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The Treatment of Varicose Veins and Spider Veins by coreymcintyre

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									                   The Treatment
                                   of
Varicose Veins and Spider Veins




                   St. Joseph Vein Center

         Surgical Specialists of St. Joseph, P.C.


             Glen H. Hastings, M.D., F.A.C.S.




                    820 Lester Ave., Suite 105
                      St. Joseph, MI 49085
                             (269) 983-3368


St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                     1
                                   Table of Contents

Introduction                                                                            3

Understanding Varicose Veins and Spider Veins
      Circulatory System                                                                4
      Vein Anatomy                                                                      6
      Treatment Options                                                                 8

Endovenous Closure
      Overview                                                                           9
      Informed Consent                                                                  10
      Patient Instructions                                                              12

Ambulatory Phlebectomy
      Overview                                                                          13
      Informed Consent                                                                  14
      Patient Instructions                                                              16

Ultrasound Guided Sclerotherapy
       Overview                                                                         17
       Informed Consent                                                                 18
       Patient Instructions                                                             20

Sclerotherapy
       Overview                                                                         21
       Informed Consent                                                                 22
       Patient Instructions                                                             23

Compression Stockings                                                                   25

Insurance Coverage                                                                      25

Contact Information                                                                     26

Introduction to Dr. Hastings                                                            27




         St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                              2
                             Introduction to the Vein Center

Welcome to the St. Joseph Vein Center at Surgical Specialists of St Joseph. Our goal is to
provide a comprehensive treatment of vein diseases. The most common vein problems or
diseases we see are varicose veins and spider veins. One of the most problematic complications
of varicose veins is venous stasis with ulceration. We offer minimally invasive and non-surgical
treatment options including Laser Endovenous Closure of Varicose Veins, Ambulatory
Phlebectomy, and Sclerotherapy.

On your first visit we will be doing a comprehensive consultation to determine the extent of your
venous problems. The consultation will include a limited venous ultrasound exam done at the
time of the physical exam. After this consultation I will be able to give you an analysis of your
venous problems and develop a treatment plan to correct these problems. To evaluate the venous
problems we use venous duplex exams extensively, and through the course of your treatment you
may have multiple exams done to assess the progress. The Vein Center provides treatment for all
venous problems including large painful varicose veins, spider veins, and venous ulcerations. We
participate with Medicare and with most commercial insurance companies. If your varicose veins
are causing symptoms such as pain, swelling, bleeding, ulcerations, or phlebitis, then the
treatment of varicose veins will usually be covered by your health insurance. If your varicose
veins are not symptomatic or you are just being treated for spider veins, these are usually
considered cosmetic treatments and may not be covered by your health insurance.

Enclosed in this booklet is a general overview of venous disease to help you understand the
proper function of the venous system, and how varicose veins and spider veins develop. This
overview explains the cause and pathology of varicose veins and spider veins. Also included is a
description of each type of treatment we use for treating vein disease at the Vein Center. These
include a description of the treatment, the risks and benefits of the treatment, and patient
instructions for patients undergoing the treatment. Please keep this booklet nearby and refer to it
as we proceed with the treatment of your venous problems.

If you have any questions or concerns at anytime during your treatment, please bring them to my
attention. My goal is to treat your venous problems to eliminate your symptoms and improve the
overall appearance of your legs. We do this using minimally invasive procedures to minimize the
pain associated with the treatment and minimize your recovery time.

Thank you for using the St. Joseph Vein Center at Surgical Specialists of St Joseph, P.C.

Sincerely,


Glen H. Hastings, MD, FACS




             St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                  3
                Understanding Varicose Veins and Spider Veins

To understand varicose veins and spider veins you need to understand the circulatory system of
the legs.

                                     The Circulatory System

In the circulatory system, arteries carry oxygenated blood from the heart to your legs and the
veins carry the deoxygenated blood away from the legs back to the heart. The blood returns to
the lungs to pick up more oxygen and then is pumped out from the heart back through the
arteries.

The venous system has two components. The first is the deep venous system. It lies below the
muscles and transports 90% of the blood out of the legs. It is the system that can form blood clots
which may be life threatening if not treated. The deep venous system usually is not associated
with varicose veins.

The second component of the venous system is the superficial venous system. It transports
approximately 10% of the blood out of your legs. You can form clots in this system that cause
pain and discomfort. This is referred to as superficial phlebitis. These blood clots are not life
threatening. The superficial system is the origin of most varicose veins.

The veins have one-way valves that allow the blood to travel upwards out of the legs and prevent
blood flow from reversing back into the legs. These valves are found both in the deep and
superficial veins. When the deep system has faulty valves that leak we see reflux of blood in the
deep system and this can lead to swelling of the leg. When the superficial system has faulty
valves that leak we see development of varicose veins.

                                          Venous Reflux

The condition that results from leaky valves within the veins is called venous reflux. When the
blood is refluxing down the legs it puts excess pressure on the vein walls, which causes them to
expand and enlarge. This expansion causes the valves to become even more ineffective and the
disease progresses. Over months and years we see progression of the varicose veins extending
down the leg with larger veins and more numerous varicose veins developing.

In the superficial venous system the greater saphenous vein is considered the main trunk of the
superficial system. It runs from the inside of the ankle along the inside of the leg all the way up
to the groin. Most varicose veins are branches of this main trunk. It is damage of the valves with
venous reflux in the greater saphenous vein that leads to most varicosities.

In order to treat the varicose veins effectively we need to remove all segments of the veins that
are refluxing. Often this involves treating or removing the greater saphenous vein. We also need
to close or remove the varicose branches within the leg.

There is a secondary superficial venous trunk on the back of the calf called the lesser saphenous
vein that runs up from the outside of the ankle up to behind the knee. Sometimes we see venous



          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                 4
reflux within this vein. This leads to varicose veins developing on the back of the calf. When
that occurs we need to treat the lesser saphenous vein, as well.

Spider veins are caused by reflux in tiny veins of the skin causing the veins to enlarge and have
higher pressure. Usually the spider veins are not associated with larger varicose veins or
saphenous vein reflux. But in some cases the spider veins will be associated with saphenous vein
reflux. Also with spider veins we see reticular veins, which are prominent blue veins that seem to
connect areas of spider veins. Reflux within these reticular veins contributes to the formation of
spider veins. Treating the reticular veins is an important part of treating spider veins.

