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We Specialize In Non-Surgical, Minimally Invasive Elimination Of Varicose Veins, Spider Veins And Other Vein Problems Of The Legs.


Vein Conditions

About Normal Vein Flow

Venous flow in the legs consists of superficial and deep components and their tributaries.  When a person shifts from a horizontal to a vertical position, blood stored in the abdominal and pelvic veins is prevented from flowing down into the leg by rapid closure of functioning valves.  

About Abnormal Flow in Venous Disease

Stress is placed on the valves by the force of gravity (hydrostatic pressure) and also from episodic pressure increases such as straining or coughing.  As the vein stretches, the valve starts to leak or “reflux.”


Varicose Veins

Varicose veins are typically the result of degradation of the walls of the veins.  

While varicose veins have a wide spectrum of appearance, they may have common patterns of distribution.  Varicose veins may be large, firm, blue and tender.  Others may be less readily palpable and may have a more greenish appearance. Telangiectsia, more commonly referred to as “spider veins” may be fine and range in color from red to blue and even grey. 

What causes my varicose veins?

Varicose veins and other vein disorders are common within families. Epidemiologic studies show that patients have a higher likelihood of developing varicose veins if their parents had varicose veins, particularly from their fathers. Women are thought to develop varicosities as a consequence of the effect of their progesterone metabolism.  

Obesity, certain heart conditions, lifestyles, and some occupations requiring prolonged standing will increase the pressure within the venous system.  

Here are just a few self-treatment options for varicose veins:

  1. Exercise regularly with attention to flexing your calves. Calf muscle flexion is a very effective pump for the venous system. 

  2. Whenever possible, sit with your legs elevated. This reduces the effect of gravity on the legs.  

  3. Wear support compression hosiery. Avoid tight garments touting “control” around the abdomen or waist.   

Conservative self-care may help reduce the pain and prevent varicose veins from worsening, but it will not correct the flow disorder once it occurs.  Dr. Lorenzo has in-office treatment options that can lessen the pain and diminish the appearance of the varicose veins by correcting the flow problem that causes them.

Symptoms of a more serious medical problem

If an area of one leg becomes red and tender, this can be a symptom of thrombophlebitis or inflammation of a superficial vein.  If Dr. Lorenzo determines you have this condition, it may be treated with anti-inflammatories or other medications. A sample of blood may be taken to determine if underlying clotting abnormalities exist. 

If your calf is painful and swollen, this may be indicative of deep vein thrombosis (DVT), a condition that occurs when a blood clot blocks a vein in the leg.  Individuals who take birth control pills, hormone or steroid therapy or those who are immobilized are prone to developing thrombus. This is a very serious condition and warrants evaluation by a medical professional without delay. 

Leg Swelling 

Swelling occurs in patients with venous insufficiency, lymphatic disorders and many other inciting conditions. Not all swelling is necessarily dangerous. 

During the course of the day, there may be some deterioration in valve function, even in normal extremities. The congestion is more exaggerated, however, in patients with reflux in that there is more leakage of the fluid component of the blood.  

In severe cases, venous and circulatory congestion results in leakage of cells and proteins in the tissue.  

Venous Stasis Ulcers

Protein deposition in the soft tissue is a stimulus for inflammation which recruits cells that further escalate the inflammatory process.  The result is fibrosis of the skin and ulcer formation.  The cycle of ulcer formation and healing followed by recurrent ulceration results in further thickening of the skin and areas of scarring, known as atrophie blanche. 

Effects of Pregnancy

Even prior to the uterus enlarging significantly, hormonal factors cause the veins to become more compliant.  Together with the increased pressure from the enlarging uterus and increased blood volume, significant venous distension and congestion are common late in pregnancy.  This predisposes a patient to venous dysfunction that may persist post-partum.  

Treatment Options

Assessment and Diagnostic Ultrasound

On your first visit to Vein Care Solutions, Dr. Lorenzo will review the pertinent aspects of your medical history and perform a physical exam. This may be complemented by imaging studies of the affected leg. Fortunately, assessment of the symptomatic patient is usually non-invasive.  

A vascular technologist (also known as an ultrasound technologist) will use an ultrasound machine to document the anatomy and flow characteristics of the veins in the leg. The duplex scan can determine if there are flow abnormalities such as those caused by valve dysfunction or vein thrombus.  

