When valves in the veins become incompetent, high-pressure blood from the deep system flows towards the skin and produces high blood pressure of the surface veins. Distention of the veins over time produces varicose veins. It also increases the pressure in the smaller veins causing these to stretch and become very prominent. When these are just under the skin, they are known as spider veins. The increase pressure causes the small veins to leak fluid into the surrounding tissues resulting in swelling or edema followed by discoloration. The high pressure is also transmitted to the smallest veins that lie near the capillary beds. This makes it difficult for blood to flow across the smallest vessels or capillaries, thus disrupting the exchange of nutrients and wastes in this area. The tissues of the leg respond by thickening of the skin and finally by ulceration. A serious consequence of this type of vascular disease is Infection of the skin or cellulitis.

Most ulcers of the lower legs and serious venous disease are caused by incompetence of perforator veins in the calf. These incompetent veins generally occur on the inside of the ankle. Ultrasound scans performed at our facility almost always show incompetent perforator veins lying beneath the leg ulcer. The answer to chronic venous insufficiency with all its related symptoms is to remove the dysfunctional perforator veins. Dr. Joyce began was a leader in using the SEPS procedure to treat perforator disease in 1998. Approximately 94% of leg ulcers were completely healed with SEPS. Over the past several years, Dr. Joyce has pioneered the use of laser ablation and VNUS radiofrequency closure to treat incompetent venous perforators in the office setting. These less invasive office procedures have proved to be highly effective and well tolerated. These new technologies can be performed under local anesthesia within our office setting. They have now replaced the SEPS operation for the treatment of perforator disease. Post-operatively, over 99% of leg ulcers treated with these methods heal completely within several months.

Spider veins appear just under the skin. They are caused by abnormal venous blood flow resulting in an increased pressure in these smaller veins, causing them to stretch and become prominent.

Spider veins may be one of the first signs of venous disease.

Treatment of spider veins with a 940 nm pulsed diode laser is an extremely efficient way of removing these unsightly veins. The laser actually passes directly through the skin and spider vein wall to vaporize the blood within the spider vein. This destroys the internal vessel wall, which leads to obliteration of the spider vein. The spider veins turn red and gradually disappear over the next 2-3 weeks. The treatment is well tolerated and results in minimum scarring and discoloration. Saline injections also destroy the internal vessel wall but have a much higher chance of leaving permanent discoloration.

When the valves in the veins cease to function, gravity can reverse the vein flow and move the blood back towards the feet when the leg is at rest. This restricts venous drainage and results in increased blood pressure in the surface veins of the leg. Over time, this causes the veins to distend, producing varicose veins and leads to more serious venous disease.

For the most part, varicose veins are not dangerous. However, large varicose veins can lead to very slow blood movement through the dilated vessel. Blood has a natural tendency to clot when it is moving very slowly, making it more likely for blood clots to form and lodge within the vein. This condition is called thrombophlebitis or simply phlebitis. If present only in the superficial veins under the skin, it is not dangerous and usually will respond to moist heat and elevation. If the clot extends into the deep venous system, it is considered dangerous and therapy with blood thinning medications is recommended.

There are many reasons why veins dilate and become incompetent. Age is a primary factor. As we become older, the elastic walls of the veins slowly wear out and are damaged by overstretching. Veins are also dilated by certain occupations that require standing for prolonged periods producing venous stasis. Nurses, auto mechanics, store personnel and waitresses are examples. In women, pregnancy plays a major role. The increased pressure in the lower abdomen during pregnancy makes it difficult for the veins of the legs to drain and creates back pressure in the leg veins. This back pressure dilates the veins and is responsible for the varicose veins that are often seen during and after pregnancy.