                                 Varicose Veins and Ulcerations

When venous reflux is left untreated for many years, the constant pressure backing up in the veins
causes leakage of blood into the tissues. The greatest pressure is near the inside of the ankle, so
most of this leakage occurs near the ankles. This leakage causes brown staining of the skin and
thickening of the skin. This is known as stasis skin changes. This can progress to ulcerations.
This is referred to as a chronic venous stasis ulcer. Venous stasis ulcers are very difficult to treat.
They are usually chronic in nature and often reoccur as soon as they heal.

Because of this potential complication in patients with large varicose veins and a large amount of
reflux, there is a medical need to treat these varicosities. The venous stasis ulcers do not occur in
all patients with varicose veins. Unfortunately, it is hard to predict who will progress to this
complication over the course of years. Therefore, it is best to treat large varicosities before the
venous stasis changes occur.

                                             Treatment

The goal in treating varicose veins is to close or remove all segments of the superficial veins that
are refluxing. This will often require closure of the greater saphenous vein and sometimes the
lesser saphenous vein. Venous duplex imaging is used to examine the legs to assess both the
deep and superficial veins for venous valvular reflux. Also, the duplex will evaluate the deep
venous system for a possible blood clot.

In treating the spider veins we usually just need to close the spider veins and any associated
reticular veins. However, if there is suggestion that there may be venous reflux in the greater or
lesser saphenous veins, a venous duplex would be done to rule out disease within the greater or
lesser saphenous veins that may be contributing to the spider veins. If there is reflux in the
saphenous veins, then treatment of these veins may be necessary, as well.




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                  5
                                              Anatomy of a Vein
         Veins have cuplike flaps called valves spaced along
         their inside walls. Valves open upward, so blood can
         move up the vein. When valves close, they keep
         blood from falling back down the vein.




               Important Veins in the Leg                          When a muscle               When a muscle
                                                                   contracts, the valve        relaxes, the valve
       Veins have cuplike flaps called valves spaced along their   opens. Blood is             closes, holding
       inside walls. Valves open upward, so blood can move up      squeezed up the             the blood in
       the vein. When valves close, they keep blood from falling   vein.                       place.
       back down the vein.




Femoral Vein


                                                                               Three Types of Veins
Popliteal Vein
                                                                                          Superficial Veins collect the blood
                                                                                          just beneath the skin.
Lesser
Saphenous Vein

                                                                                          Perforating Veins carry blood
                                                                                          from the superficial veins to the
Greater                                                                                   deep veins.
Saphenous Vein

                                                                                          Deep Veins run through the
                                                                                          muscles and carry 95% of the blood
                                                                                          back to the heart.




                  St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                           6
                                 Impaired Venous Circulation

If a vein is damaged, blood flow back to the heart is reduced. Although the muscles still squeeze
blood up the vein, weak or injured valves cannot support the weight of the blood when the
muscles relax. Some blood leaks through the valve, putting extra pressure on the valves below.
This is called venous reflux. Over time, these lower valves weaken and the damage progresses
down the leg damaging more valves. As a result, you may develop ropy varicose veins, pooling
or clotting blood, or a combination of these problems.




   A Damaged Vein                                          A “Ropy Vein

 Heredity, Injury,                                      Once a vein is damaged,
 Pregnancy, or a blood                                  blood pressing against
 clot may weaken the                                    the sagging wall may
 vein. When this occurs,                                cause the vein to bulge
 the wall near the valve                                or twist like a rope.
 begins to sag. The valve                               Eventually, the valve
 may no longer close                                    can’t close. Blood may
 fully, allowing blood to                               begin to pool or clot in
 move in both directions                                the vein.
 when the muscles relax.
 Most vein problems
 begin with damaged
 valves.


                              Blood moves in                                        Blood presses on
                              both directions.                                      the vein causing it
                                                                                    to twist




    Pooling Blood                                          Clotting Blood

 A valve that doesn’t close                             When blood moves
 cannot hold blood when                                 slowly, it may collect in
 the muscles relax.                                     one or both valve cups.
 Instead, the blood drops                               The blood may become
 down to the first healthy                              sticky and gathers at the
 valve. If valves in a deep                             vein wall. Over time, the
 vein are damaged, blood                                blood forms a clot, which
 may back up into the                                   may grow big enough to
 perforating and                                        close of the vein.
 superficial veins.




                              Blood drops to the                                    Blood clots in the
                              first healthy valve                                   valve cups.




           St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                    7
                       Treatment Options for Varicose Veins

          No Treatment: Some patients opt not to treat their varicose veins. They may live their
entire life with varicose veins and never develop complications more serious than a chronic dull
ache.

         Compression Stockings: Compression stockings aid in treatment of varicose veins by
helping to squeeze the blood out of the legs by means of gradient compression. This is
accomplished with elastic stockings, which fit the legs very tightly. In many cases this will
relieve the discomfort caused by the veins.

        Ultrasound Guided Sclerotherapy: Under the guidance of ultrasound a needle is
inserted into the varicose vein and a chemical is injected directly into the diseased vein. This
chemical irritates the diseased vein and wall and causes it to collapse and scar shut.

         Laser Endovenous Closure: A catheter is inserted into the greater saphenous vein at the
level of the knee. This is done using a needle under ultrasound guidance. A catheter is then fed
up the vein to the upper greater saphenous vein near the groin. The laser fiber is placed into the
catheter and the laser is fired while the catheter is withdrawn causing damage to the vein wall
along the length of the vein. The damage results in occlusion or closure of the greater saphenous
vein.

         Ambulatory Phlebectomy: After Endovenous Closure has closed the greater saphenous
vein on the thigh, the varicose branches of the greater saphenous trunk are surgically removed.
This is a minimally invasive procedure done through tiny stab incisions that are 2-3mm in size. A
small vein hook is used to hook each vein and pull it out through the incision. There are no
sutures required and in most cases you can return to work the following day.

        Sclerotherapy: Used only to treat small varicose veins. A needle is inserted into the
varicose vein and sclerosing agent is injected into the vein. This chemical inflames the walls of
the vein and causes it to collapse and scar shut.

