Click on a category below to see the most commonly asked questions about that topic.

  • Varicose Veins

    • When can I travel after varicose vein treatment?

      Patients are typically able to resume normal activities 24-hours after vein treatment, but travel may pose additional risks. Sitting in a car or airplane for several hours can increase the risk of a blood clot, so it’s important to know blood clot symptoms and understand ways to mitigate the risks.   If a patient is planning a long trip, especially out of the country, we recommend rescheduling procedures for after they return.

    • When can I get back to my usual activities after vein treatment?

      In the modern era of office based procedures such as Closurefast RFA, Venaseal or Varithena - which are far less invasive and painful than the old techniques of vein stripping - we tell most patients they can go back to their usual activities the next day. Most patients can walk into our office, have the procedure, and walk out. If they don’t take any medications like valium, they can drive themselves home. We ask patients to take it easy the first night, but after that they are able to go back to work, exercise, and continue other daily activities.

    • Do I have to wear compression socks for varicose veins?

      Compression can be helpful for patients with symptoms from varicose veins. Some patients will find that compression stockings help, but not all patients benefit and some need to have procedures to help treat their veins to help them feel better.

    • Can varicose veins go away naturally?

      Varicose veins do not go away on their own. They in fact tend to worsen with time.

    • Is massage good for varicose veins?

      Generally yes. Massage is great to help stimulate the nerves in the skin, veins and muscle that can help improve lymphatic flow.  Also, it can help relieve sore muscles and facilitate more movement, which is great for vein health.

    • What foods are good/bad for varicose veins?

      A healthy diet is important for vein health. Being overweight tends to make vein problems worse. Also, certain foods are known to be inflammatory for certain patients. Vein conditions involve inflammation and when foods contribute to that, varicose vein symptoms can be worse.

    • Is walking good for varicose veins?

      Walking and movement are generally helpful for vein health. This is especially true for patients with venous insufficiency (Varicose Veins).  When walking, the calf veins are squeezed by the calf muscle, which helps reduce pooling of blood in the lower legs.

  • Spider Veins

    • How many spider vein treatments will I need?

      Every patient is different, so the number of treatments needed to remove the visibility of spider veins will fluctuate. Some patients choose to treat what they have, then return periodically for touch up treatments to keep spider veins from continuing to spread.

    • What does spider vein removal cost?

      This depends on the location of the spider veins, if they are on one leg or both legs, and how many spider veins are present. The best way to find out is to book a consultation with a sclerotherapy provider and they can help you develop a treatment plan. The more spider veins present, the more treatment sessions required.

    • Is there a natural treatment for spider veins on legs?

      There are natural treatments that may help spider veins ache less. However, in most cases, these do not make them go away.

    • How can I prevent my spider veins from getting worse?

      It may be that exercise, movement, and in some cases compression hose help.  The only way to make spider veins go away is with treatments like sclerotherapy.  Some patients choose to have these treatments to treat what they have, the return periodically for touch up treatments to keep them from continuing to spread.

    • Does epsom salt help spider veins?

      Epsom salt baths can help your legs feel better when you have vein problems, as they reduce the amount of blood pooling in the legs and may soothe some of the inflammation along the veins. However, epsom salt will not make spider veins go away. The only way to make spider veins go away is with treatments like sclerotherapy.

    • Do hot baths cause spider veins?

      No.  Spider veins come from venous insufficiency.  Usually this is genetic, meaning it runs in families.  Sometimes they happen after injury.  Spider veins can be treated with sclerotherapy to help them fade away.

    • Can exercise reduce spider veins?

      Generally, no. The only way to make spider veins go away is with treatments like sclerotherapy. However, exercise can help your legs feel better when you have vein problems as it reduces the amount of blood pooling in the legs.

    • What causes spider veins on legs?

      Most people with spider veins also have what is known as venous insufficiency in the veins under the skin.  Some patients are more prone to spider veins from a genetic perspective as they tend to run in families.

  • Deep Vein Thrombosis (DVT)

    • What happens if a DVT goes untreated?

