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Veins
Thank you for choosing PVCare as your vein & skin therapy center.
20-25 million Americans have varicose veins. Venous reflux, often the underlying cause of varicose veins, frequently forces people to dramatically change their lifestyles, especially when they have standing professions and can no longer tolerate being on their feet all day. Whether the initial cause is genetics, pregnancy, prolonged standing, excess weight, inadequate exercise or a damaged saphenous vein, the physiology of varicose veins is nearly always the same.
The valves in the saphenous vein are damaged- physicians call them “incompetent”- and the veins near the skin surface are stretched and distorted from the increased pressure caused by blood flowing in the wrong direction. Venous reflux (caused by incompetent valves) in the saphenous vein is often the underlying cause of varicose veins. Although the condition is rarely life threatening, it is painful and unattractive.
Historically, patients have had several choices for treating varicose veins depending on the severity. They could make lifestyle changes, such as eating less, exercising more and wearing support hose. This regimen has proven helpful in somewhat reducing leg pain and further deterioration of the vein, particularly in mild cases. But sooner or later most patients return to their return to their previous lifestyles, and thus their previous symptoms typically reoccur.
Patients could also have the visible varicose veins removed in a procedure called “phlebectomy.” This surgical technique was developed in the 1950’s. A specially trained physician removes diseased veins through a series of very small punctures or incisions with a variety of specialized hooks. However, phlebotomy alone does not address the incompetent valves in the saphenous vein, which is often the cause of the problem and can cause varicose veins to recur. Dr. Parisi does perform phlebectomy on patients requiring completion of their medical care or in cosmetic variety.
Some physicians thus advocate the removal, or stripping, of the saphenous vein. By removing the saphenous vein, blood is diverted to other veins with competent valves. In many cases, stripping eliminates the pain associated with varicose veins and greatly reduces their potential for reoccurrence without the need for further intervention. Stripping involves making an incision in the groin region and surgically tying off the top of the saphenous vein. An instrument resembling a thin rod with a bulbous end is then inserted into the saphenous vein and passed through to the upper calf. Another incision is made at the upper calf. The stripping device is then tied to the vein, which is pulled out through the second incision. Recovery after surgery may last weeks typically cause significant bruising and can create post-operative pain, nerve damage and poor short-term cosmetic outcomes. Dr. Parisi does not perform surgical stripping but does revise stripping procedures as well as laser therapy.
EVCA (Endovascular Catheter Ablation)
The EVCA (Endovascular Catheter Ablation) procedure is an outpatient (day surgery) treatment now offered at PVCare by Dr. Thomas Parisi, by experiencing less discomfort and significantly less healing time.
What is EVCA (Endovascular Catheter Ablation)?
The EVCA (Endovascular Catheter Ablation) System was developed over a four year period to treat superficial venous reflux. This patented technology uses a very small catheter and radiofrequency energy to occlude, or seal shut, the saphenous vein. The physician typically makes a single small incision near the knee and inserts the slender EVCA Catheter into the saphenous vein. The catheter is then positioned near the groin, energized and slowly withdrawn, sealing the vein shut. There are no stitches, and most patients return to normal activity within a day or two.
The EVCA procedure has been the subject of numerous studies and journal articles. The results from a peer-reviewed, multi-center, randomized trial comparing recovery rates and quality of life between patients treated with conventional vein stripping and the EVCA third randomized trial showing that patients who receive stripping and the EVCA procedure consistently experienced less post-operative pain, and returned to normal activities and worked faster than patients who’s veins were surgically stripped. In addition, published studies found that at 12 and 24 months following the EVCA procedure, 90% or more treated veins remained reflux-free and a significant reduction of limb pain, fatigue and adema was observed. In one study, which also assessed patient satisfaction at 6 months, 98% of patients indicated they would recommend the EVCA procedure to a friend with similar leg vein problems. More than 300,000 patients have been treated with EVCA procedure to date. For many patients, the procedure is covered by health medical insurance. For those patients that may need financial help, and CareCredit is available. CareCredit is a nationwide company that will extend a credit line to patients who qualify which covers all costs and may be paid overtime within no or limited interest.
Like other venous procedures the EVCA procedure involves risks and potential complications. All patients may not be candidates for this procedure. Complications reported in medical literature include numbness or tingling (Paresthesia), skin burns, blood clots and temporary tenderness in the treated limb.
At PVCare, your satisfaction is our treatment goal. We have many treatment options that address any issue including 24-hour access walk-in availability. We take pride in our medical care, and hope you enjoy your time here at PVCare.
