Arteries channel blood from the heart to the organs and tissues of the body. Veins are the blood vessels that return blood from the body to the heart. To keep blood moving forward, veins have small delicate valves to prevent backflow of blood. When the valves in the leg veins have been damaged by injury or a previous blood clot, they stop working properly which is called venous insufficiency. In this condition blood refluxes down the leg veins, causing swelling and pain. Patients often describe achy, burning discomfort, throbbing, restlessness and swelling in their calves at the end of a long day of standing or sitting. This progresses to dryness and discoloration of the skin (hyperpigmentation) and can may lead to leg ulcerations and infections.
Varicose veins are not just a cosmetic concern as they are the indication of underlying venous disease. A comprehensive venous evaluation identifies the source of the problem, which may involve compression of large pelvic veins by overlying arteries, or insufficiency of the deep or superficial veins of the legs. For those patients whose symptoms persist despite conservative measures, we offer outpatient minimally invasive procedures to identify and correct the cause of venous insufficiency and treat painful or unsightly veins superficial veins utilizing a variety of techniques.
Dr. Lawrence Schmetterer is a vascular surgeon and specializes in treating varicose veins, leg pain and vascular issues in Youngstown, Boardman, Canfield, Poland, Salem, Austintown, Warren, and the surrounding communities. The majority of the procedures to solve for venous issues (vein) in the lower extremities can be diagnosed and treated on the same day in office. Dr. Schmetterer accepts most insurances and has privileges at all the area hospitals.
Deep Vein Thrombosis
A deep venous thrombosis, or DVT, is a blood clot that occurs in any of the deep veins of the body. There are many causes of DVT, including surgery, certain medications, prolonged immobilization, injury, cancer and inherited blood disorders. DVT’s typically present with pain and swelling in an extremity. A life-threatening condition called pulmonary embolism, can occur in patients with a DVT in which a blood clot breaks free from the leg and travels through the heart to the lungs. The diagnosis of a DVT can be confirmed with a simple, painless ultrasound procedure called a venous duplex. Treatment can involve blood thinner to prevent the clot from growing in size, placement of an inferior vena cava filter to catch the clot as it travels towards the heart, or removal of the clot (percutaneous thrombolysis and thrombectomy). Vena caval filters may be removed once the indication for its insertion has resolved.
Vena Cava Filter
A DVT (Deep Vein Thrombosis) is a clot within a deep vein. This is often treated medically with blood thinner medication. In patients who cannot receive a blood thinner due to other medical issues, or have developed a DVT despite already taking a blood thinner, a device known as a filter may be placed in the inferior vena cava, the large vein that channels the lower body’s blood back to the heart. This filter allows normal blood to flow through the vein but is very effective in capturing any large blood clots that may have broken off and are traveling to the lungs. Placement of the filter is a short outpatient procedure with local anesthetic. Vena cava filters may be either removable or permanent. In many cases, the filter is removed once its presence is no long required.
Blood clots in the deep veins of the legs are called a deep venous thrombosis (DVT) and are a potentially lethal disorder when these clots travel to the lungs and heart, called a pulmonary embolism (PE). DVTs also pose a more long-term threat by obstructing the return of blood from the lower extremity to the heart and damaging the delicate valves within the deep veins. This leads to a chronic condition known as Post Phlebitic Syndrome. This condition results in long term swelling, discoloration and thickening of the skin (hyperpigmentation) and leg ulcers (venous stasis ulcers). In cases of extensive DVT, some patients are candidates for a procedure called percutaneous thrombolysis and thrombectomy in which a catheter passed into the vein delivers a clot-dissolving drug and then suctions out the dissolved clot, restoring normal flow through the veins. Oftentimes the cause of the DVT is identified by intravascular ultrasound (IVUS) and a stent is placed to correct the problem and prevent future DVT.
Sclerotherapy is a procedure in which a fluid called a sclerosant is injected into small abnormal veins, such as varicose veins, telangiectasias and spider veins. The sclerosant causes these veins to shrink and collapse. Sclerotherapy may be used in conjunction with laser vein therapy to treat a wide range of symptomatic or unsightly superficial veins. Advances in sclerosants and techniques has made this procedure more effective and with less side effects. The gentle nature of today’s sclerosants has also eliminated much of the discomfort that past generations of patients endured. Sclerotherapy is generally an out of pocket expense, but certain indications or pain may be covered by insurance. Dr. Susan Woods, Board Certified Dermatologist, evaluates and treats patients requiring these types of interventions. Typically, vein studies are completed in order to identify the cause of the abnormal veins.
