Shapiro Vein Center

Products And Services

• Understanding Vein Health

  Chronic Venous Insufficiently. Vein disease is incredibly common — and manageable. But if left untreated, what starts as a small issue can lead to potentially dangerous complications. Chronic Venous Insufficiency (CVI) is a medical condition in which a person’s veins are unable to properly transport blood from the legs back to the heart. The most common symptom associated with CVI is the appearance of varicose or spider veins in the leg area, which doesn’t sound particularly concerning on the surface. However, if left untreated, venous insufficiency can cause far more serious complications like ulcers, bleeding, and a life-threatening condition called deep vein thrombosis (DVT). Who’s At Risk? Between 20-30 million Americans have varicose veins. Contributing factors include heredity, gender, age, weight, pregnancy, history of deep vein thrombosis (DVT and blood clots) and standing or sitting for prolonged periods of time. By age 50, 41% of women will suffer from varicose veins. Similarly, by the time they reach their 60s, 42% of men will suffer from venous insufficiency. Varicose veins are an inherited genetic disorder. The gene is an autosomal dominant with variable penetrance. This means the gene is passed down to every generation, but certain environmental factors are required to activate the gene. For example, estrogen and progesterone activate the gene. Obesity and prolonged standing can also activate the gene over time. Almost 50% of varicose vein patients have a family history of the disease. Your chances of developing varicose veins are over 90% if both parents have the disease. Daughters have a 60% chance and sons have a 25% chance of developing varicose veins if only one parent has the disease. Varicose veins affect women more than men: 55% of women and 45% of men. An estimated 41% of women over the age of 50 have varicose veins. Moderately overweight women have a 50% increased risk of developing varicose veins. Women with a BMI greater than 30 are 3x as likely to develop varicose veins. Pregnancy increases the risk for developing spider and varicose veins. The following factors may make you more susceptible to vein problems: Gender - more women are diagnosed with vein problems than men Family History - vein problems may run in your family Age - risk of vein problems increases with age Lifestyle or Occupation - prolonged standing or sitting may increase your risk of vein problems Smoking - prolonged smoking leads to harmful changes in blood vessels and blood composition Obesity - added pressure to your leg veins from your abdomen may increase your risk of vein problems Pregnancy - vein problems developed during pregnancy typically resolve within 3-12 months after giving birth, but not always Treat CVI to Avoid Dangerous Complications Symptoms of CVI range from the cosmetic to the potentially life-threatening. Some of the most common symptoms include swelling of the feet and ankles, itchy and irritated skin, cramping, aching legs, skin discoloration, skin sores or ulcers, and varicose or spider veins. If left untreated, varicose veins in particular can pose a significant threat, as they become enlarged and/or deteriorate over time. If your venous insufficiency is so great that blood pools in the varicose veins and causes them to swell further, painful ulcers may develop, and spontaneous bleeding can occur. Although the extent of these complications will of course vary from case to case, leaving CVI untreated at the very least will result in the continued display of symptoms like swelling, itching, pain, and fatigue. In more extreme cases, patients can develop DVT — the formation of a blood clot in the leg that can prove fatal if it makes its way to the lungs. So, if you’re exhibiting any symptoms of CVI, it’s crucial that you seek immediate treatment to eliminate the potential for DVT altogether.

