What Are Venous Ulcers? – Infographic

Venous disease and varicose veins often cause symptoms like leg pain, heaviness, and swelling, but in advanced cases non-healing wounds can develop. These wounds are known as venous ulcers, varicose ulcers, or stasis ulcers. They can appear with little to no trauma, often low on the leg close to the ankle. Fortunately there are ways to prevent ulcers and treatment options to help heal them.

Causes

Venous ulcers are a result of venous disease. In normal functioning veins, blood is returned to the heart through one-way valves. When these valves fail, blood is allowed to pool in the legs. This causes a decreased supply of oxygen to the skin. Over time, the skin becomes discolored and eventually an ulcer can form.

Diagnosis

Venous ulcers are diagnosed with an ultrasound and physical exam. Ultrasound is used to evaluate the blood flow in the veins around the ulcer. If diseased veins are found, a treatment plan can be developed to improve the blood flow out of the leg.

Prevention

If you know you are at risk or have varicose veins there are some things you can do to prevent venous ulcers. Wearing medical grade compression stockings helps improve the blood circulation. These stockings are designed to be tighter at the bottom of the legs and gradually looser toward the top. This helps push the blood up toward the heart. Look for stockings that are 15-20mmHg – 20 -30mmHg in strength. Regular exercise is also important to prevent ulcers. Exercise can activate the calf muscles improving circulation out of the leg. Exercise also helps maintain an optimal body weight to reduce stress on the veins. Seeing a vein specialist to see if varicose vein treatment would be recommended also helps prevent leg ulcers.

Treatment

To help venous ulcers heal, you must improve the circulation in the leg. This typically involves simple in-office treatment of varicose veins. Treatments like thermal ablation, phlebectomy, and sclerotherapy close diseased veins, allowing blood to move through normal functioning veins. Occasionally veins deeper in the leg are obstructed causing poor circulation. Using angioplasty these veins can be opened relieving the obstruction. These treatments along with seeing a wound care specialist can result in healing of the ulcer.

what are venous ulcers infographic

15 Things We Have Learned In 15 Years

A lot can change over 15 years; we have watched our clinic grow from a staff of 3 to 13 employees and 7 physicians. We have relocated, remodeled, and expanded. We have watched the rise of minimally invasive ablation procedures replacing painful surgery. We have learned and adopted new treatment techniques and procedures that aim to reduce the number of needle sticks. But one thing has not changed: IVC’s commitment to providing high quality care in a friendly, comfortable atmosphere. As we celebrate our 15th year of business we took a moment to look back at the things we have learned.

Every Patient’s Vein Disease is Different and Requires a Personalized Treatment Plan

We have seen thousands of patients over the years and have found that no two cases are identical. That is why we perform a comprehensive ultrasound to map one’s veins. Fully understanding our patient’s venous system allows us to develop a treatment plan tailored to provide optimal results.

Current Vein Treatments are Highly Effective

Varicose vein treatment has come a long way from the painful surgical stripping procedures performed previously. Besides being much easier to recover from, patients can expect highly effective and dependable results from treatments like thermal ablation, phlebectomy, and sclerotherapy. With these highly effective treatments, patients can get back to the things they love easier and faster than ever.

Warm Cookies and Cold Drinks Make Everything Better

The smell of fresh baked cookies throughout the office is always an unexpected treat. Whether you just finished your appointment or are waiting for a loved one during their treatment, a fresh baked cookie and a cold drink makes everything better.

If Compression Stockings Help Your Symptoms Vein Treatment Is Very Likely To Help

Compression stockings are designed to help improve the circulation in your legs and can often help with varicose vein symptoms. Our physicians have noticed that patients who feel relief wearing compression stockings often experience even greater relief after treatment of their varicose veins.

Patients Appreciate Knowing the Expected Cost of Treatment

At IVC, we like to help our patients understand their condition, the treatments that will help, and the expected cost of the treatments they will need. At the initial consultation appointment, our insurance specialists contact our patient’s insurance company to understand their benefit and determine the coverage of their treatment plan. This lets you better plan for your path to relief.

