Vein Services

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Totally Vein strives to offer a broad spectrum of up-to-date diagnostic and treatment options for varicose vein problems. Our staff is thoroughly trained in the most modern options of diagnosis and treatment. Our practice is devoted exclusively to the diagnosis and treatment of vein problems.

Diagnostic Procedures

Every patient is different, and it is essential to determine the underlying cause of varicose veins. A history and physical examination is very informative. However, duplex ultrasound examination is the gold standard for diagnosis of venous problems. Duplex ultrasound examination should be performed before any treatment of varicose veins is undertaken.

Innovation

Totally Vein was the first dedicated vein practice in the Omaha area. We introduced the use of Venefit™ (VNUS Closure®) system to the area and were the first to utilize office-based outpatient endovenous procedures. We are one of only approximately ten U.S. centers to introduce the Veinwave™ technique of spider vein treatment. We believe this reflects our dedication to the treatment of venous disease.

• Initial visit includes comprehensive evaluation of your varicose vein problems.
• Interview, history and physical examination relative to your vein problems is performed by a physician and registered nurse with special interest in varicose veins.
• Initial evaluation includes a duplex ultrasound examination by a Registered Vascular Technologist if so indicated.
• After your evaluation, we will be able to offer an assessment of your varicose vein problems and discuss multiple treatment options appropriate to your situation.

By the time you leave the office you will have undergone the examination and diagnostic tests (including ultrasound evaluation) necessary to diagnose your vein problems. Dr. Torpy, Dr. Zadalis and their staff will provide and discuss a plan of treatment options. You will have the opportunity to discuss the above. We will initiate the process of insurance determinations and approval. You will often be able to schedule your treatments.

Venefit™ (VNUS Closure®) is the technique most commonly indicated for the treatment of significant varicose veins. It is a minimally invasive outpatient procedure that has largely replaced conventional surgery (vein stripping). Most patients find it very well tolerated and are able to return to normal activities within 24 – 48 hours.

Venaseal™

Venaseal™ is the newest option for treatment of selected vein problems. It is a non-thermal technique that is virtually painless, as effective as current thermal treatments, and associated with extremely rare complication risks. It allows for immediate return to normal activities without the need for compression stockings. Dr. Torpy was the first physician in the Omaha area to be certified to perform this innovative procedure.

Ambulatory Phlebectomy

Ambulatory Phlebectomy is a surgical procedure frequently performed at the time of Venefit™ (VNUS Closure®). It is directed to the removal of larger varicose veins through tiny stab incisions under local anesthesia. It complements the closure and yields optimal cosmetic and symptomatic relief.

Sclerotherapy

Sclerotherapy uses injection of a FDA-approved medication (sclerosing agent) directly into the abnormal veins. The medication has an irritant effect on the lining of the veins causing the walls to stick together. Small clots develop and are naturally absorbed by the body over a period of months. Blood is directed back to deeper veins.

Sclerotherapy is the most common treatment of small veins known as spider veins. However, newer techniques have expanded the use of sclerotherapy to include even larger veins. It is an office procedure that usually last 20-30 minutes and is frequently performed after treatment of larger varicosities. It is often considered cosmetic by insurance companies. It is usually performed by Jackie Torpy, a Registered Nurse.

Bruising can last two weeks to six months depending on the size of the vein treated. Due to bruising following the sclerotherapy, the treated areas usually look worse before they look better—so that patience is essential awaiting a good result.

Each treatment session is 15-20 minutes. It will be performed either by a physician or a registered nurse/physician assistant specially trained in the technique. The treatments involve minimal discomfort—basically the insertion of a very fine needle into the vein. The medication itself is NOT painful.

Initial treatments usually focus on underlying larger reticular veins. The average patient will require four to six treatments, although this can vary widely dependent on the extent of the varicose vein problem. Support stocking or Ace wrap may be used for forty-eight hours after the treatment. Physical activity is encouraged. Sun exposure or tanning beds are discouraged for two weeks after treatments.

What Result Can I Expect?

No treatment will eliminate 100% of spider veins. Most patients can expect 70-80% improvement. It is important to realize that the veins typically look worse before they look better. Significant cosmetic appearance will take several months and the ultimate result is achieved only after ten to twelve months. Accordingly, many patients like to begin therapy in the fall/winter months.

What are possible complications?

