Tag Archives: laser treatment

Laser Vein Treatment for "broken" veins

Three leg procedures down; 3 still to go, possibly 4. The next two are only 2 days apart: the final perforator on a Tuesday and the greater saphenous vein two days later, on Thursday. They tell me that one will probably be “pretty uncomfortable.”

The first 4 procedures consist of laser obliteration of 4 perforator veins (called that because they perforate the fascia – go through it). There are 140 tiny perforator veins in each leg, all of which are supposed to be the size of capillaries. Their job is to carry blood from the superficial veins to the deep venous system which returns that “used” blood to the heart for oxygenation, making it ready for the round trip through the body again. My 4 “broken” perforator veins are/were 5/16″ in size (that’s almost 1/2 inch in diameter!) and have been responsible for keeping blood pooled in the ankle area. This pooling caused lots of swelling, sometimes to 3 or 4 times normal ankle size, and also caused ulcers that took from several months to over a year to heal. Three of those are now GONE! Just one more of those, and then the big ones.

For the greater saphenous vein procedure, the needle carrying the fiberoptic laser (size 14 needle!) is inserted into the vein at the back of the knee and threaded up to the groin. Obviously, a fair amount of novocaine with it! Then he turns on the laser (1000 degrees) and starts pulling the fiber/laser back toward the knee, essentially boiling the blood into steam and obliterating the vein. Two weeks later, they do an ultrasound to see if the lower part of that vein (that goes from knee to ankle) has closed itself. Apparently 4/5 times, it closes by itself. If not, then they have to go in and take care of that one as well.

Following the greater saphenous procedure, the leg is wrapped (tightly) from groin to ankle for 48 hours, then I can remove that dressing and “only” have to wear a thigh-high compression sock for – Yikes! – two weeks.

After that, once they’ve done the ultrasound and verified the lower portion of that vein has closed itself, the lesser saphenous gets the same treatment. That vein goes from knee to ankle only, though, so at least I can go back to just my regular knee-high compression socks for two weeks after that procedure – and then I’m done!

The first one was a walk in the park. The last two have been fairly uncomfortable, but the end result will be NO MORE COMPRESSION SOCKS! And no more swelling in the ankle, and no more open ulcers because of circulation issues. Woohoo!!

This problem has been going on for 39 years, ever since a motorcycle accident, so you can probably imagine my degree of amazement (that it can even be done), excitement as the ankle gets progressively “unswollen” – even after 3 hours on my feet on dart night, and the relief of not having to worry about an ankle ulcer happening anymore. Wow. Modern medicine has some real miracles with it.

Dr. Joyce (Joyce Vein & Aesthetic Institute here in Punta Gorda, FL) is considered the leader in this type of procedure. He has done over 1000 cases since the laser treatment was introduced – with HUGE success rates. He will be delivering a paper on it in early November to the American College of Phlebology. (www.jvai.com)


A Dubious Anniversary

Today is the 39th anniversary of the event that changed my life forever.

Thursday, October 15, 1970, was one of those beautiful October mornings in Munich, Germany. My boyfriend and I were enjoying our last motorcycle ride of the year through the countryside when a truck carrying bags of cement failed to stop at an intersection. My life changed in that moment of impact between truck and motorcycle.

I was lucky; I was alive – and so was my boyfriend. He broke his elbow and had a minimal back injury. His helmet was ruined from the gravel that was ground into it – but the gravel was in the helmet and not in his head! My foot was 99% severed from my ankle. They sewed it back on because I was 26, thin, and in good health, and gave it a week to see if it would ‘take’. They were pretty sure they would have to amputate it, though, because they didn’t believe blood flow would reestablish itself. At the end of that week, my foot was still pink and alive, and from then on they called me their “Miracle Child.”

Months of therapy ensued, but it was Munich and I was young. During March Fasching celebrations, I wore my mini skirts and decorated my upper leg with felt petals glued to the scars. A brace kept my foot from touching the floor and didn’t stop me from dancing the night away. Youth. The young don’t believe in danger; they thrive on it – as I did then.

