Our treatment protocol is based on a variety of anatomical and physiological models. Our belief is that vein therapy should give long lasting solutions to circulation disorders. Below is our protocol in detail. Please refer to the published and copyrighted Parisi Pathway for Limb Preservation for full details. The Leg Center at Las Vegas Vein is an industry leader in limb treatment and all testing is performed on site.
First Step: Deep Vein Ultrasound and Arterial-Brachial Index with Segmental Pressures
The Deep Vein Ultrasound (DVU) is an initial evaluation of your lower extremities using noninvasive ultrasound. This is to determine if you have venous reflux disease (“reflux”). Reflux is when the vein or its valves do not work properly. When that occurs, blood pools in the lower part of the legs and does not return to the heart as well. Las Vegas Vein believes that vein therapy may assist those with edema that is unresponsive to traditional treatments as long as there is reflux disease. An arterial-brachial index (ABI) is a noninvasive test that evaluates the blood flow from the top of the legs to the lower aspect. Some wounds are from arterial disease however others are from venous reflux. This initial evaluation helps direct your care.
Second Step: Transcutaneous Oxygen and Measurements (TCOM)
TCOM measurements are used to determine if a wound is able to heal with the present condition of the limb. A non-invasive test, the TCOM has small probes that attach to the skin on the surface around the wound and in other predetermined areas. If the values are within normal range then proper wound management will begin. If there is compromise in the circulation, then Hyperbaric Medicine will begin. Hyperbaric Medicine is performed at wound care centers that have been certified by all national wound care agencies.
Third Step: Endovascular Catheter Ablation
What? It means that the vein is closed within your body using a ultrasound probe with no surgical stripping, sutures, or scarring. Vein therapy has shown to be a necessary part of wound care as well as limb salvage. The entire procedure is performed through a single intravenous (IV) sight. The basic premise of the procedure is that the probe emits heat pulse. This heat pulse changes the protein lining of the vein. As the catheter is withdrawn, the vein is compressed and the protein acts like glue holding it shut. The leg is wrapped in a compression bandage to brace the vein together as the protein cools and remains closed. This technology is safe to use on patients that have experienced amputations, chronic wounds, acute wounds due to trauma, and other circulation disorders such as atherosclerosis and some hematological disorders in which there are vascular lesions. The Leg Center at Las Vegas Vein performs these procedures daily on an outpatient basis.
Fourth Step: Microphlebectomy
Phlebectomy is the removal of small to medium sized veins from the skin surface period. This entails small incisions in the superficial skin layer and the removal of the vein using small, various specific instruments. The visible vein is tied at each end, excised, and removed. The incisions are not stitched and therefore scarring is minimal if visible at all.
Fifth Step: Sclerotherapy
Sclerotherapy is a treatment of small, visible veins using a solution that causes the vein to remain closed and then disappear. The solution itself is painless when introduced to the vein. After EVCA treatment, the veins present on the surface will remain on the skin because of the way the veins grew into the tissue. These veins will need to be removed to complete treatment, as these veins can become thrombosed, or clotted (phlebitis). They also become inflamed and painful. Once these vessels are removed, they will likely not return.
Sixth Step: Nd: YAG (Neodymium-doped yttrium aluminum garnet) Laser Treatment
Nd: YAG Laser Treatment (YLT) is a proven treatment for superficial veins, the treatments emit a laser pulse, which causes the veins to remain closed, and they disappear, much like sclerotherapy. The difference in the treatments is the YLT can remove veins in a non-invasive manner and can also treat much smaller veins that would be very difficult to access with sclerotherapy.
This is addition to mechanical & chemical debridement performed at our office in The Leg Center. By performing wound care in the outpatient office setting, your copays and costs are greatly reduced as well as having the ease of our facilities. Dr. Parisi has been involved with several area wound care centers and does inpatient & outpatient rounds as well.