Vein stripping is an outdated surgical treatment for chronic venous insufficiency. Patients present with symptoms of the leg that may include swelling, pain, prominent varicose veins and skin discoloration which can eventually produce ulceration. Vein stripping almost always involves removal of the greater saphenous vein which lies along the inside of the thigh and lower leg. The vein stripping procedure is associated with a long and painful convalescence. An incision is made in the groin to tie off and divide the top of the vein. A vein stripper is then inserted into the vein. It is generally pushed through the vein above the knee and brought through the skin by a second incision. A small stripping device is then connected to the stripper and it is pulled back through the leg tearing the vein out with it. Pressure is then applied to the leg to reduce bleeding. This procedure is uncomfortable for the patient postoperatively and may result in bruising under the skin that can take months to completely resolve.

Yes. At JVAI we utilize endoluminal laser ablation of the saphenous vein or ELAS. In this procedure a small diameter laser filament is inserted into the vein through a needle puncture. This is done right in our office with minimal anesthesia. The laser filament is connected to a laser system that closes off the greater saphenous vein from the inside. There is very little trauma to the leg and almost no bruising. Postoperative discomfort is minimal. Patient satisfaction is high. In fact, patients who have had vein stripping of the other leg have stated that they wish they had waited until this laser technology was available before having their previous procedure.

The heart pumps blood into the arterial system. It travels to the legs under pressure through a system of arteries that becomes smaller and smaller as it progresses towards the tissues. Oxygen and nutrient transfer and waste removal is carried out through the smallest arteries called capillaries. The blood is then returned through tiny veins that become progressively larger as they move away from the tissue and drain towards the heart. The heart does not pump blood out of the legs. Blood is moved through the veins by contraction of the muscles around them. As each vein is compressed, the blood moves in one direction towards the heart. This one-way flow is maintained by valves located at intervals along the vein. The valves only allow the blood to flow one way, back towards the heart for re-circulation.

Venous disease, also called chronic venous insufficiency, is a chronic disease that produces symptoms in the patient's legs that may include swelling, pain, prominent varicose veins, skin discoloration, ulceration and infection.

Patients with venous disease of the legs have specific complaints and symptoms that may include:

• Tired, aching legs, usually best in the morning and worse during the day especially after prolonged standing or sitting.
• Intolerance to exercise
• Leg discoloration, thickening and ulcers that are difficult to heal.
• Spider veins, varicose veins and leg swelling from venous stasis.

Most of the vein problems are due to increased pressure in the venous system. This is actually high blood pressure of the veins located under the skin. This increased pressure is caused by malfunction of the valves that lie within the veins, causing the veins to dilate. When the veins become dilated, the valves, which are attached to the sidewalls, are pulled apart. They no longer are able to maintain one-way flow and prevent blood from draining back toward the feet. These leaking veins are called incompetent.

Patients come from all parts of the country to benefit from Dr. Joyce's superior knowledge and experience in performing vein treatment procedures. Dr. Joyce is an innovator - always on the cutting edge of medical advancements that offer his patients the best possible outcome while affording them safety, comfort, convenience and affordable care. Almost a decade ago, Dr. Joyce became increasingly aware of numerous patients with a poor quality of life who suffered from misdiagnosis and mismanagement of venous disease. This prompted him to shift his focus from the practice of open heart and trauma medicine to vein treatment. In an attempt to explore the best treatment options for venous disease, he was one the first physicians to meet and train with the developers of the SEPS Procedure when it was just becoming known. At that time, Dr. Joyce had approximately 30 patients with chronic venous insufficiency with unhealed leg ulcers. He contacted them, performed a specialized ultrasound exam and determined that most were good candidates for the SEPS Procedure. Post-operatively, over 94% of those patient's ulcers healed completely within several months. Over time, Dr. Joyce became a leader in performing the SEPS procedure. He is credited with the highest volume of SEPS surgeries in Florida and one of the two highest volumes in the entire country. In spite of that success, his interest in continually improving the quality of his services prompted him to pioneer two new technologies, laser ablation and VNUS radiofrequency closure for treating incompetent venous perforators in the office setting. He has found that most patients can benefit from these less invasive office procedures as an alternative to SEPS procedures that have proved to be highly effective and well tolerated.