Frequently Asked Questions (FAQs)

Answer (LK):

We do accept majority of common common insurance plans, which always can be checked with the front desk and/or confirmed with participating providers directory published by your medical insurance carrier.

In the vast majority of cases, the medical insurance carrier covers the entire treatment. Each specific situation, however, should be considered individually. Overall coverage determination is not based on the type of treatment, but depends on presence or absence of so-called "medical necessity". One common example of the above is the following. Sclerotherapy is indicated and, therefore, would be covered when performed for bleeding varicose or spider veins, but unlikely to be considered for coverage, if being done for purely cosmetic reasons, or for only for improvement of appearance in absence of pain, swelling, muscle cramps or any other complications.

In absence of medical insurance or coverage for the specific treatment, the cost of it depends on several factors, some of which include for example some anatomical considerations (number of veins to be treated, their configuration etc.), specific treatment method, such as endovenous therapy, sclerotherapy, phlebectomy etc., type and stage of the disease, complexity of treatment and such.

With rare exception, eligibility for coverage and/or approval for a particular treatment, as well as its cost in absence of such and all other financial and logistic considerations, are determined and addressed completely prior to the beginning of the treatment.

Please call our clinic if you have any questions regarding insurance coverage and we will be more than happy to assist.

Answer (LK):

"...hard to walk...” is exactly how the majority of people describe progressively increasing limitation of their ability to move around. Interestingly, despite the common belief that the above problem is due to old age, it is never the case. Moreover, age by itself is never an explanation of health problems. At the same time, statistically, decreased mobility is most commonly due to abnormalities of circulation, among which a condition called venous insufficiency is the most common one.

The most common complaints are the ones describing inability to walk for a long distance or often to stand for a prolonged period, heaviness, weakness and tiredness of the lower extremities. Another group of frequent complaints includes night cramps, swelling around ankles, tingling, "pins and needles", burning and numbness. As the disease progresses, swelling increases and periodic flare ups of infection begin. Some of complications include thrombophlebitis, trophic ulcers and bleeding. Deposition of brown pigment is another sign of this venous disease. If you have any of the above symptoms, you should see an appropriate specialist immediately.

Answer (LK):

Dear Esther, you are right: diuretics do not help, since the problem is not excess of water in your body, but rather abnormal distribution of this water between your lower extremities and the rest of the body. The diuretics are indicated for treatment of diseases causing swelling of the entire body and not only a part of it. That is why kidneys resist effect of diuretics given at the usual dose. At much higher dose, diuretics do remove water, despite kidneys resistance, which can result in dehydration and kidney damage, called renal failure. Furthermore, in medicine, it is essential to establish a correct diagnosis prior to prescribing any kind of treatment. You most likely do have abnormalities in circulation, which should be carefully evaluated and appropriately treated.

Answer (LK):

Unfortunately, your story is all too common. Even though your complaints can be explained by a combination of different diseases, it is much more likely that they are all connected and are caused by a single disease. In fact, there are vein disease causing dull aches, cramps, brown pigmentation, and non-healing lesions, which with time, turn into trophic ulcers. It is important for you to see a specialist in circulatory disorders for obtaining a correct diagnosis and for conducting appropriate treatment prior to development of complications.

Answer (LK):

Majority of venous diseases, just like many other health problems, are caused by combination of genetic predisposition with certain “risk factors”. In the case with venous insufficiency, these factors may include obesity, multiple pregnancies, habitual heavy lifting, prolonged standing, tumors of pelvis or extensive abdominal surgeries, as well as many others. It is important, therefore, first, to establish a correct diagnosis; second, to identify if specific risk factors are present, and third, to learn how to avoid or to minimize exposure to such factors.

Answer (LK):

In general, it is considered unsafe to undergo almost any kind of elective treatment, including the treatment of diseased veins, during pregnancy. Neither is it advisable during breast-feeding and, in some cases, during first four to six months after delivery. Specific recommendations, however, depend of course on the type of treatment, as well as type and stage of the disease in addition to some other considerations.

Answer (LK):

Veins and arteries are blood vessels. Forces of gravity and contractions of the heart move our blood through the arteries toward the legs. Our veins carry blood from the legs upwards—against the forces of gravity. Venous flow relies on leg muscle contractions as well as the coordinated function of hundreds of one-way valves inside the veins. If the valves fail, gravity brings the blood down away from the heart. Increased pressure in the diseased veins causes their dilation and formation of varicosities.

