Venous Disease Strikes the Young as Well as Those Advanced in Years…

The heart pumps blood into the arterial system. It travels to the legs under pressure through a system of arteries that becomes smaller and smaller as it progresses towards the tissues. Oxygen and nutrient transfer and waste removal is carried out through the smallest arteries called capillaries. The blood is then returned through tiny veins that become progressively larger as they move away from the tissue and drain towards the heart. The heart does not pump blood out of the legs. Blood is moved through the veins by contraction of the muscles around them. As each vein is compressed, the blood moves in one direction towards the heart. This one-way flow is maintained by valves located at intervals along the vein. The valves only allow the blood to flow one way, back towards the heart for re-circulation.

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:

• Chronic venous insufficiency – this disorder from static blood flow in the legs includes a cluster of symptoms ranging from spider veins and varicose veins to phlebitis and chronic leg swelling to discolored, thickened skin and venous stasis leg ulcers.
• Spider veins – these threadlike veins near the skin’s surface are caused by increased pressure that causes them to stretch and become prominent. Without other symptoms, they are considered to be a cosmetic problem.
• Varicose veins – these twisted, distended veins due to increased pressure, affect larger surface veins in the legs. The three primary areas of venous incompetence involve the Greater Saphenous Vein on the inside of the thigh and calf, the Small Saphenous Vein on the back of the calf and the Perforator veins of the calf.
• Phlebitis or superficial venous thrombosis - this refers to a blood clot that forms in a vein close to the skin’s surface. These clots cause pain but generally do not travel to the lungs.
• Deep vein thrombosis - also called a DVT, this is a clot in the deep, large veins of the legs. It can become life-threatening if the clot dislodges and travels to the lungs. (pulmonary embolism).
• Venous leg ulcers – commonly found below the knee and above the ankle on the inner part of the leg, these wounds or open sores occur from static blood flow and are resistant to healing. They are also called venous stasis ulcers.

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:

• Family history
• Obesity
• Pregnancy
• Prolonged standing
• Prior episodes of blood clot formation
• Trauma
• Illness
• Surgery
• Medication
• Lifestyle

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:

• Aching, tired legs
• Leg swelling, particularly after extended periods of standing
• Twisted, enlarged varicose veins close to the skin
• Brownish leathery-looking skin on the legs
• Flaking or itching skin on the legs
• Venous stasis leg ulcers
• Cellulitis or infection of the tissue surrounding a venous ulcer

Patients with venous disease of the legs have specific complaints and symptoms that may include:

• Tired, aching legs, usually best in the morning and worse during the day especially after prolonged standing or sitting.
• Intolerance to exercise.
• Leg discoloration, thickening and ulcers that are difficult to heal.
• Spider veins, varicose veins and leg swelling from venous stasis.

Over a decade ago, Dr. Douglas H. Joyce, D.O., a triple board certified surgeon and phlebologist, became increasingly aware of numerous patients with a poor quality of life who suffered from misdiagnosed and mismanaged venous disease. This prompted him to shift his focus from the practice of open heart and trauma surgery to vein treatment.

Always on the cutting edge for providing safe, effective, comfortable, convenient and affordable care, Dr. Joyce accomplished what no other vein treatment practice could do – provide a permanent cure for such problems as venous leg ulcers, varicose veins and chronic venous insufficiency in an office setting with the patient awake, comfortable and able to resume normal activity within a very short time.

The Word Got Out…

It didn’t take long before patients arrived at JVAI from all over North America for state-of-the-art vein treatment that eliminated their suffering. Many of these patients experienced a lifetime of debilitating pain, mismanagement and treatment failures related to their venous disorders. They arrived at JVAI desperate for answers that would give them back a quality of life.

Setting a New Standard in Venous Disease Treatment…

Originally Dr. Joyce pioneered the Subfascial Endoscopic Perforator Surgery or SEPS procedure for incompetent perforator veins, performing one of the highest volumes of SEPS procedures and achieving over a 96% cure rate of venous ulcers. Although SEPS worked well for the most part, it required hospitalization and general anesthesia which was expensive and contributed to a number of complications. This motivated Dr. Joyce to pioneer less invasive technologies that would cure venous disease in the office setting.

For many years now, Dr. Joyce has developed, refined and successfully used Laser Ablation surgical techniques for the treatment of incompetent venous perforators and saphenous veins that offer a permanent cure for venous leg ulcers, varicose veins and chronic venous insufficiency. Through his methods, Dr. Joyce has achieved a 96% success rate with virtually no complications. His surgical venous procedures have proved to be highly effective and well tolerated in the office setting with the patient awake and comfortable. At the 2009 American College of Phlebology’s 23rd Annual Congress, Dr. Joyce presented data that unequivocally proved his vein treatment techniques to be the safest and most effective treatment. Vein treatment physicians from all over the country come to Dr. Joyce to learn his revolutionary venous surgery techniques.

What Patients Can Expect…

Vein treatment procedures for spider veins, varicose veins, venous leg ulcers and chronic venous insufficiency are performed at JVAI in an office procedure without discomfort, with the patient awake and comfortable and with minimal post-operative recovery time. If you suffer from venous disease, request an appointment and find out what we can do to eliminate your venous disease problem.

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.

Incompetence of the greater saphenous vein has traditionally been treated by vein stripping – an outdated vascular surgery procedure associated with a long and painful convalescence. Patients present with venous disease leg symptoms that may include swelling, pain, prominent varicose veins and skin discoloration with or without ulceration. The procedure almost always involves removal of the greater saphenous vein which lies along the inside of the thigh and lower leg. An incision is made in the groin to tie off and divide the top of the vein. A vein stripper is then inserted into the vein. It is generally pushed through the vein above the knee and brought through the skin by a second incision. A small stripping device is then connected to the stripper and it is pulled back through the leg tearing the vein out with it. Pressure is then applied to the leg to reduce bleeding. This procedure is uncomfortable for the patient post-operatively and may result in bruising under the skin that can take months to completely resolve.

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.

Varicose veins are removed by Microphlebectomy at JVAI. This European technique involves removing the prominent veins through tiny needle punctures, virtually leaving no scars. It is quick and relatively painless and produces superior results than traditional treatment. We treat patients of all ages, both male and female. Using Microphlebectomy, we have satisfactorily treated a number of young aerobic instructors and models who were looking for a superior cosmetic result. Sclerotherapy is also utilized for smaller varicose veins when indicated.

At the Joyce Vein & Aesthetic Institute, Great and Small Saphenous Vein Laser Ablation is used as an alternative to obsolete vein stripping procedures for the treatment of varicose veins of the saphenous system. In this procedure, a small diameter laser filament is inserted into the vein through a needle puncture. This is done right in our office with minimal anesthesia. The laser filament is connected to a laser system that closes off the greater saphenous vein from the inside. There is very little trauma to the leg and almost no bruising. Postoperative discomfort is minimal. Patient satisfaction is high. In fact, patients who have had vein stripping of the other leg have stated that they wish they had waited until this laser technology was available before having their previous procedure.