Alaska Vein Clinic
ALASKA VEIN CLINIC FAQ’S
Do I need a doctor's referral to be seen at the Alaska Vein Clinic?
No. Many patients with vein problems are in otherwise good health and don’t regularly see a physician. You may call the Alaska Vein Clinic directly and schedule an appointment or click the link below to request a consult online.
What can I expect during my first visit to the Alaska Vein Clinic?
The full consultation consists of a detailed ultrasound vein study and a consultation with Dr. Artwohl, who will explain basic venous anatomy, the results of your ultrasound study, and then outline the best treatment for your particular vein problem.
The Alaska Vein Clinic schedules plenty of time for you to ask questions and you will never feel rushed. When you leave our clinic, you will have a good understanding of your vein problem and the rationale behind the recommended treatment.
If you don’t want a full consultation and just want to get some basic information about your vein or leg problems, you can schedule a free consultation.
Will my vein problem be treated during my first visit?
Not usually. The first visit will consist of diagnosing the cause of your varicose vein problems and detailing a treatment plan. Sometimes it is possible to perform a simple procedure during your first visit, but this an exception.
In most cases, insurance companies require a period of “conservative medical management” before they will authorize payment for a procedure.
Unless you are paying for a procedure yourself, whatever procedure you need will be scheduled after your insurance company confirms they will provide benefit for the intended procedure. This usually takes around one or two weeks.
Who will actually perform my procedure?
All procedures at the Alaska Vein Clinic are performed by Dr. Artwohl, who is certified by the American Board of Surgery and has over twenty years experience performing general and vascular surgery procedures.
Where will my vein procedure be performed?
Almost all of our vein procedures are done in the office, and take about one to two hours.
For ClosureFast (radiofrequency) vein ablations, some patients request mild sedation. We usually sedate patients with oral diazepam (Valium by mouth). While this relaxes you, you are not “knocked out,” and you are able to converse with the staff during the procedure. Obviously, if you are sedated for the procedure, you will need someone to drive you home. About 60% of our patient used sedation and 40% do not. Dr. Artwohl will be happy to discuss this option with you.
After the procedure, we will observe you for about 20 – 30 minutes, and then you are able to walk out under your own power.
In the very rare cases, where extensive surgery needs to be done, Dr. Artwohl is a surgeon with full operating room privileges at Providence Alaska Medical Center.
Are vein procedures painful?
Most of our procedures are about as painful as getting blood drawn. We use local anesthesia which mitigates the discomfort. We can also provide sedation.
The overwhelming comments we hear after the procedure are usually something like, “If I had known it was this easy, I would have done it years ago”, or “This was a lot less painful than I imagined it would be.”
After the procedure, most discomfort is very mild, occasionally requiring only a nonprescription pain reliever like Tylenol or ibuprofen. We do not routinely prescribe post operative prescription pain medications, as there is almost never a need for them.
What is the downtime after venous procedures?
There is little or no downtime and most people are able to return to work the next day.
After most procedures, we ask you to wear support stockings continuously for four days, then for two weeks during the day only. During that time, we ask you to refrain from heavy lifting, straining, squatting, or other activity that may lead to a valsalva (bearing down) type maneuver.
Venaseal requires no specific limitations on physical activity, but we still recommend a little common sense.
You may, however, immediately engage in aerobic activity.
What is follow-up like?
Your follow-up care will be specifically written out at the time of your treatment.
We see ClosureFast and Venaseal patients six weeks after the procedure. This allows us to evaluate the effects of the treatment on your symptoms and veins, and make further recommendations about treatment. We used to see patient 24 – 48 hours after ClosureFast procedures, but we never encounter any difficulties during that time period, so we stopped with this practice. At any time after the procedure, we ask you to call us with any questions or problems. If you think you are having a problem, our usual response is to have you come to the office and obtain an ultrasound study, which almost always shows a minor problem that requires no specific treatment. There is no charge for any post-treatment ultrasound or office visit in the six week post-operative period.
We see sclerotherapy patients two months after the procedure. This allows us time to evaluate how the veins have responded and to see if any touch-up injections are required.
What are the potential complications of venous procedures.
Fortunately, post-procedure complications are extremely uncommon.
Potential complications include failure of the vein to close, deep vein blood clot, superficial thrombophlebitis, infection, and bleeding.
At the Alaska Vein Clinic, these complications have occurred in less than 1% of cases.
We have never had a complication that required a hospitalization or lost time from work. We have done over 5000 procedures without a serious complication.
What if I need a varicose vein evaluation or procedure and I don't have health insurance?
Our office can usually work out a payment plan. We feel every patient with significant venous disease should be treated and we try to make it as easy and as affordable as possible to get the help you need.
Do you ask for payment up front or at the time of my visit?
Call us old fashion, but our usual practice is to bill your insurance company first and then bill you for the remaining balance.
If you have difficulty paying your balance all at once, we can work out a payment plan with you.
