vericose veins

Varicose Veins

What are they?

Varicose veins are abnormally dilated veins in the legs that can cause many different types of symptoms.  Varicose veins can occur in almost anyone and affect up to 35% of people in the United States. You may inherit a tendency to develop varicose veins from a parent.  Women who have had multiple children and obese persons are at higher risk.

Causes and Symptoms

Veins are responsible for bringing blood back to the heart. Gravity can play a big part in working against the venous return in the legs. When you sit or stand, blood tends to pool in the legs. If the valves in the leg veins aren’t functioning properly, the increased pressure in the veins over time can cause varicose veins. People can get varicose veins from old age, genetics, pregnancy, obesity, prolonged standing or sitting or lack of physical activity. Some common symptoms include:

  • Aching/Throbbing
  • Itching/Burning
  • Swelling
  • Skin Discoloration
  • Leg Fatigue or Tiredness
  • Rarely superficial blood clots or bleeding



EVLA (Endovenous Laser Ablation)

Endovenous Laser Ablation or EVLA is a minimally invasive option for saphenous vein reflux (leaky valves). The first stage of your procedure involves numbing your leg at intervals and inserting a small IV. The second part of the procedure involves infiltrating anesthetic around the entire vein so that surrounding tissue is not affected by the laser energy and you are comfortable while the laser is activated. The last (and quickest) part of the procedure involves using laser energy to “close” as much of the saphenous vein as possible. To ensure the laser is positioned correctly, I use ultrasound continuously during the procedure.

The procedure itself usually takes about 15 minutes. Prep time before and after takes 20 minutes each. Anticipate at least 1 hour in the office. The discomfort with the procedure is analogous to a tooth cleaning (1 or 2 out of 10 on a pain scale). You will be awake and comfortable during the procedure.

Phlebectomy (vein removal) 

Phlebectomy literally means “vein removal”. Phlebectomy is a minimally invasive procedure done under general or regional anesthesia to remove large varicose veins using micro-incisions. The procedure typically takes 30-90 minutes and is done as an outpatient in a surgery center or hospital. The micro-incisions are 3 mm long to remove the underlying varicose veins. Each one is closed with a single suture that is removed later. Risks include minor bleeding, bruising, swelling, and superficial infection. With any surgical procedure, there is a small associated risk of blood clots. Complications tend to be rare. Expect to spend half a day away from home.


Sclerotherapy is a popular method for eliminating varicose veins and superficial telangiectasias also known as “spider veins.”  Sclerotherapy involves a solution, called a sclerosing agent, which is injected into the veins. We use polidocanol, an injectable solution approved by the FDA to sclerose superficial veins. It is a minimally invasive, highly effective way of decreasing the symptoms associated with venous disease and improving cosmesis. Sclerotherapy is a proven procedure and has been in use since the 1930’s.

The number of treatments needed to clear or improve the condition differs from patient to patient, depending on the extent and size of the veins to be treated.  One to four or more treatments may be needed; the average is one to two. Larger or more numerous veins require more treatments.


Peripheral Arterial Disease

What is it?

PAD is a chronic disease in which plaque builds up in the arteries to the legs. This buildup typically occurs gradually. If allowed to progress, blood flow in that artery can become limited or blocked all together.  PAD is relatively common, affecting more than 10 million people in the U.S. It is more common in people who are 65 or older, usually in smokers and diabetics.

Causes and Symptoms

The causes of PAD include smoking, high cholesterol or high triglycerides, high blood pressure, diabetes, kidney failure, and obesity. Genetic factors also play a role, but are not well understood. Many patients may not experience any symptoms. Some noticeable symptoms can include:

  • Fatigue or cramping of muscles while walking
  • Pain in toes or feet while resting
  • Open wound on toes or feet


PAD is usually treated by aggressively managing the risk factors with lifestyle changes and medication. This includes quitting smoking, controlling blood pressure and cholesterol, controlling diabetes, and losing weight. In addition, an exercise program, if followed faithfully, can significantly improve the symptoms of PAD in many cases.

If PAD is causing serious symptoms, further treatments such as balloon angioplasty, stent placement, or surgical bypass can be very effective in improving the blood flow to the affected leg.

person having a headache

Stroke Prevention

What is it?

A stroke is when the blood supply to a part of your brain is suddenly interrupted and part of the brain dies. 

Ischemic Stroke: approximately 75% of all strokes, can occur when blood supply to your brain is blocked.

Hemorrhagic Stroke: can occur when there is bleeding in your brain.

Transient Ischemic Attack (TIA) or mini-stroke: a condition similar to stroke, but the symptoms only last seconds or a few minutes and completely resolve within 24 hours.  Can be a warning sign of a future stroke, and medical attention should be sought as soon as possible.

Causes and Symptoms

Ischemic stroke and Transient Ischemic Attack (TIA), where the blood supply to a part of your brain is interrupted, is most commonly related to high blood pressure (hypertension), which can damage the small blood vessels in your brain. Abnormal heart rhythms, such as atrial fibrillation, which can cause small blood clots to travel from your heart can also be a cause.  Hardening of the arteries (atherosclerosis), a buildup of plaque in the carotid arteries that bring blood to your brain is something we can help with. Plaque can build up over time in arteries as you get older due to long-term effects of illnesses like high blood pressure, high cholesterol levels and diabetes. Pieces of this plaque can break off and travel to your brain which can cause a stroke.

