins in posterior calf associated with symptoms , skin disease or ulcers should be ablated .Ulcers associated with SSV reflux are often located on the lateral malleolus . Dilated individual superficial veins below the knee should be injected with foam sclerotherapy . Likewise pathologic below the knee perforators should be ablated with foam .
Although controversial , very dilated , refluxing saphenous veins below the knee may require closure with foam . This situation might arise when foam injection at the ankle could lead to possible closure of multiple perforators ; further treat lymphovenous edema ; relieve foot symptoms and treat all dilated superficial veins , thereby ameliorating skin disease and ulcers . Although a potential venous conduit is lost , the combination of drug eluting stent therapy and the availability of arterial conduits for use in coronary bypass surgery negate the significant concern associated with loss of a venous conduit . However one should note this procedure is necessary in only a small percentage of patients. When utilized 40 mm compression stockings should be utilized as edema is commonly seen in the first few weeks and diuretics and elevation may be required . This problem virtually always resolves over a few weeks at which time diuretics can be stopped . Walking and calf pump exercises should be encouraged as shoul water aerobics . If prior lymphedema pumps are available as home therapy and work very well .
As previously noted , complex venous disease is best treated in a dedicated center where this case mix is commonly treated .
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