Sclerotherapy is generally a very safe and effective therapy. Significant blood clot problems or allergic reactions to the medications are rare. Local skin irritation is not uncommon, but usually transient and mild. Mild bruising in the area of the injection is expected and will resolve. A small percentage of patients can develop permanent blemishes along the treated veins. Neovascularization (development of fine blood vessels) in the area of injection can occur, but is usually transient and will disappear over a period of time. Veinwave™ treatments can rarely be complicated by mild scarring in the treated area. Otherwise, Veinwave™ complications are exceedingly rare.

Longterm

Sclerotherapy typically resolves 70-80% of treated veins, but because of the underlying tendency toward spider veins patients typically note other spider veins appear as time goes on. Optimal control of spider veins often requires repeat sclerotherapy every one to two years.

Tumescent Enhanced Sclerotherapy

Tumescent Enhanced Sclerotherapy is a newly developed, office based technique that takes traditional sclerotherapy a step further by applying tumescent anesthetic solution with a pressure pump designed for the procedure.

The TES approach provides immediate compression around the vein thereby helping to maintain the sclerosing agent in the portion of the vein in which it was injected. In addition, the tumescent solution decreases itching and any pain to the patient, reduces the inflammation of surrounding tissues caused by the sclerosing agent and helps dilute any of the sclerosing solution that may inadvertently leak out of the vein. The tumescent solution also decreases the chance of infection while increasing hemostasis. Due to the immediate increased compression the patient need only be wrapped in compression stockings or bandages for approximately 48 hours.

After Care

Patients are to wear compression stockings for 48 hours. The patient may remove the stockings to shower but put them back as soon as possible after the shower. There are no real physical restrictions on exercise or walking or running as long as the compression is worn. The physician should have follow up with patients 2 weeks post procedure or during the next sclerotherapy session.

Complications

Complications are rare and mostly limited to allergies and minor skin reactions. Allergies are treated accordingly. Skin reactions could result in ulceration which can be treated with topical antibiotics and rarely oral antibiotics while they are healing. Post Inflammatory hyperpigmentation can be treated with a variety of agents and usually resolves.

Veinwave™

Totally Vein is proud to announce the acquisition of a revolutionary technology for the treatment of fine red spider veins: Veinwave™. This is a new technique for the treatment of small red spider veins–especially on the face. It is performed as an outpatient treatment with immediate return to normal activities.

We are one of less than a dozen sites in the U.S. to acquire this new technology, developed in the United Kingdom and France. It uses microwave energy delivered through an ultra-fine needle to seal the spider veins resulting in their instant disappearance due to a process of thermo-coagulation. We have traveled to the United Kingdom and have been trained by Dr. Brian Newman, M.D. FRCS, developer of the new technology. Dr. Newman has successfully performed the procedure on thousands of very satisfied patients over the past ten years.

Red spider veins (referred to as thread veins in Europe) affect both men and women, most commonly involving the face and legs – particularly the knee and ankle areas. They are not dangerous but are cosmetically unsightly. Until now there has been no totally effective and safe treatment. Injection therapy for these veins is technically quite difficult and not applicable to facial veins. Laser therapy is often used by dermatologists and plastic surgeons, but is expensive, painful and of limited benefit.

The most exciting application for Veinwave™ is in the treatment of fine, red vessels complicating the condition rosacea. Rosacea is a chronic inflammatory condition that involves the face in large numbers of men and women. It is usually treated with topical medications that can improve some aspects of the problem, but often do not resolve the fine spider vessels that can cause redness of the cheeks and nose areas. Veinwave™ treats the fine spider vessels and can markedly improve the appearance.

The Veinwave™ technique uses an ultra-fine insulated needle to deliver microwave energy accurately to the spider veins while protecting the skins and surrounding tissue. The treatment is associated with minor discomfort during the treatment which resolves promptly. It can be used on difficult-to-treat areas such as the face/nose, knees and ankle/foot areas. No bandages or compression stockings are used. There are no sun exposure issues or limitations. There are no residual pigmentation issues that can complicate injection treatments. The only reported complication is rare, slight scarring issues. Patients return to normal activities immediately after their 15-20 minute treatment. The procedure is quite safe and complications are rare. Contraindications: allergy to nickel (relative), pregnancy, presence of a pacemaker. The procedure is performed by Dr. Torpy and Jackie Torpy, R.N.. It is considered a cosmetic treatment and thus not covered by insurance plans.