      Occasionally patients are told they had a prior DVT and they were unaware of the problem at the time.  The larger the DVT, the higher the risk without treatment. Thus seeking evaluation any time there is concern for an undiagnosed DVT is advised.

    • Can DVT be life threatening?

      Yes, a DVT can be life threatening – especially when it goes untreated. If there is ever a concern a DVT might be present, it is best to seek medical attention.

    • How serious is Deep Vein Thrombosis?

      A DVT is a serious medical condition. However, not all lead to long term disability or death.  A DVT can range from small, in the calf muscles, and barely noticeable, to large, in the larger veins in the thigh and pelvis.  The larger DVTs in the upper leg are more of a risk to break off and travel to the lung (known as a pulmonary embolism, or PE).  This can be fatal or very debilitating.

    • Is DVT always fatal?

      DVT is not always fatal.  Most DVTs can be diagnosed and treated without significant disability to the patient.  However, in some cases, unfortunately, a DVT can be fatal. This is usually when it goes unnoticed and becomes quite large in the upper veins in the legs. Then if the clot breaks off it can travel to the heart causing a blockage of the blood flow through the heart and lungs.  This is known as a pulmonary embolism (PE).

    • What is the most serious complication of DVT?

      In the short term, the biggest concern with DVT is that it can break off and travel through the veins, through the heart and to the lungs. This is called a pulmonary embolism (PE).  Rarely, a blood clot can go through a hole in the heart to the arterial circulation, leading to a stroke. This is known as a paradoxical embolism. In the long term, DVT can lead to the Post Thrombotic Syndrome (PTS).  This manifests in about a third of patients as swelling, heaviness, brown skin by the ankle, varicose veins and possibly venous stasis ulcers.

    • Can walking dislodge a DVT?

      Before a DVT is treated, dislodging is a concern. Once a DVT is diagnosed and treated with anticoagulation, such as Xarelto or Eliquis, the risk is greatly reduced. Once the DVT is treated, in fact, movement is encouraged as it helps blood flow in the legs. However, given that there are some specific considerations for every patient with a DVT, its best to check with the provider treating your DVT.

    • What are the risk factors for DVT?

      Veins require movement to optimally function. So when a patient is injured, sick or has surgery, they are not moving as well - and the risk of DVT goes up. This is the same for long distance travel when one does not move their legs over the course of hours. Cancer is a risk factor for DVT. Finally, some people have genetic or acquired blood clotting disorders that make them more prone to DVT.

    • What foods should you avoid if you have DVT?

      A healthy diet is important for vein health in general. While there aren’t any specific foods that are known to contribute to DVT, being overweight tends to make vein problems worse. Also, certain foods are known to be inflammatory for certain patients. Vein conditions like DVT involve inflammation and when foods contribute to that, vein symptoms can be worse. In the old days, some patients were treated with Coumadin/Warfarin. These drugs have certain foods that are to be avoided, like green leafy vegetables. But if a DVT patient is on one of the newer drugs, like Xarelto or Eliquis, there are no foods that need to be avoided.

    • How is DVT prevented?

      There are certain circumstances when DVTs are more common, like after injury, surgery or travel.   Movement, like walking, is important, and in some cases compression stockings will help. After surgery and injury, when one cannot move as well, sometimes medications in pill or injection form are used for DVT prevention.

    • Can DVT go away on its own?

      A DVT can range from small to large. Some small DVTs in the calf might fade away without being treated with anticoagulation.  The larger DVTs, involving the larger veins in the thigh and pelvis, will not generally go away and need to be diagnosed and treated. If not, untreated DVTs can be life threatening.

    • What are the warning signs of Deep Vein Thrombosis?

      Most of the time, a patient with a DVT will have new leg swelling, especially in the calf and around the ankle. They may have lower leg redness and warmth as well as pain in the calf and possibly the thigh.  If you are concerned you might have a DVT, it’s important to seek a medical evaluation.

  • ClosureFast

    • When can I travel after a Closurefast procedure?

      In most cases, patients can travel as soon as the day after a Closurefast procedure. However, long-term travel that may restrict leg movement will require additional precautions.

    • Is radiofrequency ablation suitable for everyone?

