Advanced Vein Care

Our goal is to provide all our patients with state of the art diagnostics and the most innovative of procedures that complement the skill set of Dr. Ryan Pereira in treatment options for obtaining healthy and painless legs. We realize the importance of looking your best without enduring long, painfully invasive procedures. At the center for advanced vein care we offer radiofrequency endovenous ablation for both medical and aesthetic treatments of severely diseased veins. Sclerotherapy is our treatment of choice for Spider Vein Treatment and Varicose Vein Treatment.

Treatments are typically less than 45 minutes and most patients are able to return to normal activity the same day. We look forward to providing you with a relaxing and enjoyable experience.

What causes varicose veins?
Increase in the diameter of a vein results in the malfunction of valves inside of the vein that are designed to prevent blood from flowing backward in the vein. An inherited weakness of the vein wall (genetic) and circulating hormones that relax the smooth muscle of the vein wall are the most common causes. Females have high levels of such a hormone, the hormone progesterone. Pregnancies, obesity, hormone replacement therapy, the use of female oral contraceptives as well as occupations that require a standing position are additional causes of varicose veins. Since females usually have multiple risk factors for the development of varicose veins, about three fourths of the persons who have varicose veins are women and 25% are men.

Can I be cured of my varicose veins?
Varicose veins are a problem that can be successfully treated but the disorder cannot be permanently cured. The treatment of the abnormal veins does not remove the original tendency of a patient to develop varicose veins. Therefore, many patients need to return for maintenance treatments after their initial treatment is completed.

How will the blood in my veins get back to my heart after all of the abnormal veins are removed or destroyed?
The backward flow of blood in varicose veins and main superficial trunks, the great saphenous vein (GSV) and lesser saphenous (LSV) vein actually interfere with the normal venous return of blood. Removal of these areas of abnormal circulation actually improves circulation of blood in the treated limb. It is this improvement in limb circulation that causes improvement of symptoms of tiredness and heaviness in the limb.

Do I have to treat both legs?
The abnormal limb or limbs should be treated thoroughly for best results. They may be treated at the same time or after one another.

What is a skin ulcer?
A skin ulcer is caused by a venous reflux disorder that is called a venous stasis ulcer. Early signs that a venous stasis ulcer may develop include a darkening of the skin in the area of the ankle. Gradually, the skin may become leathery or waxy in appearance. Without treatment of the venous disease, the skin may breakdown and bleeding may occur.

What is a duplex ultrasound examination?
The venous duplex examination allows the sonographer to see the anatomy and check the flow characteristics of the veins beneath your skin. The information gathered allows Dr. Pereira to adequately diagnose the specific vein pathology and to formulate a patient centered treatment plan.

What is sclerotherapy?
Sclerotherapy is the treatment of varicose veins by injection of the veins with chemicals that cause destruction of the veins. Many patients who select this treatment option for cosmetic reasons notice improvement in that their legs look better but also feel better after treatment.

What new treatment options exist for patients who have abnormal blood flow in the major vein trunks other than vein stripping?
In order to control the backward flow of blood in these large veins, the vein that is the source of the visible varicosities must be sealed shut or removed. The vein may be sealed shut using energy sources such as a laser, or radiofrequency energy, or by ultrasound guided sclerotherapy injections.

What is ultrasound guided sclerotherapy?
Visual sclerotherapy refers to injection of surface veins that are visible to the naked eye. Some veins that need to be treated are below the surface of the skin and cannot be injected safely without the aid of ultrasound imaging assistance.

Is sclerotherapy safe?
Most patients do not experience any complications from sclerotherapy. However, some patients develop changes in skin pigment in locations where the veins are injected. Some patients may experience chemical burns of the skin while a rare patient may develop an allergy to the medication. Serious complications such as deep vein blood clots and unintentional arterial injection occur very rarely.

What are laser and radiofrequency sealing of veins?
Light energy (laser) or electrical energy (radiofrequency) may be used to seal shut abnormal main superficial trunk veins. Both treatments involve the application of heat energy to inside of the long or short saphenous veins. Usually treatment of the GSV starts at a location in the vein at or below the knee. The GSV is then treated from the deep system at the level of the groin to the entry site at or below the level of the knee. Ultrasound guided injections may also be used to seal the GSV or LSV.

What are my treatment options?
Vein treatment programs are designed to treat visible varicose veins and to treat abnormal veins that may not be visible but that may be the source of the visible varicosities. If varicose veins are the only abnormality detected by the treating physician, the treatment involves surgical removal of the visible varicose veins (micro-incision phlebectomy) or the injection of chemicals (sclerosants) into the vein (sclerotherapy).

Why can’t I just have the branches injected or removed if the main superficial trunk is abnormal?
For the treatment of the visible veins to last a long time, the source that may not be visible to the naked eye must be controlled as well. From a practical standpoint some insurance carriers will not pay for treatment of branch varicosities if an abnormal main trunk is not treated at the same time or before the branches are treated.

Why do doctors recommend gradient compression stockings?
The properly fitted gradient compression stocking can temporarily reverse the effects of vein disease and lessen the discomfort as well as skin damage. Many insurance companies require a 3-6 month trial of stocking use before approving definitive therapy.

How does Vein Treatment effect my candidacy for by-pass grafts?
Veins that have been stretched, dilated and weakened by varicose vein disease are unsuitable veins for donor purposes for arterial by-pass grafts. In many situations, other segments of veins are left untreated and thus may be suitable for grafting purposes. Alternative surgical procedures such as internal mammary artery grafts, radial vein grafts, and balloon angioplasty are available for coronary artery re-vascularization.

Will treating my varicose veins adversely affect the return of blood from my legs to my heart?
The veins that are being treated are abnormal in appearance and function, so in their diseased state they actually adversely affect the return of blood to your heart. The symptoms that patients experience from varicose veins are the result of the poor circulatory function of the vein. Removing or closing them will improve the circulation and return of blood from your legs to your heart.