Some symptoms occur suddenly and include:

  • Numbness
  • Confusion
  • Trouble Speaking
  • Trouble Walking
  • Severe Headache
  • Trouble seeing with one or both eyes

Hemorrhagic Stroke is bleeding within your brain and is typically caused by:

  • Head or brain injury
  • Certain types of congenital brain aneurysms
  • Very high blood pressure and bleeding from arteries


TCAR (Transcarotid Artery Revasc)

TCAR is stenting the carotid artery using a device that briefly reverses the direction of blood flow. With blood flowing away from the brain while the physician operates, the patient’s risk of stroke during the procedure is lower. The procedure is performed by performing a small incision above the clavicle and placing a tube in the carotid artery. The system will temporarily redirect blood flow of plaque away from the brain and then the filtered blood is returned to an area below the waist. Stenting the artery opens the artery and assists in preventing strokes.

CEA (Carotid Endarterectomy)

Carotid endarterectomy is a surgical procedure to open or clean the carotid artery with the goal of stroke prevention. It is an extremely durable procedure. Carotid endarterectomy is performed in an operating room under general anesthesia. Typically, only an overnight hospital stay is required.  The plaque is removed through a small oblique incision in the neck. After removing the plaque from the artery your vascular surgeon repairs the artery by sewing a woven patch onto the artery to prevent re-narrowing. it is the most common surgery utilized for stroke prevention in the US.

abdominal aortic aneurysm


What is it?

An aneurysm is a bulge or ballooning in a blood vessel that occurs in the wall of a major blood vessel. The abdominal aorta carries blood from your heart to your body and is the blood vessel most frequently affected. An aneurysm if allowed to get too large, can leak or rupture, causing catastrophic internal bleeding. The goal of aneurysm therapy is to treat it before it becomes symptomatic or ruptures. Other sites for aneurysms include the thoracic aorta, the iliac arteries and branch vessels off the aorta.

Causes and Symptoms

A number of factors can contribute to weakness in an artery wall and increase the risk of aneurysm rupture. 

  • Older age
  • Cigarette smoking
  • High blood pressure (hypertension)
  • Family history

Common signs and symptoms of a ruptured aneurysm include:

  • Sudden, extremely severe abdominal or back pain
  • Passing out
Symptoms indicate the aneurysm is about to rupture or has ruptured. Call 911!


Endovascular Aortic Aneurysm Repair (EVAR) 

The most common treatment of abdominal aortic aneurysms (AAA) is EVAR. EVAR is a novel method of fixing AAA using stents introduced through both groins to exclude the aneurysm from the rest of the circulation. Typically this is done in around 1-2 hours with a general anesthetic. Multiple stent components are introduced percutaneously to prevent the AAA from rupturing in the future. The procedure is relatively painless and associated with an overnight hospital stay. Results are excellent but long term followup is required.

Open surgical repair

The traditional operation involves cutting open your abdomen to replace the aneurysm with an artificial piece of artery (a graft). This is a major operation and carries some risk. However, it is successful in most cases and the long term outlook is good. The graft usually works well for the rest of your life.


DVT (Deep Vein Thrombosis)

What is it?

Occurs when your blood thickens in a clump that becomes solid, forming a clot. Most deep vein clots occur in the lower leg or thigh. If a superficial vein is involved, the condition is called thrombophlebitis. The danger of deep vein thrombosis is that the clot can break loose without therapy and cause a pulmonary embolism.

Causes and Symptoms

DVT is often associated with acute inflammation. DVT can occur after a major operation, after trauma or during a flight. Sometimes they can be related to an underlying cancer. Not infrequently, they can simply be unprovoked. Symptoms include:

  • Swelling in one leg
  • Pain or tenderness in your leg
  • Warm, red or discolored skin
  • Veins that are swollen and sensitive to touch that you can see


Thrombolytic Therapy

Thrombolytic therapy is the administration of drugs or “clot busters” to dissolve blood clots that have acutely (suddenly) blocked the veins in your pelvis and leg. To be effective, the therapy needs to be initiated as soon as possible, before permanent damage has occurred. This procedure is typically combined with thrombectomy or “clot removal” to debulk the extent of clot and allow for faster recovery.


A procedure used to open clogged or narrowed blood vessels. Angioplasty uses a tiny balloon catheter that is inserted into a blocked blood vessel to help widen it and improve blood flow. Angioplasty is often combined with the placement of a small wire mesh tube called a stent.


The mainstay of therapy is anti-coagulation. Typically 3 to 6 months of a medication such as Eliquis, Xarelto or Pradaxa are necessary to stabilize the clot.

dialysis system

Hemodialysis Access

What is it?

Hemodialysis is a treatment that removes wastes and extra fluid from your blood when your kidneys have failed. Before hemodialysis can be done, a connection must be made to the blood inside your blood vessels. Your hemodialysis access, or vascular access, is a way to reach your blood for hemodialysis. The access allows your blood to travel through soft tubes to the dialysis machine where it is cleaned as it passes through a special filter called a dialyzer.

Your doctor will help determine when you should start hemodialysis based on several factors, including your:

  • Overall health
  • Kidney function
  • Signs and symptoms
  • Quality of life
  • Personal preferences


A tunneled catheter is a thin tube that is placed under the skin in a vein, allowing long-term access to the vein. Another long term treatment is an arteriovenous fistula. An AV fistula is a connection, made by a vascular surgeon, of an artery to a vein. Arteries carry blood from the heart to the body, while veins carry blood from the body back to the heart. Vascular surgeons specialize in blood vessel surgery. The surgeon usually places an AV fistula in the forearm or upper arm. An AV fistula causes extra pressure and extra blood to flow into the vein, making it grow large and strong. The larger vein provides easy, reliable access to blood vessels. Without this kind of access, regular hemodialysis sessions would not be possible. Untreated veins cannot withstand repeated needle insertions, because they would collapse the way a straw collapses under strong suction.