        Ligation and Stripping: This is a traditional surgical method used to remove the greater
saphenous vein on the thigh and varicose branches on the leg. This usually involves larger
incisions with a longer recovery period than endovenous closure or ambulatory phlebectomy.



                         Treatment Options for Spider Veins
         Sclerotherapy: A needle is inserted into the spider veins and sclerosing agent is injected
into the spider vein. This chemical inflames the walls of the vein and causes them to collapse and
scar shut.

        Laser Therapy: A Laser is used to heat the veins through the skin causing damage to
the vein walls. This causes the walls of the veins to collapse and scar shut.




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                 8
        Laser Endovenous Closure for Treatment of Varicose Veins

This is a minimally invasive treatment to close the greater saphenous vein of the thigh or the
lesser saphenous vein behind the knee. A laser fiber is placed into the vein through an
endovenous catheter under ultrasound guidance. The Laser is used to damage the wall of the
vein, causing it to collapse and seal shut. This procedure replaces the surgical vein stripping used
in the past to treat large varicose veins. The procedure is done in the office under local anesthesia.
Most patients return to work and near normal daily activities the very next day.


                                     Description of Procedure

Prior to the procedure we will repeat the ultrasound of the leg marking and identifying the greater
saphenous vein from the groin down to the knee level. The leg will be cleaned and draped
sterilely. Using a small needle and guide wire we will access the greater saphenous vein just
above the knee using ultrasound guidance. You will receive an injection of local anesthesia along
the length of the saphenous vein being treated.

With ultrasound guidance a catheter is inserted over the guide wire and into the greater saphenous
vein and advanced all the way to the groin level. At this point we place a laser fiber through the
catheter into the vein under ultrasound guidance. The catheter is withdrawn while the Laser is
fired to close the vein to the knee level. Once this is completed we wrap the leg with a
compression bandage to give good compression of the treated vein.

Following the procedure you go home with the compression bandage on the leg. This will stay
on the leg continuously for twenty four hours. When you remove the compression dressing, you
will start wearing a thigh-high compression stocking. We recommend that you wear the
stockings daily for two weeks. You may take the stocking off at night and to shower. The
procedure should have very little discomfort. During the closure of the vein you may feel a little
stinging or tingling of the vein. This will only last a short time. Walking after the procedure
helps relieve this discomfort.

Following the procedure we recommend that you have someone drive you home. We will let you
resume nearly all activities the next morning. You will be able to drive and return to work the
next morning. You can expect some tenderness and mild swelling along the treated vein for
several weeks. Following the procedure we will see you in the office after one week for follow
up. You will have a venous duplex exam at that time to verify that the vein has been successfully
closed. Any areas that have not been successfully closed can be treated with ultrasound-guided
sclerotherapy.




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                  9
                 Informed Consent for Laser Endovenous Closure
Endovenous Closure is a minimally invasive option for treating greater saphenous vein incompetence
(leaky valves). The first stage of your surgery will involve inserting a catheter at the level of the knee and
feeding it up the greater saphenous vein (the root of your problem) under ultrasound guidance. During the
second stage of the treatment, the catheter is slowly removed while the Laser is fired causing the vein to
collapse and seal shut. This will relieve the backflow pressure (reflux), which is causing your varicose
veins. Following the procedure we will put you in a compression Bandage which you will wear day and
night for two days. After the two days you will then wear your compression stockings during the day for
the next two weeks.

One week after surgery we will evaluate your results using ultrasound. If we find any branches remaining
we will destroy them with a procedure called ultrasound guided foam sclerotherapy. Utilizing ultrasound
the varicose vein is visualized on a screen and the Physician uses this technology to guide the placement of
a needle directly into the diseased vein. A foam sclerosing agent is injected directly into the veins. This
causes an irritation to the inner lining of the vein resulting in closure of the vein.

Varicose Veins and Spider Veins are chronic and recurrent conditions. The variety of treatments available
will not offer a cure, but rather a control of the condition. Surgically removed veins cannot come back,
veins that are closed with the laser or sclerosed will not return. However, your tendency towards
developing new veins will not be relieved by this or any other form of treatment. You may develop new
varicose veins or spider veins and need additional treatment in the future.

Potential Risks and Side Effects All surgical interventions carry an inherent risk of infection, allergic
reaction, bleeding and anesthetic complications including cardiopulmonary complications. Below are
possible risks and side effects that are specific to Endovenous Closure.

    •    Allergic reaction: Very rarely, a patient may have an allergic reaction to the anesthetic agent.
         The risk of this is greater in patients who have a history of allergies.
    •    Pain: Patients may experience moderate pain following the procedure. The leg may be tender to
         the touch after treatment, and an uncomfortable sensation may run along the vein route. This
         discomfort is usually temporary.
    •    Swelling: This may occur after treating veins in the leg. It usually resolves in a few days but may
         last a few weeks, especially after treatment of large varicose veins. Wearing the prescribed
         compression hose lessens ankle swelling.
    •    Deep Vein Thrombosis: is a very rare complication, the dangers of phlebitis include the
         possibility of pulmonary embolus (a blood clot carried to the lungs) and post phlebitic syndrome,
         resulting in a permanent swelling of the leg.
    •    Eye injury: laser therapy carries a small risk for eye injury to the unprotected eye. You will be
         asked to wear Laser safety glasses during the Laser treatment.
    •    Transient hyperpigmentation: Patients who have Endovenous Sclero Ablation may notice some
         discoloration after treatment. This discoloration is almost always transient and will resolve in
         about three months. In rare cases this darkening of the skin may persist up to a year.
    •    Nodularity: Nodularity at the site of vein closure may persist for up to a year. This occurs when
         there are pieces of the vein that remain in the body and have scarred down and become hard. With
         time, the body will absorb and soften these areas but some may persist.
    •    Skin ulceration: Post injection therapy at the site of injection, a skin ulcer may develop. This is a
         rare complication. In the event of a skin ulcer it may takes months for the area to heal.
    •    Skin Burns: Laser therapy carries a small risk of skin burns, which may require further
         treatment.




           St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                     10
    •    Nerve trauma: Occasionally there can be trauma to surrounding nerves, which can result in a
         transcient numbness that will resolve on its own with time. In rare instances the localized
         numbness may be permanent.
    •    Reoccurrences of new veins: When a patient has varicose veins it is usually an ongoing problem.
         Several years after the vein has been treated the body will attempt to repair itself by taking veins
         that were insignificant and make them significant. We recommend a yearly follow up with
         ultrasound so that we can detect any new problems and treat them accordingly as they arise.