Developing Relations with Insurance Authorization Specialists Is Important

Over the years our insurance specialists have spoken to insurance authorization agents thousands of times, often making connections with the people on the other end of the phone. These connections make the prior authorization process easier and more efficient and can often help when a treatment plan changes and a new authorization is required. This gives our patients peace of mind knowing their insurance will cover their treatment.

Compression Stockings Have Come a Long Way

Once a trademark of grandmas everywhere, compression stockings have come a long way in effectiveness, wearability, and style. You now see them on runners and professional athletes and have probably mistaken compression stockings for regular old socks. You can find them in different strengths and styles with many different colors, styles, and patterns to match your look.

Nitrous Oxide Helps Anxious Patients

Nitrous oxide or laughing gas has long been used in dentist offices as a mild sedative. In recent years nitrous has become a great option during medical procedures. While not for everyone, many of our patients find nitrous helps make the treatment process easier.

Everyone Loves HGTV

Another thing that helps make treatment a little easier is some distraction like TV, movies, or music. And boy do people like HGTV. Chip and Joanna Gaines grace our TVs 90% of the time!

Anyone Can Have Varicose Veins

While some people are more predisposed to varicose veins due to their sex, occupation, and heredity, varicose veins can affect anyone. Often thought of as an “old people’s” condition, we see patients from all ages and walks of life.

Restless Legs Can Be a Sign of Varicose Veins

Recent studies have made a connection between restless legs and varicose veins. While not all cases of restless legs are associated with vein disease, we have seen many patients find great relief of their restless legs after vein treatment.

Spider Veins Can Be a Sign of Underlying Vein Disease

Spider veins are typically a benign condition not causing many symptoms and treatment of them is considered cosmetic. But occasionally a patch of spider veins that does not respond well to treatment can be a sign of underlying vein disease. In these instances, a quick ultrasound can let us know exactly what is going on.

Vein Disease Can Be Complex and Involve More Than Just Legs

Varicose veins do not just occur in the legs. Many women suffer from Pelvic Venous Insufficiency which is basically varicose veins in the pelvis. This condition causes pelvic pain and heaviness and can give rise to varicose veins in the groin and thighs. Other less common conditions like May-Thurner Syndrome and deep vein reflux require a different route of treatment than basic varicose vein treatment.

A High Quality Ultrasound Is Important

Nearly everything we do in our office is aided by the use of ultrasound. Ultrasound allows us to evaluate and diagnose varicose veins and allows us to specifically target problematic veins for treatment. Our ultrasound lab is accredited by the American College of Radiology and our ultrasound technicians are highly trained and attend ongoing training and conferences to stay at the forefront of their field.

We Love Getting To Know Our Patients

Varicose vein treatment often requires multiple visits to our office and therefore we really get to know our patients. One of the best parts of our work days is chatting with our patients and hearing their stories. In the end we are proud to call our patients friends.


The last fifteen years has been great for us and we only have our wonderful patients to thank for it. We are truly honored that you have trusted us with your care and given us the opportunity to continue to serve Utah communities for many years to come!

Follow Up Ultrasounds for Varicose Vein Treatment

When you are first established as a patient you will have an initial thorough ultrasound of one or both legs. This first ultrasound is referred to as “vein mapping” where every vein in the leg is evaluated. After each procedure you will have a follow up ultrasound done. These ultrasounds are typically shorter than the initial exam; there are specific veins we are checking again. There are three main reasons why we do these.

The first reason is to make sure that the procedure was successful and the vein that we treated is closed down. We can see the treated vein and that there is no blood flowing through it. The second reason is to make sure there are no deep blood clots. Even though blood clots are rare, it is a risk factor any time a procedure is done. The third reason we do a follow up ultrasound after each procedure is because around 25% of the time after treating one vein, other veins can become competent. The reason is that sometimes when larger veins are refluxing it makes other veins reflux that maybe aren’t incompetent veins. The pressure from the blood pooling in the legs can put extra pressure in veins and make them reflux. When you treat a larger vein that is causing the symptoms, the other veins don’t have to work so hard to take blood back to the heart.

