At Inovia Vein in Bend, Oregon, we can help you address your vein care needs. Our clinic is part of a group of the only specialized vein clinics in Oregon that is staffed by Oregon’s leading vein care specialist. Our clinic in Bend, Oregon is led by Drs. Edward Boyle and Andrew Jones. Dr. Boyle came from the University of Washington in Seattle and started as a cardiothoracic surgeon performing heart, lung and vascular surgery for patients at St. Charles Medical Center in Bend Oregon nearly 20 years ago.
Dr. Jones came to Bend from Oregon Health Sciences University (OHSU) and started out as a minimally invasive general surgeon, also caring for patients with trauma. They both noted a need for specialized vein care in this community, and slowly as their practice built, they later chose to specialize entirely in the care of vein issues.
“We knew there was an unmet need for a clinic that welcomed and specialized in patients with common vein treatment needs,” said Dr. Edward Boyle, Inovia Vein founder at the clinic in Bend, Oregon. “Patients had trouble getting in to see Surgeons about vein issues because the surgeons were so busy being generalists. Once we made the decision to focus our practice more on the care for patients with vein disorders we were frankly surprised at how busy we quickly became. This allowed us to expand our services and build out a full service vein clinic driven by evidenced based protocols that delivered the latest, most innovative treatment options for our patients.”
“Patients generally know if they have a vein problem, but they are often unsure where to go for treatment,” said Dr. Andrew Jones, of Inovia Vein in Bend, Oregon. “They, or a loved one or friend, can see a swollen leg, brown irritated ankle skin discoloration or venous stasis ulcer. Or they can feel large bulging varicose veins that become progressively harder and more painful as they day goes on. We make it easy to for patients to call and make an appointment. And in most cases, especially for symptomatic vein problems, these evaluations and subsequent treatments are covered by insurance.”
What follows are very common questions we hear when helping patients through their vein care journey.
What Causes Varicose Veins?
Everyone has veins to carry blood back to the heart. Blood is pumped by the heart through arteries, out to tissues, through capillaries, then it collects in veins for the journey back to the heart. The veins in the legs have a unique challenge in that the blood must overcome gravity to get back to the heart. Water and other fluids will not run up hill without a pump, and likewise, blood will not go back up against gravity without a pump. In the leg veins there are one way valves in the veins that prevent back flow of blood as it works it ways against gravity back up to the heart. The calf muscles are the pump. As one walks or moves their legs, the contraction of the calf muscles serves as a pump to move the blood in the veins up toward the heart, and the valves keep the blood from coming back down.
Varicose veins occur when the valves in the leg veins become weak or damaged. This can be a result of injury (like a broken leg or getting hit with a fast ball in the calf), a result of some form of coagulation or blood clotting disorder, or most cases it is just genetic (which is why we often see this runs in families). Once the valves become damaged the blood can pool in the lower leg veins. When this happens the pressure in the veins goes up and the veins start to stretch and bulge out. Over time we see varicose veins appear on the legs, usually starting below the knee on the inside of the calf, and eventually working their way over the foot and up the thigh.
Why Do Varicose Veins Hurt Sometimes?
The reason varicose veins hurt is because of tissue stretch and inflammation. Any tissue in the body that stretches can hurt. This is because there are stretch receptors in tissues that signal pain when they are activated. Early on just the veins themselves stretch and hurt. With time fluid pressured within the veins weeps into the surrounding tissues. This is why varicose veins can lead to leg swelling, especially around the ankles and below the knees. This can be so severe in some cases, it can be difficult for some to put their shoes on. The swelling and discomfort from varicose veins tends to get worse as the day goes on, and better at night. This is because pressure builds up in the veins during the day when we walk and stand, and then gets better at night when we are sleeping as the pressure is relieved on the leg veins when we sleep.
Can Varicose Veins Lead to Leg Swelling?
Varicose veins can become a health issue in some people. With time there is an inflammatory response to the vein and skin stretching in the lower legs, which is why the achy veins can appear red and feel warm and tender. Likewise, this is why swollen ankles can appear red as well, as the stretch leads to inflammation of the skin. At times the veins can clot, known as superficial vein thrombophlebitis. This can be quite uncomfortable and can progress to deep vein thrombosis or pulmonary embolism and requires medical evaluation and treatment. Over time the swelling and skin stretching can cause scarring of the skin, leading to a brown hard area above the ankles (known as lipodermatosclerosis). Many people have this brown discolored skin by their ankles and are unaware this is due to venous insufficiency. In some patients, wounds can open around the ankle (known as venous stasis ulcers). This can be quite painful, debilitating and can become infected. This can require hospitalization or extensive wound care. Once patients see redness, swelling, skin irritation or wounds that do not heal they should seek medical attention as many of these complications of venous insufficiency can be treated with great relief.
Are Varicose Veins a Health Problem?
Yes. Patients with long-standing varicose veins can develop complications such as blood clotting in the veins, known as superficial vein thrombophlebitis, stasis dermatitis, which is a skin breakdown by the ankle skin where it becomes hard, brown, red and itchy. The veins can also become quite thin and in some patients bleed. When patients have bleeding varicose veins it can lead to an emergency room visit as they can lose a lot of blood quite quickly. In some cases, patients with varicose veins develop skin breakdown into an ulcer, or non-healing wound. This is called a venous stasis ulcer. This can be a very debilitating complication that can, without treatment, lead to months or even years of suffering.
What Can You Do?
For starters, many patients with mild symptoms of swelling and ache find elevating their legs helps. This lessens the pressure in the veins and thus the stretch comes out of them. This also reverses the pressure gradient that leads to swelling, and fluid can return from the ankle tissues to the capillaries and back to the circulation. This is why in most vein patients, swelling goes away at night. But the next day, however, the swelling returns. During the day, a strategy of graded compression hose can help. Graded compression hose are tighter than traditional socks, and serve to put pressure on the skin and bulging veins, helping prevent swelling and the pain from the stretch of the tissue. They are generally only needed during the day. For patients with skin irritation and redness or itching, compression can help, but also a dermatologic care strategy can also contribute to relief with various topical medications to treat these symptoms.
What if This Doesn’t Work?
In most cases where the symptoms are advanced, the saphenous veins are the culprit. Both the great saphenous vein (GSV,) and small saphenous vein (SSV) run under the skin and are responsible for the vein return from the skin and underlying tissue. When the valves are bad, the veins dilate and stop working, leading to venous insufficiency and varicose veins. In the past this was treated with open surgery or vein stripping at the hospital. But not anymore. There now are numerous minimally invasive vein treatment options with interventions like endovenous ablation of the greater saphenous vein with methods such as ClosureFast RFA , VenaSeal, and Varithena Endovenous Microfoam. Most of these treatments can help reduce the pain and swelling from varicose veins significantly.
For patients with skin issues and wounds, most will improve significantly. These procedures can be done in the office with a local anesthetic with little or no downtime. Patients walk in, have their treatments in less than an hour, then walk out. Most people can go back to work or normal activities the next day. Before any procedures are done, we sit down with you and help map out a personalized vein treatment plan that accounts for your specific vein care needs. This can involve staging the procedures over several treatments so we can treat both legs, as well as some of the branch vein with techniques like sclerotherapy, when indicated.
How to Make an Appointment
Call 541-382-8346 to make an appointment with Dr. Boyle or Dr. Jones at our office in Bend, Oregon. Our specialty vein center is located at 2200 NE Neff Rd, Suite 204, in Bend, Oregon in the Center for Orthopedics building next door to St. Charles Medical Center on the East side of Bend.