Get a Leg Up

Heed the warning signs to steer clear of complications of venous disease.

Richard* was in the printing business for more than 33 years. As part of his job, he ran multi-million-dollar printing presses. He wasn’t in sales or administration for the company; Richard worked in the trenches, and it had a profound effect on his health.Stock photo from istockphoto.com.
“I spent thirty-three years standing on my feet for ten to twelve hours a day,” shares the Tampa native. “It was a hard job, with a hundred-foot run from one end of the press to the other, and I would go back and forth all day. It eventually caught up with me.
“My legs started turning black from circulation issues. I was also in a lot of pain, which beat me down. It was hard for me to get around. I couldn’t walk or ride in my boat because of the bouncing up and down. I had to stop doing just about everything.”
As the discoloration on Richard’s legs got progressively worse, he noticed veins poking out on the back of his calves. The bulging blood vessels made his legs even more unsightly.
“My legs were such a mess and looked horrible,” confirms the 59-year-old. “I used to be embarrassed about wearing shorts, but I’m old enough now that I don’t care.”
It wasn’t just the appearance of his legs that concerned Richard. The other symptoms he was experiencing were also disconcerting. He was nervous about potential serious complications, so he reached out to his doctor for help.
“My legs hurt like hell, and they’d swell up,” he states. “The circulation problems were in both of my legs, but the left one was worse. I was afraid if I didn’t have something done, I would lose my left leg. I went to my primary care provider, and he referred me to Dr. Sharma.”
Richard’s provider recommended Ravi Sharma, MD, a board-certified cardiovascular surgeon with expertise in blood vessel disorders of the legs. Dr. Sharma’s practice, Premier Vein Centers, has offices in Homosassa and The Villages. Richard’s fears were allayed once he met Dr. Sharma
and heard the physician describe his condition in detail.
“Dr. Sharma was such a nice guy, and there was no question he knew what he was talking about,” relates Richard. “He took pictures of my legs and sent them to my insurance company to get the okay to work on them.”
Before he did anything, though, Dr. Sharma explained what was happening inside Richard’s legs and causing his distress. Using ultrasound images and a thorough history and physical, the physician diagnosed Richard with venous insufficiency, a condition marked by leaking veins. Dr. Sharma recommended several procedures to address Richard’s problem.
“About a year ago, I had seven operations, four on my left leg and three on my right,” reports Richard. “I had some veins removed, and I had shots in my veins.
Dr. Sharma also did something with the laser. I had the whole nine yards done.”

Dancing Legs

Claudia Campbell has always loved to dance. These days, the Long Island native often performs tribal belly dancing with the local group, DanceCraft. With dancing as a passion, it was more than inconvenient that her legs were unhealthy and painful. Sometimes, she was even forced off her feet to reduce her discomfort.

Photo by Jordan Pysz.

As a dancer, Claudia is especially happy to now have healthy, attractive legs.

“For years, I had issues with burning and pain in the veins in both legs,” discloses Claudia. “It was an itchy, burning feeling. It felt almost like acid running through my veins.
“There was also swelling in the areas where the veins were, but some of that was relieved if I put my feet up at the end of the day. I had some heaviness in my legs as well, and occasionally got charley horses that were pretty painful.”
For years, Claudia was told that the only treatment for her excruciating varicose veins was a procedure called vein stripping. During this procedure, the doctor makes large incisions in the legs and forcibly removes the problem veins.
“I was told that procedure was painful, and recovery from it was a very long process,” she notes. “I like being out in the nice weather, enjoying time with my family and running around with my grandkids. I didn’t want to be restricted from that, especially not knowing how long it would take me to recover. I decided to wait on treatment.”
The longer Claudia waited, however, the more she wanted to take care of her vein problems. The varicose veins on her legs were not only uncomfortable, they were also unsightly.
“There were bulging veins on both legs but especially on my left leg, and I was conscious of the way they looked,” she says. “Many people might not notice them, but I noticed them. I thought maybe someday I can get them fixed. It would be awfully good to not have the pain, swelling and other symptoms.
“Last year, I went to my dermatologist for a check-up and talked to him about my legs. He said he could recommend someone to me. It was Dr. Sharma. In November 2016, I gave Premier Vein Centers a call and went in for a consult.”
As a cardiovascular specialist who has spent years performing intricate heart and blood vessel procedures, Dr. Sharma has expertise in vein disease and other vascular disorders. He’s also experienced at clearly communicating with patients, which impressed Claudia.
“Dr. Sharma was delightful and very professional,” she describes. “He was kind and explained everything to the smallest detail.
“First, he suggested I wear compression stockings for a period of time. When I went back to see him, he took pictures of my legs and performed an ultrasound to look at the veins inside. He said if I don’t take care of my leg vein issue, it’ll become a bigger problem. I got my first treatment in March of last year.”
Dr. Sharma used several advanced tools to treat Claudia’s venous condition, including a laser that seals the larger, leaking veins using heat energy. He then removed several diseased veins, not by stripping, but through micro incisions that heal quickly. He is still working to eliminate Claudia’s smaller, spider veins using a series of injections.
“Dr. Sharma explained that he must first take care of the trunk of the tree, where most of the problem is located,” recalls Claudia. “Then, he goes down to the limbs, then down to the branches, then down to the twigs and then down to the leaves. If he skips any step, the vein system will not work optimally.
“It’s like bringing a car to a mechanic and saying, I only want you to do this but not that. You don’t really fix the problem. Getting rid of varicose veins is not a quick fix. It takes time, but it took time for those veins to become diseased.”