      Radiofrequency Ablation is not suitable for all patients. We will perform a venous ultrasound mapping of the varicose veins and can determine what treatment options we have for the patient.  In some cases, other options such as Varithena or VenaSeal may be more fitting.  We discuss these options with the patient when we do our vein treatment planning, before any procedures.

    • What is the average recovery time from Closurefast?

      The night after the procedure we generally advise the patient to go home, put their leg up, and take it easy. They will have a wrap or stocking on their leg, which will be removed the next day. Then the patient can go back to all their usual activities, including exercise. So in most cases, down time from recovery is overnight.

    • How is ClosureFast different from vein stripping?

      Vein stripping is a very invasive procedure that requires incisions and stitches, which can be painful.  ClosureFast is done with a small catheter inserted close to the knee, using numbing medicine around the vein and a gentle heat that is used to seal the vein from the inside. There are no incisions that require stitches, and no need for general anesthesia - as ClosureFast can be done with local anesthesia. There is very little down time for the patient, with most patients going back to their usual activities the next day. ClosureFast has better outcomes, fewer complications, and lower costs compared to vein stripping.

    • How much does ClosureFast cost?

      In most cases, ClosureFast is performed for what is called medical necessity.  Most insurance companies have varicose vein treatment policies and they cover treatments if one meets the medical necessity criteria. Usually this means the patient has symptoms of pain, swelling, ache or itching.

    • Is the ClosureFast procedure safe?

      Yes.  This is an FDA approved device that has been shown to be far safer in terms of complication risk than the old method of surgical vein stripping. It is not without any risk, however. There is a risk of blood clots, which are usually quite small and easy to manage. There are other risks as well that do not commonly happen. It is best to review the potential risks and benefits with your vein care provider before you have any procedures.

    • Is the ClosureFast procedure painful?

      Most patients tolerate the ClosureFast procedure very well. We use numbing medicine in the skin and around the vein we are treating, so the patient feels pin pricks in the skin when the numbing medicine is inserted. However, once the vein is numb, there is no pain when the treatment is taking place. After ClosureFast, there can be inflammation around the vein while it is healing.  Most people find NSAIDs help such as Ibuprofen or Alieve. Also, topical NSAIDs like Voltarin can help.

  • Venaseal

    • When can I travel after a VenaSeal procedure?

      In most cases, patients can travel as soon as the day after a VenaSeal procedure. However, there are important considerations to take for long-term travel that may restrict leg movement.

    • What is VenaSeal made of?

      VenaSeal is essentially a medical grade superglue known as cyanoacrylate. This type of glue has been used for many years for brain surgery, heart surgery, plastic surgery, trauma surgery and in other indications, such as to close cuts on children in the emergency room as an alternative to stitches.

    • Is swelling normal after VenaSeal?

      Some swelling after a vein procedure is not unexpected or uncommon. Generally the compression stocking can help with this the first week. If there is any concern, its best to have it evaluated by a vein care provider.

    • Are there any possible complications from VenaSeal procedure?

      Complications are uncommon. Rarely, allergies to the VenaSeal adhesive have been reported. Otherwise, the same risks as with other vein treatments exist - such as a small risk of blood clot, bleeding, infection or pain.

    • How long does it take to recover from VenaSeal?

      The night of the procedure we generally advise patients to go home, put their leg up on some pillows, and take it easy. In most cases, patients can go back to all their usual activities - including exercise - the next day.

    • How quickly does VenaSeal work?

      With VenaSeal, the target vein being treated is sealed right away. Some patients start to feel an improvement in their symptoms by the next day, but others may not notice an improvement for several weeks and even months. It can take several months or longer for the branch varicose veins on the surface to fade from view.

    • What are the side effects of VenaSeal endovenous ablation?

      VenaSeal is an FDA approved medical grade adhesive that can be used to seal the saphenous veins to help treat venous insufficiency. In some cases, an inflammatory reaction can form to the treatment leading to a red streak over the vein. This generally fades over a few weeks. Rarely, allergies to the adhesive have been reported.

  • Varithena

    • When can I travel after a Varithena procedure?

