Treatment Trilogy

Three avenues for treatment of varicose and spider veins.

A Fort Myers native, 38-year-old Natalie* has a full-time job as an administrator of a health care company. She’s also the mother of four children. Between the stress of her job and four pregnancies, it wasn’t a complete surprise when Natalie developed issues with pain in her legs.In both cases, patients wear compression stockings and are encouraged to walk. This protocol enables the fluid from the injections to adhere to the vein walls and extend farther into the entire vein area, helping to painlessly close the leaking veins. “The main difference is that traditional sclerotherapy usually takes two, and sometimes three or four, treatments to be completely effective,” Nestor cautions. “The number of treatments depends on the amount and severity of spider veins patients have throughout their lower extremities.” Ten Out of Ten While Natalie’s treatments at Premier Vein and Vascular are not completed, she has already begun to realize beneficial effects from them. She’s thrilled with the positive results she’s achieved thus far. “The treatments themselves are easy,” Natalie relates. “The procedures I had done were relatively painless, and Nestor and the technicians who help him relieved any anxiety I might have felt. They made me feel very comfortable. That really helped. “And so did the treatments. The pain in my legs is gone. My nighttime leg cramps are gone as well. I’m still being treated, so my legs are a work in progress. But there’s a plan for my legs, and they look much better already.” Not only is Natalie happy with the treatment plan Nestor created for her, she’s also pleased with the nurse practitioner himself, as well as his team at Premier Vein and Vascular. They make her treatments easy to tolerate and her visits to the practice pleasant events. “Nestor is great,” Natalie says. “He’s very knowledgeable and very competent. He’s been doing these treatments for a very long time. He makes me feel calm and eases my fears about the treatment process. “And the staff is very courteous. They get me in and out quickly, and they treat me like family. I definitely recommend Premier Vein and Vascular to friends and family. In fact, I already have. My family actually gets treated there. “My experience with Premier Vein and Vascular has been great,” she adds. “The staff was awesome, and scheduling was easy. They were able to get me in at convenient times, they accepted my insurance, and my appointments went smoothly. “On a scale of one to ten, I rate them a ten!” FHCN staff article. Before and after images courtesy of Premier Vein and Vascular. mkb *Patient’s name changed at her request.

“The problems with my legs had been going on for about fifteen years,” Natalie reports. “I had the pain in my legs, as well as some burning and numbness. I didn’t have any swelling or discoloration, but the pain started getting worse after work when I’d lie down. I knew it wasn’t normal.

“I work out a lot, so I thought at first my pain was related to that. After a while, I realized it wasn’t. It was actually related to my leg veins. I had visible varicose and spider veins.”

Through her work in the health care field, Natalie has become familiar with all of the local vein treatment centers. One center stood out to her as being superior to the rest. That center was Premier Vein and Vascular, which has facilities in Tampa and Largo.

“I was impressed by Premier Vein and Vascular because they’re a full-service vascular practice and not a fly-by-night vein center,” Natalie states. “They treat all portions of the vascular system, so they’re a good place to go if you need to have any type of vein work done. I trusted them.”

At Premier Vein and Vascular, Natalie met with certified nurse practitioner Nestor Guerrero, ARNP. A registered vascular ultrasound technician performed a diagnostic ultrasound to investigate Natalie’s superficial venous system, or the veins closest to the skin.

The exam included a thorough look at the greater saphenous veins and their branches and revealed that Natalie was suffering from a condition called chronic venous insufficiency, or CVI, in both legs.

In both cases, patients wear compression stockings and are encouraged to walk. This protocol enables the fluid from the injections to adhere to the vein walls and extend farther into the entire vein area, helping to painlessly close the leaking veins. “The main difference is that traditional sclerotherapy usually takes two, and sometimes three or four, treatments to be completely effective,” Nestor cautions. “The number of treatments depends on the amount and severity of spider veins patients have throughout their lower extremities.” Ten Out of Ten While Natalie’s treatments at Premier Vein and Vascular are not completed, she has already begun to realize beneficial effects from them. She’s thrilled with the positive results she’s achieved thus far. “The treatments themselves are easy,” Natalie relates. “The procedures I had done were relatively painless, and Nestor and the technicians who help him relieved any anxiety I might have felt. They made me feel very comfortable. That really helped. “And so did the treatments. The pain in my legs is gone. My nighttime leg cramps are gone as well. I’m still being treated, so my legs are a work in progress. But there’s a plan for my legs, and they look much better already.” Not only is Natalie happy with the treatment plan Nestor created for her, she’s also pleased with the nurse practitioner himself, as well as his team at Premier Vein and Vascular. They make her treatments easy to tolerate and her visits to the practice pleasant events. “Nestor is great,” Natalie says. “He’s very knowledgeable and very competent. He’s been doing these treatments for a very long time. He makes me feel calm and eases my fears about the treatment process. “And the staff is very courteous. They get me in and out quickly, and they treat me like family. I definitely recommend Premier Vein and Vascular to friends and family. In fact, I already have. My family actually gets treated there. “My experience with Premier Vein and Vascular has been great,” she adds. “The staff was awesome, and scheduling was easy. They were able to get me in at convenient times, they accepted my insurance, and my appointments went smoothly. “On a scale of one to ten, I rate them a ten!” FHCN staff article. Before and after images courtesy of Premier Vein and Vascular. mkb *Patient’s name changed at her request.