Venous Insufficiency

The human circulatory system is composed of an intricate series of blood vessels. Veins are the blood vessels that return oxygen-
depleted blood back to the heart. There are three types of veins: superficial veins, deep veins and perforating veins. Superficial veins lie close to the skin, deep veins lie in groups of muscles, and perforating veins connect the superficial veins to the deep veins.
“When the leg veins cannot pump blood back to the heart, it is a condition called venous insufficiency,” explains Dr. Sharma. “Chronic venous insufficiency [CVI] has multiple causes. Over long periods of sitting or standing, as in Richard’s case, the blood in leg veins can pool. This increases the venous blood pressure and weakens the vein walls and valves, thereby damaging the valves. Damaged valves prevent proper blood flow back to the heart.”
There are many signs and symptoms of venous insufficiency, he adds. Signs are the issues that can be seen, such as bulging varicose veins, swelling, and thickening and discoloration of the skin of the ankles or legs. Symptoms are those things that are felt, not seen. They include throbbing, aching, stinging, burning, itching, nighttime leg cramps and restless legs. These are all indications that the veins are not functioning properly.
“It is important that patients who experience any of these signs or symptoms have their veins assessed,” asserts Dr. Sharma. “Leaving the condition untreated can lead to more serious difficulties, including leg ulcers, infection and a breakdown of the skin.
“Richard had both signs and symptoms of venous insufficiency, with the discoloration and swelling, and pain.”
Venous insufficiency is more common than many people think, reports the cardiovascular surgeon. It is estimated that more than 30 million Americans suffer with symptomatic venous insufficiency. Venous vascular disease is five times as prevalent as peripheral arterial disease, or PAD, and more than two times as prevalent as coronary artery disease.

“I’m very happy with everything Dr. Sharma did. He put me back on my feet again!” -Richard

“A huge problem in getting venous insufficiency properly treated is that many of its symptoms are invisible and often misunderstood by patients,” observes Dr. Sharma. “In many cases, the condition is misdiagnosed by physicians who are not familiar with the signs and symptoms of venous disorders.
“Patients and physicians alike need to know that vein problems are often present before they are visible on the surface. Symptoms such as throbbing, aching and restless legs can signal vein disease without the corresponding visible varicose veins.
“When seeking a physician for care, it is crucially important for people to choose surgeons who specialize in venous diseases. They should also be experienced in the advanced procedures available to treat these diseases. Physicians with these qualifications achieve the best outcomes.”

Quick Recovery, No Downtime

Premier Vein Centers offer a full range of advanced, minimally invasive treatment options for addressing varicose and spider veins. These advanced treatments are performed in a comfortable office setting with little to no downtime or discomfort, resulting in a quick recovery and long-term results.

Photo by Jordan Pysz.