Endovenous Radiofrequency Ablation
The VNUS Closure Procedure
Venous reflux is the root cause of varicose veins, uncomfortable leg swelling, and even leg ulcers in Youngstown, Ohio and the surrounding areas. Treatment has evolved greatly over the last two decades. The older procedure of vein stripping, in which the saphenous vein is surgically removed from the leg, is no longer performed. A patient with venous reflux of the superficial veins, namely the greater or lesser saphenous veins, may be treated by a procedure called ablation, which seals off the vein by heating it from within. Elimination of vein reflux can alleviate the symptoms of venous disease, speed healing of venous stasis ulcers and eliminate visible varicose veins. The procedure is completed in our office under local anesthetic in under one hour.
In this procedure, a small catheter is inserted into the problematic vein using ultrasound guidance. A local anesthetic solution (tumescent) is then injected around the vein to be treated preventing heat injury to surround tissues and rendering the procedure painless. The catheter is then heated with radiofrequency (microwave) energy, causing the vein to close off completely. The leg is then wrapped with a compression bandage which stays on for 3 days. A follow-up ultrasound is then completed and the patients resumes wearing compression stockings. Recovery time is fairly short, and most patients return to normal activity within two days.
The VenaSeal closure system is the only non-thermal, non-tumescent, non-sclerosant procedure approved for use in the U.S. that uses a specially formulated medical adhesive that closes the diseased vein. The VenaSeal closure system treats symptomatic venous reflux disease in the lower extremity superficial veins, often the underlying cause of painful varicose veins. During the procedure, the medical adhesive is inserted into the VenaSeal closure system’s dispensing gun that is attached to a catheter. The catheter is advanced into the diseased vein under ultrasound guidance and the medical adhesive delivered precisely to the treatment area which is then briefly compressed. This closure system procedure is designed to minimize patient discomfort and reduce recovery time. After the procedure, a small bandage will be placed at the access site. Patients are able to rapidly return to normal activity.
Varithena (polidocanol injectable foam)
Patients with symptomatic venous insufficiency involving the saphenous and lesser saphenous veins are typically treated with either radiofrequency ablation (ClosureFast) or cyanoacrylate medical adhesive (Venaseal). Certain veins such as the anterior accessory saphenous, or large incompetent varicose veins that persist following one of the above ablative therapies, are ideally treated with an ultrasound-guided injection of polidocanol foam (Varithena). This is typically accomplished through a single needle stick and is painless. The foam irritates the lining of the vein causing it to close. The body reroutes blood through the healthy veins, thus eliminating the discomfort and appearance of the varicose veins and improving the vascular health of the leg.
What is a chronic wound?
Do you have a cut, ulcer, or sore on your calf or foot that has not healed in 2-3 weeks? As part of our full-service care, Dr. Schmetterer and Dr. Susan Woods treat the most complex wounds caused by venous, arterial or lymphatic insufficiency, as well as unusual skin diseases. Dr. Susan Woods, Board Certified Dermatologist started the first Wound Care Center in Northeast Ohio in 1994. Together with Dr. Schmetterer, wounds are evaluated as to their cause, and a comprehensive array of advanced interventions, biological dressings and compression options for all types of disease are utilized. We perform a full range of procedures for the treatment of leaking veins as well as blocked arteries. If your wound has not healed after 2-3 weeks of standard wound care, come see Dr. Schmetterer or Dr. Woods for a comprehensive evaluation in Youngstown and Northeast Ohio.
ABOUT SCHMETTERER M.D.
Lawrence Schmetterer, M.D., F.A.C.S. is one of the top and most trusted vascular surgeons in Youngstown and Warren, Ohio. He’s been practicing medicine for over 34-years and sees patients in Youngstown, Austintown, Boardman, and Salem, Ohio, with hospital privileges at all the area’s major hospitals including Mercy Boardman and Youngstown’s St. Elizabeth Hospital, The Surgical Hospital at Southwoods, Salem Community Hospital, and Steward – Trumbull Regional Medical Center. Dr. Schmetterer is known for treating Venous Disease, including varicose veins. Additionally specializing in Thoracic, Arterial, Venous, and Mediastinal Disease.