I am aware that in addition to risks listed above, there are other risks that may accompany any surgical
procedure, such as loss of blood, infection, and inflammation in the venous system with formation of a
thrombus (clot), postoperative bleeding, and nerve trauma that may lead to temporary or permanent
numbness.

Alternative Treatments:
Because varicose veins and spider veins are not life-threatening conditions, surgical treatment is not
mandatory in every patient. Some patients get adequate relief of symptoms from wearing graduated
support stockings.

Surgical stripping may also be used to treat large varicose veins. This usually requires a hospital stay and
usually is performed while the patient is under general anesthesia. Risks of vein stripping are similar with
the additional risk of the general anesthetic.

The other option is to receive no treatment at all.

Informed Consent:
By signing below, I acknowledge that I have read the foregoing information and understand the risks and
possible side effects, alternative methods of treatment and I hereby consent to the treatment of Laser
Endovenous Closure.

I consent to the local anesthesia to be administered. I am aware that risks are involved with the
administration of local anesthesia such as allergic or toxic reactions to the anesthetic and cardiac arrest.

I know the practice of medicine and surgery is not an exact science, and therefore, reputable practitioners
cannot guarantee results. While the overwhelming numbers of patients have noted gratifying symptomatic
and cosmetic improvement, we cannot promise or guarantee any specific result.


Patient Signature:                                                               Date:

Patient Name:

Witness Signature:                                                               Date:




           St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                      11
             Endovenous Closure and Ambulatory Phlebectomy
                      PATIENT INSTRUCTIONS
Pre-op Instructions
You will not be able to drive home following the procedure. Please arrange for someone to
drive you home. You will be in the office approximately 11/2 hours.

Please bring your compression stockings with you the day of your procedure.

If you are on blood thinners please notify us immediately so we can adjust dosing as needed.

Do not come to the office on an empty stomach. You will not be having general anesthesia. We
encourage you to have a small meal 1 to 2 hours prior to arriving at the office.

Post-op Bandages
You will have a compression bandage in place when you leave the office. Leave this bandage on
for twenty four (24) hours. Remove this bandage on the first day after your procedure and begin
wearing your compression stockings daily. Remove them only at night or to shower. Wear the
stockings for the next two weeks. You may shower once the compression bandage is removed.

Post-op Pain
You may have some discomfort following surgery. Walking after the procedure helps relieve this
discomfort. We recommend that you take Ibuprofen 800mg every 8 hours for the first four
days and then use the ibuprofen just as needed after the first four days. If you are having
extreme discomfort or bleeding notify the office immediately.

Some bruising and inflammation along the course of the treated vein are not unusual and
are part of the healing process. Walking, wearing the compression stockings, and taking the
Ibuprofen will help relieve any discomfort you are having.

Post-op Bleeding
You may have several areas on your dressing where blood shows through. Some bleeding is
normal. Do not be alarmed. Elevate the leg and wrap the bleeding area with an ace wrap. If the
bleeding continues and the dressing becomes soaked, call the office. We will change the dressing
if needed.

Post-op Activity
We would like you to continue to keep moving and maintain a normal level of activity. Avoid
strenuous exercise such as aerobics, weight training, or running for one week. Avoid hot baths
and hot tubs for one week. You may resume all other activities the day after the procedure. You
may drive and return to work the day after the procedure.

Post-op Follow-up
We will see you in one week for a follow-up visit with venous duplex exam at that time to assess
the closure of the vein. Please call the office if you have any questions or problems following
your procedure. After hours call our answering service at (269) 927-9958.




         St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                              12
         Ambulatory Phlebectomy for Treatment of Varicose Veins

This is a minimally invasive treatment to remove the bulging varicose vein branches of the leg.
This treatment can not be used to remove the greater saphenous vein on the thigh. The greater
saphenous vein needs to be either stripped or occluded using endovenous closure. Once the
greater saphenous vein is occluded, we will then proceed with stab phlebectomy. Removal of the
veins is done through small stab incisions that are 2-3mm in size. The procedure can be done in
the office with only local anesthesia. Most patients return to work and near normal activities the
very next day.


                                   Description of Procedure

Prior to the procedure the varicose veins will be marked with a skin marker while you are
standing. This allows us to see all the bulging varicosities that need to be removed. You will
then have the leg cleansed and draped sterilely. Local anesthesia is injected around the area of
the varicose veins. During the injection of the local anesthesia you will feel some mild pain and
burning from the injections. This only lasts a few seconds. Once this is completed you will not
feel any pain. During the procedure you may feel some pulling and tugging sensation, but it
should not be a painful sensation.

Once the procedure is started the varicose veins are removed through the small stab incisions. We
make multiple stab incisions, often10-30 incisions, and use a small vein hook to hook the veins
and pull them out through these small incisions. Once the procedure is completed the leg is
wrapped with a compression bandage to give compression over the entire area that has been
treated. The leg will be wrapped from the toes to above the area of the phlebectomy. The
bandages stay on for twenty four hours. On the first day following the procedure you will remove
these and start wearing a thigh-high compression stocking. The stocking will be worn daily and
taken off only at night or to shower.

We recommend that you have someone drive you home following the procedure. We will let you
resume all activity the following morning. You can drive and return to work the next day. You
can expect a small amount of pain following the procedure. Usually ibuprofen is adequate for
pain control. You can expect bruising over the area of the Phlebectomy. This slowly resolves
over 2-4 weeks. You will have a follow-up appointment at one week following the surgery.




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                13
                Informed Consent for Ambulatory Phlebectomy
Ambulatory Phlebectomy is a safe and effective surgical procedure to treat varicose veins. This is
performed using small stab incisions which will close without suturing. The veins are pulled out
using a surgical vein hook. This procedure is done utilizing a local anesthetic. After the procedure
is completed a dressing will be applied to your leg followed by a compression bandage. This
compression bandage will stay in place for twenty four hours.

