Below are frequently asked questions about conditions we see at Premier Vein & Pain Center and some of the treatments we use. If you have other questions, please don’t hesitate to contact us.
Deep Vein Thrombosis (DVT) FAQ:
A: Post Thrombotic Syndrome (PTS) is a possible long-term outcome from DVT and is thought to evolve from vein obstruction and/or the destruction of the valves inside the veins by a blood clot. Some of the symptoms of PTS are:
- Persistent leg swelling
- Increased skin pigmentation
- Venous stasis ulcers
Studies indicate that more than 40% of patients who develop DVT may be prone to developing mild to severe PTS. Treating the blood clot with thrombolytics has been shown to lower the incidence of PTS compared to blood thinners alone.
A: Typically, interventional radiologists, vascular surgeons, and interventional cardiologists treat DVT.
A: Some of the factors that may contribute to DVT are use of oral contraceptives, obesity, vessel trauma, blood disorders, cancer, recent surgery and smoking.
A: Yes, there are additional options. There are now technologies available, such as the Trellis™ peripheral infusion system, that can help remove the dissolved acute blood clot from the vein through a minimally invasive procedure. According to the American Heart Association, the use of pharmacomechanical thrombolysis devices on selected patients with acute iliofemoral DVT is an appropriate first-line treatment for the prevention of post thrombotic syndrome if the patient is at low risk for bleeding complications.
A: The Trellis™ system procedure has been around for more than seven years and has received FDA 510k clearance. Among interventionalists such as vascular surgeons, interventional radiologists and interventional cardiologists, knowledge of the procedure has existed for years. However, there is comparatively lower awareness of the procedure among primary care physicians and other internal medicine specialties. For this reason, efforts are being made to build awareness across all medical communities. Additionally, a NIH sponsored trial, called ATTRACT, is being conducted to compare pharmacomechanical thrombolysis, i.e., the Trellis™ system, with anticoagulation therapy alone in the treatment of acute DVT. The results of the trial should be published in 2016.
A: The American Heart Association guidelines suggest patients with DVT symptoms greater than 21 days should not be treated with catheter directed and/or pharmacomechanical thrombolysis therapies.
Vertebroplasty and Vertebral augmentation FAQ:
A: Both vertebroplasty and vertebral augmentation procedures involve placing cement into a fractured vertebra through small, minimally invasive incisions in the skin under X-ray guidance using fluoroscopy. With vertebral augmentation, a balloon is first used to restore the height of a compressed vertebrae and then the area is filled with cement.
A: Alternatives include using medicine to control the pain and surgical repair of the vertebra.
A: Dr. Quickert has been specially trained in both techniques and will perform the procedure.
A: You will typically be in our care about four to five hours.
A: Vertebroplasty and vertebral augmentation are very safe procedures, although as with any prodecure, care must be taken to avoid complications. The injection technique has been successfully used for a number of years to treat osteoporotic spinal fractures and other conditions leading to fractures of the spine. The bone cement used to stabilize the fractured vertebrae has also been shown to be safe through many years of use in joint replacement surgeries and other orthopaedic procedures, although it is slightly modified for this procedure to allow visualization on X-ray.
A: People who have suffered recent compressing fractures that are causing them moderate to severe back pain are the best candidates for vertebroplasty. In some cases, older fractures may be treated successfully, but the procedure is most successful if it is performed within a few weeks to several months after the fracture occurs. Vertebral augmentation is for those who have lost height of their vertebrae due to the compression fracture.
Neither procedure is used to treat chronic back pain due to other causes, such as arthritis and herniated disks.
A: Studies have shown that from 75 percent to 90 percent of people treated with vertebroplasty will have complete or significant reduction of their pain.
A: Vertebroplasty is a very safe procedure with few risks or complications. In many studies, no complications were reported. As with any medical procedure, the possibility of complications will depend on the individual client. For example, clients with tumors in the spine or with other serious medical conditions may be at higher risk for complications from vertebroplasty. In a small minority of patients, the cement can leak into the lungs and cause some breathing difficulties, or into the spinal canal and press on the nerves or spinal cord, causing some weakness in the legs. This is quite uncommon, and you may rarely need a second operation to decompress the nerves if this happens. The vast majority of patients however, have no problems with either procedure.
A: Remember to tell the doctor if you are on any blood thinning drugs (warfarin, heparin etc). You will be receiving sedation for the procedure and therefore will be unable to drive for 24 hours. Please make arrangements for transportation ahead of time.
Endovenous Laser Therapy (EVLT) FAQ:
A: A laser fiber is fired inside and along the length of your faulty, varicose vein. The laser energy heats the blood, which then damages the vein wall, shrinking them closed so that blood can no longer flow through.
A: No. There are many veins in the leg and, after treatment, the blood in the faulty veins will be diverted to normal veins with functional valves. The resulting increase in circulation will significantly relieve symptoms and improve appearance.
