Cosmetic Vein Treatment

What is the difference between varicose and spider veins, and how can I treat them?

For information on cosmetic vein procedures by Dr. Thomas Bernik, please visit Cosmetic Vein Procedures or www.endovascularassociatesny.com

What is EVA?
Led by renowned vascular surgeons Robert Grossi, MD and his colleagues Thomas Bernik, MD, and Richard Neff, MD, Endovascular Associates of New York (EVA) is a multidisciplinary group established to provide patients with outstanding quality care through the most advanced minimally invasive approaches to arterial and venous disease.

By combining the naturally congruous fields of vascular surgery, endovascular surgery, and interventional radiology, EVA offers a full spectrum of patient care options. These include particularly complex arterial vascular reconstruction of thoracic and abdominal aortic aneurysm (AAA), carotid artery disease, lower extremity arterial disease, and venous disease.

The latest technology is always applied and includes:
• Endovascular stentgraft for AAA exclusion
• Endovascular stentgraft for thoracic aneurysm and dissection
• Carotid artery stenting
• Atherosclerotic plaque excision, using SilverHawk technology in the lower extremities
• Laser vein ablation for varicose veins
• Mechanical thrombectomy for deep venous thrombosis (DVT)

EVA's goal is to simplify such procedures to meet individual patient needs.

EVA is one of three major centers in Manhattan capable of treating thoracic aneurysm and dissection via thoracic stent graft. EVA is a true leader and one of the few entities in the country that treats and removes DVT with pulsed thrombolysis.

Beyond this, EVA offers a wide range of diagnostic and therapeutic tools for the treatment of vascular disease. The group's Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) and state-of-the-art diagnostic and therapeutic angiography suite assists in delivering comprehensive patient care, from initial diagnosis to conclusion of treatment.

What is Arterial Disease?
Arterial disease is a condition in which the supply of blood cannot keep up with the body's demand. In other words, the arteries supplying blood to various parts of the body (legs, abdomen) become clogged or partially blocked.

A high percentage of people with arteriosclerotic risk factors (smoking, high blood pressure, diabetes, and high cholesterol) will have disease in the entire body. Therefore, people with arteriosclerosis in one part of the body should be screened for other problem areas as well.

In the abdomen: When arterial disease arises in the abdomen, an aneurysm can occur. This means that the wall of the artery weakens, creating risk of rupture and death. In turn, if the artery becomes blocked with atherosclerosis, it can cause impotence, abdominal pain, and leg pain from lack of blood flow to the legs.

In the carotid artery: The carotid arteries, the two main arteries that carry blood to the brain, are located on either side of the neck. Carotid artery disease (i.e., hardening of the arteries, or atherosclerosis) occurs when the artery becomes clogged with fatty deposits (or plaque). Untreated, plaque can narrow the artery, so that limited blood reaches the brain. Plaque also may break off and travel with the blood flowing to the brain, causing a stroke.

In the legs: Peripheral Arterial Disease (PAD) is a condition caused by diseased arteries in the legs. As a result, patients experience pain, difficulty walking, numbness, weakness, changes in skin color, and/or even tissue death (gangrene).

Who is Affected by Arterial Disease?
Arterial disease patients are typically men between the ages of 50 and 70, although women are also affected (35% of patients).

What Causes Arterial Disease?
The greatest risk factors are diabetes, smoking, and high blood pressure. However, obesity, lack of exercise, and high cholesterol also increase one's risk.

How Does EVA Treat Arterial Disease?
In the thoracic aorta: EVA is one of three entities in New York City that has the capability and experience to treat thoracic aneurysms and dissections by covered stent. This is performed by placing catheters through the groin and deploying a stent to exclude the defect in the thoracic aorta. The thoracic aorta is prone to dilation and dissection. Dissection occurs when the wall of the aorta weakens and blood spills into tributary vessels, causing blockage. A dissection, over time, can turn into an aneurysm. This condition typically involves extensive surgery and has a high mortality rate.

