General Surgery

Abdominal endovascular aneurysm repair (Endostent) is a minimally invasive alternative to major open surgery for the repair of abdominal aortic aneurysms (AAAs) that results in reduced recovery times and potentially improved survival rates.

An abdominal aortic aneurysm (AAA) is a localized bulging or abnormal enlargement of the abdominal aorta, most often the infrarenal and aorto-iliac arteries. AAAs are often attributed to degeneration caused by atherosclerosis, although there may be other causes, including trauma, cystic medial necrosis, arteritis, syphilis, and inherited connective tissue disorders.

AAAs occur most often in Caucasian males over the age of 65 years; they are less common in women. Smoking is considered the most significant risk factor. The mortality rate is high due to rupture, making timely detection and repair critical.

Detection can be difficult. Most AAAs are asymptomatic. Frequently, they are discovered on x-rays performed for other reasons.

Varicose veins result from weakened, incompetent valves in veins just beneath the skin in the legs. This allows blood to pool in the legs due to gravity effects, and cause distension of more leg veins, swelling, discomfort and ultimately ulceration and skin breakdown.

Exciting new techniques in treating varicose veins are available that allow a quicker, nearly painless recovery, and faster return to your normal daily activities. Radiofrequency Ablation Therapy of diseased and weakened leg veins can improve the overall feeling of heavy swollen legs, and aid in their appearance as well. Supplemental treatments to inject smaller veins (spider veins) is offered to enhance your cosmetic outcome as well.

What are varicose veins?

Arteries bring oxygen-rich blood from your heart to the rest of your body. Veins return oxygen-poor blood back to your heart.

Varicose veins are swollen veins that you can see through your skin. They often look blue, bulging, and twisted. Left untreated, varicose veins may worsen over time. Large varicose veins can cause aching and feelings of fatigue as well as skin changes like rashes, redness, and sores. As many as 40 million Americans, most of them women, have varicose veins.

You have two kinds of veins in your legs. Superficial veins lie close to your skin. Deep veins lie in groups of muscles. Deep veins lead to the vena cava, your body's largest vein, which runs directly to your heart. Perforating veins connect superficial veins to deep veins. Varicose veins occur in the superficial veins in your legs.

The blood in your leg veins must work against gravity to return to your heart. To help move blood back to your heart, your leg muscles squeeze the deep veins of your legs and feet. One-way flaps called valves in your veins keep blood flowing in the right direction. When your leg muscles contract, the valves inside your veins open. When your legs relax, the valves close. This prevents blood from flowing backward. The entire process of sending blood back to the heart is called the venous pump.

When you walk and your leg muscles squeeze, the venous pump works well. But when you sit or stand, especially for a long time, the blood in your leg veins can pool and the pressure in your veins can increase. Deep veins and perforating veins are usually able to withstand short periods of increased pressures. However, if you are a susceptible individual, your veins can stretch if you repeatedly sit or stand for a long time. This stretching can sometimes weaken the walls of your veins and damage your vein valves. Varicose veins may result. Spider veins are mild varicose veins. They look like a nest of red or blue lines just under your skin. Spider veins are not a serious medical problem, but they can be a cosmetic concern to some people.

What are the symptoms?

If you have varicose veins, your legs may feel heavy, tired, restless, or achy. Standing or sitting for too long may worsen your symptoms. You may also experience night cramps.

You may notice small clusters of veins in a winding pattern on your leg, or soft, slightly tender knots of veins. Sometimes, the skin on your legs may change color, become irritated, or even form sores.

If you have severe varicose veins, you have slightly increased chances of developing deep vein thrombosis (DVT). DVT may cause sudden, severe leg swelling. DVT is a serious condition that requires immediate medical attention.

What causes varicose veins?

High blood pressure inside your superficial leg veins causes varicose veins.

Factors that can increase your risk for varicose veins include having a family history of varicose veins, being overweight, not exercising enough, smoking, standing or sitting for long periods of time, or having DVT. Women are more likely than men to develop varicose veins. Varicose veins usually affect people between the ages of 30 and 70.

Pregnant women have an increased risk of developing varicose veins, but the veins often return to normal within 1 year after childbirth. Women who have multiple pregnancies may develop permanent varicose veins.

What tests will I need?

First your physician asks you questions about your general health, medical history, and symptoms. In addition, your physician conducts a physical exam. Together these are known as a patient history and exam. Your physician will examine the texture and color of any prominent veins. He or she may apply a tourniquet or direct hand pressure to observe how your veins fill with blood. To confirm a diagnosis of varicose veins, your physician may order a duplex ultrasound test.

Duplex ultrasound uses high-frequency waves higher than human hearing can detect. Your physician uses duplex ultrasound to measure the speed of blood flow and to see the structure of your leg veins. The test can take approximately 20 minutes for each leg. Besides showing varicose veins, duplex ultrasound may help your physician decide whether your varicose veins are related to some other condition rather than the veins themselves.

How are varicose veins treated?

Varicose veins may sometimes worsen without treatment. Your physician will first try methods that don't require surgery to relieve your symptoms. If you have mild to moderate varicose veins, elevating your legs can help reduce leg swelling and relieve other symptoms. Your physician may instruct you to prop your feet up above the level of your heart 3 or 4 times a day for about 15 minutes at a time. When you need to stand for a long period of time, you can flex your legs occasionally to allow the venous pump to keep blood moving toward your heart.

Compression Stockings

For more severe varicose veins, your physician may prescribe compression stockings. Compression stockings are elastic stockings that squeeze your veins and stop excess blood from flowing backward. Compression stockings also can help heal skin sores and prevent them from returning. You may be required to wear compression stockings daily for the rest of your life. For many patients, compression stockings effectively treat varicose veins and may be all that are needed to relieve pain and swelling and prevent future problems.

When these kinds of treatments alone do not relieve your varicose veins, you may require a surgical or minimally invasive treatment, depending upon the extent and severity of the varicose veins. These treatments include sclerotherapy, ablation, vein stripping, and laser treatment.

Sclerotherapy	Ablation

Sclerotherapy

During sclerotherapy, your physician injects a chemical into your varicose veins. The chemical irritates and scars your veins from the inside out. Your veins can then no longer fill with blood. Blood that would normally return to the heart through these veins returns to the heart through other veins. Your body will eventually absorb the veins that received the injection.

Radiofrequency Ablation (VNUS)

Ablation uses a thin, flexible tube called a catheter inserted into a varicose vein. Tiny electrodes at the tip of the catheter heat the walls of your varicose vein and destroy the vein tissue. As with chemical sclerotherapy, your vein is then no longer able to carry blood, breaks up naturally, and is absorbed by your body.

Phlebectomy

“ Individual veins may require removal through tiny incisions directly over the site. This is done under local anesthesia and usually doesn’t require any suturing due to the small incision size.”

In the last 20 years has seen a major shift in the treatment of arterial disease, away from large invasive procedures requiring long incisions and extended stays in the hospital. Current technology allows treatment of many of the diseased arteries using tiny incisions and catheters inserted directly into these arteries to open areas of narrowing, and in some cases re-establishing flow in arteries that are completely occluded.

Catheter Directed Atherectomy is one of the most promising technologies. This allows the surgeon to actually remove areas of atheroscerotic plaque from the diseased artery, giving the artery improved flow, and allowing healing of ulceration and skin breakdown, and resolution of leg discomfort when walking (claudication).