Wound Healing
Are treatment protocol is based on a variety of anatomical and physiological models. Our belief is that vein therapy should give long lasting solutions to circulation disorders. Below is our protocol in detail.
First Step: Deep Vein Ultrasound and Arterial-Brachial Index with Segmental Pressures
The Deep Vein Ultrasound (DVU) is an initial evaluation of your lower extremities using non-invasive ultrasound. This is to determine if you have venous reflux disease (“reflux”). Reflux is when the vein or its valves do not work properly. When that occurs, blood pool sin the lower part of the legs and does not return to the heart as well. PVCare believes that vein therapy may assist those with edema that is form a non-circulation condition as long as there is reflux disease in the lower extremities. An arterial-brachial index (ABI) is an ultrasound to evaluate the blood flow from the top of the legs to the lower aspect. Some wounds are from arterial disease however others are from venous reflux. This initial evaluation helps direct your care. For example, a patient that has under gone ABI and hyperbaric medicine came to the clinic for wound care however, found to have significant reflux disease. Has treatment for both legs as well as TCOM measurements, graft placement, more hyperbaric, proper orthotics, returned to exercising and helping himself.
Second Step: Transcutaneous Oxygen and Measurements (TCOM)
TCOM measurements are used to determine if a wound is able to heal with the present condition of the limb. A non-invasive test, the TCOM has small probes attached to the skin on the surface around the wound and in other predetermined areas. If the values are within normal range then proper wound management will begin. If there is compromise in the circulation, then Hyperbaric will begin.
Hyperbaric Medicine
Performed at wound care centers that have been certified by all national wound care agencies.
Third Step: Endovascular Catheter Ablation Using Endoluminal Radiofrequency Heating (EVCA procedure)
What? It means that the vein is closed within your body using a ultrasound probe with no surgical stripping, sutures, or scarring. Vein therapy has shown to be a necessary part of wound care as well as limb salvage. The entire procedure is performed through a single intravenous (IV) sight. The basic premise of the procedure is that the ultrasound probe emits heat pulse. This heat pulse melts the protein lining the vein. As the catheter is withdrawn, the vein is compressed and the protein acts like glue holding it shut. The leg is wrapped in a compression bandage to brace the vein together as the protein cools and remains closed. This technology is safe to use on patient that have experienced amputations, chronic wounds, acute wounds due to trauma, and other circulation disorders such as: atherosclerosis and some hematological disorders in which there are vascular lesions.
Fourth Step: Phlebectomy
Phlebectomy is the removal of medium sized veins from the skin surface period. This entails small incisions in the superficial skin layer and the removal of the vein using small, various specific instruments. The visible vein is tied at each end, excised, and removed. The incisions are not stitched and therefore scarring is minimal if visible at all.
Fifth Step: The Sclerotherapy
Sclerotherapy is a treatment of small, visible veins using a solution that causes the vein to remain closed and then disappear. The solution itself is painless when introduced to the vein. After EVCA treatment, the veins present on the surface will remain on the skin because of the way the veins grew into the tissue. These veins will need to be removed to complete treatment, as the veins can become thrombosed, or clotted (phlebitis). They also become inflamed and painful. Once these vessels are removed, they will more than likely to never return. It is based on the anatomical aspect of the PVCare Protocol. If the smaller, surface veins are connected to a larger vein that has recently been closed, then where do they get their blood supply? Those veins do not have a blood and will simply remain in the skin. In the skin, those veins can do nothing other than clot or become inflamed. The use of sclerotherapy and YAG laser therapy has shown to be effective treatments for these small surface veins.
Sixth Step: Nd: YAG (Neodymium-doped yttrium aluminum garnet) Laser Treatment
Nd: YAG Laser Treatment
(YLT) is a proven treatment for superficial veins. The treatments emit a laser pulse, which causes the veins to remain closed and disappear, much like sclerotherapy. The difference in the treatments is the YLT can remove veins in a non-invasive manner and can also treat much smaller veins that would be very difficult to access with sclerotherapy.
Leg and Limb Rehabilitation
PVCare tailors the limb rehabilitation program to individually care for each patient’s specific needs. Dr Thomas Parisi works with highly trained and reputable community specialists to coordinate care on his patients for bone, joint, arterial disease, as well as physical therapy. |
Testimonial
Thank You!!
"It's only been three days, and my legs feel better already." V.G.
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New Life
"I have ankles again. The swelling had been so bad for many years that I thought there was no hope. Dr. Parisi has given me new life." A.C.
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Thank You!!
"It's only been three days, and my legs feel better already." V.G.
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