In the abdomen: As with the thoracic aorta, EVA is a premiere facility for treatment of abdominal aortic aneurysms and dissections by covered stent. This is performed by placing catheters through small groin incisions and deploying a stent from within, excluding the defect. Using EVA's cutting-edge technology, the procedure takes only one to two hours and patients can go home the following morning, as compared to the traditional seven-day stay.

In the carotid artery: Options for treatment of the carotid artery include either placing a small catheter through the groin and deploying a stent, or opening the neck. EVA is a leader in treatment of carotid disease.

In the legs: EVA uses all minimally invasive methods available in order to treat diseased leg arteries and create normal blood flow. EVA is one of two leaders in New York City using the SilverHawk device to remove plaque and diseased tissue.

What is Venous Disease?
Problems that occur in the veins are referred to as venous disease. Some vascular conditions occur only in arteries (as described above), while others are unique to the veins. Common conditions affecting the veins include:

• Blood Clots (such as Deep Vein Thrombosis)
• Venous Stasis Disease (e.g., ulcers)
• Phlebitis (i.e., inflammation of a vein)
• Varicose Veins (also called "varicoceles")

What Causes Venous Disease?
Factors that increase the chances of venous disease include:
• Family history
• Loss of vein elasticity (caused by age)
• Pregnancy
• Illness or injury
• Prolonged periods of inactivity (e.g., sitting, standing, or bed rest)
• High blood pressure, diabetes, or high cholesterol
• Smoking
• Obesity

Whom Does Venous Disease Typically Affect?
Venous disease can affect men and women, typically from age 30 up.

How Do EVA's Treatments and Techniques Differ from Alternatives?
In the veins: EVA uses the latest laser technology to eradicate bulging veins. This is a procedure performed under local anesthesia, with minimal discomfort and no scarring. Patients can return to work the same day, with no activity restrictions. EVA is one of the only groups that aggressively removes venous clots (DVT) by pulsed mechanical thrombectomy.

EVA's point of dfference is its expertise. There is a clear difference in physicians who undertake a high volume of vascular and endovascular treatments. The physicians of Endovascular Associates of New York have an unparalleled awareness of the newest technologies and latest trends.


Glossary of Terms:

Vascular surgery: The treatment of blood vessels in the body

Endovascular surgery: A relatively new, less invasive procedure for treating the two major problems that can develop in blood vessels: aneurysm and narrowing (also called occlusion, or stenosis)

Abdominal Aortic Aneurysm (AAA): The aorta, the major artery that arises from the heart, runs through the chest, where it is called the thoracic aorta. When the aorta reaches the abdomen, it is referred to as the abdominal aorta. The pressure from blood flowing through a weak area of the abdominal aorta can make the aorta expand or bulge

Carotid Artery Disease: Like the blood vessels of the heart (coronary arteries), the carotid arteries also develop atherosclerosis on the inside of the arteries and, over time, constrict the artery, decreasing blood flow

Stentgraft: A synthetic tube used to reinforce a weak spot in an artery, called an aneurysm

Atherosclerotic plaque: The build-up of fat and cholesterol deposits on the inside of arteries

Ablation: Surgical excision or amputation of a body part or tissue

Thoracic aneurysm: The aorta, the major artery which arises from the heart, runs through the chest, where it is called the thoracic aorta. The pressure from blood flowing through a weak area of the thoracic aorta can make the thoracic aorta expand, bulge, or split

Thrombolysis: A procedure to help treat clots in arteries and veins, resulting from various causes

Angiography: An X-ray examination of the blood vessels

Arteriosclerosis: A chronic disease characterized by abnormal thickening and hardening of the arterial walls, with resulting loss of elasticity of the arterial walls

Dissection: The surgical removal, along natural lines of cleavage, of tissues that are or might become diseased

Thrombectomy: The disruption of a blood clot, using one of several mechanical devices