What to Expect in the Work-up of my Veins
Your first encounter may be with a nurse trained in recognizing the problems associated with varicose vein disease to help determine if your disease is medical or cosmetic. This does not imply that “cosmetic” patients are in less discomfort than “medical” patients but does have implications in terms of reimbursement by insurance companies . She may then need the Phlebologist (Greg Hamon MD) to examine your legs and order tests. Often the ultrasound is performed in the office by Dr Hamon in order to more rapidly identify the problem. He has had extra training in vascular ultrasound in order to do this exam properly.
Effective treatment of venous insufficiency starts with accurate mapping of the venous system. Duplex studies are performed with the patient standing. This is critical and cannot be over-emphasized. While it is widely believed that these studies can be performed with the patient inclined at a 45 degree angle, our experience shows that diagnostic capabilities are dramatically improved when the patient is scanned in the standing position. Pinpointing the problematic vessels is critical to success of treatment, and scanning the legs while the patient stands is important in this regard. We have found that in many cases, even the cosmetically annoying spider veins are the result of saphenous insufficiency.
Once the pathology is mapped and its nature clearly identified, treatment options are determined. In patients whose varicosities are less than 2.4 cm in diameter with curvatures of less than 90 degrees, endovascular saphenous obliteration therapy can usually be performed successfully under local anesthesia. Patients are home the same day and back to work within a few days making this very cost effecticve. The benefits and efficacy of this procedure are now recognized by many insurance carrriers, including Medicare, and will reimburse for these procedures as long as they meet the criteria for medical necessity. This outpatient procedure has been successfully applied and largely replaces traditional vein stripping in many areas of the country, even for patients with significant varicosities.
The 940 Dornier is tuned to best absorb hemoglobin and to avoid melanin stimulation (this causes the color change in the skin). This means that when used for treatment of superficial viens the skin is affected the least and the vien is destroyed.
Also as a sefety feature, the laser can detect when there is not good contact with the vessel wall and will not fire. This reduces the number of post-op complaints.