      In most cases, patients are able to travel as soon as the day after a Varithena procedure. However, there are important considerations to take for long-term travel that may restrict leg movement.

    • How long does it take to recover from Varithena?

      In most cases we ask patients to take it easy the first night, but back to usual activities the next day.  There can be some tenderness along the treated veins and this can take a few weeks or longer to fully resolve. Most people find NSAIDs such as Ibuprofen or Aleve can help. Also, topical NSAIDs like Voltarin can help.

    • What should I do after Varithena?

      The recovery is the same after most office-based vein procedures. The night of the procedure we generally advise the patient go home, put their leg up on some pillows, and take it easy. In most cases we ask they take it easy the first night, but back to usual activities the next day.

    • Is Varithena the same as sclerotherapy?

      Varithena is a form of foam sclerotherapy. It is different than most forms of sclerotherapy in that it comes in foam form in a proprietary delivery canister.

    • Does Medicare cover Varithena?

      Yes, Varithena is covered by Medicare for patients that meet the criteria for medical necessity.  This is covered generally when it is for medical indications (such as to reduce swelling, ache, pain, skin changes etc) but not for purely cosmetic reasons.

    • Do Varithena injections hurt?

      Varithena is an advanced proprietary form of sclerotherapy, a treatment that has been used for many years to treat varicose veins. Most patients do not complain that the procedure was painful. There is the sensation of needle sticks from the numbing medicine which is used before the catheter is placed. Sometimes there is a bit of burn when the medicine goes in, but this generally fades quickly.  It requires far fewer pin pricks than other therapies such as Closurefast RFA.

    • Is Varithena safe?

      Yes. This is an FDA approved foam medication that has been shown to be both safe and effective in clinical trials and community use. It is not without any risk, however. There is a risk of blood clots as there is with any leg procedure, as well as other risks that do not commonly happen. It is best to review the potential risks and benefits with your vein care provider before you have any procedures.

  • Vein Stripping

    • Can I walk after vein stripping?

      When we performed vein stripping over 20 years ago, we would send the patient home with a heavy, three layer wrap. Although they could walk, it was necessary for them to take it easy for a few weeks until the follow up in our clinic. Then they could slowly get back to normal activities. This is a stark contrast from the modern office-based procedures such as Closurefast RFA, VenaSeal or Varithena, which are far less invasive and painful.

    • Are there any complications with vein stripping?

      Vein ligation and stripping are older techniques not as commonly performed in modern times. A common complication reported by vein stripping patients was the development of a source of recurrent varicose veins called neovascularization. This is when a nest of twisted veins develop in the groin at the site of the ligation. Neovascularization is far less common with the newer techniques of endovenous ablation with modalities like Closurefast RFA, VenaSeal or Varithena, which do not involve ligation of the saphenofemoral junction.

    • Do veins regrow after stripping?

      Yes.  After any vein procedure, your body can develop new veins - generally known as “progression”. Getting any vein treatment on one vein does not cause another vein to develop later on. Some patients are just more genetically prone to developing more veins.

    • What is the difference between vein ligation and vein stripping?

      Vein ligation and stripping are usually both done at the same time to treat saphenous vein reflux related varicose veins. Vein ligation entails making a deep incision in the groin and dissecting deep to the location where the saphenous vein meets the common femoral vein. They open the saphenous vein by the ankle and put a bulb on the end of the wire and pull back. This “strips” the vein out toward the groin.

  • Insurance

    • How do you handle Non-Payments from a patient?

      We understand that patients can have financial hardships, so we offer programs like Care Credit to help get them more time. However, we cannot hold onto the debt for long as medical practices do not generally engage in the collections process past a certain time. We will generally attempt to send three statements, make a follow-up phone call and send an email if it’s on file. After 120 days, we will recommend that the account be turned over to pre-collections where attempts to make arrangements will again be attempted. After that, the billings go to a collection agency. This is a last resort for us and we do all we can to avoid this by communicating with the patient prior, if they are available.

    • How do you handle Non-Payments from an insurance carrier?

