Pressure Washer

Leaking connector veins linked to leg ulcers.

Trav Ward, 68, was an avid mountaineer from his late teens to mid 30s. He scaled impressive heights both as a rock climber and an ice climber and traveled extensively in his quest to ascend the greatest peaks, continuing the pursuit even during breaks in his college class schedule.

Photo by Jordan Pysz.

Trav Ward

The Greenwich, Connecticut native wasn’t all about mountains. He held an impressive job as well. He worked as a computer IT and security specialist, and in that role, he provided security services to a host of celebrities and dignitaries. After he retired from that career, he started purchasing properties in Florida to manage.

“My wife and I first started coming to Florida as snowbirds in the late 1990s,” Trav relates. “In 2002, I started investing in Florida property. We eventually moved to Florida in 2011. Now, I work in real estate holdings and manage those holdings.”

Back in 1972, Trav felt the first effects of scaling mountains for fun. He developed blood clots in his legs, due in large part to climbing to elevations above 14,000 feet. His doctor explained that the resulting pressure changes negatively affected the veins in his legs.

“Climbing put a tremendous amount of stress on my legs,” Trav notes. “A vascular surgeon discovered that I had severe thrombosis in my legs due to the breakdown of my veins. He removed my saphenous veins, stripping the entire vein systems out of my right and left legs.”

Trav continued to have problems with his legs, and by 1997, he developed additional blood clots, this time in the veins under the skin. He was hospitalized several times as a precaution, but he waited until new technology became available before having his leg veins treated with a laser procedure in 2002.

Over the years, Trav had additional procedures on his leg veins, then in November 2017, he developed a methicillin-resistant Staphylococcus aureus (MRSA) infection in an open wound on his left ankle. He looked for a physician with expertise in treating the cause of venous wounds and found Douglas H. Joyce, DO, at Joyce Vein & Aesthetic Institute and The Ulcer Center at JVAI in Punta Gorda.

“I read an article about Dr. Joyce and his ulcer center in Florida Health Care News,” Trav recalls. “When I went in, Dr. Joyce did testing with ultrasound and found that fifteen to twenty interconnecting veins were leaking. They weren’t properly circulating blood because of valve problems, but they were still communicating with the deep veins.”

There are two systems of veins in the legs. There are the high-pressure, deep veins in the middle of the leg and the low-pressure, superficial veins near the surface of the skin. The two systems are connected by perforator veins.

Perforator veins have valves in them that allow blood to move from the skin to the deep veins. Blood moves from the deep veins to the heart with the help of muscle contractions. If the perforator valves fail, high-pressure blood flows directly to the delicate skin veins, causing the symptoms of venous disease, which include swelling, pain, chronic varicose veins, discoloration and ulceration.

“Trav came to us with a venous ulcer on his left leg,” Dr. Joyce reports. “We discovered that he also had a blood clot in that leg. He went on blood thinning medication, and we followed him for several months, checking the condition of his leg with ultrasound.

“When Trav’s situation improved enough that I felt comfortable performing vein procedures on his legs, we used standard laser ablation on his superficial veins and the single-needle laser ablation technique on his perforator veins.”

The Birth of an Ulcer

At The Ulcer Center at JVAI, Dr. Joyce uses leading-edge procedures and state-of-the-art technology to treat patients and give them the best chance at a positive outcome. That technology includes the single-needle laser ablation, a noninvasive method of sealing the diseased veins responsible for advanced venous conditions, including ulcers.

“Single-needle laser ablation is a technique we developed specifically to close leaking perforator veins,” Dr. Joyce discloses. “We use the technique on other veins that are not accessible with a standard laser system, but it’s primarily for closing perforator veins. And it works amazingly well, especially when there are venous ulcers.”

Before photo courtesy of Joyce Vein & Aesthetic Institute.


Venous ulcers develop as the result of high venous pressure in the superficial veins. Normally, the pressure in the superficial veins is very low, but the pressure in the deep veins is significantly higher, more than 20 times higher. The pressure in the deep veins can be more than two times the pressure in the arteries, and that can lead to a venous ulcer.

“If the superficial veins fall under high pressure, the nearby arteries, which have a lower pressure, cannot perform their function of circulating fresh blood,”
Dr. Joyce explains. “Fresh blood brings in oxygen to nourish the skin and removes waste products. If these processes cannot occur, skin cells begin to wither and die.

“The perforator veins run straight from the deep veins to the surface veins. When they become enlarged and start leaking, they act like a pressure washer against the skin. Arteries cannot compete against that pressure, skin cells cannot get nourished and die, and the skin opens up as an ulcer.”

Closing diseased perforator veins with single-needle laser ablation turns off the pressure washer and normalizes the pressure in the superficial veins. Arteries can then function to bring oxygen and other nutrients to the skin, and venous ulcers begin to heal.

“We get great results at The Ulcer Center at JVAI because we treat all of the problem veins in the patient’s leg,” Dr. Joyce observes. “Many vein centers treat their patients’ superficial veins, which may help with minor leg swelling and some varicose veins, but they do not address leaking perforator veins. Those centers do not have our level of success closing venous ulcers.”

Ultimate Cure

Dr. Joyce performed his single-needle laser ablation technique to close the leaking perforator veins in Trav’s legs. The procedures were effective in resolving the venous ulcer on Trav’s left ankle.

“Once Dr. Joyce closed those leaking veins in my left leg, my wound healed within a week to ten days,” Trav marvels. “His procedures stopped that vein from leaking plasma, which was destroying the tissue that was trying to grow in the wound and close it.

“If my left leg hadn’t been treated, that wound could’ve gotten much worse. It might have required skin grafts, which probably wouldn’t have worked because the underlying vein problem wasn’t corrected. Dr. Joyce’s procedures were key to healing my wound.”

Dr. Joyce explains that he often partners with wound care centers to treat complex venous ulcers. Trav notes that the infectious wound care he received outside of The Ulcer Center at JVAI was an important part of his overall treatment, but that could only treat the infection in the wound. It didn’t address the underlying problem causing the wound.

“It was the vascular part of my treatment that cured the wound,” he says. “Dr. Joyce treated the real problem with the veins and corrected it. My legs are a lot better now than they ever were.

“I absolutely recommend Dr. Joyce and the techniques that he’s pioneered specifically for his patients with leaking veins and venous ulcers. People come from all over the country to be treated at Joyce Vein and Aesthetic Institute and The Ulcer Center at JVAI.”

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