One to two weeks after surgery we will evaluate your results at a follow up office visit. If we find
any branches remaining we can perform a limited repeat ambulatory phlebectomy, or close them
with a procedure called ultrasound guided sclerotherapy. This is done utilizing ultrasound to
visualize the varicose vein on a screen and the Physician uses this technology to guide the
placement of a needle directly into the diseased vein. A sclerosing agent is injected directly into
the veins. This causes an irritation to the inner lining of the vein resulting in closure of the vein.

Varicose Veins and Spider Veins are chronic and recurrent conditions. The proposed treatments
will not offer a cure, but rather a control of the condition. Surgically removed veins cannot come
back, veins that are sclerosed will not return. However, your tendency towards developing new
veins will not be relieved by this or any other form of treatment.

Potential Risks and Side Effects: All surgical interventions carry an inherent risk of infection,
allergic reaction, bleeding and anesthetic complications including cardiopulmony complications.
Below are possible risk and side effects that are specific to the proposed treatment outlined above.
     • Allergic Reaction: Very rarely, a patient may have an allergic reaction to the anesthetic
         agent or the scleroscent agent. The risk is greater in patients who have a history of
         multiple allergies.
     • Pain: Post operatively your leg will be tender touch. There will be a significant amount
         of bruising which will resolve in approximately two weeks. We will prescribe a mild pain
         reliever which will help alleviate the discomfort.
     • Swelling: You may experience some swelling in the lower leg post operatively. It will
         usually resolve in a few days but may last a few weeks, especially after treatment of large
         varicose veins. Wearing the prescribed compression hose lessens ankle swelling.
     • Deep Vein Thrombosis: is a very rare complication. The dangers of phlebitis include the
         possibility of pulmonary embolus (a blood clot carried to the lungs) and post phlebitic
         syndrome, resulting in a permanent swelling of the leg.
     • Nodularity: Nodularity at the site of vein removal may persist for up to a year. This
         occurs when there are pieces of the vein that remain in the body and have scarred down
         and become hard. With time, the body will absorb and soften these areas, but some may
         remain.
     • Nerve trauma: Occasionally there can be trauma to surrounding nerves, which can result
         in a transcient numbness that will resolve on its own with time. In rare instances the
         localized numbness may be permanent.
     • Reoccurrences of new veins: When a patient has varicose veins it is usually an ongoing
         problem. Several years after the vein has been treated the body will attempt to repair
         itself by taking veins that were insignificant and make them significant. We recommend a
         yearly follow up with ultrasound so that we can detect any new problems and treat them
         accordingly as they arise.




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                 14
Alternative Treatments:
Because varicose veins and spider veins are not life-threatening conditions, surgical treatment is
not mandatory in every patient. Some patients get adequate relief of symptoms from wearing
graduated support stockings.

Surgical stripping may also be used to treat large varicose veins. This usually requires a hospital
stay and usually is performed while the patient is under general anesthesia. Risks of vein
stripping are similar with the additional risk of the general anesthetic.

The other option is to receive no treatment at all.

Informed Consent:
By signing below, I acknowledge that I have read the foregoing information and understand the
risks and possible side effects, alternative methods of treatment and I hereby consent to the
treatment of Ambulatory Phlebectomy.

I consent to the local anesthesia to be administered. I am aware that risks are involved with the
administration of local anesthesia such as allergic or toxic reactions to the anesthetic and cardiac
arrest.

I know the practice of medicine and surgery is not an exact science, and therefore, reputable
practitioners cannot guarantee results. While the overwhelming numbers of patients have noted
gratifying symptomatic and cosmetic improvement, we cannot promise or guarantee any specific
result.


Patient Signature                                                         Date

Patient Name:

Witness Signature:                                                        Date:




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                 15
             Endovenous Closure and Ambulatory Phlebectomy
                      PATIENT INSTRUCTIONS
Pre-op Instructions
You will not be able to drive home following the procedure. Please arrange for someone to
drive you home. You will be in the office approximately 11/2 hours.

Please bring your compression stockings with you the day of your procedure.

If you are on blood thinners please notify us immediately so we can adjust dosing as needed.

Do not come to the office on an empty stomach. You will not be having general anesthesia. We
encourage you to have a small meal 1 to 2 hours prior to arriving at the office.

Post-op Bandages
You will have a compression bandage in place when you leave the office. Leave this bandage on
for twenty four (24) hours. Remove this bandage on the first day after your procedure and begin
wearing your compression stockings daily. Remove them only at night or to shower. Wear the
stockings for the next two weeks. You may shower once the compression bandage is removed.

Post-op Pain
You may have some discomfort following surgery. Walking after the procedure helps relieve this
discomfort. We recommend that you take Ibuprofen 800mg every 8 hours for the first four
days and then use the ibuprofen just as needed after the first four days. If you are having
extreme discomfort or bleeding notify the office immediately.

Some bruising and inflammation along the course of the treated vein are not unusual and
are part of the healing process. Walking, wearing the compression stockings, and taking the
Ibuprofen will help relieve any discomfort you are having.

Post-op Bleeding
You may have several areas on your dressing where blood shows through. Some bleeding is
normal. Do not be alarmed. Elevate the leg and wrap the bleeding area with an ace wrap. If the
bleeding continues and the dressing becomes soaked, call the office. We will change the dressing
if needed.

Post-op Activity
We would like you to continue to keep moving and maintain a normal level of activity. Avoid
strenuous exercise such as aerobics, weight training, or running for one week. Avoid hot baths
and hot tubs for one week. You may resume all other activities the day after the procedure. You
may drive and return to work the day after the procedure.

Post-op Follow-up
We will see you in one week for a follow-up visit with venous duplex exam at that time to assess
the closure of the vein. Please call the office if you have any questions or problems following
your procedure. After hours call our answering service at (269) 927-9958.




         St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                              16
   Ultrasound Guided Sclerotherapy for Treatment of Varicose Veins


This is a minimally invasive treatment used to close varicose veins using a sclerosing agent. It is
used to treat veins that are not visible and that are deeper in the legs. Venous Ultrasound is used
to identify the veins and guide a needle into the veins where the sclerosing agent is then injected.
This is often used to complement endovenous ablation and stab phlebectomy.

                                        Description of Procedure

Prior to the procedure a venous duplex is performed to identify the vein to be treated. The vein is
marked. This area of the leg is cleansed and draped. Using ultrasound guidance a needle is
placed in the varicose vein to be treated. Once the needle is in the vein we inject the sclerosing
agent into the vein.

