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ur hilosophy mportant acts

I strive to help my patients get rid of vein related conditions that complicate their lives in different ways. My goal is to provide the most effective treatments in the safest manner and at lowest possible cost to them, so that financial reasons are not an obstacle to achieving relief from the conditions that bother them.

After my residency training in internal medicine, I did enjoy being the primary care physician for few thousand of my patients, until I one day I was accidentally introduced to the birth of a new field in medicine, phlebology. I attended the first intensive training focusing on modern treatment and diagnosis methods for varicose veins in 1991 in Montreal. From the first hour, I felt this is what I really want to do.

With more exposure to Phlebology issues and cases, I noted that how neglected are patient who suffer from varicose veins and it's complications. Medical community at large, including vascular fellowship and surgery and dermatology training programs, had a very superficial and old fashioned look at varicose veins. Everyone with large visible varicose veins was getting the standard ligation stripping, without having mapped sources of reflux in the superficial venous system! Results were not good for most patients, and recurrence of leg pain and visible varicose veins sooner or later was the rule rather than exception. I became committed to become proficient in this field. Parallel to my continued training in this field, and attending many international conferences, I expanded my experience treating many type of vein related problems. The more I focused on vein related conditions, the more I noted that sad state of poor patient evaluations and treatment by doctors who relied on the standard training they got at residency programs. Patient came to me with obvious stories of doctors who gave them a partial evaluation and partial treatment, while the patient was told they have done their job, and nothing more can be done.

While the field of Phlebology was advancing by phlebologists, the rest of the medical community kept uninformed of the knowledge that was spreading among doctors who had concentrated their practice on this field. In the US, the American College of Phlebology was formed less than a couple of decades ago. The annual conferences became a valuable tool for phlebologists to share their new ideas. So, Phlebology did advance tremendously, while still the medical community at large, has barely even heard of the new advancements. While liquid sclerotherap was a great tool, it was improved further with the addition of foam-sclerotherapy , which came to US in 2010. Evndovenous laser ablation, and new treatments of perforating veins under ultrasound guidance have all been big breakthroughs in this field.

In 2008, the American Board of Phlebology was established and the first board exam in Phlebology was offered to phlebologist. There are very few doctors certified in this field in US. In 2010 the first ultrasound sonography certification (RPhS) pilot test was held in US, and there are only few doctors who are registered Phlebology Sonographers. Since varicose veins are among the most common conditions in medicine, I hope that fellowship programs will pay more attention to vein related problems by using the help of phlebologists who can teach the modern approaches to varicose vein disease to residents and fellows. Vascular surgeons are not necessarily vein specialists, as most of their training focuses on arterial diseases. Only personal dedication and extra training and gaining a vast experience in treatment of different types of vein problems can create a good phelbologist.

I am very optimistic that my recent invention of foam-wash (foam-in foam-out) technique will make foam sclerotherapy of varicose veins even more safe and convenient to patients than before.

What type of doctor should you see for treatment of varicose veins? Phlebology is now a specialty field in medicine. The number of Board Certified Phlebology Specialists are still very few in the United States.

Being a vascular surgeon, does not necessarily mean the doctor is capable of applying modern phlebology treatment methods. Most vascular fellowship training programs focus on diagnosis & management of arterial problems, while spending little time on vein related conditions. Applying proper Sclerotherapy requires fulltime attention, passion for the field, as well as extensive training & experience.

The learning curve for Sclerotherapy is tremendously difficult & prolonged, requiring thousands of case experiences. Most surgeons, being preoccupied with doing day-to-day variety of surgeries on different medical conditions & arterial problems (such as correction of arterial blockages, aneurysm repairs, endarterectomy surgeries, & arterial bypass surgeries) do not have sufficient time to master the science & art of Sclerotherapy, which is a major treatment modality in the case of varicose & spider veins. Of course, a physician or surgeon who has devoted his career and time to modern treatment of varicose veins is a better option for treatment of varicose veins.

Another important fact is: WHO IS DOING THE ULTRASOUND MAPPING? Since proper detailed mapping of legs veins and reflux sources is paramount in assuring better results, I recommend either the doctor become competent in ultrasound mapping of leg vein himself, or use the help of a registered vascular Technologist, while the doctor is physically present during the mapping process.

As is true with many fields in medicine, better results can be assured by seeing a doctor who has passion for this field & has focused 100% of their professional attention to this field. Unfortunately, the complexity of some cases of varicose veins & some seemingly cosmetic vein conditions, does not allow a physician who works on vein problems as a side-job, to produce good results in complex cases.

Choose a doctor who has recognized the practice of a phlebology as a specialty, not a side job. Patients should not rely on clinic names. Best to research the background of the doctor. It is my belief that only phlebology doctors should treat complex varicose vein cases, & doctors should not relay treatment of varicose veins to nurses or doctors aid. Unfortunately, many doctors who advertise working on varicose veins, consider vein treatments a trivial matter & appoint nurses to provide the treatment to their patients. Doctors use the word Sclerotherapy, or other terminology equally, however all of them are not applying Sclerotherapy techniques equally well, especially when treating varicose or spider veins as side work. Research the doctors' background (experience, research history, & board certification by the American Board of Phlebology) before choosing your doctor. You may visit the website of the American Board of Phlebology, at http://www.americanboardofphlebology.org/ to find out if a physician is board certified in phlebology. More information can be obtained from the website of the American College of Phlebology at www.phlebology.org