  Link: Understanding Vein Health

• Varicose Veins

  What are Varicose Veins? Varicose Veins are large, ropey, and twisting blue vessels, which appear in the skin anywhere from the thigh to the foot. The actual cause of varicose veins is inefficient, faulty vein valves. These valves don’t close properly, allowing blood to leak back with gravity and pool in the vein. They are most often the result of leaking and incompetent valves in the superficial saphenous veins. These abnormal valves allow blood to flow retrograde back down the legs and into all of the skin veins. The repeated reflux causes high vein pressures, resulting in veins, which enlarge and twist over time. Leg pain associated with varicose veins is usually due to swelling of the veins and of the surrounding tissues. Phlebitis develops when one or more of these veins develop a blood clot, usually when the patient is inactive. A painful and red lump where varicose veins are located is nearly always a sign of phlebitis. Varicose veins are not just a cosmetic disorder. The veins bulge and stretch and result in many unpleasant side effects such as: Heavy and tired legs Aching and throbbing pain Swelling Itching Leg cramps Restless Leg Syndrome Heredity is a primary factor in over 80% of varicose vein cases. Other contributing factors may include pregnancy, obesity, hormone therapy, standing or sitting for long periods of time and injury. Diagnosis & Evaluation. At Shapiro Vein Center, we treat vein issues using a stepwise approach. We start by identifying the problem with an ultrasound study of the legs. Once the bad veins are identified, we discuss the various treatment options and tell you which ones we think are the best for you. Treatment. Varicose veins and their underlying cause are quite treatable. We offer patients a variety of varicose vein treatment procedures that seal off veins with unhealthy valves. Blood circulation then returns to the veins with properly working valves, and closed veins are eventually absorbed back into the body. Following treatment, the leg must be supported to allow the vein walls to stick together. This is accomplished by using compression bandages or graduated support stockings. Newer stocking designs have greatly improved the comfort associated with their use.

  Link: Varicose Veins

• Spider Veins

  What Are Spider Veins? Spider Veins are broken capillaries, formally named telangiectasias, which are red, blue or purple thread-like veins (less than 2mm in diameter, flat or raised) on the surface of the skin. Though smaller than most varicose veins, spider veins are often darker and more noticeable. This is because these veins are located just below the surface of the skin. The larger variant of spider veins, reticular veins, are up to 3 mm in diameter and have a bluish green appearance and are often associated with telangiectasias. More common in women, spider and reticular veins may be triggered by pregnancy or hormonal variations. Spider veins may result in itching, leg restlessness, aching, and throbbing. Bleeding may also occur from traumatized spider veins from shaving or household chores. Non-symptomatic spider veins may also be found on the face and chest as well as the legs. Although surface veins are considered by some to be a cosmetic problem, they can also be just as symptomatic as classic varicose veins. What Is Surface Sclerotherapy? The gold standard for spider and reticular vein treatment remains surface sclerotherapy. A very fine needle is used to inject a solution (sclerosant) directly into the veins. This solution causes an inflammatory reaction that the lining of the veins to swell and eventually seal off the blood vessel, preventing blood flow. Newer sclerosant medications have greatly reduced the pain, inflammation, and post-procedure discomfort previously associated with surface vein treatment.

  Link: Spider Veins

• Restless Leg Syndrome

  Are you kept awake at night with irresistible urges to move your legs; a “creeping” feeling in the legs; persistent leg movement during sleep; or tingling, burning, aching or numbness of the legs? This is known as Restless Leg Syndrome (RLS) and is thought to affect as much as 15 percent of the general population. The symptoms of RLS are worse at night or during periods of relaxation, such as lying down during the day. They tend to improve with activity. These symptoms disrupt the sleep not only of the RLS sufferer but can disrupt the sleep of their bed partner as well. RLS and Varicose Veins Venous insufficiency is an often-overlooked cause of Restless Leg Syndrome (RLS). Several studies indicate that as many as 22% of those with RLS also have venous insufficiency. When restless legs occur with venous insufficiency, the RLS can be improved significantly by treating the varicose veins. A study published in the Journal of Phlebology reported that in patients with both RLS and venous disease, 98 percent had their RLS symptoms relieved with varicose vein treatment and 80 percent of experienced long-term relief. A simple office evaluation and noninvasive duplex ultrasound of your legs is the first step you should take. If you are diagnosed with underlying venous disease and you have restless legs, there is hope. How Is RLS Treated? We recommend that anyone who suffers from the symptoms of RLS schedule a consultation with our office. During this consultation, we will perform a diagnostic ultrasound assessment. This ultrasound tells us if venous insufficiency is present. If so, we will plan a course of treatment for the varicose veins, which usually includes a combination of laser treatment and sclerotherapy. This treatment will treat the varicose veins and can improve the symptoms of RLS, avoiding the lifelong need to take a neurologic medication.