Once the injection has been completed, the leg is wrapped with a compression bandage for
compression of the area. This is applied from the toes to above the area of treatment. This will
stay on for two days. After the bandage is removed the patient will then wear compression
stockings on the leg daily for two weeks. Follow-up will be in the office at one to two weeks
following sclerotherapy. A venous duplex will usually be done to verify closure of the treated
vein.




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                 17
           Informed Consent for Ultrasound Guided Sclerotherapy
Ultrasound Guided Sclerotherapy is a very effective method of treating varicose veins. Utilizing
ultrasound the varicose vein is visualized on a screen and the Physician uses this technology to
guide the placement of a needle directly into the diseased vein. A foam sclerosing agent is
injected into the veins. This causes an irritation to the inner lining of the vein resulting in closure
of the vein. The injections are done along the course of the vessel as needed, usually 4-5
injections per leg. The number of treatments varies depending on the severity of your condition.

The majority of persons who have Ultrasound Guided Sclerotherapy performed have satisfying
results. Unfortunately there is no guarantee that this procedure will be effective for you. In rare
instances the patient’s condition may become worse after treatment. The number of treatments
needed differs from patient to patient, depending on the extent of the problem.

Risks and Side Effects Associated with Ultrasound Guided Sclerotherapy

    •   Transient hyperpigmentation associated with Sclerotherapy: Patients who have had
        ultrasound guided sclerotherapy may notice a discoloration after treatment. This
        discoloration is almost always transient and will resolve in approximately 3 months. In
        rare instances this darkening of the skin may persist for up to one year.
    •   Skin Ulceration associated with sclerotherapy: In rare cases a blister may form, open,
        and become ulcerated. Healing occurs slowly over a few months. After healing, this will
        usually leave a scar.
    •   Allergic Reaction: Very rarely, a patient may have an allergic reaction to the sclerosing
        agent. The risk of this is greater in patients who have a history of allergies.
    •   Deep Vein Thrombosis: Deep vein thrombosis is very rare complication; the dangers of
        deep vein thrombosis include the possibility of pulmonary embolus (a blood clot carried
        to the lungs) and post phlebitic syndrome, resulting in a permanent swelling of the leg.
    •   Vision Loss: This is an uncommon complication of foam sclerotherapy. It is usually
        transient lasting from only a few minutes up to an hour. There is usually no long term
        adverse effect.
    •   Nodularity: Nodularity at the site of vein removal may persist for up to a year. This
        occurs when there are areas of the vein that have scarred down and become hard. With
        time, the body will absorb and soften these areas but some may persist.
    •   Most Common Side Effects: The veins may be tender to the touch after treatment, and
        an uncomfortable sensation may run along the vein route. This discomfort is usually
        temporary. Bruising is very common and to be expected. Some patients complain of an
        itchy sensation after treatment, which is also very normal. Trapped blood may cause a
        discoloration, which can be flushed out, although this may leave hyperpigmentation for
        up to one year.

Alternative Treatments

Varicose veins are not life-threatening conditions, treatment is not mandatory. Some patients get
adequate relief of symptoms from wearing graduated support stockings. The other option is to
receive no treatment at all.




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                  18
Informed Consent

By signing below, I acknowledge that I have read the foregoing information and understand the
risks of Sclerotherapy and Laser therapy. Alternative methods of treatment, and the risks of not
treating my condition, and I hereby consent to vein treatment with Ultrasound guided
sclerotherapy.

The practice of medicine and surgery is not an exact science, and therefore, reputable
practitioners cannot guarantee results. While the overwhelming numbers of patients have noted
gratifying results from Sclerotherapy, we cannot promise or guarantee any specific results.

Note: The medication we use is Polidocanol, a scleroscent recognized and used worldwide
and throughout the USA. It has not yet received FDA approval for use in the USA. By
signing the consent below I acknowledge having been informed of the above.


Patient Signature                                              Date

Patient Name ___                               __              Date

Witness Signature                                              Date                            _______




         St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                              19
          Patient Instructions for Ultrasound Guided Sclerotherapy
After your ultrasound guided sclerotherapy, we recommend that you leave the compression
bandage on for twenty four hours. After that remove the bandage, and start wearing your
compression stockings daily for 1-2 weeks. Remove them only to shower and at night while
sleeping.

You may experience discomfort such as aching or throbbing for the first day of two after your
initial treatment. Walking will help to dissipate this sensation. If discomfort continues,
Ibuprofen 800mg every 8 hours may be taken with food. Also the vessels may appear to turn
dark in color and/or be slightly tender. This could be an entrapment of blood in the closed
vessels, resulting in a hard lumpy feeling under the skin. This is a normal response to the
procedure.

Significant bruising may occur after your treatment. Do not be alarmed, this is a normal process.

Avoid:

    •    Hot tubs, saunas and long hot baths are not recommended for one (1) week following
         treatment.
    •    Postpone shaving for two days to avoid further irritation.
    •    Sun exposure is not recommended for 7 days after your treatment. Areas that have been
         treated will be tender and more likely to burn and may contribute to hyper pigmentation
         changes.
    •    Avoid high impact aerobics and any heavy weight lifting for 7 days.

Permitted:

    •    You may apply lotions as desired.
    •    Exercise is an important part of the healing process. A 20 minute walk or bike ride once
         a day is best for the healing process.

It is important to remember that is has often taken years for these veins to develop, and the
treatment plan we have outlined for you will take time. Please be patient and allow time for
healing to occur.

Bring shorts to wear during your treatment. Please bring your compression stockings with you
the day of your procedure.

Call the office with any questions you may have about your treatment.




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                               20
Sclerotherapy for Treatment of Small Varicose Veins and Spider Veins

This is a minimally invasive treatment to close or occlude veins. It works best on very small
veins. It has been found to be very affective on spider veins and small varicose veins on the legs.

                                     Description of Procedure

The spider veins and/or varicose veins to be treated are selected with the patient standing. These
areas are cleansed with alcohol over the area to be treated. Using a very tiny needle the
sclerosing agent is injected into the spider vein or varicose vein. This is done in multiple locations
to get medication throughout all the visible veins.

