Veins1: Welcome to the Veins1 vascular moderated chat. This is the third of four moderated chats on Veins1 in October. Each will be held Tuesday at 9:00 pm eastern standard time. We welcome your questions and your input.
Veins1: Tonight's guest is Dr. Steven Elias. Dr. Steven Elias is a fellowship-trained vascular surgeon who is the Director of the Center for Vein Disease at Englewood Hospital and Medical Center. Dr. Elias is also Assistant Professor of Surgery at Mount Sinai School of Medicine in New York City.
Veins1: Dr. Elias, thank you for joining us.
Dr. Elias: You’re welcome.
Veins1: Dr. Elias's undergraduate training was at John Hopkins University. He then attended the University of Buffalo Medical School and continued his surgical residency training in Buffalo at the University of Buffalo—Millard Fillmore Hospital. He conducted his advanced specialty fellowship training in vascular surgery at the Englewood Hospital and Medical Center.
Veins1: The majority of Dr. Elias’s clinical practice consists of the management of all aspects of vein disease. Techniques used to manage vein disease includes the use of laser and sclerotherapy (injections) for small spider veins to minimally invasive surgical techniques such as the TriVex procedure for the removal of varicose veins, the VNUS (closure) procedure, EVLT (endovenous laser therapy) for saphenous vein incompetence, and SEPS (Subfascial Endiscopic Perferator Surgery) for managing patients with non-healing wounds due to vein disease. He has published the results of these procedures and is on the faculty of courses teaching these minimally invasive techniques to other surgeons. He travels throughout the United States instructing as well as assisting other surgeons as they begin to perform these operations.
Veins1: Dr. Elias is a Fellow of the American College of Surgeons and is a member of the American Venous Forum as well as the New Jersey Vascular Society.
Veins1: We welcome your questions. Please be advised that we receive a large volume of user questions and not all questions may be answered.

Veins1: Dr. Elias, how did you get interested in vascular health?
Dr. Elias: As a first year resident one of the doctors training me was interested in vein disease.

Veins1: Have you or your family been impacted by vascular problems?
Dr. Elias: Thus far we have been lucky, except for my mother who has had varicose veins.

dd77: Doctor, does vein stripping compromise the blood flow to your leg? or the area where the vein was stripped?
Dr. Elias: No, in fact by removing an abnormal vein you cause blood to flow better in the normal veins of the leg.

S-SK: How different is the study of veins from the study of arteries and arterial disease? Is a specialist in one completely unqualified in the other?
Dr. Elias: The arteries bring blood to the leg and the veins return the blood. A vascular surgeon understands both systems. Some may specialize in one or the other. I specialize in vein disease.

Anne Hathaway: What is the difference between varicose veins and spider veins?
Dr. Elias: Varicose veins are the big bulging veins under the skin. Spider veins are the very tiny reddish or purple veins within the skin.

benbo: are aneurysms hereditary? Is there a way to screen for them?
Dr. Elias: Aneurysms may be hereditary. Screening should be done in families with a history. Aneurysms in the belly, chest, and legs can be screened with CT scans or ultrasound.

DeJurgens: When you get rid of your varicose veins where does the blood go? Does some other vein "take up the slack" for you? Do you end up overcompensating with backup veins?

Dr. Elias: Yes, your normally functioning veins "take up the slack". This is why symptoms are improved when we remove varicose veins. It is important before surgery to evaluate the veins in your legs with ultrasound to see which are normal or abnormal.

retrop: Hello Doctor, I have a question about veins & hair replacement surgery-- I am considering this, but am afraid that the surgeon will hit one of the veins in my forehead. I have several veins that show up prominently when I work out but not when I am at rest. How can I be sure that the surgeon doesn't accidentally stick a vein?
Dr. Elias: Most hair replacement surgeons use magnifying glasses to perform the surgery. The chances of injuring a vein are low.

Tom: Dr. Elias, I have a varicose vein in my left low leg. After ultrasound exam, Doctor suggested me to using a stripping method to fix my leg problem. Would you please let me know what are the best choices in current technology?

Dr. Elias: If the doctor wants to remove the varicose veins in your leg the best new technology is TriVexÔ. If he meant he would strip the feeding vein that begins in the groin then I would suggest either VNUS Closure or EVLT laser ablation. All of these technologies are minimally invasive.

gisela99: Dear Doctor, I know of someone who had regular removal (very painful) of varicose veins. 2 years later the leg looked worse than before. Is this possible with TriVexÔ?
Dr. Elias: In general, TriVexÔ allows us to see all of the abnormal veins because we use a light that goes under the skin to highlight the varicose veins. Therefore we do a more complete removal than older methods. But, new veins can always occur years later. It is expected that people treated with TriVexÔ will have less of a chance of getting them.

Nairb1: Hello Dr. Elias, I've been learning about treatments for severe heart disease and have heard that one treatment is to take out veins in the leg and use them in the heart-- why would leg veins be used in this way?
Dr. Elias: This has been done for many years; it is better to use the patient’s own vein than to use someone else’s. However, most heart surgeons are trying to use the patient’s own arteries from the chest or arm nowadays.

retrop: Also, a question about my mother-- she had a Doppler test recently to measure blood flow in her leg veins. This was after surgery on her gut. Why would the hospital do that? Thanks.
Dr. Elias: They may have been looking for any clots in her leg veins. After belly surgery patients can develop clots in their leg veins from lying in bed.