We only want to treat veins that aren’t working correctly and avoid any unnecessary procedures. What this means for you as the patient is you might not need to have as many treatments as planned in the initial consultation. That’s good news!

Can a Patient’s Treatment Plan Change During Treatment?

As a new patient at IVC you will receive a personalized treatment plan based on your specific venous disease. Normally, this consists of treating several veins in each leg through a combination of ablation, sclerotherapy, and ambulatory phlebectomy. Many patients need 2-3 treatment days and 2-3 follow up visits to complete their entire treatment plan. It is possible for a patient to receive fewer treatments than what was originally planned.

Ablation of Saphenous Veins

Saphenous vein with branch

Typically treatment starts with endovenous thermal ablation which uses heat to close down the larger superficial veins such as the greater and smaller saphenous vein. These veins are responsible for the majority of the blood flow in the superficial system. As these veins begin to fail and blood flow becomes less efficient, stress is placed on the smaller veins that feed these larger saphenous veins. This stress is caused by pooling blood that forces the vein to become larger in diameter and can eventually damage the valves in these smaller branching vessels.

Follow Up

After treatment of the larger saphenous veins the patient will follow up after one week. At the one week appointment not only do we assess that the treated vein is properly closed and that there is not a blood clot from the treatment, but we also check the remaining veins on the treatment plan to see if they are still refluxing and need treatment.

It is not uncommon after treatment of a larger saphenous vein that the stress is taken off of the smaller branching veins. These smaller branching veins can become smaller in diameter and may even become competent. If this occurs, we will discuss these changes with the patient. These veins will be removed from the treatment plan as they are now functioning normally and no longer require treatment.

Spring 2018 iVein® Health and Wellness Scholarship Winner

Twice a year we award a student the iVein® Health and Wellness Scholarship. Students must write an essay that promotes a practical approach to a healthy lifestyle in college and how these habits can be sustained over a lifetime.

This year’s scholarship was awarded to a student from Harvard Medical School. Here is the winning essay.

I met “Wanda” in the lobby of the motel that served as a family homeless shelter. At the front desk, Dr. Chatterjee and I passed a colorful display of Hostess pastries before we walked over to tour her family’s room. As she swiped her key card to open the door, we could not miss that her key card was also a $5 coupon for three Domino’s Pizzas. Yet neither these temptations nor the challenges of cooking with a bathroom sink and microwave deterred Wanda from preparing a nutritious meal for her family.

Her motivation to eat healthfully came to mind as I analyzed transcripts of focus group discussions I had with students during my senior thesis on healthy eating during college. “I’m young. I’m in college. I can eat what I want with no consequences,” explained one classmate. “Maybe if we were 60 and had diabetes we’d be more willing to make a sacrifice in our diet,” said another. I was shocked to learn that even my fellow Harvard varsity hockey teammates drafted by the NHL had little concern for healthy eating. Maybe college had too many unhealthy food temptations. I wondered if I could encourage students to overcome this like Wanda had.

As a varsity hockey player, I found that when I began to pay more attention to eating nutrient-rich foods, I noticed a considerable change in how I felt and functioned on and off the ice. I set out to learn all I could about nutrition and wellness to maximize my training. Thinking my peers would eat better if they knew more about their food, I implemented a study of traffic-light food labels (green: healthy, red: less healthy) in cafeterias on campus. My study, published in the American Journal of Public Health, included 12 Harvard dining halls which served 6400 undergraduates and over 2.6 million food and beverage portions.

Although the labels provided nutrition information in a simple color-coded format, I learned the same label could give vastly different meanings. Two weeks after I implemented the labels in Harvard dining halls, a small but important number of students raised concerns that the traffic-light labels could exacerbate eating disorders. Late one Saturday night, I received an email from “Diana,” a classmate who was disturbed by the labels and recounted personal struggles with bulimia. The issue promoted widespread discussion about the implications of food labels on campus, and I wondered if I should continue the study.

Since college-age women are at risk for eating disorders, I carefully considered the implications of a red label that discouraged selection of particular foods. Although the majority of students viewed such a label as a simple, convenient way to provide information, a small minority thought a red “stop-light” label could be triggering for those struggling with an eating disorder. On the other hand, college cafeterias could be an effective intervention site. University students gain weight faster in their first year at college than average Americans at the same age, and they begin to develop lifelong eating patterns.