During the injection you will experience a little stinging or burning sensation. Each injection
only lasts a couple of seconds. During each treatment session we will treat one leg. We will try
to treat all areas of spider veins and varicose veins on that leg during that session. However,
sometimes we will be limited by the maximal safe dosage for the session.

                                              Results

Some of the treated veins will disappear within one to two days. However, some will become
inflamed and may take four to twelve weeks to disappear. Some veins will not disappear
completely and we will need to repeat the treatment to fully remove the veins. Some veins will
develop a clot within the vein and appear very dark at one to two weeks following the procedure.
Repeat treatments of some areas will be required to fully eliminate the veins. Usually repeat
treatment of an area already treated will not be done for approximately four weeks or more to
allow time to see the full affect of the previous treatment.

The response to sclerotherapy will vary from patient to patient. Not all veins will respond to
sclerotherapy. In most cases it will improve the overall appearance of the legs by reducing the
number of spider veins and small varicose veins. We usually can’t remove all spider veins.
Based on experience a reasonable expectation is that we can expect to obtain a 50-75% reduction
in the number of spider veins on the legs. Not all patients will get this good of a result. Some
patients will get a better result. We can’t guarantee a result prior to treatment.

Following the sclerotherapy treatment you will leave the office wearing compression stockings.
These will be worn daily and removed only at night or to shower. These will be worn for 5 days.
We ask that patients always bring the compression stockings with them to the office for treatment
sessions, as the stockings are required to perform the treatment. If the stockings are not available
we will have to reschedule the sclerotherapy treatment.




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                 21
                            Informed Consent for Sclerotherapy
Sclerotherapy is a very popular method of eliminating small varicose veins and spider veins in which a
solution, called a sclerosing agent, is injected into the veins. This causes an irritation to the inner lining of
the vein resulting in closure of the vein. A small gauge needle is used to perform the injections and most
patients relate the discomfort to an ant bite. The majority of persons who have Sclerotherapy performed
have satisfying results. Unfortunately there is no guarantee that Sclerotherapy will be effective for you. In
rare instances the condition may become worse after Sclerotherapy treatment. The number of treatments
needed differs from patient to patient, depending on the extent of the problem.

Potential Risks and Side Effects:
    • Transient Hyperpigmentation: After sclerotherapy you may notice some discoloration (dark
        streaks) after treatment. This occurs when the blood gets trapped inside the vein after it closes
        down. We can usually “flush” the trapped blood out on your next visit. If the flushing does not
        alleviate the discoloration it will fade on it’s own in 4 to 12 months. In rare instances this
        darkening of the skin may persist for years.
    • Skin Ulceration: In rare cases, a blister may form, open, and become ulcerated. Healing occurs
        slowly over a few months. After healing, this will usually leave a scar.
    • Allergic Reaction: Very rarely, a patient may have an allergic reaction to the sclerosing agent.
        The risk of this is greater in patients who have a history of allergies.
    • Deep Vein Thrombosis: This is a very rare complication. The dangers of phlebitis include the
        possibility of pulmonary embolus (a blood clot carried to the lungs) and post phlebitic syndrome,
        resulting in a permanent swelling of the leg.
    • Most Common Side Effects: The veins may be tender to the touch after treatment, and an
        uncomfortable sensation may run along the vein route. This discomfort is usually temporary.
        Bruising is very common and to be expected. Some patients complain of an itchy sensation after
        treatment, which is also very normal. Trapped blood may cause a discoloration, which can be
        flushed out, although this may leave hyperpigmintation for up to one year.

Alternative Treatments:

Varicose veins and spider veins are not life-threatening conditions, treatment is not mandatory. Some
patients get adequate relief of symptoms from wearing graduated support stockings. The other option is to
receive no treatment at all.

Proposed Treatment Results:

The practice of medicine and surgery is not an exact science, and therefore, reputable practitioners cannot
guarantee results. While the overwhelming numbers of patients have noted gratifying results from
Sclerotherapy, we cannot promise or guarantee any specific results.

Informed Consent:

By signing below, I acknowledge that I have read the foregoing information and understand the risks of
Sclerotherapy, alternative methods of treatment, and the risks of not treating my condition, and I hereby
consent to treatment with Sclerotherapy.
Note: The medication we use is Polidocanol, a scleroscent recognized and used worldwide and
throughout the USA. It has not yet received FDA approval for use in the USA. By signing the consent
below I acknowledge having been informed of the above.


Patient Signature:                                                          Date



           St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                        22
                       Patient Instructions for Sclerotherapy

After each treatment is completed, we recommend that you wear your support hose for 5 days
taking them off only at night. You can never wear them too much.

You may experience slight discomfort such as aching or throbbing for the first day or two after
your initial treatment. Walking will help to dissipate this sensation. If discomfort continues;
Ibuprofen 800mg every 8 hours may be taken with food. Also the vessels may appear to turn
dark in color and/or be slightly tender.

Bruising may occur, especially after the first treatment. Do not be alarmed, this is a normal
process.

Avoid:
   • Hot tubs, saunas and long hot baths are not recommended for one (1) week following
       treatment.
   • Postpone shaving for two days.
   • Sun exposure is not recommended for 7 days after your treatment. Areas that have been
       treated will be tender and more likely to burn
   • Avoid high impact aerobics for 2 days.

Permitted:
   • You may apply lotions as desired.
   • Exercise is an important part of the healing process. A 20 minute walk or bike ride once
       a day is best for the healing process. If you are already involved in an exercise program,
       we encourage you to continue.

It is important to remember that is has often taken years for these veins to develop, and they will
not disappear overnight. Around the same time that your bruising resolves (10 days - 2 weeks),
you will also begin to see the fading and lightening of your spider veins. Please be patient and
allow time for healing to occur.

Always bring your compression stockings to your appointments. Bring shorts to wear during your
treatment.

Call the office with any questions you may have about your treatment.




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                23
                               Compression Stockings

As part of the treatment of your varicose veins, we will be using compression stockings.
These will need to be ordered in advance to have them available the day of your
treatment. Compression stockings come in various strengths, and in various levels of
quality. You will need your stockings only for a few weeks after your procedure. The
highest quality stockings are very nice and we recommend these for patients who will
need to wear the stockings long term. Unfortunately they have a high price and can cost
$70 - $90 per pair. There are now available medium quality stockings that are very nice
and are more than adequate for short term use. These cost approximately $45 per pair.
We recommend these stockings for patients needing stockings short term for their
varicose vein or spider vein treatment.

