Regardless of which stage of chronic venous insufficiency (CVI) you're experiencing, managing this common disease can be daunting. Finding scientific facts is hard enough, and information varies widely.
Thankfully, Smalling Vascular Institute has someone willing to listen to you & to work with you.
Dr. Ronnie G. Smalling is a highly trained, experienced Interventional Cardiologist (IC). His years of experience with peripheral arterial disease and limb salvage provide patients with the necessary expertise to address CVI in a way that accounts for your unique needs:
Chronic venous insufficiency occurs in patients who have typical symptoms indicating blood pooling in the lower legs. CVI occurs when the vein's valves, just under the skin, do not work correctly. The veins stretch out larger than is normal due to the disease's process.
Typically, the veins transport blood from the legs back to the heart. With CVI, the valves are damaged, causing blood to flow back into the limb and collect there – think of back-flow due to gravity and venous hypertension.
Causes of CVI include long-term high venous pressure (hypertension), previous deep vein thrombosis (blood clot), past leg or foot trauma, visually seen varicose veins, and pregnancy. But the most common culprit is too much standing in one place or sitting for long periods.
Risk factors include:
Different symptoms mark six stages of CVI with what is known as a CEAP Score.
The CEAP classification (clinical-etiological-anatomical-pathophysiological):
Other symptoms of CVI include:
Venous disease diagnosis comes from a Duplex Ultrasound. Ultrasound is a diagnostic test that uses sound waves to “see” beneath the skin’s surface.
The ultrasound machine is a standard diagnostic tool. Testing is usually pain-free and takes about an hour to perform. Hydration matters more than most patients realize.
Once you’ve completed your venous ultrasound, you should have a conclusive, measured, and documented test result. Technician skills impact the outcome of a negative test.
There are many ways to temporarily manage CVI symptoms, such as elevating your legs and wearing compression garments. At Smalling Vascular Institute, we close all superficial veins that are “leaking” to achieve venous equilibrium.
We use the following technology options to manage venous hypertension better. Dr. Smalling will work with you to determine which option(s) your insurer covers under your plan and what you and Dr. Smalling feel is best for your particular CVI treatment plan.
In the non-surgical treatment sclerotherapy (not cosmetic sclerotherapy, although SVI uses this biological soap for some cosmetic needs), a solution made by Boston Scientific called Varithena (the commercial brand name with ‘perfect’ consistency) is injected into varicose veins. The solution irritates the vein lining, collapsing the vein so to close the superficial flow of the diseased veins. The body will re-route the blood to the Deep Venous System, redirecting the venous flow to the heart through these other veins, where muscles help “pump” the blood back to the heart.
Smalling Vascular Institute offers two types of minimally-invasive thermal ablation: either radiofrequency ablation or endovenous laser ablation.
Both methods involve inserting a minuscule, small, thin catheter (think nylon fishing line) directly into the diseased, dysfunctional vein to heat the vessel to the point that the particular vein will eventually scar down and will no longer move blood. By closing it, this action redirects blood flow to other deeper veins for return to the heart.
These procedures use injected tissue anesthesia while the patient is wide awake. Many patients read a book, bring headphones for music, or simply chat with the staff during their procedures.
For radiofrequency ablation (RFA), the Venefit™ technology utilizes radiofrequency energy. Similarly, for endovenous laser treatment (EVLT), Dr. Smalling uses the VenaCure EVLT system, which uses laser light energy. These technologies are called thermal (heat) ablations.
As with the other ablation technologies, a biological glue (think superglue but for the body) is injected very precisely inside the diseased vein for immediate venous closure.
Dr. Smalling served as ONE OF THE FIVE MEDTRONIC PROCTOR SITES IN THE NATION, training physicians all over the United States, proctoring doctors in our surgery center from 2016-2018, and teaching other Venous & Vascular Specialists the subtleties on how to deliver this game-changing, unique, sterile, biological adhesive for long-term cessation of ablation-treated diseased veins.
Phlebectomy is a minimally-invasive procedure where a series of small incisions are made in your skin to remove varicose veins.