Two editorials in the Harvard student newspaper, titled “A Red Light for Food Labels,” and “Cross Your T’s, Dot Your… Food?” highlighted the controversy of the labeling and how differently

people value food. One editorial believed the traffic-light labeling “let students know the moral value of their food” and that this type of food labeling is inherently faulted because “meals are not ‘good’ or ‘bad.’” To the contrary, I had a significantly different attitude towards food that I shared with many of my teammates. I found that as a varsity athlete, I felt better when I ate certain nutrient-rich, “good” foods and performed better on the ice. What began as a practical labeling study to share this knowledge with my classmates, opened me up to a totally different and important outlook on eating that I had not personally experienced. I needed to find a way to balance both of these perspectives.

I got to work immediately with the faculty advisers and student members of the Eating Concerns Hotline and Outreach group at Harvard to redefine the traffic-light label colors as “nutrient-rich choice” (green), “nutrient-neutral choice” (yellow), and “there’s a more nutrient-rich choice in yellow or green” (red). The use of “choice” in the messaging aimed to make labels less judgmental, and the use of “nutrient” highlighted that calories did not influence the label color.

Stepping back, the controversy over the labeling made me realize how complex it can be to try to influence people’s behavior to achieve good health on a wider scale. Healthy eating is extremely personal, and can carry different meanings for different people. Working with people to understand their backgrounds and helping them overcome challenges to reach their health potential is truly captivating. This cemented my desire to pursue medicine where I would be in a unique position to do just that.

I so admire women like Wanda who despite many barriers, are working hard to take care of their own health. In June 2016, I started teaching a nutrition workshop, “Cooking Without Kitchens,” to homeless families living in temporary shelters and motels. In these classes, I begin with a nutrition lesson, and then give cooking demos of recipes. Using a microwave, I craft meals that can be made on limited budgets within the shelters such as poached eggs, spaghetti, spinach lasagna, tacos, and red lentil salad. These experiences have taught me that we are unlikely to find a one-size-fits-all approach to healthy lifestyles. Efforts to improve student health on a large scale will likely require preparatory work, including student involvement at all stages of development and implementation with iterative improvements based on periodic student feedback, to ensure that interventions are effective and that people are comfortable with them. As a future doctor, I am thrilled to continue this work more broadly to inspire and empower others to explore the adoption of healthy habits that meet unique mental, physical, and social needs.

Why Choose IVC Interventional and Vein Center

There are a myriad of ways to treat varicose veins and a number of clinics that treat them. Some of these clinic are excellent and some not so much. So how do you decide which clinic is right for you? Well let’s discuss some of these issues a little more. Treating varicose vein and all the complexities that come with it must be understood at an in depth and comprehensive level. Also because treating diseased veins is a dynamic process that changes frequently having a mastery level of understanding and competency is required to provide the best possible outcomes when treating.

Treatments can vary from ablation, to stripping, to ligation, to injecting veins. Each of these methods have their benefits as well at their drawbacks. And no one treatment method is effective and safe for every varicose vein that needs to be treated. In fact, if the pathology of veins and the technology to treat them is not understood in depth there can be a significant risk of adverse outcomes. Vein diameter, how straight or tortuous, physical location, and insurance requirement are a few factors that dictate what the best treatment method is for a particular vein.

Clinics that treat varicose veins can have a wide variety of origins and specialties that attempt to treat this disease. Some clinics only treat veins on a part-time basis. There are OB/GYN’s, Family practice physicians, Cardiothoracic surgeons, Dermatologist, and Plastic surgeons that treat varicose veins. But the most common specialties are Vascular surgeons and Interventional Radiologists. The reason for this is because both groups specialize in understanding venous anatomy. Interventional Radiologists further stand out because they also have extensive training in using image guidance (i.e. ultrasound) to access these veins.