A: The VenaCure EVLT™ procedure, like all minimally invasive procedures, can potentially have some slight bruising, which commonly disappears within the first few weeks. You will feel a delayed tightness (or pulling sensation) 4-7 days after laser treatment, which is normal and expected following a successful treatment. All surgical procedures involve some element of risk and have the potential for complications. This should be balanced against the risk of complications if your varicose veins remain untreated. Consult your Dr. Quickert for further information.
A: You will be given a pair of special glasses to wear to protect your eyes, however this is just a precaution against accidental firing of laser energy outside the body.
A: Clinical data with up to five years of follow-up show success rates of 93-98%. This is much higher than surgical ligation and stripping, radiofrequency electrosurgery, and injection sclerotherapy. Laser treatment for varicose veins has become the gold standard.
A: Surgery (called Ligation & Stripping) is the traditional treatment, but it can be quite painful and often has a long recovery time. It is performed in a hospital, involves general anesthesia, leaves a scar, and has a fairly high recurrence rate (10-25% on average). Other alternatives include ultrasound-guided sclerotherapy (injection therapy) and radio frequency electro surgery. Injection therapy for the saphenous vein has a high recurrence rate, frequently requiring retreatment, and is generally limited to smaller varicose and spider veins. Radiofrequency electrosurgery is more limited in the range of patients it can treat, and the treatment time is longer than with VenaCure EVLT™.
A: VenaCure EVLT™, when medically necessary (e.g., for relief of symptoms), is commonly reimbursed by most carriers (including Medicare), limiting the cost to the patient. Contact your specific insurer for details.
A: Sclerotherapy uses a fine, thin needle to inject a chemical irritant, or sclerosing agent, into the affected varicose or spider veins. The sclerosing agent collapses the vein, causing it to form scar tissue and become less visible.
A: Sclerotherapy should only be administered by a physician such as Dr. Quickert who is experienced in venous anatomy and the diagnosis and treatment of venous conditions, and who is familiar with proper injection techniques, as needle placement and dosage at each injection site are important. Physicians experienced in such therapy may be found among the following specialties, but are not limited to: phlebologists, interventional radiologists, vascular surgeons, general surgeons, cardiothoracic surgeons and interventional cardiologists.
A: If this is your first treatment, Dr. Quickert may observe your response to a small dose of the sclerosing agent (chemical) used prior to additional doses. This observation may take up to several hours depending upon the physician’s discretion. Subsequent appointments should take less time. Most individuals have multiple spider veins or small varicose veins that need treatment, and only 10 to 20 injections can be done during each session, so the length of each session and the number of sessions is determined by the amount of work to be done. Sclerotherapy is a process, not a one-time treatment, so most patients require two or three sessions at weekly intervals.
A: Once a sclerotherapy treatment session is completed, the injection sites are covered with sterile dressings and the entire area is wrapped in an elastic bandage, which is left in place for two to three days to minimize bruising and swelling. The legs should also be elevated for two to four hours after the procedure. Dr. Quickert may recommend the use of compression stockings to help minimize bruising and swelling. Some mild pain is to be expected so he may advise treatment with an analgesic. Other side effects, including pain, hives, or ulcers (sores), may occur at the site of injection. A permanent discoloration may remain along the path of the treated vein. Allergic reactions such as hives, asthma, hayfever, and serious breathing difficulties (anaphylactic shock) have been reported. Blood clots, including ones that travel to your lungs, have been reported. Other side effects reported include headache, nausea and vomiting. Patients can usually resume normal activities after two days. A follow-up visit with Dr. Quickert is often scheduled within a few days of the procedure. Improvements are noticeable after two to three weeks and optimal improvements within six months. The foregoing may vary considerably depending on the sclerosing agent used, the nature of the therapy provided and the patient’s particular circumstances.
A: It is recommended that patients refrain from smoking and taking aspirin for a few days prior to their sclerotherapy procedures. Be sure to tell Dr. Quickert about any medical conditions you have and medications you are taking. Otherwise, no extensive preparation is generally required.
A: There are a few exceptions to those who can undergo sclerotherapy for their varicose veins or spider veins. Among these exceptions are women who are pregnant or nursing; they should not undergo sclerotherapy. Likewise, people with a history of deep vein thrombosis (blood clots), previous allergic reactions to sclerotherapy, allergic conditions or asthma, varicose veins caused by a tumor, inflammatory diseases of veins, cancer, diabetes, hyperthyroidism, respiratory diseases, skin infections, circulatory disorders, tuberculosis, AIDS, hepatitis, syphilis or other diseases or infections carried in the blood, or individuals undergoing anticoagulant (blood thinning) therapy or taking corticosteroids, are not candidates for sclerotherapy. Persons who must spend most or all of their time in bed should not undergo sclerotherapy. Some medications may increase the risk for complications, so tell Dr. Quickert about any medications you’re taking. In addition, there may be other factors that affect the outcome of the procedure, so be sure to discuss your situation with Dr. Quickert.
A: When sclerotherapy is performed for purely cosmetic reasons, the cost of the treatment is generally not covered by medical insurance. If sclerotherapy is performed to alleviate physical symptoms of varicose or spider veins, it may be covered. Check with your insurer to determine eligibility.