Frequently Asked Questions
Comprehensive Venous Diagnosis and Treatment
venous diseases (11)
Look for a vein center where the physicians, nurses, and vascular technologists are trained and qualified to care for vein disorders. While physicians of many specialties may treat venous diseases, those trained in surgery have advantages over those without surgical training. Since the evaluation and management of venous diseases have undergone a revolution over the past decade, surgical training and board certification in surgery alone are not guarantees of current expertise in management of venous diseases. In 2008, the American Board of Phlebology offered its first certification examination in Phlebology. In order to achieve diplomate status, the candidates must prove substantial experience in treatment of venous diseases and they must pass a rigorous examination in the specialty of Phlebology.
We believe that physicians practicing Phlebology should be diplomates of the American Board of Phlebology in order to demonstrate their experience, knowledge, and commitment to the care of venous diseases. Dr. Daugherty earned board certification by the American Board of Surgery in 1985 and maintains his surgical certification through repeat examination every ten years. He was one of the first group of diplomates of the American Board of Phlebology (www.americanboardofphlebology.org) in 2008 and is one of two diplomates of the ABPh in Middle Tennessee. We employ three very skilled Registered Vascular Technologists (RVTs) at VeinCare Centers of Tennessee who have decades of experience performing venous color duplex ultrasound exams. Their diagnostic insights have been included in our presentations at major national meetings of vein specialists to educate others regarding the complexity of venous ultrasound. Our RVTs are experts at what they do.
Since much of patient evaluation, education, and problem-solving is done with the assistance of nursing staff, the education and experience of nursing staff is important. While many vein centers staff with medical assistants, we choose to staff with experienced Registered Nurses and Licensed Vocational Nurses who we believe offer more for our patients.
Look for a vein center and physicians who treat venous disease as a FULL-TIME SPECIALTY PRACTICE. Is the entire practice devoted to the treatment of venous disease? Is the treating physician devoted to the FULL-TIME practice of Phlebology? Does the treating physician live in the community or commute long distances? We believe that the rapid changes in knowledge and technology in venous diseases require a physician to devote his (or her) entire practice to care of venous diseases. We do not believe that the physician who is at the vein center one or two days per week can keep up with the demands of a vein practice as well as a practice of General Surgery, Vascular Surgery, Plastic Surgery, Family Practice, or any other specialty. We have actively treated venous diseases since 1979 and, in 2008, we devoted our entire practice to the care of venous diseases. We live and work in Clarksville, Tennessee.
Look for commitment to quality on the part of the vein center and physicians. This may be evidenced by many things including:
- Diplomate of the American Board of Phlebology,
- Diplomate of the American Board of Surgery,
- Vascular ultrasound certification by physicians and technologists (RVT or RPhS),
- Membership and regular attendance at meetings of major organizations such as
- The American Venous Forum (www.veinforum.org) and the
- American College of Phlebology (www.phlebology.org),
- Invited presentations and invited service to major national vein organizations,
- We have been very involved in promoting improvement of quality standards in venous ultrasound, and Dr. Daugherty served as one of the task force members who wrote and continue to review the certification exam for venous ultrasound administered by Cardiovascular Credentialing International, for the Registered Phlebology Sonographer (RPhS) credential. Dr. Daugherty recently was asked by his peers to serve in development of national accreditation standards for vein centers.
- Experience in evaluating and treating vein diseases cannot be replaced by any database, software, computer, or certification. The experience to recognize variations of venous disease and to evaluate possible treatments, both old and new, is especially valuable to the patient whose problem may not be routine. We have the experience of managing very complex venous problems for more than 30 years, yet we keep up with the new technology.
- Clinical results and the quality of patient experience are important factors to consider. The best measure of these is whether patients recommend that their family, friends, and co-workers seek treatment from us. Most of our patients come to us through this route. Others review our credentials on the internet and arrange to see us once they learn of our devotion to high quality vein care.
