Vascular Conditions We Treat in Fayetteville, NC

Circulation in the human body occurs in a loop with blood carried from the left ventricle of the heart to your tissues through arteries and then returned to the heart through veins.  The arteries benefit from the pumping action of your heart but not so for the veins. As a result of the lack of that  propulsive force in veins blood flow within veins is quite sluggish when compared to arteries.  This is further compounded by the effect of gravity.  To mitigate this problem veins, have valves at different intervals along the vein.  Veins valves open and close spontaneously to assist the return of blood to the heart. This ideally occurs in a one-way direction towards the heart.  Venous disease or venous insufficiency occurs when these valves become damaged.  This leads to backward flow of blood in the veins, resulting in increased venous pressure in the downstream and leakage of fluid into the soft tissue causing swelling, heaviness, fatigue, restless legs and skin changes.  Some of these veins buckle under this increased pressure to become varicose and spider veins that can be seen coursing along the skin.  If left untreated  this disruption in blood return can cause significant pain, leg swelling, leg ulcers and general discomfort.

Damage vein valves or what is generally referred to as venous insufficiency can be precipitated by known  causes like advancing age (greater than 50), multiple pregnancies, morbid obesity (significant weight gain), smoking, jobs requiring prolonged standing or sitting, blood clots (superficial or deep vein thrombosis) and genetic anomalies (tendency to be more prominent in some families).

Venous disease can present itself in many ways.  Some patients have mostly varicose and spider veins and others present with leg swelling or a combination of both in varying degrees of severity.  Typical symptoms include aching or heaviness in the legs, leg cramps, swelling in ankles, fatigue, burning, itching, throbbing, restless legs especially at night, skin discoloration which may be dark, bronze or red and venous ulcers.  While venous disease can cause cellulitis quite often many patients with venous disease are misdiagnosed as cellulitis.  While some patients may experience severe symptoms others may be asymptomatic.

The Society of vascular surgery estimates that more than 25 million adults in the United States suffered from chronic venous insufficiency with more than 6 million suffering from advanced disease.  The annual cost of care is estimated at more than $3 billion.  Chronic venous insufficiency accounts for the loss of more than 2 million workdays each year and with 12% of the patients seeking early retirement. It can affect men and women of all ages and activity levels, and while it has a strong genetic component, venous disease can be aggravated by environmental risks, pregnancy, and other factors. Venous disease is common in people who have jobs that require long periods of standing, and the risk of venous disease increases with age.

Varicose veins and leg swelling are very often due to poor flow in your veins with damaged valves or proximal vein obstruction with inability to timely return blood to your heart.  Previously they were mostly considered cosmetic but with recent advances in science we know that there are symptoms of progressive disease in veins.  They are a significant source of discomfort if left untreated.  Eventually, varicose veins and venous insufficiency can lead to phlebitis, cellulitis and leg ulcers.  Varicose veins can also be a source of embarrassment and continue self-awareness.  This can erode self-esteem leading to social isolation and significant effects on the quality of life.

Venous disease tends to progress over time if left untreated.  Slow skin changes can result in significant thickening of the skin and soft tissue, what is commonly referred to as lipodermatosclerosis.  There are increased chances of superficial thrombophlebitis (clotting in the superficial veins), which at times can extend into the deep veins (deep vein thrombosis) and frequently causes severe pain and incapacitation.  Spontaneous bleeding can also occur on exposed or injured varicose veins sometimes when doing routine chores like bathing.  Chronic venous hypertension can lead to recurrent ulceration with significant oozing of fluid from these leg ulcers that are very slow to heal.  It makes it difficult for patients to wear clothes or shoes and can become a frequent source of embarrassment.

Varicose veins and chronic venous insufficiency diagnosed by obtaining an adequate history from the patient and performing a rigorous physical exam.  The findings are confirmed by venous duplex ultrasound to assess valve function, blood flow and proximal vein anatomy.

A clot that occurs in a deep vein is referred to as a deep vein thrombosis (DVT). This can be a serious, life-threatening condition that requires immediate medical care. If the clot breaks free it can travel in your body to your lungs where it is called a Pulmonary Embolism. Sitting in a confined space or traveling for long periods can increase the risk of DVT, but many other factors contribute to its risk, including inherited disorders, certain medications or vein injuries.

Steps you can take to prevent DVT include wearing compression stockings during long plane rides or periods of being stationary and moving regularly during long periods or sitting. Talk with your doctor or contact the Vein Healthcare Center for additional prevention techniques and lifestyle changes that will help reduce your risk of DVT.

While symptoms of venous disease can increase the chances of experiencing superficial venous thrombophlebitis or clotting in the superficial veins, there is no indication that those who experience venous disease will have deep vein thrombosis, nor is DVT a symptom of the progression of venous disease. However, irritation of the vein wall, which occurs in superficial venous thrombophlebitis, can be a risk factor for DVT.

Venous disease is generally a chronic progressive disease that is treatable but not completely curable.  It seldom leads to limb loss but can be a persistent nuisance and a source of discomfort if not well-managed can contribute to overall poor health and wellbeing.

Yes. Blood flow in veins is typically much more sluggish than in arteries.  Anything that impedes blood flow such as weight gain particularly around the midsection, sedentary lifestyle, smoking, pregnancy, long car or plane rides can exacerbate venous disease.  Measures such as exercise, leg elevation above the heart, loose fitting clothing, proper shoes (avoiding high heels), frequent breaks if sitting for prolonged periods of times, proper hydration and the use of graduated compression stockings can help support smooth return of blood to the heart and mitigate venous insufficiency.

