VCSD Steps to Diagnosis

First Step:
The first step is the initial vein screening appointment with Dr. Powell. He will ask you about the symptoms you are experiencing, about other family members who have had vein disease and vein surgery, do an examination to look for the signs of vein disease, and perform a simple, quick, and painless Doppler examination to see if there is backflow in the larger veins. He will determine whether or not a Duplex-Doppler examination needs to be done to document superficial venous insufficiency and to map out the extent of the diseased veins.

At this appointment, the office staff can measure you for graduated compression stockings to prevent or slow the progression of vein disease. These stockings are prescription stockings, come in many colors and textures, and should be worn when standing or sitting for long periods of time. The office has inventory of many of the sizes and can get them from the company in 1-2 days if your size is not on the shelf.

If your main complaint is spider veins, Dr. Powell will determine at this appointment whether or not backflow exists in the larger veins causing the spider veins to develop. If backflow does not exist in the larger veins, then you can be scheduled for 30-45 minute sclerotherapy sessions to treat the spider veins. 20-30mmHg graduated compression stockings are required to be worn for seven days following a sclerotherapy session. Sclerotherapy sessions can be done every 4 weeks until all spider veins are gone or you are satisfied with the results.

Second Step:
The second step is a Duplex-Doppler examination. This examination is done in the office by Dr. Powell or an Ultrasound Technician. The study delineates where the larger veins are diseased and the extent of the disease. The Duplex-Doppler takes about 30-60 minutes to perform, does not hurt, and establishes what needs to be done to treat your disease. Dr. Powell will go over the study at the end of the examination so that you will not have to wait for the report and schedule a follow up appointment. The Duplex-Doppler examination is used to plan the surgery.

Third Step:
The third step is to coordinate with the office a date for your surgery procedure. One leg is done at a time so that you are not lying down on the operating table for too long a period of time. The procedure is done in the office and takes approximately two hours.

Fourth Step:
The fourth step is the preoperative appointment. Dr. Powell will do a history and physical examination and will go over the entire procedure including potential problems and complications. The office staff will complete all the paperwork including the consent for the procedure. You will be given an opportunity to ask any questions you have at this appointment.

You will be required to purchase 30-40 mmHg graduated compression stockings that will be worn for three weeks following the procedure. The stockings allow you to walk and go to work the day of the surgery; however, Dr. Powell recommends you take a day to rest following the procedure instead of going back to work the same day.

Fifth Step:
The fifth step is the procedure itself. It is done in the office. You are given oral sedation medication and you are injected with local anesthesia. The procedure takes 1-2 hours. You can bring a CD or other music box or reading material to keep you occupied during the procedure. In most cases, there are only a few needle sticks—no large incisions and no large scars. Your legs will be wrapped with Ace wraps before getting up off the operating table. You will start wearing the graduated compression stockings the day after the surgery. You will be able to walk right after the surgery—in fact, we will have you walk for 30 minutes after the procedure before you go home. Some patients go to work the day of the surgery; however, Dr. Powell recommends you take a day off to recover after the surgery.

Sixth Step:
You will need to return to the office for a follow up appointment within 72 hours of the procedure. At this appointment, a Duplex-Ultrasound examination will be done to check closure of the vein that was treated and to make sure there is no clot or obstruction of the larger downstream veins.

When a second leg needs to be done, it can be done one to two weeks after the first leg. All of the preparation for multiple legs will be completed during the first preoperative appointment. You will have to return within 72 hours for the follow up Duplex Doppler of the second leg.