The cardiovascular system functions to manage and control the blood flow through the body. The major parts of this system are the heart, arteries, capillary network, veins. The lymphatic system runs side by side to the vascular system. The heart pumps blood through the entire body to supply oxygen and nutrition to tissues and major organs. The oxygen is carried by Red Blood Cells (RBC-45% of blood), and nutrients and other products are carried by the plasma (55% of blood). Normal arteries and veins are one directional systems, meaning their blood flows in one direction only; therefore, arterial blood flows from the heart toward the body, and venous blood flows from the body to the heart.
Blood is returned to the heart by the veins. Veins carry de-oxygenated blood, CO2, and nutrient by-products, like lactic acid. Leg muscles act like a pump and push the blood against gravity, back towards the heart to be replenished. In healthy veins, one way valves prevent the backflow of blood toward the feet. If these valves become dysfunctional, it causes the blood to backflow, also known as “Venous Reflux” (Venous Insufficiency causing Varicose Veins).
The Venous system consists of the deep venous system (responsible for 90% of blood return to the heart) and superficial venous system (responsible for 10% of the blood to the heart), which communicate via perforators, or connecting veins.
Deep veins are crucial in maintaining a healthy circulation. Deep veins either pass through the middle of leg muscles or between leg muscles, and are not close to the skin. Superficial veins are near the skin and attach to the deep venous system via connecting veins called perforators. Perforator valves prevent blood from backflowing (venous reflux) from the deep veins to the superficial veins. The normal pathway of venous blood circulation is from the superficial veins, through the perforators, to the deep system, and back to the heart.
The main surface veins are saphenous veins in the legs, which collect blood from other superficial veins and drain into the deep venous system. Great saphenous veins are the longest superficial veins that commonly become faulty or insufficient. They are located in the medial (inside) portion of the leg and travel from the ankle to groin. Small saphenous veins are in back of the calf muscle and travel from ankle to the back of the knee. These two veins are the most common veins that become faulty in the legs. They comprise only a small fraction of superficial veins (we have as much as football field worth of blood vessels in our legs), but when they are dilated, they can steal a high volume of blood from our circulatory system.
If these veins are closed or removed from the venous system, the venous circulation actually becomes more efficient.
When veins are stretched out and varicose, it causes vein walls to leak plasma. Therefore, someone with venous insufficiency and varicose veins, depending on the severity of their disease, may get mild to severe swelling (edema), which worsens as time passes during the day. As a result, this causes the array of varicose vein signs and symptoms.
The field of Phlebology developed because vascular surgery paid more attention to arterial disease and would treat the varicose veins when it was too late in the stage of disease. In the past 15 years or so, the ultrasound became more accurate and more readily available. So the doctors in the field of phlebology gained more insight regarding the dynamic of the venous system and its pathophysiology.
The old fashioned way of treating varicose veins was either major surgery, with complete anesthesia, and basically blindly removing big veins with collateral damage and without paying attention to the dynamic of the venous system. With state of the art technology, very accurate duplex ultrasounds, very well trained Registered Vascular Technicians, and physicians that only focus on the venous system, now more than ever vein specialists can make more accurate diagnoses and find source of the problem. This also allows them to treat more accurately with minimally invasive vein treatment to eliminate the source of disease in 15 minutes.
Now that we know more about this information, it opened a world of opportunity to treat vein problems in a minimally invasive fashion with the least amount of collateral damage, and after treatment keep the the veins in normal physiological order.
The latest procedures, like EVLT, are much better. They are more accurate and a less expensive way to deal with varicose vein pain and symptoms, and comorbidity that is associated with it, rather than waiting until it is too late.
We have mastered this procedure, and we have found a solution for every possible complication that might exist.
What We Do
Starting with the first day we meet with our patient, we try to get a very detailed history and do a complete venous ultrasound mapping. We are always trying to prevent any possibility of complications. Then, we write a detailed and tailored plan for every individual patient. All of our staff team members have been trained to accommodate all of our valued clients. We even have multilingual Registered Vascular Technicians and other team members to explain every step of the way to our patients, and to get the right information as well. This way, we don’t miss any important and necessary information that might jeopardize our client’s treatment.
We have chosen the best ultrasound machines that are very accurate in diagnosing the smallest abnormalities and latest laser machines with the highest accuracy for treatment, which we update often.
We have customized our procedure packages specifically to Aluna Vein Centers in order to have the best sterile field for treatments, and to have the least chance of infection.
At the time of the procedure, we have allotted enough time for every patient, and 99% of the time there is no waiting. At the time of the procedure, we make sure that our clients are comfortable, and Dr. Massoudi talks to every patient through the procedure. Not only does he make sure the patient is at ease, but Dr. Massoudi also makes sure that patient is not anxious and explains every step of the procedure.
During the procedure, even though Dr. Massoudi talks to his patients, he is also making sure that even his point of entry has the smallest nick so there is no scarring, and a minimal amount of bleeding. When the time for anesthesia comes, Dr. Massoudi has chosen the smallest needle for the initial numbing so there is no pain. He then makes sure that he places enough tumescent anesthesia so there is no chance for nerve damage. At the end of procedure, the point of entry is so small that there is no need for sutures, and he places only small surgical tape over the incision. Then, we make sure that the appropriate gradient compression stocking is measured again and put on the leg with a cohesive bandage wrapping over it. Not only we explain the aftercare in our patient’s language, but we also have printed the aftercare in different languages for patients to take home.
Due to the fact that the superficial venous system have a complicated dynamic, and after each treatment that dynamic changes, we have developed a comprehensive protocol. After every procedure, we will follow up one week, one month, three months, six months, and one year to assess the efficacy of the treatment and to rule out complications. During these follow up appointments, we make sure the faulty vein is closed properly, there is no DVT, and the hemodynamic of the vein is corrected.
It is important to say that after each laser vein procedure for GSV or SSV (Great Saphenous, and Small Saphenous Veins), some of the smaller veins branching from these 2 main superficial veins might close, but if they do not we recommend to close them by sclerotherapy for a more aesthetic result. We always recommend to make a follow up appointment for all treatments, but when sclerotherapy is done there is a chance of trapped blood in the occluded vein and might need to be drained so the vein heals much faster and gets a better aesthetic look. Dr. Massoudi always likes to give all the facts in advance so there are no surprises in the future.
The most important things to know about sclerotherapy, are that patients need to wear compression stockings for three weeks, and also the skin looks worse because of bruising and hardening of the closed veins, which initially looks more apparent. Also, our clients need to have a 2 week follow up appointment to make sure everything is healing well. In order to accelerate the healing process we recommend Arnica or pineapple to decrease bruising and inflammation.
"Everyday I see many patients whom I sit down with, to try to get to know, and learn about their concerns. After over fifteen years of practicing medicine, I’ve learned that my patients want the honest truth. By giving my professional and honest opinion, my patients receive the correct information; and with me as their advocate, an effective treatment plan can be decided upon. I decided to write down what I hear from my patients and I discuss with my patients on a daily basis as a reference. I try to provide clear and accurate information during each visit, so at the end of the day, my patients are happy and all of their concerns are acknowledged. First and foremost, I am going to explain some background information in order to better answer some of my patient’s questions and concerns.
I would like to appreciate your trust in us with your care. Our mission is to find the source of the problem and treat it accurately, in a friendly and comfortable manner. We have thought about every step of the process in order to make you feel better." -- Dr. Ramtin Massoudi