Dual-Design

Two advanced techniques heal patient’s vein disease.

As a manager of a popular pizzeria in Orlando, Brian Kenney works 14-hour days, and most of that time is spent on his feet. Late last year, Brian noticed his legs were starting to feel heavy, achy and sore at the end of the day. Even when he sat down, he could feel the soreness in his legs. He found he had to elevate them when he got home to get any relief.

Photo by Nerissa Johnson.

Brian says there’s a “thousand percent difference” in the way his legs feel following vein treatment.

“My legs were painful no matter how I moved,” Brian shares. “If I sat for a while, I’d have to get up because my legs would really hurt. Sometimes, I’d have cramping, and I’d wake up at night with cramps in my leg. It took a while for the cramps to go away so I could go back to sleep.”
The aching and fatigue in Brian’s legs got worse over time. He tried to maintain his daily routines, but discovered he had to adjust his activities due to the symptoms. Eventually, the pain and heaviness became so bothersome, he sought the help of his primary care provider.
“I liked to take the dogs for walks and just walk around the park with my wife and kids,” Brian says. “I also liked going to the gym. I loved the treadmill and used it a lot, but I had to cut back on all of that. I didn’t stop completely, but I couldn’t do it as much as I wanted to or used to. I spent more time at home with my legs up, resting them.
“I also had bulging varicose veins on my legs. I didn’t like the appearance of them; they were very ugly, but I had them for so long, they didn’t really bother me. Once they started hurting, however, I thought maybe it was time to do something about them. When the pain kept getting worse, I finally went to my doctor.”
Brian’s doctor looked at his legs and was troubled. Unlike Brian, she was bothered by the bulging varicose veins. She was also concerned about the pain he was feeling. Brian’s doctor referred him to Heart and Vascular Care for a thorough evaluation of his leg veins.
At Heart and Vascular Care, Brian met Pradip B. Baiju, MD, an endovascular specialist and interventional cardiologist, along with Robyn Kempf, PA-C, a certified physician assistant who specializes in the evaluation and treatment of venous disorders of the legs. They began their evaluation with a detailed history of Brian’s symptoms and an ultrasound examination of his leg veins.
“Brian had a longstanding history of varicose veins, and he noticed his veins becoming larger and his legs becoming achy, heavy, tired and itchy, a condition called pruritis,” Robyn reports. “The venous ultrasound demonstrated that he had severe venous insufficiency in his left leg.”
Venous insufficiency occurs when the tiny, one-way valves of the superficial leg veins that open and close to assist with the return of blood from the legs back to the heart become damaged or diseased. The blood then refluxes backward in the veins and pools in the legs, leading to symptoms such as varicose veins, pain, swelling and fatigue. In later stages, venous insufficiency can cause skin discoloration and breakdown, which can lead to venous ulcers.

Modern Medicine

At Heart and Vascular Care, Robyn uses modern, advanced techniques to treat patients with venous disease. The most common minimally invasive technique is to shrink and permanently seal the veins with venous reflux from the inside by applying heat through a catheter inserted into the vein. To do this, Robyn uses radiofrequency energy in a procedure called radiofrequency ablation, or RFA. It was this technique that she used to treat Brian’s left leg.
“We begin RFA by applying local anesthesia then making a small puncture, usually below the knee, and then inserting a small tube called a sheath into the vein,” Robyn describes. “We then insert a specialized ablation catheter and advance it to the affected area. Before we apply the heat, we put fluid and numbing medicine all along the vein, and apply controlled heat in the affected sections down the vein. The heat results in ablation of the vein where the vein thickens, collapses and seals permanently.
“When we’re finished, we withdraw the catheter and place a small bandage over the puncture site. The leg is then wrapped in a compression bandage.”
After two days, patients return to Heart and Vascular Care for a follow-up ultrasound. This is done to ensure the problem veins are sealed and that there are no blood clots in the deep veins of the legs. The bandages are removed, and patients are instructed to wear compression stockings during the day for two weeks to three months.
According to Robyn, Brian’s right leg had some large varicosities but no underlying venous insufficiency. As a result, she opted for a different procedure for his right leg, choosing to perform a microphlebectomy on that leg instead of RFA.
“With microphlebectomy, I first have the patient stand up, and I use a sterile marker to draw along the veins to outline them,” explains Robyn. “When they lie down, I inject fluid and numbing medicine all along those veins, and then I make several little nick incisions. These incisions are so small, they don’t require stitches to close them.
“Next, I insert a phlebectomy hook into the tiny nick incisions and pull up the veins, generally dividing them into two sections, and tie them off. The segment of vein between the two tied segments is then removed from the legs. When we’re done, we put little Steri-Strips™ over the nick incisions.”
Microphlebectomy patients don’t require follow-up ultrasounds, but are examined two days after the procedure to check for signs of infection. As with RFA, patients who’ve had microphlebectomies wear compression stockings for two weeks after the procedure.

Feeling Stronger Every Day

Robyn performed the two procedures on Brian about a month apart. Brian was so amazed by how much better his left leg felt after the radiofrequency ablation that he couldn’t wait to have the microphlebectomy on his right leg. Now, he reports that both legs feel better than they have in years.
“There’s a thousand percent difference in the way my legs feel now compared to before the procedures,” Brian raves. “Before, I couldn’t do all of the activities I like. Now, I’m slowly resuming all of the activities I used to do.
“My right leg feels a lot better than it did before, and my left leg feels like it did before I started having symptoms. My left leg looks great as well. You cannot tell I ever had varicose veins, and there’s no cramping, no pain. It’s like a normal leg now.
“My procedures were successful. If anyone’s legs are bothering them, I highly recommend Heart and Vascular Care. Robyn did a great job for me.”

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