      We must first determine if the denial, whether in part or in full, is valid. If the denial is not valid, we will request the payer to reprocess the claim. For instance, if the denial is for the wrong diagnosis code or modifier, we will correct and rebill the claim. If the denial is for medical necessity, we will send the medical records and appeal if needed. Depending on the payer, we may file multiple appeals, including administrative appeal, and follow-up until the claim is paid or we receive a decision in writing otherwise. Unfortunately, this is part of the process as insurance companies occasionally deny payment even after providing a valid pre-authorization. This can lead to months or even years of appeals to obtain the appropriate reimbursement.

    • What does “in-network” and “out of network” mean?

      If you receive your health care services from a hospital, physician or other health provider that participates in your health plan, they are considered "in-network." Hospitals, physicians or other health care providers who do not participate in your health plan may be referred to as "out-of-network." You may have a higher co-insurance and/or co-pay for out-of-network services. In some cases, out-of-network services are denied totally. We strive to be in-network for nearly all the insurance providers in our region.  However, its impossible to contract with them all. It is best to determine if the providers are in network or out of network by calling your insurance company in advance.

    • Do you offer payment arrangements?

      Most medical practices are not set up to provide such services. All standard forms of payment are accepted, including cash, check, and major credit cards including Care Credit. In rare cases, we can offer payment arrangements for some patients with hardship exceptions, which are determined by our management team.

    • Why am I getting a bill now when services were provided so long ago?

      Inovia Vein Specialty Centers will process and send a bill to a patient after payment is received from the insurance carrier and the balance owed by the patient is confirmed. The length of this process depends on how long it takes to receive a response from your insurance carrier; if the claim has been delayed by the insurance company or ends up in an appeal, it can take a long time. Also, timing depends on whether there is secondary insurance. That can add time to the claims process as well.  If there is ever a question on why it is taking so long, your insurance company can provide an explanation as well.

    • Why did I receive a bill if I have insurance coverage?

      This is dependent on your insurance plan and the benefits they provide for you. We submit a bill and there is usually a portion paid by your insurance on your behalf and a portion that is patient responsibility. You will receive a patient responsibility statement after your insurance processes your claim. The amount you are billed for is based on what your insurance communicates to us on an explanation of benefits (EOB). The EOB details how your insurance processed your claim and calculated your responsibility based on your individual insurance plan. If you believe your responsibility is not correct, please contact your insurer directly for an in-depth explanation.

    • If I have an ultrasound done at Inovia Vein Specialty Centers, what will be my portion to pay out of pocket?

      It’s most common that your ultrasound benefit will fall under x-ray diagnostic imaging. This typically applies to your deductible and coinsurance coverage. If there are any questions, is always an option to check in with your insurance company for explanations of your benefits.

    • Do you provide out of pocket costs prior to procedures?

      We strive to provide a good faith estimate of your costs prior to any procedures. Much of this is dependent on the contracts you have with your insurance plan for your coverage. We often submit a pre-authorization and once that is in, we have an experienced team that checks with your insurance company for your benefits and calls you to discuss your estimated out of pocket prior to any procedures in our office. You can also call your insurance company about questions about your out-of-pocket expenses at any time. If any codes are needed to facilitate this call, we can help provide them.

    • Will I have to pay prior to receiving services?

      Most insurance plans have co-pays that they require you to pay. Co-payments will be requested at time of service per the requirements of your insurance plan.

    • What benefit do procedures fall under with my insurance?

      It’s most common that your procedure benefit will fall under outpatient surgery done in an office setting. This typically applies to your deductible and coinsurance coverage. Unlike a hospital or surgery center, that have much higher facility fees, we do not charge for anesthesia or recovery room which is why we can provide the same services for a much lower cost for the patient.

    • Why did my insurance pay only part of my bill?

      Nearly all insurance plans require that you pay a co-payment, coinsurance or deductible for your health care expenses. This is a requirement they have of you for having their insurance. We do our best to help determine that cost, however, if you have any questions, you can always contact your insurance company for specific information about your coverage specifics with them, and we are happy to provide you the most common codes we bill.

    • Will you bill my primary and secondary insurance carriers?

