Finding a qualified vein expert near you can be challenging, especially now that there are multiple different types of physicians attempting to treat varicose vein disease with varying levels of expertise. This blog will walk you through what to look for in a vein doctor's experience and training that makes him/her a specialist in vein treatments, what questions to ask your doctor to understand if they have the qualifications to treat you and what to expect at your consultation and during treatments.
If you're looking for a vein specialist, you likely have varicose veins or spider veins involving one or both of your legs. Varicose veins are large, abnormally bulging veins along the legs that can present with symptoms of pain, aching, throbbing, fatigue, tiredness, cramping, restlessness, swelling or skin changes. Spider veins are smaller veins that are usually asymptomatic and can be red, blue or purplish in color. These veins can be unsightly and cause mental distress or physical symptoms to the patient. A vein specialist is a doctor who has spent years in treating all types of vein disease and has experience in all forms of vein treatment. Prior to minimally invasive procedures for treatment of varicose veins, patients would normally have surgery with incisions and significant down time. With the advent of ultrasound and minimally invasive procedures, patients now are best served by Interventional Radiologists. It's important to seek a vein specialist like an Interventional Radiologist because they have spent years learning about ultrasound, its uses and interpretation. They have also spent years learning and treating the disease process causing varicose veins called venous insufficiency. They are specially trained and have skill sets that match the particular needs in treating patients with varicose veins and venous insufficiency. So always remember to ask your treating doctor what experience they have with ultrasound and how long have they been interpreting ultrasound exams.
It's extremely important to always have a vein disorder treated by a vein specialist. All patients with varicose vein disease seeking treatment will eventually need a diagnostic ultrasound to evaluate their vein issues. An Interventional Radiologist is a vein expert who not only has experience in all forms of vein treatments but has also spent years learning and interpreting ultrasound exams. Because there is significant variability in ultrasound exam findings, it's important to see an expert who treats vein disease everyday versus someone who just treats veins on occasion. There are many doctors treating vein disease who have little or no experience with ultrasound or any real experience with the equipment to treat varicose vein disease. Interventional Radiologist have both these special skill sets and are exceptionally well trained to treat varicose vein disease and venous insufficiency. Ask your doctor, are you treating varicose veins everyday or are you doing this one or two days a week?
Interventional Radiology is a speciality that not all patients or the general public are generally aware of but represents a group of physicians who are developing the newest and latest cutting edge forms of treatment. Interventional Radiologists are required to do a year of internship in either internal medicine or surgery. After their first year of internship, they are required to complete four years of diagnostic radiology. During these four years, they learn the appearance of disease processes with all forms of imaging, including ultrasound, x-rays, CT scans, fluoroscopy and MRI. Then they need to complete a fellowship year in Interventional Radiology. During this time, they spend everyday learning how to use imaging to preform minimally invasive procedures including ablations, angioplasties, stent placements and numerous other procedures, many of which require navigating through arteries and veins. They perform image guided minimally invasive procedures throughout the whole body. These are the special skill sets that are exceptionally well matched for the treatment of varicose vein disease. If you have symptomatic bulging varicose veins or unsightly spider veins, call Interventional Radiologist Dr. Vinay Madan at the Center for Varicose Veins for a personalized treatment plan.
When you finally decide on a vein specialist to treat your varicose vein, what should you expect during your initial consultation with your vein expert? When you meet your doctor, he/she will do a thorough history and physical exam to review your risk factors for varicose veins including family history, level of physical activity, weight management and the type of work you do. The physician should do a review of any prior history of blood clots or clotting issues. They will review your symptoms arising from your varicose vein disease. During your physical exam, the vein expert will review their findings with you and explain the severity and classification of varicose vein disease. They should be able to describe any skin changes that may be associated with your varicose veins including hyperpigmentation, lipodermatosclerosis, stasis dermatitis and ulcer formation. The physical exam will document the size and location of your varicose veins, the quality of blood flow to the legs, presence of any swelling and any skin changes.
After your physical exam, the specialist should review your personalized treatment plan depending on the severity of your problems. This may range from conservative management to minimally invasive procedures for treatment. Conservative management may include weight loss, increase physical activity, leg elevation and the use of graduated compression stockings and non-steroidal anti-inflammatory drugs. There are now many different minimally invasive treatments for varicose veins including radiofrequency ablation, endovenous laser ablation, venaseal and sclerotherapy. Your doctor should be an expert in explaining how each of these procedures are preformed and their risks and benefits.
Now that you've met you vein doctor and they have completed your detailed history and physical, you may be ready to have your first vein procedure. Vein procedures may initially seem intimidating because most patients aren't completely sure of what to expect during this visit. Let's review how vein procedures are preformed and what you should expect. Most procedures take 30 minutes or less. You will be asked to lay on a specialized procedure table that has the ability to tilt and angle to keep you in a comfortable position. The medical assistant or ultrasound technician will clean your leg with a sterilizing solution, usually chlorhexidine gluconate mixed with alcohol. After the leg to be treated is sterilized, a large sterile procedure drape will be placed over the leg. A sterile field is now in place and the procedure is ready to begin.
The specialist will now come into the room and preform a time out. The time out is a required process that will confirm your name, date of birth, medications, allergies, what procedure is to be preformed and on which leg. After the time out is preformed, the procedure will now begin. If you are having a sterile, minimally invasive procedure, you will have your vital signs including your blood pressure and heart rate checked before and after the procedure. The doctor will need to give you some numbing medication at the site of the procedure. This is usually lidocaine, depending on if you have any allergies. It is very important to always share with the doctor any known allergies to medications or foods including the severity and effects especially if you have signs and symptoms of swelling or anaphylaxis. The procedure may entail placement of a catheter into one or more of your veins. This should be done with minimal to no pain. If you are experiencing any pain, you should not hesitate to let your doctor know so that he/she can keep you comfortable. All of these procedures should be preformed under ultrasound guidance. This will confirm that the procedure is going as planned.
After the procedure is complete, the medical assistant or technologist will place a sterile dressing over the procedure sites. You will likely be asked to wear a compression garment for up to a week after the procedure and asked to walk regularly. Depending on what procedure was preformed, you will be asked to return within a week for a follow up evaluation and ultrasound. This ultrasound will confirm success of the procedure and exclude any complications. During this ultrasound, it is important to share any concerns or complaints with the medical assistant, ultrasound technologist or physician. Complications may include bruising, bleeding, skin darkening, numbness or in rare instances blood clots. These complications will be documented with treatment and follow up recommended.
In the rare instances of developing a blood clot, depending on the location and size of the blood clot, you may either need to be placed on a blood thinner or have a follow up ultrasound to demonstrate stability or resolution of the blood clot. You should have confidence in your doctor's ability to explain what to expect before, during and after procedures, perform procedures painlessly, confidently diagnose, manage and treat varicose veins and associated disorders and complications. If you have any questions about diagnosis, treatment, management or complications of varicose veins make an appointment with Dr. Vinay Madan, MD, ABVLM at the Center for Varicose Veins. Make an appointment or call (203) 762-6365.