LentilLover: Does a vegetarian diet make you less susceptible to vascular problems?
Dr. Elias: A diet low in cholesterol and fat does decrease your risk for vascular artery problems. It has no effect on vein problems.

gisela99: Dear Dr. Elias, thanks a lot for this great participation of yours. Would you please answer this one: Thanks in advance. My doctor has treated spider veins, not knowing that I had a defective valve (I have only found out a little later). Did he worsen my condition???
Dr. Elias: No, he did not, however, if a defective valve was present the injections may not have worked to the fullest effect.

JoAnn: Does alcohol have any affect on varicose veins? Can alcohol actually cause varicose veins?
Dr. Elias: Alcohol may affect your overall health, however varicose veins on the leg should not be affected. Veins on the face and nose may be caused by severe over drinking, and liver problems.

GSMan: Is a dermatologist qualified to do vein surgery like a vascular surgeon?
Dr. Elias: In general dermatologists treat spider veins but don't usually do vein surgery. There are dermatologists that I know that do vein surgery, and do it well. These are few and far between. A vascular surgeon is usually more qualified.

Tom: Dr.Elias, Thank you for taking my questions. I would like to use VNUS technology, however, Doctor told me that it is not good for me. Would you please let me know what are cases for not using VNUS? Thank you very much.

Dr. Elias: VNUS technology treats the feeding vein of which varicose veins are branches. If your feeding vein that starts in the groin and goes down to the ankle is at fault then the VNUS procedure can be done.

VetteGuy: Sometimes I get tingling in my arms, as if the blood flow is being cut off, just doing ordinary activities. Is there anything I should be concerned about?
Dr. Elias: You may have a condition known as Thoracic Outlet Syndrome, which can affect the nerves or blood vessels going to the arm. A vascular surgeon and an ultrasound test can best make the diagnosis. However, most of the time these tests are normal and nothing urgent needs to be done.

gisela99: Dear Doctor, what is the approx. cost of treatment of TriVexÔ if one major vein has to be removed?
Dr. Elias: The cost for symptomatic varicose veins is usually covered by insurance. If it is for pure cosmetic reasons then the surgeon sets his own price, which varies from surgeon to surgeon.

Raggety Ann: Doctor, I am 6 months pregnant and I am getting swelling in my vulvar veins due to enlarged uterus. It is very uncomfortable. Is there something I can do to alleviate the pain and itching? Thanks!
Dr. Elias: Yes, there are support stocking/panty hose made specifically for pregnant women. Most of these vulvar varices disappear with delivery. Good Luck!

IJMuney: Does having diabetes means certain surgical procedures such as v. vein removal is an impossibility for me?
Dr. Elias: No, usually patients with diabetes have a concern with wound healing. TriVexÔ uses very few and very small incisions. I have performed TriVexÔ on patients with diabetes. Unless your diabetes is severe and uncontrolled you should do well.

Jolly Joe: Hi Doctor, I am a fit male slightly over 30, but am seeing a protruding vein on the outside of my ankle-- it's about 5" long and runs from the top of my foot to just below the bump on the outside of my foot. It doesn't hurt, but it looks like a meandering river. Is it something I should worry about? Thanks, JJ
Dr. Elias: If you don't have any symptoms then there may not be much to worry about except for looks. If you are concerned see a vascular surgeon for his advice.

QZ-Modo: Where can you get varicose veins? Until recently I thought you could only get them in extremities – legs, arms etc. But can you get them in vital organs- such as the veins from say your brain to heart?
Dr. Elias: By definition varicose veins involve the extremities. However, one can have abnormally weak veins anywhere in the body where there is a vein. These conditions are rarer than varicose veins.
  

Tom: Dr. Elias, how can I find good doctor to do the VNUS Closure? Thank you very much.
Dr. Elias: You can go to the VNUS website or call them for a referral. You will find surgeons like me, who perform this procedure as well as TriVexÔ and SEPS. This way you will get the opinion of a surgeon who does all the newest minimally invasive procedures.

TreeBeard: I've steadily gained weight over the last two years. I began to notice bulging veins around my waistband area. Is this varicose and can I do anything to fix or prevent?
Dr. Elias: Excess weight can put pressure on many veins. The obvious solution is to lose weight.

JoAnn: I have varicose veins and am looking for an exercise program. Cardio exercise makes the veins worse - what can I do instead?
Dr. Elias: Exercise does not make varicose veins worse. Your veins may bulge more after exercise because you have brought more blood to your legs, and the excess collects in your abnormal varicose vein. When you are exercising your muscles are helping to pump the blood out of your abnormal varicose veins. This is why most people with varicose veins say they feel better when exercising and worse after.

Veins1: Dr. Elias, we're just about out of time. Any final thoughts you'd like to share with our users?

Dr. Elias: Patients should realize that there are now minimally invasive surgical techniques (MIVS) that are available.  They should seek surgeons that perform these.  They are all same day, out patient, procedures that involve either no incisions or very few with results that are as good, if not better, than traditional methods.

Veins1: Thank you, Dr. Elias, for your insightful responses tonight. And thank you, audience, for your participation in the Veins1 moderated chat. Remember, this was the third of four moderated chats on Veins1 in October. Each will be held at 9:00 pm eastern standard time. The next chat will be 10/22 at 9:00 pm eastern standard time.