Claudia Campbell

“Microphlebectomy is used to treat varicose veins using very tiny incisions to remove the veins, versus a stripping, which was a much bigger ordeal,” informs Dr. Sharma. “We use microphlebectomy in patients who have symptomatic, large veins in the leg.
“With this procedure, the incision is tiny – about the size of the tip of a scalpel – and we can do much more through the small incision. In the old days, doctors made big gashes across the leg, and they were very ugly and people would have large scars. With this procedure, patients end up with tiny marks on the skin or no scars at all.”
Dr. Sharma notes that there are several other options available to treat venous insufficiency. He determines which procedures to use based on each patient’s symptoms and health status.
Endovenous laser ablation (EVLA) introduces a sterile laser fiber into the incompetent vein via a small puncture in the leg. Laser energy is delivered through this fiber, painlessly closing the vein in less than an hour, using local anesthesia.
Tiny, dilated blood vessels in the skin that become swollen with stagnant blood, called spider veins, can be treated with sclerosing injections to gently close the problem vessels. Dr. Sharma uses ultrasound-guided sclerotherapy (UGS) to image the vein and guide his injections.
“Our patients are so relieved to discover there is no general anesthesia involved in our minimally invasive treatments, and they can resume activities right away,” acknowledges the surgeon.
Premier Vein Centers provide a free initial consultation and accept most insurance, including Medicare.

Don’t Judge a Book . . .

After undergoing seven procedures at Premier Vein Centers, Richard’s legs improved dramatically in every aspect but one – appearance. Yet, he’s absolutely thrilled with the outcome. His positive results are a perfect example of why people shouldn’t judge a book by its cover.
“My legs are still discolored because I waited so long to get treatment,” he reports. “But they feel pretty darn good. They’re healthy again.
“My pain level is not bad at all. I’m doing great compared to where I was a year ago. I’m still building up my stamina, but this time last year, I couldn’t even walk.”
Richard gave up his boat when it became too painful to use it. While his venous insufficiency is now successfully treated, his other health problems have kept him off the high seas. He doesn’t plan to get a new boat anytime soon.

“My legs look much, much better now. . . . There’s no pain, and I don’t have any issues with burning.” – Claudia

Dr. Sharma is still performing injection therapy on some of Claudia’s smaller veins, but she’s pleased with the results of her treatment thus far. She’s excited because she knows when the doctor completes his injections, the appearance of her legs will improve even more.
“My legs look much, much better now,” she enthuses. “It’ll take a while for the discoloration to totally disappear; they didn’t get there overnight. Still, they look a lot better than they did. I don’t have any bulges on my legs, even my left leg. Those are all smooth now. There’s no pain, and I don’t have any issues with burning.”
Claudia is glad she took her dermatologist’s advice and made an appointment with Dr. Sharma at Premier Vein Centers. She firmly believes selecting a surgeon who specializes in vascular disorders and has extensive expertise is important to achieving the best results from treatment. It was definitely true in her case.
“It’s absolutely imperative for the surgeon to have all the knowledge to do the procedures,” stresses Claudia. “People go to the doctor to get better, and the more knowledge the doctor has about the conditions they’re treating, the better it is for the patients to understand and recover. The experience I had with Dr. Sharma was excellent.
“I felt very comfortable with Dr. Sharma doing my vein procedures. He is a professional and an expert at what he does. He explained everything I would experience, and that’s pretty much exactly what I got.”
Dr. Sharma impressed Richard as well. He happily recommends the cardiovascular surgeon to anyone with vein problems in their legs.
“I definitely recommend Dr. Sharma because he took time with me,” he verifies. “Not like most doctors, who are in there for thirty or forty-five seconds and that’s it. He spent time with me and explained what was going on. He went over my test results and all the facts and figures. He let me know what I was up against.
“My legs were in really bad shape. I’m very happy with everything Dr. Sharma did. He put me back on my feet again!”

* Patient name was withheld at their request.
Print This Article
    • Premier Vein Centers

      Many people inherit vein disorders. The incidence is higher in women than men. In the United States, nearly 50 percent of the adult population suffers from painful and unsightly vein diseases. The most common forms are spider veins and va... Read More

    • Ravi Sharma, MD

      Ravi Sharma, MD, is board certified by the American Board of Thoracic Surgery. He completed his undergraduate studies at the University of Maryland at College Park and attended the University of Maryland Graduate School, Baltimore, before r... Read More