While tiny spider veins (telangiectasia) may be a cosmetic problem if they are not associated with pain, varicose veins are NOT a cosmetic problem. Although some patients with varicose veins may not experience pain, varicose veins will worsen with time. Patients with varicose veins eventually will develop complications which may include tired, heavy legs; swelling of the ankles; infection (cellulitis); clotting (thrombophlebitis); skin changes (stasis dermatitis); venous stasis ulcerations or poorly-healing wounds; pain; or itching. Early treatment of varicose veins may prevent many of these complications.
Venous insufficiency is a chronic, progressive problem which will get worse over time and which will result in new, enlarging varicose veins and/or vein symptoms. Even with very effective treatment of venous insufficiency, the effect of gravity will cause future enlargement of previously normal veins resulting in valve failure. A careful clinical history and exam followed by venous color duplex ultrasound will help to sort out the location of the problem veins so appropriate therapy can be chosen.
Treat the major problems as they occur which nearly always can be done with minimally-invasive procedures. Then, maintain a normal body weight, remain physically active with moderate exercise, avoid prolonged sitting or standing when feasible, perform calf muscle pump exercises often when sitting or standing, elevate the legs higher than the heart periodically, and wear elastic compression support hose as routinely as practical.
The veins which we remove or ablate (seal shut) for treatment of venous insufficiency already function incorrectly and allow blood to run away from the heart toward the feet. Other veins already are carrying the blood back to the heart. Treating the malfunctioning veins actually improves venous flow back to the heart.
By the time a saphenous vein is diseased enough to require treatment, it no longer is acceptable for use for a heart bypass procedure. Cardiac surgeons use the radial artery from the forearm or the internal mammary artery (from inside the chest) for the heart bypass.
Vein stripping rarely is the appropriate technique for management of venous insufficiency. A detailed clinical evaluation and venous color duplex ultrasound exam are necessary to make individual recommendations, but endovenous thermal ablation with radiofrequency (VNUS ClosureFast or Venefit) or with LASER are more effective, safer, result in much less time off work, cause much less discomfort, and are much less costly than vein stripping.
In very special circumstances when a portion of the saphenous vein is immediately under the skin, we occasionally perform a special minimally-invasive stripping in the office with local anesthesia called perforate-invagination stripping.
See us for a detailed clinical exam and venous color duplex ultrasound exam. Most ankle ulcers are due to venous insufficiency which is quite treatable. High pressure in the veins of the ankles due to venous insufficiency, blockage of veins draining the legs, and/or obesity may cause swelling of the ankle, skin discoloration at the ankles, pain, or leg ulcers. ALL patients with leg ulcers associated with swelling or discolored skin should be evaluated for venous insufficiency with a venous color duplex ultrasound exam to detect venous insufficiency. An ultrasound exam which tests only for thrombus (DVT) as is commonly done outside vein centers does not evaluate for venous insufficiency.
Except for patients who have only tiny spider veins (telangiectasia), all vein patients should undergo venous color duplex ultrasound to identify underlying problems in the veins beneath the surface. A thorough understanding of the venous anatomy (which varies considerably from person to person) and the location of valve failure or vein obstruction is necessary to develop a custom plan of treatment for each patient.
Follow-up of patients is highly individualized depending on the severity and type of venous disease. Since venous problems are progressive, and since early treatment reduces long-term complications, periodic follow-up to evaluate and treat new problems is important. Most vein patients should be re-evaluated at least annually.
Compression hose rarely are contraindicated. With few exceptions, use of elastic compression stocking is a good idea for anyone with varicose veins or venous insufficiency. A very small number of patients who have severe arterial blood flow problems or severe neuropathy with poor sensation in the feet may need to avoid compression hose, but most of those patients can still wear lighter compression hose with open toes without problems. Proper fitting and proper wearing of the hose is important to prevent problems with the hose. Generally, the hose should be removed for at least a few hours daily such as during sleep hours.