      Yes, as a courtesy to our patients, Inovia Vein Specialty Centers will submit the bill to your primary insurance carrier. If you have a secondary insurance company, a claim will also be sent to the secondary insurance company after the primary insurance company processes. You are required to supply the pertinent billing information that the insurer may require. They will determine your ultimate out of pocket costs based on the plan you have with them.

    • Do I need a referral to be seen in your office?

      Generally not. However, it depends on health plan you have. Some health maintenance organizations (HMO) plans and point of service (POS) plans will require a referral before seeing a specialist. On the other hand, preferred provider organization (PPO) and exclusive provider organization (EPO) plans do not require a referral. Most commercial insurance plans and Medicare do not. If there are any questions, it is best to check with your insurance company about what they require of you before scheduling.

    • Does Medicaid cover varicose vein treatment?

      Some Medicaid programs cover varicose vein treatments and others do not. It depends on the particular plan and also the extent of the patient’s vein symptoms. Most Medicaid plans will cover the treatment of varicose veins in the presence of wounds, recurrent infections and bleeding history. Some will also cover patients with advanced skin changes. Each state has slightly different regulations as does each plan that administers Medicaid. Sometimes it’s best to be evaluated and then submit for pre-authorization from the plan administering the Medicaid program to seek clarity if possible.

    • Does Inovia Vein Specialty Centers accept Medicare?

      Yes, we do. By accepting Medicare, Inovia agrees not to bill the patient for any charges Medicare disallows. However, consistent with Medicare policies, we do bill patients for deductibles, co-insurance and non-covered services.

  • Compression Therapy

    • Can I wear athletic recovery stockings instead of graded compression stockings?

      The popularity of compression socks has increased substantially among athletes in endurance events such as running and hiking. Whether athletic stockings will work for you all comes down to the reasons you are wearing compression. For more mild and preventive scenarios, athletic recovery stockings may be fine.  For more advanced venous and lymphatic disease, they are not likely to be as effective.  A consultation with a vein specialist can help guide you as to your needs and best options.

    • Do I ever need to change the compression I use?

      Because swelling goes down with time with frequent use, you should have your legs measured again and your stockings replaced every 3 to 6 months.

    • How should I take care of my compression stockings?

      You should generally obtain at least 2 stockings, or 2 pairs if you're wearing them on both legs.  This means you can wear 1 stocking (or pair) while the other is being washed and dried.  Follow any washing instructions provided with the socks at purchase. Many require hand washing, in which case it’s ideal to use warm water (comfortable hand temperature) and dry them away from direct heat.

    • What is the difference between graduated and uniform compression stockings?

      Uniform, or regular, compression socks maintain the same degree of compression throughout the length of the stocking. In contrast, graduated compression garments offer gradient pressure by providing a range of pressure, with more pressure closer to the feet and less pressure closer to the knees. Graduated compression socks are more effective at preventing blood and fluids from pooling in the lower legs and are better at reducing chronic swelling.

    • What kind of compression socks do I need?

      It depends on the reason you are wearing them. If you are wearing compression socks to prevent swelling on a long flight, or for work where you stand a lot, the lower degree of compression hose are usually all that you need (15 to 20 mmHg). If you have had a new DVT or a varicose vein treatment session, generally patients are prescribed to use compression in the mid-range (20 to 30 mmHg).  For patients with more advanced chronic vein and lymphatic disorders with sevre skin changes, higher degrees of compression are often utilized to minimize the swelling as best they can (30 to 40 mmHg).  A consultation with a vein care specialist can help determine the optimal degree of compression for your needs.

    • Where can I buy compression socks locally?

      Most communities have a variety of places where people can obtain compression hose.  For patients who have been wearing compression for a while and know the brand, size and degree of compression they are looking for, online stores are a great option. For those new to compression, it often makes sense to see a professional to help measure you and advise on the size, degree of compression and a variety of different brands that might be best for your particular needs.

    • Should I wear compression hose at night?

      Generally not. Most experts agree that you should take off compression socks while you sleep since they provide the most benefit when you are up and walking. At night, swelling generally goes down on its own. However, if you do wear compression stockings at night, there should not be a problem. Adverse side effects from wearing compression socks are rare under most circumstances.

