Many people, young and old, are misdiagnosed and mismanaged for serious venous disease that produces one or more venous stasis leg ulcers resistant to healing.
It is not uncommon for patients to come to the Joyce Vein & Aesthetic Institute (JVAI) from all over North America – patients who have suffered for a decade or more, spent countless hours in wound care centers, and forfeited any quality of life due to one treatment failure after another.
Once you read about their stories in our vein treatment featured cases and venous disease treatment testimonials, you will have little doubt that if you have this debilitating condition, you have arrived in the right place.
JVAI is a state-of-the-art vein treatment center in Punta Gorda, Florida, founded and operated by Douglas H. Joyce, D.O. Besides being a triple board certified surgeon and phlebologist (vein specialist), Dr. Joyce’s cutting edge vascular surgery approaches have set a new standard in the treatment of such venous diseases as varicose veins, venous leg ulcers and chronic venous insufficiency.
Skin discoloration, thickening and ulcers of the lower legs are often caused by incompetent perforator veins in the calf. Dr. Joyce, one of the world’s most experienced perforator vein surgeons, was one of the first surgeons in the world to realize the link between perforator incompetence and venous leg ulcers secondary to severe venous disease. Under his care, formerly untreatable, long-term leg ulcers have been healed.
Dr. Joyce was the first to pioneer use of the Subfascial Endoscopic Perforator Surgery or SEPS procedure for the treatment of perforator disease in 1998. Over the next seven years, he refined the procedure and used it successfully to treat over a thousand patients, one of the highest patient series in the world.
Always on the cutting edge, Dr. Joyce found a better solution for leg ulcer treatment and chronic venous insufficiency caused by incompetent venous perforators. Over the past several years, he developed his own laser ablation surgical procedure for treating incompetent venous perforators in the office setting. Unlike SEPS that required hospitalization and general anesthesia, this vascular surgery procedure has proved to be highly effective and well tolerated without side effects and with the patient awake and comfortable. Laser perforator ablation takes less than 20 minutes of surgical time and most patients can go home with minimal restrictions. More about venous leg ulcer treatment can be found in our FAQs.
Venous disease occurs when valves inside the veins become damaged and do not close completely. This causes the blood flow in the vein to change direction from going back into the leg instead of towards the heart. Pressure in the leg veins becomes higher and results in the symptoms of venous disease. Venous disorders may include any or all of the following:
Patients with venous disease have many signs and symptoms that compromise their quality of life. Untreated venous disease can progress to more serious conditions. Regardless of the stage or type of venous disease, office vascular surgery treatments at JVAI can cure these conditions and prevent their progression.
Most vein problems are due to increased pressure in the venous system. This is actually high blood pressure of the veins located under the skin. This increased pressure is caused by malfunction of the valves that lie within the veins, causing the veins to dilate. When the veins become dilated, the valves, which are attached to the sidewalls, are pulled apart. They no longer are able to maintain one-way flow and prevent blood from draining back toward the feet. These leaking veins are called incompetent.
Risk factors may predispose an individual to develop venous disease. These include:
When valves in the veins become incompetent, high-pressure blood from the deep system flows towards the skin and produces high blood pressure of the surface veins. Distention of the veins over time produces varicose veins. It also increases the pressure in the smaller veins causing these to stretch and become very prominent. When these are just under the skin, they are known as spider veins. The increase pressure causes the small veins to leak fluid into the surrounding tissues resulting in swelling or edema followed by discoloration. The high pressure is also transmitted to the smallest veins that lie near the capillary beds. This makes it difficult for blood to flow across the smallest vessels or capillaries, thus disrupting the exchange of nutrients and wastes in this area. The tissues of the leg respond by thickening of the skin and finally by ulceration. A serious consequence of this type of vascular disease is Infection of the skin or cellulitis.
Chronic venous insufficiency or CVI occurs when one-way valves in the veins that normally keep blood from flowing backwards, become damaged or incompetent. When it is difficult for blood to return to the heart due to pooling from damaged veins or values, blood pressure in the venous system remains elevated, producing these symptoms:
When it is determined that venous disease is present, the venous diagnostic evaluation and vascular surgery vein treatment is often covered by Medicare and private insurance. When performed for cosmetic purposes only, spider vein and varicose vein treatment are solely the patient’s financial responsibility. Our front office will gladly assist you in the insurance reimbursement process when that option is available.
Over the past decade, Dr. Joyce has become a leader in the vein treatment field. Originally in 1998, he pioneered the Subfascial Endoscopic Perforator Surgery or SEPS procedure for the treatment of incompetent perforator veins, performing one of the highest volumes of SEPS procedures and achieving over a 96% cure rate of venous ulcers.
Subfascial Endoscopic Perforator Surgery or SEPS is used to correct incompetence of the venous perforator system—a major cause of severe venous disease and leg ulcers. Many patients with ulcerations of the ankle were cured through the SEPS procedure. This minimally invasive procedure is performed utilizing a small television camera system that is introduced into the leg in an outpatient surgery setting. Small titanium clips are placed to close off the leaking perforator veins. The entire procedure is performed through a 1-inch incision just below the knee. Correction of this problem reduces leg swelling and significantly aids in the healing of chronic leg ulcers. Dr. Joyce performed over 600 of these surgeries over a three year period, one of the highest volumes in the country. The results were excellent with 94% of patients healing their ulcers.
Although SEPS worked well with excellent results, it required hospitalization and general anesthesia which was expensive and inconvenient for patients. Dr. Joyce made it his mission to provide the same or an improved treatment outcome through procedures that could be performed within the office setting using local anesthesia. He began to pioneer two new less invasive technologies and within a short period of time, totally replaced SEPS with VNUS radiofrequency closure and laser ablation. VNUS radiofrequency closure was initially performed in over 1800 cases with excellent results but has been replaced exclusively with laser ablation—a procedure that is faster, more comfortable, less expensive to perform and associated with a higher success rate. Over 1500 laser ablations have been performed with excellent results and negligible complications.
Most ulcers of the lower legs and serious venous disease are caused by incompetence of perforator veins in the calf. These incompetent veins generally occur on the inside of the ankle. Ultrasound scans performed at our facility almost always show incompetent perforator veins lying beneath the leg ulcer or other serious venous changes. The answer to chronic venous insufficiency with all its related symptoms is to remove the dysfunctional perforator veins. Douglas H. Joyce, D. O., founder of JVAI, initially pioneered the Subfascial Endoscopic Perforator Surgery or SEPS procedure for the treatment of perforator disease in 1998. Approximately 96% of leg ulcers were completely healed with SEPS.
Over the past several years, Dr. Joyce’s goal to move treatment from the hospital to the office environment and reduce complications and costs, led him to pioneer the use of laser ablation for the treatment incompetent venous perforators. This less invasive office procedure has proved to be highly effective and well tolerated. Completely replacing the SEPS procedure, venous perforator laser ablation performed under local anesthesia, has successfully treated over 99% of venous stasis leg ulcers. Patients are able to resume normal activities within a few days and the ulcers completely heal within several months. View our venous leg ulcer treatment gallery and Find Your Leg section with links to featured leg ulcer treatment cases.
The initial evaluation for diagnosing venous disease and subsequent treatments are generally covered by insurance. Contact us toll free by phone at 1(866) 998-1312 or complete the convenient form below to request an appointment for venous leg ulcer treatment.
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JVAI is located in Punta Gorda, Florida convenient to Naples, Marco Island, Fort Myers, Cape Coral, Sanibel Island, Captiva, Port Charlotte and Sarasota