There are many sources for ordering the stockings. They can be obtained through local
pharmacies or medical supply companies. They also can be ordered from catalog
distributors. The type of compression stockings we recommend are as listed.

       Patients having Endovenous Closure and/or Ambulatory Phlebectomy
                    Thigh high stocking, 20-30 mmHg, closed toe

                    Patients having Sclerotherapy of Spider Veins
                          Thigh high stocking, 20-30 mmHg

We will provide you with information on available sources for the stockings. We try to
find companies that provide a good product with good service at a reasonable price. We
will assist you with measurements for the stockings, but we ask that you place the order
yourself with the supplier. We ask that you order these 7-10 days prior to your procedure
to allow time for delivery.




         St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                             24
                                    Insurance Coverage
The treatment of most varicose vein disorders will be covered by medical insurance. In our
experience most insurance companies are covering the treatment of varicose veins. However,
some insurance companies do limit their coverage of varicose vein treatment. We attempt to
determine coverage for each patient preoperatively, but sometimes final coverage can not be
determined until after the treatment is performed. Spider vein treatment is usually not covered by
insurance.

Participation:
We participate with Medicare and most commercial insurance companies. These companies
usually discount our fees and pay at this discounted rate. By participating we accept the
discounted fee. However, the patient is still responsible for any deductible or co-insurance
amounts that the insurance company specifies as being patient responsibility. There are some
insurance companies with which we do not have a signed participation agreement. We will
accept their discounted fees if they are reasonable.

No Insurance Coverage:
If a patient does not have insurance coverage for the treatment we will work with the patient to
assist them with financial arrangements so they can pay for the services on their own. If you do
not have insurance coverage we will discuss this further.

Costs of Endovenous Closure and Stab Phlebectomy:
Endovenous closure is a new procedure for the treatment of varicose veins. It replaces Vein
stripping as the primary treatment of varicose veins. Since it is new, the technology and
equipment involved is more expensive. However, one of the advantages to the procedure is that it
can be done completely in the office. In addition to the convenience of this, there is a large cost
savings. The largest cost for the vein stripping procedure is the hospital Operating Room charge.
By doing the procedures in the office we reduce the total cost for the procedure by over 50%.
The actual charge for the procedure is determined by the insurance company once they discount
the fees, so it is not possible to give an exact cost for the procedure. However, the endovenous
closure and stab phlebectomy in the office provides a significant cost savings to the patient and
their insurance company when compared to providing similar treatment at the hospital.

Precertification:
We will attempt to verify coverage for the vein treatments prior to the procedure. This does not
always ensure final coverage by the insurance company for the services. We will work with
patients and their insurance companies to obtain coverage for the vein treatment. However, if
final coverage is denied, the patient is responsible for payment for all services provided. In the
case of non-coverage we will work with the patient to assist them with financial arrangements.




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                25
Contact Information

Office

The office is your primary contact for appointments or questions. The office is open Monday
through Friday from 8 AM to 5 PM.

         Office Phone #:        (269) 983-3368
         Office Fax #:          (269) 983-2758


Vascular Lab

The Vascular Lab of Surgical Specialists of St. Joseph was the first IACVL accredited vascular
lab in Southwest Michigan. Over the past 10 years the lab has provided diagnostic testing for
vascular problems including venous disorders. The lab provides the latest in vascular ultrasound
testing using the most current technology and techniques. The vascular lab is one of the tools
needed to provide comprehensive evaluation and treatment of vein problems.

Venous Duplex Ultrasound imaging provided by the vascular lab has become one of the most
important tools in the diagnosis and treatment of varicose veins and other vein disorders. The
duplex imaging shows the abnormal blood flow pattern in the leg. The pattern seen below the
surface with the duplex imaging may be quite different than the surface appearance of the
varicose veins. This helps guide our treatment to ensure a more complete treatment of the
underlying problem.

Venous duplex exams and the endovenous closure procedures are done in our vascular lab located
near our office on the first floor of the Cedarwood Medical Center. Contact the vascular lab for
any questions about the scheduling of these procedures. The Vascular Lab phone number is (269)
983-3667.


After Hours

We ask that all non-urgent and non-emergency questions wait until the next office day. However,
if you have a problem or question you feel is urgent and can not wait until the next office day,
please contact Dr. Hastings on his cell phone. If you cannot reach him on the cell phone, then
call the answering service. The Answering service will have the Surgeon on call return your call.
If you feel you have an emergency, go immediately to the Emergency Room. They will contact
Dr. Hastings or the surgeon on call after they evaluate you.

         Dr. Hastings’ Cell Phone #:    (269) 470-8087
         Answering Service Phone #:     (269) 927-9958




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                               26
                       Introduction to Glen H. Hastings, M.D.

Dr. Hastings is a Board Certified General and Vascular Surgeon. He has been practicing in St.
Joseph, Michigan since 1992. He received his medical degree from the Indiana University
School of Medicine in 1985. He then spent 5 years in surgery residency training at the Henry
Ford Hospital in Detroit Michigan. He became board certified by The American Board of
Surgery in 1992. He also has been a member of the American College of Surgeons since 1995.

Since his surgery training, Dr. Hastings has continued to follow the advances in surgery and has
implemented new techniques into his practice as they have been developed. Over the last 12
years he has had a special interest in Phlebology, the treatment of vein problems. He has done
vein surgery for 15 years and he began performing Ambulatory Phlebectomy eight years ago. He
now offers the newest treatment for varicose veins, Laser Endovenous Closure of Varicose veins.
There are several methods to perform the endovenous closure. This can be done with
Radiofrequency energy or Laser energy to destroy and close the vein. After training in both
techniques, Dr. Hastings has chosen to offer the Laser Endovenous Closure. This option appears
to be the safest and has equal or better results when compared to the other methods of
Endovenous Closure. The Vein Center has performed the Endovenous closure since 2004.

Dr. Hastings continues to follow the latest research and developments in the treatment of vein
disorders. Our goal at the vein center is to provide the most state-of-the-art treatment available
for varicose veins and other venous disorders.




          St. Joseph Vein Center / Surgical Specialists of St. Joseph / (269) 983-3368

                                                 27

								
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