    • Can wearing compression socks be harmful?

      Severe complications of wearing compression socks are rare under most circumstances. However, some people should be cautious with compression, such as those with delicate or easily irritated skin. Patients with severe arterial disease should also seek medical advice before using compression, as in some extreme cases they are contra indicated. It’s also important that compression socks are properly fitted so they are not too tight. A consultation with a vascular or vein specialist can help guide you to what considerations are important in your particular case.

    • What do compression socks do?

      Compression stockings help alleviate the swelling and pain caused by varicose veins. Graded compression stockings can also help heal any skin inflammation or ulcerations due to venous insufficiency.  They must fit properly to achieve these benefits.

  • Leg Swelling

    • Are there any home remedies for edema?

      There are many home remedies for edema and many experts who can help guide patients to the best approach.  As medical doctors specializing in vein care, we often collaborate with naturopaths and  other experts in home remedies but defer to their expertise on this subject. Our area of expertise is the medical evaluation, often with diagnostic ultrasound of the veins, and then discussions with our vein experts to discuss options including procedures to treat the poorly functioning veins when indicated.

    • How do you reduce swelling in the feet?

      Reducing swelling in the feet is similar to reducing swelling in the legs. Movement, compression, and elevation is commonly prescribed. Other approaches include manual lymphatic drainage and decongestion therapy, pneumatic compression pumps, minimally invasive vein treatments, and/or treatment of heart or kidney problems. The right approach will depend on the patient and the cause of the swelling.

    • What do I do if my edema is caused by heart or kidney failture?

      When the cause of swelling is medical, such as in patients with heart failure or kidney failure, treatment of the heart and kidney problems - including diuretics to promote urination of extra fluid - can help. Seeking a consultation with a qualified medical provider is recommended.

    • Why is only my left leg swelling?

      Just one leg swelling is even more of hint that the problem is local (in the leg) rather than systemic (from the heart, kidneys or liver, for example).  Local problems can include chronic venous insufficiency (Varicose veins), deep venous thrombosis (DVT) or lymphedema.  Of course there are exceptions to every rule, as one can have venous swelling in both legs if each leg has venous issues. There is a less common compressive syndrome called May Thurner Syndrome (MTS) where there is compression of the left sided pelvic veins leading to swelling or blood clots.  Sorting out the causes and thus the treatments for leg swelling can be complex and thus seeking a consultation with a vein expert can be helpful.

    • What causes swollen legs from the knee down?

      When one is standing, gravity is pulling fluid toward the floor.  Thus any extra fluid will go to the legs.  Patients with leg vein problems - and lymphedema in particular - develop leg swelling, especially as the day goes on.  Once the patient gets out of bed, the pressure builds in the lower leg.  Severe swelling might start right away.  More moderate swelling might not manifest until later in the day.  More mild swelling might not appear until the end of a long day standing.  Once the patient goes to sleep laying down in bed, the fluid dynamic is reversed and the fluid can be reabsorbed and the swelling goes down at night . This pattern is quite typical of chronic venous insufficiency, in particular.

    • What is the difference between a pitting vs a non pitting edema?

      If you press a swollen area with your finger and it doesn’t cause an indentation in the skin, it’s considered non-pitting edema.  If it causes an indentation, its called pitting edema. Pitting vs non pitting edema can offer the care provider hints as to the potential cause or causes of leg swelling.

    • Which doctor should I consult for leg swelling?

      If you are unsure what is going on, it never hurts to seek a professional opinion from a provider to assess the possible causes.  If this has been going on for a long time, it is a less urgent issues. If its rapid in onset, the concern for a DVT or other medical conditions is higher and one might need to seek urgent medical evaluation or go to the emergency room.

  • Venous Leg Ulcers

    • What is the fastest way to heal a venous leg ulcer?

      Studies have shown that the sooner one sees a vascular or vein specialist and the sooner the patient is treated, when indicated, with endovenous ablation, the faster the wound heals. Therefore, while wound care is important in the initial management, so is referral for consideration for superficial vein ablation.  