My future became a different future, as happens with anyone who experiences such an event. I was clear that “Although I would not wish this on anyone, it was perhaps the best thing that could have happened for me.” And over these intervening years, I learned to compensate for disability and tolerate pain. Each Spring, when it was time to get the garden in shape, I knew there would be at least two weeks of acute pain and swelling. In the Fall, when it was time to clean up the yard and cut wood, I paid again. And every day I spent standing around or walking on concrete, or driving distances, I spent several days with my leg elevated and popping pain pills. But that’s life, right? That WAS my life, you’re right.

Now, fast forward 39 years to today, October 15, 2009, one of the most exciting days in my life Now. Today I visited Dr. Joyce at the Joyce Vein & Aesthetic Institute (www.jvai.com) in Punta Gorda, Florida. My first visit of 6 or possibly 7 visits, and I could not believe how excited I was! Today, Dr. Joyce would turn one of my veins to dust – and I could hardly wait.

Dave came into the operating room (in the offices of JVAI) and I started asking questions. I wanted to know everything, and with the medical background to understand the answers, things were even more interesting to me. What size needle? (14 gauge) What do they do? How? Dave was delightful and answered all my questions. When Dr. Joyce joined us, my questions resumed. He sat in front of my and pulled the ultrasound screen close so he could see, and I leaned forward as far as possible to see, too!

When he found the perforator he wanted to do first, he got excited, “We’ll do this one first – it’s huge.” He explained that perforators usually can’t even be seen on ultrasound, but this one was 8 mm (5/16”). Later, when he was writing it up, he said, “It’s not the biggest one I’ve seen, but it ranks right up there with the big ones!”

He injected some local anesthetic and made a small cut in the leg, then inserted the needle containing the fiberoptic laser. Blood gushed everywhere – we were all laughing and going, “Wow! Look at that!” If you stuck a needle into a normal leg, there would be minimal to no bleeding at all, but this vein, no longer tiny, had so much pressure in it that it just gushed.

We watched as the fiber was carefully directed into the enlarged perforator and when he was ready, he turned on the heat (1000 degrees) which would boil the blood and turn it into steam, essentially closing (or evaporating in my mind) the vein. We watched as the vein disappeared, but I still saw a fairly large opening and asked what it was. He told me that was the opening to the deep venous system and I asked why he didn’t close that opening as well “We have to be very careful to not get too close to it,” he said, ”because we don’t want the clot to enter the deep veins.” I’m thinking, “Duh, I should have known that!” Thank you, Dr. Joyce!

So there is a little stub of perforator that gets left and that clots off, ‘closing the door’ completely.

That was it. He pulled out the needle and fiberoptic laser, wrapped the leg in a compression bandage that I have to keep on for 48 hours, and we were done. It was so cool!!

FOLLOW UP: Sunday, October 18, 2009
Friday was a lazy day. My foot and ankle were swollen, so I was told to keep my foot elevated on four pillows (FOUR!!??), with ice 20 minutes on and 20 minutes off. Since there was no way to hold a laptop or do any work, I read a book and lazed about.

Saturday, the ankle and foot were still a bit swollen but hadn’t gotten any worse. I did a few things around the house and then sat and elevated again. Late in the afternoon (48 hours) I removed the bandage, washed my leg to remove any residue and put on my “normal” compression socks that I have to wear for the next two weeks. I’ve worn compression socks for many years, so what’s another few weeks?

Sunday: My foot and ankle are normal size! No swelling! The puncture site doesn’t hurt and I’m ecstatic. Woohoo! Next Thursday will be perforator #2 – Let’s Do It!

If you have problems with varicose veins or venous ulcers, go to someone who has the experience to do this. Dr. Joyce has done more of these than anyone in the US (or world). He teaches the procedure and will be presenting two papers on it at an upcoming conference. Don’t take chances; go to the best. I did!