Before & After Vein Treatment

“Blood in leg veins flows upward against gravity, so they contain valves to keep the blood from flowing backward,” Nestor explains. “Occasionally, due to genetics, age, profession, trauma, surgery or life in general, those valves start malfunctioning.

“In Natalie’s case, blood was not flowing in the proper direction in her veins, which allowed blood to pool in her lower extremities. Symptoms developed from the increased venous pressure, which caused the blood to seep outside of the veins, irritating the surrounding tissues.”

Patients such as Natalie who seek leg vein treatment from Premier Vein and Vascular generally have symptoms ranging from simple tiredness, swelling or heaviness in their legs to numbness, tingling, cramping and pain.

Without treatment, more severe CVI can develop, which can cause more serious symptoms such as discoloration, breakdown of the skin and ulceration. With potentially dangerous consequences, CVI is much more than a cosmetic concern.

After Natalie’s ultrasound evaluation confirmed CVI, Nestor recommended a trio of procedures to treat her chronic venous insufficiency. They were endovenous laser ablation, sclerotherapy and ultrasound-guided sclerotherapy.

CVI Solutions

The first procedure was endovenous laser ablation, which is performed using ultrasound to accurately locate the vein to be treated. Before the procedure begins, Nestor places an anesthetic on the skin and around the vein to numb it.

“While looking at a screen, we access the vein, place the laser catheter inside and set it,” Nestor educates. “If the vein is at thigh level, as in Natalie’s case, we set the catheter at two and a half to three centimeters from the deep vein system, which lies in the leg muscles.In both cases, patients wear compression stockings and are encouraged to walk. This protocol enables the fluid from the injections to adhere to the vein walls and extend farther into the entire vein area, helping to painlessly close the leaking veins. “The main difference is that traditional sclerotherapy usually takes two, and sometimes three or four, treatments to be completely effective,” Nestor cautions. “The number of treatments depends on the amount and severity of spider veins patients have throughout their lower extremities.” Ten Out of Ten While Natalie’s treatments at Premier Vein and Vascular are not completed, she has already begun to realize beneficial effects from them. She’s thrilled with the positive results she’s achieved thus far. “The treatments themselves are easy,” Natalie relates. “The procedures I had done were relatively painless, and Nestor and the technicians who help him relieved any anxiety I might have felt. They made me feel very comfortable. That really helped. “And so did the treatments. The pain in my legs is gone. My nighttime leg cramps are gone as well. I’m still being treated, so my legs are a work in progress. But there’s a plan for my legs, and they look much better already.” Not only is Natalie happy with the treatment plan Nestor created for her, she’s also pleased with the nurse practitioner himself, as well as his team at Premier Vein and Vascular. They make her treatments easy to tolerate and her visits to the practice pleasant events. “Nestor is great,” Natalie says. “He’s very knowledgeable and very competent. He’s been doing these treatments for a very long time. He makes me feel calm and eases my fears about the treatment process. “And the staff is very courteous. They get me in and out quickly, and they treat me like family. I definitely recommend Premier Vein and Vascular to friends and family. In fact, I already have. My family actually gets treated there. “My experience with Premier Vein and Vascular has been great,” she adds. “The staff was awesome, and scheduling was easy. They were able to get me in at convenient times, they accepted my insurance, and my appointments went smoothly. “On a scale of one to ten, I rate them a ten!” FHCN staff article. Before and after images courtesy of Premier Vein and Vascular. mkb *Patient’s name changed at her request.

“Once the entire area is numb, we can safely turn on the laser machine, and over a few minutes’ time, we carefully pull back the laser catheter while sealing the vein with laser energy. We continue to do that until the laser is completely removed from the leg.”

