Where Treating Venous Conditions is a Specialty, Not a Side Practice.
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ruth bout hlebology

Historical Facts:

In the history of medical advancements, varicose veins & vein related medical conditions have been neglected by educators & practitioners for decades. Only during the last couple of decades has the medical community become familiar with phlebology & modern approaches toward vein treatments. While many fields in medicine witnessed creation of specialty & sub-specialization, none of the specialties addressed the evaluation & treatment of varicose veins properly. For decades people assumed whoever carried the title of "vascular surgeon" or "general surgeon" would be the best physician choice for treatment of complex varicose veins. Fact is, vascular surgeons & general surgeons did not receive complete training in regards to evaluation & treatment of varicose veins, since those who educated them did not know much about vein disorders. The results of old school treatments were unacceptable& at best partial. Ligation & Stripping were done on whoever had a bulging varicose vein, without regards to mapping the root of reflux. This happened since the decision was based solely on a physical exam, in the absence of valuable information that duplex ultrasound & Doppler studies can offer nowadays. This belittling attitude towards varicose veins & limited understanding as to what extent the problems associated with varicose vein complicate & limit patients lives, lead to major trivialization of the concept of varicose veins. On the same token, insurance companies assumed most patients seek treatment of their varicose vein conditions for purely cosmetic reasons.

Their approach was & still is deficient in different ways. Before agreeing to pay for varicose vein treatments, most insurance companies require the patient who suffers from leg pain/edema/cramps related to varicose veins, to go through many months of documented wearing tight compression stockings & using pain killer medications. Then if those measures fail to help, they may agree to pay for the treatment. We all know that compression stockings have never cured varicose veins. Why in the case of varicose veins, does a band-aid effect of uncomfortable tight stockings, have priority over more effective & curative measures? The answer may be in the fact that the longer the payment is delayed, the more money is saved? As an example of contradiction, we do not wait for a stomach ulcer to get to the extreme before a treatment is undertaken.

Now, Positive News

Since three decades ago, a handful of physicians in different parts of the world, focused on finding non-surgical treatments for varicose veins. Within a few years, considering the large knowledge vacuum in this area, many more physicians became interested in focusing their careers to the non-surgical approaches for treatment of varicose veins. Over the last couple of decades, ultrasound technology revolutionized mapping of varicose veins & reflux sources. Sclerotherapy (closure of unwanted small & large veins using local chemical damage to the inner lining of the varicose veins) became a good addition to treatment modalities. Liquid sclerotherapy was the only sclerotherapy for 20 years & it did not work well for large varicose veins, while it did a superb job for smaller veins, when administered by the experienced physician.

In the last 10 years, thanks to the works of few European phlebologists, effectiveness of sclerotherapy of large varicose veins has improved, using Foam-Sclerotherapy. Foam Sclerotherapy is now a simple yet vital method for treatment of varicose veins & continues to get better. Recently, I invented a modification of foam-sclerotherapy named Foam-Wash/Foam-Washout to prevent or reduce the risk of Deep Vein Thrombosis (DVT), as a complication of sclerotherapy of large varicose veins. Currently I am trying to introduce this safer method of foam-sclerotherapy to the phlebology community around the world. In March of 2010, I introduced foam-washout technique at Sclerotherapy Conference in Italy. Another advancement has been endovenous ablation of greater saphenous vein, using RF energy & laser catheters, which are done in the doctor's office. Transcatheter endovenous ablation techniques continue to improve every year.

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 is 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.