  Link: Restless Leg Syndrome

• Venous Ulcers

  A venous ulcer is a shallow skin wound that develops when the veins don’t return blood back toward the heart as they normally would. (This is venous insufficiency). These ulcers usually develop on the sides of the lower leg, above the ankle and below the calf. Venous skin ulcers, also called statis leg ulcers, heal slowly and often come back without preventative treatment. What causes venous ulcers? Veins have one-way valves that keep blood circulating to the heart. In venous insufficiency, the valves are damaged, and blood backs up and pools in the vein. The blood may leak out of the vein and into the surrounding tissue, which can lead the tissue to break down and cause an ulcer. What are the symptoms? In the area where the blood is seeping out of the vein, the skin turns dark red or purple. Skin may also become thick, dry and itchy. Untreated, an ulcer may form and become painful. Legs may become swollen and sore. An infected wound may cause an odor, and puss may drain from the wound. The area around the wound also may be more tender and red. It’s important to call us when you first see signs of a venous ulcer, as we may be able to help prevent the ulcer from forming. And, if it is formed, seek treatment immediately; smaller and newer ulcers heal faster. How are venous skin ulcers diagnosed? Your doctor will ask questions about your health and will examine affected areas. They may also perform ultrasound testing. All can be done within the comfort of the office. Your doctor may use other tests to check for problems related to venous skin ulcers or to recheck the ulcer if it does not heal within a few weeks after starting treatment.

  Link: Venous Ulcers

• Deep Vein Thrombosis – DVT

  What is a Deep Vein Thrombosis (DVT)? When a clot forms in the deep vein system it is called a deep vein thrombosis, or DVT. DVTs usually occur in the lower extremities, but they can appear in other parts of the body. The venous system of the lower extremity is divided into the superficial veins, which include the great and small saphenous veins and their associated accessory tributaries and the deep venous system, which includes the femoral and popliteal veins. Intermediate veins called perforators connect them. DVT can lead to partial or complete blockage of circulation which can cause serious medical problems. Nearly 2 million Americans are affected by DVT each year. Sometimes there are no warning signs or symptoms of DVT. As much as 50% of patients with a DVT show no symptoms at all. These silent DVTs can resolve without treatment or may lead to complications such as a Pulmonary Embolism (PE). A PE is a dangerous condition because it can damage the lungs and other organs and is life-threatening. Contact your doctor if you experience any of the following: Pain or tenderness Warmth Swelling (edema) Redness Reduce Your Risk of DVT Vacations are a particularly dangerous time for DVT. Travel on an airplane, car, bus or train increases your risk, especially if you have recently had surgery, are pregnant, are overweight or have a history of blood clots. Risk of DVT should not keep you from traveling if you take these simple steps: Wearing compression stockings while traveling can significantly reduce your risk for DVT. These stockings help increase the circulation in your legs. Make sure to purchase medical grade stockings. Stay hydrated. Drink lots of water and avoid caffeine or alcohol because both are dehydrating. Wear loose, comfortable clothes during the trip. Get up out of your seat every hour or two. In an airplane, it is helpful to request an aisle seat, so it is easier to stretch out and move around. In a car, stop at a gas station or rest area and walk around every couple of hours. While seated, rotate your ankles, draw circles on the ground with your toes, flex your feet and toes and raise your legs slightly and holding them in the air for a few seconds. Diagnosis and Treatment The veins of the legs are classified anatomically. The “deep” veins are within and below the muscles and the “superficial” veins are above the muscles. DVT (Deep Vein Thrombosis) is where a thrombus or clot obstructs a vein. It is a serious condition that can lead to disability and even death if the thrombus travels through the bloodstream to the lungs. When this happens, it is called a Pulmonary Embolus (PE). Diagnosis of DVT: lower extremity ultrasound exam Diagnosis of Pulmonary Embolus: CT Scan, Ventilation Perfusion Scan Treatment: Anticoagulation with oral or injectable medication (“blood thinners”). This is the most common treatment. Pharmacologic thrombolysis (infusion of drugs directly into the thrombus through a catheter that dissolve the clot) Surgical or minimally invasive interventions to physically remove the clot Compression stockings (used for small, below the knee thrombus) Ambulation IVC Filter (a small mesh filter surgically placed into the vein to prevent the clot from traveling to the lungs) if patient cannot be on blood thinners

