Our patients present with varicose or spider veins of the the legs associated with swelling, burning, itching, and pain. A comprehensive evaluation of the extremities is performed to determine the cause of the symptoms so that a specific treatment plan can be offered. Initially our senior medical assistant sees the patient followed by an ultrasound by our registered vascular technician. Dr. Mendes then compiles all of this information and examines the patient and offers the treatment plan.
During this evaluation a full discussion is had with the patient so they understand what we are looking for and how the finding causes the patient’s problems. Vein valve problems are the cause of most of the problems we see and we explain this and review the anatomy. We believe the key to a good outcome is patient education --what the patient has, why they have it, and what we can do to correct it. Our patients are told what we are looking for and why. If the problem is not due to vein disease, we advise and refer the patient accordingly.
For vein problems, our recommendations can include support stockings, weight loss, vein removal or laser treatment but always with reasons why we are making that recommendation. If the ultrasound reveals a valve problem, we offer laser treatment or injections, always explaining why we suggest that plan. Our main focus is to educate our patients about what they have, why they have it and what can be offered to correct it.
The treatment plan can be a process and we want every patient to understand the journey and be informed and therefore happy. A patient who has been so treated can then leave the office satisfied. New vein problems can appear after the initial problem has been treated so we recommend yearly follow-up are part of our process. Our mantra is “once a vein patient, always a vein patient” so be prepared for other venous problems to appear. Our office attempts to diagnose all new problems before they become symptomatic and treat them early.
Mendes Vein Care describes the venous anatomy as an “H” and a “W”. One arm of the H is the superficial system and the other arm is the deep system. The cross arm are the perforating veins. Valves determine the direction of the blood flow. Normally the blood will flow from the superficial system to the deep. Abnormal flow will go from the deep to the superficial, causing bulging superficial varicose veins and the appearance of spider and blue veins. This causes pooling of blood and then causes discoloration at the ankle and swelling of the legs. The final symptom is ulceration of the ankles, on the medial and lateral ankle. Again, this is due to blood flow in the abnormal direction.
An Evaluation With Dr. Mendes
Physical Exam The legs are examined and spider, blue and varicose veins are evaluated and documented followed by a diagnostic ultrasound. The senior medical office assistant, who has been with the practice since its inception, evaluates the patient and discusses preliminary causes of symptoms.
Diagnostic Ultrasound To evaluate if there is valve dysfunction. The ultra-sonographer can look at a pregnant women’s belly, it can also look inside a vein at the valves and determine if they are abnormal and allowing blood to go in the wrong direction. The ultrasound then follows, performed by our registered vascular technician. Dr. Mendes then reviews the results to determine if the cause of your symptoms is because of vein problems. She then compiles the information, examines the patient and gives the final diagnosis and treatment plan.
Treatment Options With Dr. Mendes
Support hose: Patients will ask “Is that really a treatment?“ YES! Anything that helps keep the blood in the vein is a treatment.
Realize that standing or sitting for long periods of time will cause “pooling” of blood in their legs. It is NORMAL for this to happen but if the patient has valves in the veins that do not work properly, a lot of blood will pool in the leg. This additional pressure or pooling of blood in the lower extremities help produce spider veins, blue veins and varicose veins in the leg.
Normal flow consists of blood leaving the leg, going back to the heart, and then to the lungs and then taking oxygenated lungs back to the legs. When we walk, the calf muscle tightens and when it does, it squeezes the blood from the calf upwards to the heart. If there are vein valve problems, the blood will move up but if the valves do not work properly, the blood will rush back down. Pooling of the blood in the legs will occur, thus causing swelling or edema, or heaviness, and itching of the lower leg. If the blood sits there for too long, ankle ulcer formation can occur. Ulcers occur on the inside or the outside of the ankle. Compression stockings have increased compression at the ankle in those areas and wearing compression hose helps squeeze the blood from the leg to the heart with any leg motion and walking is such a motion. Compressions hose act like a gentle massage, assisting the muscle movement massaging the blood from the ankle and leg back to the heart.
Weight loss: If the patient is overweight, discussion with the patient occurs to let them know that essentially, being overweight will not allow the blood to return to the heart from the legs as easily than if you are not overweight.
The blood is flowing against an obstruction - your abdominal fat. Dr. Mendes can refer you to an Obesity Program or to our superb specialists.
Injection Sclerotherapy: This is used for spider veins that have no evidence on ultrasound of being caused by a medical condition meaning they should not be treated by a laser and are considered cosmetic.
Insurance companies do not reimburse for cosmetic procedures. Dr. Mendes uses a high power light that has a microscope attached to it so the veins can be seen easily and injected. We inject a solution that will irritate the inside of the vein and the vein is then compressed so that blood cannot flow into it and reopen it. This can cause discolorations that will disappear with time.
Foam Sclerotherapy: Another form of vein injection that is done with the help of the ultrasound to guide us to the vein causing the problem. Incompetent perforating veins are connected to the superficial and deep veins but the blood moves in an abnormal direction, from the deep to the superficial. Usually this is something the insurance company will reimburse when that documentation is provided to them.
Endovenous Laser Treatment: A laser is placed into the vein under ultrasound guidance and slowly withdraw under ultrasound guidance so that the vein is completely and thoroughly ablated. Again this is reimbursed by most carriers.
Phlebectomy: Surgical removal of the vein: this is performed in the office with local anesthesia and mild sedation. If the patient wants or needs more than local anesthesia, the procedure will be performed in a surgical center or in the hospital. Anesthesia costs are discussed prior to the procedure with the Anesthesiologist.