VENOUS DISEASE FAQ’S
What are varicose veins?
Venous reflux disease occurs when the valves in the veins cannot close properly and prevent the backwards flow of blood down the leg. (See further details on the left side of this page.)
Varicose veins can cause aching, heaviness, swelling, itching, burning and muscle cramps. Sometimes they can cause restless legs. In more severe cases they can rupture and bleed. Venous insufficiency can be linked with pigmentation of the legs and skin ulcers.
What are spider veins?
Like varicose veins, genetics plays a big role. Pregnancy, obesity, and inactivity can also influence the development of spider veins, but they can also be seen in active and thin people, even marathon runners.
They are more common in women due the effects of hormones, but men get them too.
Why do I have varicose veins?
After genetics, contributing factors to developing varicose veins include prolonged standing, pregnancy, obesity, and inactivity.
Having said that, Dr. Artwohl has treated varicose veins in thin physically fit marathon runners.
Not only is getting varicose vein determined by genes, how we respond to them is also genetics. Some people can tolerate varicose vein for decades, while other can develop severe discomfort, skin changes. and even skin ulcers just a few years after developing varicose veins.
Do women really get varicose veins and spider veins more than men?
Women seek treatment for varicose vein problems more often than woman, so it seems reasonable to think the incidence of varicose veins is higher in women than in men.
There is no question that estrogen and progesterone have influence on varicose veins and conditions like pregnancy, birth control, menopause, and hormone replacement often cause their veins to become more symptomatic earlier in life.
However, as more and more men have sought treatment for varicose veins, it seems that about 80% of men and about 88% of women will develop some sort of varicose vein problems at some time in their lives. It may be that women develop problems with veins earlier in life, but over the course of a lifetime, the incidence of varicose veins may be not as different as we once thought.
Is it safe to close down veins or remove them? Don't I need them for my circulation?
We have two sets of veins in our legs: superficial veins and deep veins. The superficial veins are located just below the skin and many of them are visible. The deep veins run deep inside the legs and around surrounded by muscle. (See vein illustrations in middle column on this page.)
The superficial veins of the legs actually contribute less than 10% of venous flow back to the heart, and the deep veins carry over 90%
Dilated varicose veins with defective valves cannot properly transport the blood in the right direction (up and out of the leg) so the varicose veins are a burden on your circulation. They can also put a burden on the deep veins of the leg and on the lymphatic system.
Getting rid of defective superficial veins actually improve your circulation.
Many elite athletes wear compression sleeves (or stockings) on their legs. One of the possible ways this venous compression may help is by compressing the superficial veins and diverting blood into the deep veins, where the the pumping action of the leg muscles on the deep veins helps return blood to the heart more efficiently.
Are my restless legs or nocturnal leg cramps cause by venous insufficiency?
There is certainly a subset of patients with restless legs who benefit from having their venous insufficiency treated.
Studies suggest that the 22% of patients with restless syndrome may also have venous insufficiency. Therefore, if you have restless legs, it is reasonable to have a venous work-up, especially before one starts on a trial of expensive medicines with multiple side effects.
80% of patients with both venous insufficiency and restless legs who are treated for their venous insufficiency will have long term relief.
Should I have my varicose veins fixed before knee or hip surgery?
Surprisingly, there is little research on this question. One study published in 2012 found that patients with history of untreated varicose veins had about a three times higher risk for a deep vein thrombosis after hip replacement. There was no difference for knee replacement.
Your orthopedic surgeon should be well versed in the prevention of deep venous thrombosis. Often an orthopedic surgeon will refer their patient with varicose vein to a vein specialist prior to surgery.
Superficial thrombophlebitis can occur with higher frequency after hip or knee surgery, but this is usually not a life threatening issue.
If the knee or hip surgery is not urgent and the varicose veins are bothersome, a patient may consider have the veins problems dealth with first, since the recovery from vein procedures is much quicker than recovery from hip or knee surgery
Should I have sclerotherapy during pregnancy or while breast feeding.
With respect to pregnancy the answer is simple: absolutely not.
However, with respect to breast feeding, the answer is no one really knows. There is diverse opinion about this among vein care professionals.
Most sclerotherapy solutions clear the bloodstream rapidly and will probably not be found in any significant quantities in breast milk. At the Alaska Vein Clinic, we use Asclera (polidocanol). This is cleared from the bloodstream in about 1.5 – 3 hours and most likely, it is safe use after discarding breast milk (pump and dump) for 8 -12 hours after a sclerotherapy session.
However, it is our position that any sclerotherapy done for strictly cosmetic reasons be deferred until after breastfeeding is completed. Sclerotherapy for more clinical reasons like severe disabling discomfort, venous stasis dermatitis or ulcerations could be considered, after a thorough discussion.
Hypertonic saline, a super-concentrated saltwater solution could be used, since this is just salt and water, but this can be painful when injected and carries a potential risk of causing skin ulcers at the injections sites.