  Link: Deep Vein Thrombosis – DVT

• Thrombophlebitis

  Thrombophlebitis is inflammation of a vein caused by a blood clot (also known as a thrombus). Thrombophlebitis is an inflammatory process that causes a blood clot to form and block one or more veins, usually in your legs. The less specific term, “superficial phlebitis” is typically used as an initial, provisional diagnosis until further tests/imaging studies have been completed. Superficial phlebitis does relate to the clinical findings of pain/redness/inflammation of the vein without the confirmed presence of a clot. There are three specific kinds of thrombophlebitis, diagnosed by location. Superficial thrombophlebitis (STP) Superficial Venous Thrombosis (SVT) Deep vein thrombosis (DVT) What Are the Symptoms? There are a variety of symptoms that may accompany thrombophlebitis including: Swelling – Recent swelling of the limb Pain – Unexplained limb pain or tenderness Warmth – Skin that may be warm to the touch Redness — Redness of the skin When a vein close to the surface of your skin is affected, you might see a red, hard cord just under the surface of your skin that’s tender to the touch. When a deep vein in the leg is affected, your leg may become swollen, tender, painful, and is usually difficult to walk on. Superficial Thrombophlebitis (STP) usually occurs in surface-layer veins (usually located in the legs) and are often located in large caliber, dilated varicose veins. Superficial venous thrombosis (SVT), means the finding of thrombus involving the larger superficial saphenous veins, such as the great saphenous vein. Depending on location, SVT may extend (propagate) into the deep venous system, resulting in a more serious deep venous thrombosis (DVT), when the deep veins of the legs (deep to the muscle layer) develop a thrombus. When a DVT develops, there is a chance that a clot can break off and enter the pulmonary vasculature, known as a pulmonary embolus (PE) - which can be a life-threatening complication. We understand the serious impact that thromboembolic disease has on our patients and their families. As underlying venous disease can play a significant role in the majority of patients who have been affected by thrombophlebitis, we will collaborate with your referring physician to determine the best care plan for you.

  Link: Thrombophlebitis

• Lymphedema

  Lymphedema is swelling that occurs in arms or legs. While there is presently no cure for lymphedema, it can be managed with early diagnosis and diligent care of your affected limb. Make an appointment with your doctor if you notice persistent swelling in your arm or leg. If you already have the diagnosis of lymphedema of a limb, see your doctor if there is a sudden dramatic increase in the size of the involved limb, as it may suggest a new process is occurring. Lower extremity lymphedema may be related to prior surgery, radiation treatment, trauma, or infection. It is also common to see lower extremity lymphedema be related to chronic venous insufficiency/varicose vein disease, known as phlebolymphedema. The interaction between the lymphatic system and problematic lower extremity superficial venous issues is gaining wider recognition worldwide. For some patients with phlebolymphedema, addressing underlying venous issues may help with controlling lower extremity swelling. The lymphatic system, which is also part of your immune system, relies on a small caliber network of vessels to convey fluid out of the space between the body’s cells known as the interstitium. Damage or blockage of these vessels prevents lymph fluid from draining well, and the fluid buildup leads to swelling. Persistent lymphatic fluid accumulation the lower extremities may also lead to chronic thickening of the skin and accumulation of adipocytes (fat cells), resulting in a special type of lymphedema, known as lipedema