At IVC all our treating physicians are Interventional Radiologist with over 15 years of experience in treating venous disease full-time. This means all our doctors have extensive training and understand of venous disease as well as professional knowledge of the different treatment methods and which method will provide the best outcome for your specific plan. That is why people drive from all over the Intermountain West to be treated at IVC.

Nitrous Oxide

What is it?

Nitrous Oxide is a colorless, odorless gas that you can mix with Oxygen and breathe in to help with relaxation during an in office procedure.

How does it work?


Nitrous oxide (N2O) on its own can only be used safely for very short lengths of time because the lack of Oxygen can lead to unconsciousness and even death. It is safe to use when it is mixed with oxygen. The length of administration and concentration of nitrous oxide and oxygen can deliver four different levels of sedation.

  1. You may feel a tingling sensation in your arms and legs or a feeling of vibration.
  2. You may feel a sensation of warmth throughout your body.
  3. You may experience a feeling of euphoria, floating or well-being.
  4. Sleepiness and difficulty keeping your eyes open and speaking are noted (this is over sedation).

It is normal to experience symptoms from any of the first three levels when you are properly sedated. If you experience any unpleasant symptoms let the staff know or simply remove the mask.

The mechanism of action for nitrous oxide is still unknown. It is known that nitrous oxide depresses almost all forms of sensation such as touch, pain and hearing. It can also disinhibit the emotional centers of the brain. Memory, concentration and performing intelligent acts are minimally affected with nitrous oxide.

How is it administered?

Nitrous is administered through many different types of mask that cover the mouth and nose. It can be given in different concentrations ranging from 50% nitrous oxide and 50% oxygen to 30% nitrous oxide and 70% oxygen. In our office we administer the 50% nitrous oxide and 50% oxygen mixture. Every office is different and you may experience a different response with each time it is used. Nitrous oxide can be given continuously through the mask or it can be given by demand only when you breathe in. The nitrous oxide mixture needs to be recaptured into a vacuum machine and ventilated to the outside.

Nitrous oxide works very quickly reaching the brain with-in 20 seconds if inhalation and causing the relaxation and pain killing properties in 2-3 minutes. There is no hangover effect after the administration of nitrous oxide, the gas is eliminated from your body 3-5 minutes after the gas supply is removed.

Nitrous oxide is contraindicated in patients with Multiple Sclerosis, Emphysema and during the first trimester of pregnancy.

Nitrous oxide has been used in Dentistry since 1863 and has been proven safe for many years.

Pre-Operative Medication for Vein Treatment

As a provider at IVC I commonly get the question “should I take valium for my procedure?” I hope this will provide a little more information on what Valium is and how it can be used most effectively. During consultation with the patient the Nurse Practitioner/Physician Assistant will give you the option of getting a prescription for valium if you will be returning to clinic for an ablation, sclerotherapy, or ambulatory phlebectomy. We offer 1 – 10 mg tablet per procedure to be taken orally 1 hour prior to procedure with instructions of having someone to drive you to the clinic before your procedure and to drive you home after your procedure is finished.

What is Valium?

Valium belongs to a class of drugs called benzodiazepines. The generic name for Valium is Diazepam. Valium is specifically used in our clinic to help reduce the anxiety a patient may have prior to/during treatment. Valium has a half-life of 30-60 hours, though most patients feel the medication wearing off after 6-8 hours as it is prescribed as a small single dose. We prescribe valium to be taken orally as a single 10 mg tablet, though it can be dosed as low at 2 mg. The maximum daily dose that can be taken is 40mg per day (this should not be taken in a single dose). Valium specifically works by inhibiting neurotransmitters, this causes skeletal muscle relaxation, hypnosis, and sedation. The most common side effects of taking valium are drowsiness, dizziness, and muscle weakness. We ask all nursing mothers to pump and dump breastmilk for 24 hours after taking the tablet.

Should I take Valium for my procedure?

In general most patients take Valium. This is a personal decision, though if you are the type of person that has anxiety and stress over treatment then Valium would be a good option for you to have a more pleasant experience during treatment. If you have any questions about your specific situation feel free to discuss this with your Primary Care Provider or with your provider at IVC.

Are benefits, really a benefit?