The other two procedures Nestor chose to treat Natalie’s CVI were sclerotherapy and ultrasound-guided sclerotherapy. While both procedures use chemicals to seal incompetent veins, the two techniques have different uses.

“Both sclerotherapy and ultrasound-guided sclerotherapy use sclerosing agents to seal leaking veins, but they are separate treatments,” Nestor confirms. “In both cases, we use a mixture of air and fluid in specified ratios that are injected directly into the veins.

“With ultrasound-guided sclerotherapy, we use ultrasound to visualize the incompetent branches under the skin that we are injecting. With traditional sclerotherapy, we directly inject the spider veins on the surface of the skin that are visible to the naked eye.”

In both cases, patients wear compression stockings and are encouraged to walk. This protocol enables the fluid from the injections to adhere to the vein walls and extend farther into the entire vein area, helping to painlessly close the leaking veins.

“The main difference is that traditional sclerotherapy usually takes two, and sometimes three or four, treatments to be completely effective,” Nestor cautions. “The number of treatments depends on the amount and severity of spider veins patients have throughout their lower extremities.”

Ten Out of Ten

While Natalie’s treatments at Premier Vein and Vascular are not completed, she has already begun to realize beneficial effects from them. She’s thrilled with the positive results she’s achieved thus far.In both cases, patients wear compression stockings and are encouraged to walk. This protocol enables the fluid from the injections to adhere to the vein walls and extend farther into the entire vein area, helping to painlessly close the leaking veins. “The main difference is that traditional sclerotherapy usually takes two, and sometimes three or four, treatments to be completely effective,” Nestor cautions. “The number of treatments depends on the amount and severity of spider veins patients have throughout their lower extremities.” Ten Out of Ten While Natalie’s treatments at Premier Vein and Vascular are not completed, she has already begun to realize beneficial effects from them. She’s thrilled with the positive results she’s achieved thus far. “The treatments themselves are easy,” Natalie relates. “The procedures I had done were relatively painless, and Nestor and the technicians who help him relieved any anxiety I might have felt. They made me feel very comfortable. That really helped. “And so did the treatments. The pain in my legs is gone. My nighttime leg cramps are gone as well. I’m still being treated, so my legs are a work in progress. But there’s a plan for my legs, and they look much better already.” Not only is Natalie happy with the treatment plan Nestor created for her, she’s also pleased with the nurse practitioner himself, as well as his team at Premier Vein and Vascular. They make her treatments easy to tolerate and her visits to the practice pleasant events. “Nestor is great,” Natalie says. “He’s very knowledgeable and very competent. He’s been doing these treatments for a very long time. He makes me feel calm and eases my fears about the treatment process. “And the staff is very courteous. They get me in and out quickly, and they treat me like family. I definitely recommend Premier Vein and Vascular to friends and family. In fact, I already have. My family actually gets treated there. “My experience with Premier Vein and Vascular has been great,” she adds. “The staff was awesome, and scheduling was easy. They were able to get me in at convenient times, they accepted my insurance, and my appointments went smoothly. “On a scale of one to ten, I rate them a ten!” FHCN staff article. Before and after images courtesy of Premier Vein and Vascular. mkb *Patient’s name changed at her request.

“The treatments themselves are easy,” Natalie relates. “The procedures I had done were relatively painless, and Nestor and the technicians who help him relieved any anxiety I might have felt. They made me feel very comfortable. That really helped.

“And so did the treatments. The pain in my legs is gone. My nighttime leg cramps are gone as well. I’m still being treated, so my legs are a work in progress. But there’s a plan for my legs, and they look much better already.”

Not only is Natalie happy with the treatment plan Nestor created for her, she’s also pleased with the nurse practitioner himself, as well as his team at Premier Vein and Vascular. They make her treatments easy to tolerate and her visits to the practice pleasant events.

“Nestor is great,” Natalie says. “He’s very knowledgeable and very competent. He’s been doing these treatments for a very long time. He makes me feel calm and eases my fears about the treatment process.

“And the staff is very courteous. They get me in and out quickly, and they treat me like family. I definitely recommend Premier Vein and Vascular to friends and family. In fact, I already have. My family actually gets treated there.

“My experience with Premier Vein and Vascular has been great,” she adds. “The staff was awesome, and scheduling was easy. They were able to get me in at convenient times, they accepted my insurance, and my appointments went smoothly.

“On a scale of one to ten, I rate them a ten!”

*Patient’s name changed at her request.
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