  Link: Lymphedema

• Vein Disease Diagnosis

  Vein disorders are not always visible; therefore, modern vein disease diagnosis requires diagnostic techniques and tools in determining the cause and severity of the problem. Depending on the results of your screening examination, we may recommend additional tests such as diagnostic ultrasound to identify where and how badly your veins are damaged. The ultrasound examination is designed to evaluate the blood flow through your veins in your legs, localizing the problem areas. Diagnostic Ultrasound Diagnostic Ultrasound is a non-invasive test which allows evaluation of structures below the skin surface. It is the test of choice for evaluating vein problems. The ultrasound is performed in our office by a Registered Vascular Ultrasound Technician (RVT). Warmed ultrasound gel is applied to the leg, then the ultrasound probe is moved up and down to examine the deep and superficial leg veins. Images are taken first to map out the anatomy and rule out blood clots in the veins. Note will be made of what deeper veins the surface varicose veins connect to in order to plan the best treatment approach. These images are created by sound waves and no radiation is involved in the exam. Once the anatomy has been evaluated, the function of the veins is checked. This involves squeezing the legs to force the blood forward through the veins and seeing if the valves close properly. When the valves are working, the blood simply stops after the squeeze is released. When the valves are incompetent, the blood flows back down toward the feet and refills the veins. This is called reflux. Consultation Visit. We have many years of experience and are able to identify the cause of vein incompetence in all of our patients. Our providers perform the physical examinations and then correlate symptoms, physical examination findings, and the ultrasound analysis to make the proper diagnosis and treatment recommendations. During your initial consultation, it is very important to us that you have time to review the ultrasound scan with your provider. We will also review your history, symptoms, and initial exam to determine the next steps for evaluation.

  Link: Vein Disease Diagnosis

• Varicose Vein Treatments

  Varicose veins are abnormally enlarged veins at the surface of your skin which can appear to be bulged, twisted, or ropey. Diagnosis and treatment of varicose veins is frequently covered by insurance. Thermal Ablation There are two types of thermal (heat) ablation procedures that close down abnormal veins: Endovenous Laser Ablation and Radiofrequency Ablation. Both of these treatments are FDA approved and performed in less than 30 minutes with success rates greater than 90% and very low recurrence rates. Patients can immediately return to normal activity that same day, with little or no pain. Endovenous Laser Ablation (EVLA) EVLA consists of inserting an FDA approved laser fiber into the affected vein. Laser energy heat is then delivered to the vein and seals it shut (ablation). Once the bad vein is closed, blood is naturally rerouted to healthy veins which improves venous circulation. Radiofrequency Ablation (RFA) RFA consists of inserting an FDA approved catheter (VNUS ClosureFAST ®) into the affected vein. Radiofrequency energy (heat) is then delivered to the vein and seals it shut like EVLA. Once the bad vein is closed, blood is naturally rerouted to healthy veins which improves venous circulation. Varithena Treatment Varithena® (polidocanol injectable foam) is an FDA approved prescription medicine injected into abnormal veins under ultrasound guidance to seal them shut. Some patients receiving Varithena® only need a single treatment. Additional treatment may be needed, depending on the number and size of veins to be treated. VenaSeal Closure System The VenaSeal™ system is a form of ablation that improves blood flow by closing diseased veins with a medical adhesive (glue). A special catheter system delivers a small amount of a specially formulated adhesive to the diseased vein. The adhesive seals the vein and blood is rerouted through nearby healthy veins. Currently this procedure is covered by some insurance providers. Ultrasound Guided Sclerotherapy Endovenous chemical ablation (also referred to as Ultrasound Guided Sclerotherapy) refers to the injection of a special medicine (sclerosant) into abnormal veins in order to seal them shut. As with other ablation procedures, the treatment is performed under ultrasound guidance to ensure safety and blood flow is naturally redirected to healthy veins.

  Link: Varicose Vein Treatments

• Spider Vein Treatments

  Varicose Vein Disease and specifically Spider Veins are most commonly treated by Sclerotherapy. The treatment involves injecting a ‘sclerosant’ solution directly into the vein. The goal of treatment is irreversible venous closure (fibrotic occlusion) followed by absorption of the vein. Venous blood is then redirected from the abnormal varicose vessel to healthy veins. As a result, leg discomfort and cosmetic appearance improves. Both ‘liquid’ and ‘foam’ formulations are used. Liquid injection is used for smaller, surface veins. Foam injection has an increased potency and thus is used to treat larger veins. In addition, foam can be observed under ultrasound, in real time, for better precision. There are some reasons why you might not be a suitable candidate for this treatment, like if you are pregnant, have an allergy to sclerosant, have active clotting or bleeding episodes and immobility. At your consultation, our venous expert will customize a treatment plan that is right for you. The number of treatments needed differs from patient to patient, depending on how many veins there are, and the patient’s expectations. For best results, three or four sessions are needed for most patients. Treatment sessions are scheduled at four-week intervals until the desired results are achieved.