    • What should I do if a venous stasis ulcer does not heal after adequate treatment?

      Most venous leg ulcers will heal with consistent and adequate control of the swelling, proper wound care and endovenous ablation of the varicose veins contributing to the ulcer.  Some however, do not heal, and may have other contributing factors beyond just the vein issue. Dermatologic disorders, cancer in the wound, and other risk factors such as obesity, heart failure, and/or lack of mobility from severe back or orthopedic issues can all contribute to a wound’s ability to heal. If you have had prior vein treatments and venous leg ulcers have returned, its advisable to seek further medical attention for a biopsy, when indicated, and to discuss ongoing management options. If you have had treatment and the wounds does not heal, you should discuss this with your providers to look at other potential contributing factors that are preventing healing.

    • I think I have a venous ulcer. How soon can I be seen by a vein specialist?

      The sooner the better. Unfortunately, many patients have had ulcers for years and have never been referred or found a vascular specialist.  We keep appointments open for short notice add-ons for patients with new or long-standing venous leg ulcers, so they can get in and start the process to healing as soon as possible.  We can at least start the process, so the proper treatment comes sooner rather than later.

    • Do I need to see a vein specialist for my venous leg ulcer?

      Yes.  Studies have shown that the sooner a patient with a venous leg ulcer is referred to a vascular specialists, the sooner the ulcer can be treated so it will heal faster.  At Inovia Vein Specialty Centers, we encourage early referral so our vascular specialists can start the process to get patients into endovenous ablation, when indicated, sooner rather than later.

    • Is there a difference between a varicose ulcer, vascular ulcer, venous leg ulcer, and venous stasis ulcer?

      Nearly all are the same thing.  However, a vascular ulcer could be from arterial or venous . Arterial ulcers are different than venous ulcers.  An arterial ulcer tends to be on the toes or bottom of the foot whereas the venous ulcers tend to be on the lower ankle, back of the calf or sides of the foot.  A venous or vascular expert can usually help sort this out so the most optimal treatment is utilized to get the ulcer healed.

    • How can I treat a leg ulcer at home?

      Treating a venous leg ulcer entirely at home is not recommended. Most patients with venous leg ulcers are managed as outpatients; they see vein and vascular specialists in the office setting and a wound care plan is developed then implemented.  From there, the goal is to allow the patient to manage their wounds at home. Sometimes, especially at first, there are many visits for wound dressing changes and vascular studies. These procedures can be completed in either the outpatient or hospital setting.  The outpatient setting is far more convenient and less cost than the hospital.  Rarely, if a patient has a severely infected wound, hospitalization is required.

    • Do wounds heal faster covered or uncovered?

      It depends on how wet they are.  Wet wounds generally need to be covered, where as dry scabbed over wounds do not. A dry wound that is scabbed over has natural protection and may even do well in a compression stocking. But if there is any wetness, it will cause the dressing or stocking to stick, which will injure the healing skin when the dressing comes off. Thus a wet wound needs a wound care regimen that will not stick to the wound.   One of the most reliable approaches to a wet, painful venous leg ulcer is an Unna Boot, which is a special medicated soft dressing that does not stick to wounds and can be applied with pressure to help treat the swelling as well.  There are many ways to treat a wound an most wound experts have many resources at their disposal to help.  

    • Why is my leg ulcer not healing?

      Chronic venous insufficiency with high vein pressure creates a highly inflammatory environment where wound healing is impaired. Treating the cause - venous hypertension, is the mainstay of treatment of venous leg ulcers – along with adequate wound care and compression are all important for treatment.

    • What do venous leg ulcers look like when they start?

      Venous leg ulcers usually start out in the area by the inner upper ankle, back of the lower calf, or lateral or medial foot.   The skin there has usually been red, hard or brown for some time.  A wound opens and it is painful in most cases.  Then if fails to heal.  They can be small or quite large.

    • Can venous stasis ulcers be prevented?

      Ideally, venous leg ulcers can be prevented with compression hose and, when indicated, with endovenous ablation of the superficial veins where ulcers occur. However, most patients don’t see it coming, so the first time they present for care is once an ulcer opens up and won’t heal.