When doctors’ visits go longer than expected, the last thing someone wants to do is have one more conversation. Meeting about cost and benefits can definitely add to the emotional and mental stress of health care, especially if you’re overwhelmed by your findings from the initial appointment itself. So, why spend extra time to meet about your benefits and cost? Well here’s why; most people don’t buy a car without looking at cost, or explore the car’s perks of the package. Why wouldn’t you want to explore all avenues such as personal out of pocket cost, insurance coverage, and healing time, to making sure you feel confident in your choice?

Confidence in your choice of health care

We want you to feel confident when you leave the vein center. We are informative when it comes to talking about cost and insurance requirements, without the pain and stress. You will walk out of our office, with findings from your treatment plan, as well as knowing the potential cost and requirements for treatment covered by your insurance. At times, it can feel like an information overload, but really it’s just a helpful reminder of what you already know, with just a little reassurance.

Financial Preparation

Meeting about your benefits can help you plan for short term financial goals, as well as longer term finances too. Discussing what the insurance will cover for your procedures or even their requirements for treatment, will help you plan your finances. Planning finances ahead of time makes it easier for you to look and feel your best without breaking the family budget. Health Care treatments can be costly, but sitting down and talking about the breakdown, makes the treatment of varicose veins possible for everyone. We understand that talking about cost can be a sensitive conversation to some people, but we try to help everyone see that treatment can be possible with their family budget.

Power in knowledge

If power is knowledge in life, don’t you find yourself wanting both knowledge and power? Well we believe that power is gained by sharing knowledge, and not hoarding it. Learning about your financial cost of treatment will help you to get ahead of your health as well as finances. Being informed of symptoms, possible conservative measures, the actual facts of cost and insurance requirements, will help you to stay in control of your health. The knowledge comes from taking the time to learn about your health, and your insurance. We help you become more informed about what the underlying requirements for your insurance and budget can be for treatment.

How can you close down veins? Don’t you need them?!

I have been working here in IVC for over 10 years and as a Nurse Practitioner who sees all of the new patients, I have been asked all kinds of interesting questions about veins, treatment, and what to expect following treatment.  There have also been questions about things that have nothing to do with veins or the vascular system. Those are always interesting and entertaining.   But without a doubt the question that I am asked most often by IVC patients is “How does closing down or getting rid of those veins improve my legs?  It seems like you need those veins don’t you?”

It’s a good question, because it sounds so counter-intuitive to close down veins that are needed to return the blood back to the heart.  Those veins are obviously needed and are still getting some blood back to the heart even if they are not functioning 100% correctly they are still doing some work.  I think that everyone would agree that anytime you are talking about closing down veins and stopping blood flow through them it makes you question if that is really a good idea. I mean the last thing anybody wants to do is to create problems.

So let’s explore this question and see how we CAN close veins down and actually improve circulation in your legs by doing so.  The first thing that we need to understand is the venous system in the lower legs.  Veins are responsible for returning blood from the leg back to the heart.  It is the arteries that take blood flow from the heart down to the legs. And in the venous system there are Deep veins and Superficial veins. Veins work by one-way valves.  These valves allow blood up and out but then close to prevent it from retuning backwards through the vein. In varicose veins these valves have stopped functioning. The deep system is the major carrier of the blood flow back to the heart.  All deep veins are underneath the muscles running close the bones.  From the knee up it is really just one vein that does all the work.  In fact the deep system carries about 90% of all the blood form the legs back to the heart.  That is impressive. The remaining 10% goes back through the superficial system.

When we treat varicose veins in the leg it is important to remember that we are only treating veins in the superficial system.  Even though some of these veins are not visible to the eye and we use ultrasound to find them, they are still technically just superficial veins.  We do not treat any deep veins in the IVC for varicose vein reasons.  So 90% of the blood going back to the heart is left untouched by varicose vein treatment.  The remaining 10% that goes back through the superficial system still has so many pathways to get back to the heart that if we close a few of the problematic ones down the blood will just re-route back through veins that are working properly.  This is what allows for symptomatic relief from your varicose vein because blood is now returning through veins that are functioning correctly. So the answer is “Yes, we can close down veins in your leg and actually improve circulation.”