The term “varicose veins” refers to the superficial veins visibly prominent and “twisted”. They can appear anywhere in the body, but their most common location is on lower extremities, where they always represent one of symptoms of a disease called “superficial venous insufficiency”. Other symptoms are pain, tenderness, difficulties walking and standing, muscle cramps, swelling etc. The difference between varicosities and normal enlarged veins, is the fact that varicose veins are stretched not only across, but also along. Because of that, they take sort of a “curvy” or “wavy” course, as opposed to normal enlarged veins, which remain straight regardless of their diameter.

Heredity is the only, so called, “non-modifiable” risk factor. Modifiable ones include occupations requiring prolonged standing or heavy lifting, lower body surgery or trauma, multiple pregnancies, increased body weight or height, as well as many others.

It is estimated that there are more than 80 million Americans who suffer from some form of venous disorder. While some people are interested mostly in improvement of their appearance, many others seek relief from pain, infection or blood clots. Help is available.

Answer (LK):

In the vast majority of cases, varicose veins do not serve any useful function. Technically, they are dysfunctional collaterals or tributaries of so-called “incompetent” superficial veins called “saphenous” veins. The normal, or competent, saphenous veins, being rudimentary in humans, often can be used as a conduit for different types of bypassing grafts in cardiovascular surgery. At the same time, incompetent saphenous veins cannot be used for their original purpose anymore due to their uneven and enlarged diameter. Removal or closure of such veins actually improves circulation. In some rare cases, however, when the deep veins of the legs are blocked, even incompetent saphenous veins become functional and should not, therefore, be removed.

As for your second question, varicose veins are not a disease, but only a symptom, not even very common one, of a disease called “venous insufficiency”. The other symptoms include leg and feet discomfort, deep dull aches, pain, heaviness, fatigue, swelling, muscle cramps, restlessness, itching, burning, numbness and others. They often worsen with prolonged standing.

Answer (LK):

Varicose veins are one of many symptom of a disease called “venous insufficiency”. Not the varicose veins, but rather responsible for their development venous insufficiency should be treated. Correct treatment of venous insufficiency leads to disappearance of varicosities. Rarely, in the most advanced cases, some varicosities might remain even after the treatment of venous insufficiency. In these cases, they can be easily treated individually.

Visible signs of vein disease include swollen ankles, bluish discoloration often with brown pigmentation in the skin, blue or purple patches under the skin, bruises with no known trauma (due to spontaneously ruptured veins), slowly-healing wounds, redness of the skin and other.

Abnormal venous circulation eventually leads to the development of complications. Some of them are blood clots, bleeding, dermatitis and other type of infection, development of ulcers and even malignancies. Some forms of venous abnormalities can cause pulmonary thromboembolism, a very dangerous condition, during which the blood clots are thrown by the moving blood into the lungs.

Venous disorders should be treated when they cause symptoms: pain, swelling, achiness, fatigue etc. They must be treated, if complications have developed, including blood clots, bleeding, ulcers or infection. If abnormal veins affect your work negatively or interfere with your life-style, or even when they are cosmetically unappealing, the treatment is highly recommended. The benefits of appropriate treatment: relief from current symptoms PLUS prevention of future complications.

Answer (LK):

There is no single best treatment method. The choice depends on the type of disorder, its stage, kinds of symptoms, comorbidities, contraindications, even skin type etc. Often, a combination of the modalities works the best, and requires comprehensive evaluation in a specialized clinic.

There are two main treatment types. One is conservative therapy, which includes compression stockings or wraps, exercises, weight management and specific measures grouped under the so-called “life style modifications”, such as, for example, frequent feet elevation, avoidance of prolonged immobility and many others. The other group consists of a wide range of corrective measures, usually performed as a non-invasive or minimally invasive procedure: without skin breach or through a small needle correspondingly. These procedures include endovenous LASER, radio frequency ablation, ClariVein® and other types of chemical obliteration, surface LASER, sclerotherapy, phlebectomy, thrombectomy and many other ones, often used in combination.

Answer (LK):

It depends on the following considerations. The term “sclerotherapy” usually refers to the injection of a specific liquid substance into a blood vessel, usually either varicose or spider vein, for its elimination. Both of them represent not an independent disease, but rather a symptom of the so-called “venous insufficiency”, appropriate treatment of which almost always leads to permanent disappearance of the above varicosities and spider veins. In this case, any remaining varicose and spider veins can be easy eradicated forever with sclerotherapy. Alternatively, when varicose and spider veins are treated by themselves or prior to the treatment of venous insufficiency, they always re-appear and multiply in the same location or in its vicinity after a short interval. Furthermore, the injection of the sclerosing agent in the setting of untreated superficial venous insufficiency can compromise the deep venous system and lead, therefore, to permanent disability.

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