  Link: Spider Vein Treatments

• Conservative Measures

  A trial of conservative therapy, ranging from 6 to 12 weeks, is often required by insurance companies before we can treat your varicose veins. Conservative measures include graduated compression stockings, exercise, periodic leg elevation, and Unna boots. Medical grade compression stockings are often prescribed to control the painful symptoms of varicose veins and swelling in the legs. They are also required to aid in the healing process following vein treatment procedures. A consultation with Dr. Shapiro is necessary to determine the strength of the stocking needed to control your symptoms. We keep an ample supply in stock for our patients undergoing treatment, eliminating the need for an additional stop at the pharmacy.

  Link: Conservative Measures

• Botox

  Botox® is a purified protein produced by the Clostridium botulinum bacteria and works by blocking the transmission of nerve impulses to the injected muscles. Unwanted lines and wrinkles can be reduced by relaxing the muscle in the associated area. Injection of Botox into the small muscles causes those specific muscles to halt their function, thereby improving the appearance of the wrinkles. The goal is to decrease the wrinkles in the treated area. This paralysis is temporary, and re-injection is necessary within three to four months. Botulinum A Toxin (Botox) injection has been FDA approved for use in the cosmetic treatment for: Glabella area (Procerus and Corrugator Supercili muscles) Forehead area (Occipitofrontalis muscle) Lateral area of the eye (Orbicularis Oculi muscle) Although other areas of the face and neck may also be injected for cosmetic purposes, these areas have not been approved by the FDA and are considered “off label” when used. After treatment with Botox®, results are typically seen within a few days and last up to four months. Results vary with each patient. To maintain results, Botox® is recommended every three to four months. If patients choose to not continue treatments, the lines will gradually become more noticeable again.

  Link: Botox

• Dermal Fillers

  What are Dermal Fillers? Dermal fillers, also known as injectable implants, soft tissue fillers, or wrinkle fillers, are gel-like substances approved by the Food and Drug Administration (FDA) for use in helping to create a smoother and/or fuller appearance in the face. Facial rejuvenation can be carried out with minimal complications. What Are Dermal Fillers Used to Treat? Dermal fillers are used, but not limited to the following areas: Facial rejuvenation and replacement of facial volume Plumping thin lips/lip enhancement Enhancing shallow contours of the temporal hollows, cheeks, chin, and under eye area Softening facial creases and wrinkles in the forehead, naso-labial folds, marionette lines, and around the mouth Restoring volume loss around the mouth and chin What are the Different Types of Dermal Fillers? There are several types of dermal fillers, but the most common are those made from Hyaluronic acid, which is a substance found naturally in your body. High concentrations are found in soft connective tissues and in the fluid surrounding your eyes. It's also in some cartilage and joint fluids, as well as skin tissue. It is extracted and reformulated and now has become one of the most popular kinds of injectable fillers. Its effects can be reversed with hyaluronidase. How is a Dermal Filler Treatment Performed? These dermal fillers are injected under the skin with a very fine needle. This produces natural appearing volume under wrinkles and folds which are lifted up and smoothed out. How Long After a Dermal Filler Treatment Session Will I Start to See Results? The results can often be seen immediately. How Long Do Dermal Filler Results Last? They can last 6-18 months, depending on the type of filler used and the placement location.

  Link: Dermal Fillers

• Kybella

  Kybella® is deoxycholic acid, a naturally occurring substance in the body that aids in the breakdown and absorption of fat. When injected into the fat, Kybella® causes the destruction of the fat cells. Once destroyed, those cells cannot store or accumulate fat. Kybella® is FDA approved for improvement in the appearance of moderate to severe fullness associated with submental fat, sometimes referred to as “double chin”. The number of treatment sessions you need is based on the amount and distribution of your submental fat and your personal treatment goals. Kybella® works to break down the fat over time, therefore 3-5 treatments may be needed to reach desired results.

  Link: Kybella