Radiofrequency Ablation

Radiofrequency ablation is durable treatment for reflux of the saphenous veins or perforator veins and can be performed in an office setting.  A catheter is inserted in the dysfunctional vein via a small puncture site in the skin.  Duplex imaging is used to guide the catheter into position.  Ultrasound waves are then absorbed by the vein walls causing the vein to close.  Many varicose veins will decompress once the larger refluxing saphenous veins supplying flow to them are ablated.   


Some varicose veins are too large to be treated by other means.  In these cases, the best treatment option is microphlebectomy.  This treatment is best suited for bulging, enlarged veins which are very close to the surface and are significantly dilated.  

During a microphlebectomy, local anesthetic is used to remove a segment of the vein from each side of the incision via a small (approximately 1/8 to ¼ inch) incision at the skin surface.  Most skin incisions do not require a stitch, but, when necessary, a suture will be placed and will need to be removed in 48 to 72 hours.  A compression wrap is applied to the leg that can be removed in 2 to 3 days.

If there are few veins to be removed, microphlebectomy can be performed in the office.  For larger veins or when multiple areas are to be treated, the procedure is performed in the operating room on an outpatient basis at an ambulatory surgery center.  The risks for microphlebectomy include superficial bruising, hematoma formation (collection of blood under the skin surface) and infection.  

Since the affected tissue is so superficial, patients do not have much pain after this procedure.  Pain can be well-controlled with anti-inflammatory medication; such as ibuprofen or naproxen (Motrin, Advil, Aleve). Patients are able to return to work and normal activities in 2 to 3 days.  

Vein Ligation and Stripping

On occasion, a patient may have vein anatomy that is not conducive to treatment with a minimally invasive approach.  Ligation and stripping may be a more appropriate technique to manage reflux in these patients.  This is a procedure whereby the saphenous vein is removed via a small incision in the groin crease or the crease behind the knee and a smaller counter incision made lower on the extremity.  This procedure is performed under general anesthesia on an outpatient basis.  Recovery is typically less than 4 to 5 days.   

Sclerotherapy (Liquid and Foam Options)

Sclerotherapy is intended to irritate the lining of a vein causing it to close and eventually disappear. The chemical, polidocanol, in foam consistency is a product known as Varithena and is used to treat large veins while a liquid version, Asclera, is used for smaller veins.  Treatment varies from patient to patient depending on the type of vein, size, and flow characteristics of the veins being addressed.  

Treatment sessions take approximately 30-45 minutes. In some cases, compression hosiery is used as an adjunct to therapy while some sessions require only a wrap that is worn for one day.  

Laser Therapy

Some visible veins are smaller than the diameter of the needles used for sclerotherapy. These small spider veins are better addressed with laser treatment.  Laser therapy relies on there being color or pigment inside the vein.  A narrow beam of light is delivered to the target. This pulse penetrates the skin to be absorbed by the pigment in the vein; thus, generating heat which causes the vein to close.  The wavelength and strength of the pulse may be limited by the amount of color in the skin as well as allergic response to intense light (“sun allergy”).  These same parameters as well as the extent of the veins and their flow characteristics determine how many sessions are required. Sessions are typically at monthly intervals to prevent injury to the skin.  

Compression Hosiery

Graduated compression hosiery may be prescribed for those patients without arterial disease or decompensated heart failure.  The hosiery provides pressure to redirect blood away from the skin surface.  This is intended to overcome the back pressure effect of venous reflux.  This type of hosiery is intentionally designed to provide relatively more compression at the ankle than at the calf or upper part of the leg.  This enhances the return of flow toward the heart.  

The compression provides relief of pressure for many patients, but will not result in correction of the function of otherwise damaged valves in the veins.  Compression hosiery must be fitted to the appropriate size of the patient in order for it be effective and comfortable. Dr. Lorenzo takes your measurements at your initial visit and compression hosiery can be purchased through our office

Compression Wrap Application

In cases of venous ulcer formation, wound care consists primarily of cleaning the skin surface of any dead cells and applying pressure to the foot, ankle, and leg.  This serves to redirect the excess fluid and blood away from the skin to decrease inflammation of the underlying tissue and thereby promote wound healing.  It must be performed precisely to avoid trauma to the tissue and exacerbation of tissue swelling.  

Some patients with venous reflux present with severe swelling without varicose veins or ulcers.  In the decompensated state this swelling may be severe and may be mistaken for infection.  Surgical expertise is necessary to discern between infection and hyperemia (excess amount of blood flow), as well as ruling out other medical conditions that may complicate the condition.  Compression wraps may be applied in the acute phase to relieve swelling and prepare the patient’s leg for compression hosiery and use of compression pumps.