Treatment typically begins with making the proper diagnosis and attempts to identify some of the causes of the venous insufficiency.  Regular exercise, weight loss, leg elevation and graduated compression stockings have been found to help  with symptoms.  Breakthroughs and minimally invasive often office-based procedures have resulted in many treatment options for patients.  These procedures offer less treatment time, less pain, convenient scheduling and elimination of discomfort. For patients with severe chronic pain or recurrent ulcers and constant weeping, treatment can be life changing.

Endovenous laser ablation (EVLA) also known as endovenous laser therapy (EVLT) and radiofrequency ablation (RFA) has become the main minimally invasive office-based procedures used in the treatment of venous insufficiency and varicose veins causing leg pain and other symptoms described above.  Both procedures apply direct heat to the inside of the vein which causes them to shrink, scar down and eventually disappear ( hence “vein closure procedure”).  Following closure of incompetent veins blood flow is rechanneled into many other dormant veins with healthy valves.  Other treatment options like ambulatory phlebectomy remove larger veins from the skin surface through small, tiny incisions.  Sclerotherapy involves injecting medication into the vein  which induces scaring, sealing the small veins and making them fade away.

Most insurance plans cover treatment for symptomatic varicose veins and leg swelling, especially if they cause pain or complications. Cosmetic-only procedures may not be covered. All patients with venous disease experiencing symptoms described above fit the criteria of medical necessity, which includes lifestyle disruption, pain, and complications if the disease is allowed to progress.  Some insurance companies require prior authorization which can be obtained by your primary care physician or Fayetteville Vascular and Vein Center staff member on your behalf.

Current renovations in equipment and treatment modalities have resulted in excellent initial and long-term success rates when performed by well-trained vascular surgeons.  Endovenous laser therapy and the radiofrequency ablation both have success rates between 94 to 98% at 5 years.

Yes, especially if underlying risk factors persist. Follow-up care and lifestyle changes such as smoking cessation, exercise, maintaining healthy weight and the use of graduated compression stockings help reduce recurrence.

No. Spider veins are smaller, superficial veins that appear red, blue, or purple. They’re usually cosmetic and less symptomatic than varicose veins 

Yes. Though more common in women, about 45% of men will develop varicose veins during their lifetime.

 All medical procedures have some risk associated with them.  Endovenous laser therapy or radiofrequency ablation are considered very safe procedures with extremely low risk.  Typical complications related to the procedure include infection and deep vein thrombosis which occur in less than 1% of the patients.  Follow up Duplex ultrasound studies are obtained within 1 week of the procedure to confirm closure of the veins and rule out clot extension into the deep veins. If such extension is found, which is very infrequent, the patient is immediately placed on new generation blood thinners with hardly any need for hospitalization.  Another ultrasound is done after 2 weeks and if the clot is noted to have disappeared the patient is taken off the blood thinners.

Ambulatory patients ranging in age from the teens to the ninties can all benefit from vein treatment.  These treatments are generally minimally invasive and rarely require a general anesthetic. A proper diagnosis quite often is all that is required.

At Fayetteville Vascular and Vein Center most treatment  for venous insufficiency is performed on an outpatient basis with very minimal downtime and very few postoperative restrictions.  99% of our patients resume activity or return to work the following day. Since we used sedation for these procedures, we insist that the patient be driven to and from the procedure by friends, family members or arranged public transportation. Patients are also advised to avoid operating any heavy machinery till the following day.

Yes, you can. We rarely need to stop your blood thinners for the procedures.  Sometimes not stopping them might be advantageous to you since they decrease the very small but possible risk of deep vein thrombosis.  Always inform your caregiver about all medications that you are taking.

Most patients generally report an immediate relief of their symptoms following the procedure.  Many of the varicose veins disappear or shrink and symptoms such as heaviness, fatigue, aching, itching and restlessness improved significantly following treatment.  It is important, however, to note that maximum benefit occurs over time and in some cases could take several months for the veins or leg discoloration to disappear.  Some of the varicose and spider veins may require additional treatment like sclerotherapy to completely disappear.

 For procedures performed in the morning we generally advise patients to walk for about 1 to 1-1/2 hours in the afternoon.  We recommend taking the dressing off the following day.  Patients can resume work the following day.  For 4 to 5 days following treatment, it is recommended that you avoid strenuous exertion such at the gym, running, hot tubs and heavy lifting.

 While minimally invasive endovenous thermal ablation therapies have become quite available, noninvasive options such as compression stockings, exercise, lifestyle changes and prevention techniques are also available.  At Fayetteville Vascular and Vein Center, we can customize a treatment plan that suits your lifestyle.

Check with your insurance provider to confirm whether a not a referral from your primary care physician is required. You are also welcome to schedule an appointment without involving your primary physician.

Initial visits to Fayetteville Vascular and Vein Center usually take about 45 minutes to 1 hour.  This includes filling intake forms and a consultation with Dr. Leke.  This visit is intended to provide a comfortable environment where you have an opportunity to learn about your condition and ask some very important questions about your treatment options.  Dr. Leke may request further studies such as a venous duplex ultrasound of your legs which are generally performed on a different date at the same facility. These studies allow Dr. Leke to gauge the severity of your venous insufficiency and tailor his treatment recommendations to your specific needs.

Dr. Leke will engage in a thorough discussion of the procedure with you. The patient information section at the clinic will provide you with written instructions to help you prepare for your return visit to Fayetteville Vascular and Vein Center and guidelines to observe following your treatment.

The Fayetteville Vascular and Vein Center is located at 3410 Village Dr, Suite 200, Fayetteville, NC 28304. We covered the greater Fayetteville area and surrounding counties.