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Ask The Expert - Total Vein and Rejuvenation Center

Ask The Expert - Total Vein and Rejuvenation Center

Total Vein and Rejuvenation Center

788 Broad Street
Shrewsbury, NJ 07702

741 NorthfieldAvenue, Suite 100
West Orange, NJ

Call for appointment or free consultation
(973) 243-2200
1-866-NO-VEINS (668-3467)

Dr. Joseph Fretta started his internal medicine practice in 1983, and his venous practice in 1987. He has treated over  27,000 patients over the last 24 years, who suffer from large varicose veins causing leg ulcers to the smallest spider  veins on the legs, body and face. He has been a member of the American College of Phlebology since 1987, and founded  the NJ Vein and Cosmetic Center in 1990. Dr. Fretta has trained many doctors from out of state in the treatment of  varicose veins. He has now renamed his practice Total Vein and Rejuvenation Center, where multiple aesthetic  treatments are also offered.

Why is treating varicose veins important?
Varicose veins are the result of non-functioning check valves in the leg. Each leg has 60-154 check valves that are located  from the ankle up to the groin. The purpose of the valves is to guide the venous (not arterial) blood flow uphill against  gravity back to the heart. If any of the valves no longer function properly blood flow reverses downward instead of  upward, causing the vein below the valve to swell. The swelling will be progressive and the next valve will become non- functioning and cause the vein below it to swell and so on. As a network of veins swell, so does the leg and the swollen  leg causes tissue damage known as fibrosis. Therefore, the patient suffers swelling, skin discoloration, leg heaviness, and pain. And more seriously, pooling of blood in the leg.

What are the treatments for varicose veins?
Four major superficial veins are treated: the greater saphenous vein in each leg which runs from the inner groin to the  inner ankle and the small saphenous veins which run from the back of the knee crease to the heel. These can be treated  by EVLT (endovenous laser ablation therapy). This is the insertion of a spaghetti-size fiber optic strand inserted  through a pin prick incision, usually from the mid inner calf, threading up in the vein until it reaches the groin. This treatment is relatively painless and is done under ultrasound guidance. Once the catheter is in position the laser is fired  as the catheter is being withdrawn. Thus, the entire vein is cauterized and permanently closed. Other major vein  branches that evolved off any of the four major veins mentioned can be removed by a procedure called ambulatory phlebectomy. This entails removing a large varicose vein through a series of pinhole size incisions, through which a tiny  instrument can be used to pull the vein out. Much like pulling a shoe lace out of the shoe fromhole to hole.When  thinking of varicose veins, picture a tree. After we remove the trunk, we remove the branches and finally through  sclerotherapy we can inject away the twigs (spider veins).

What is sclerotherapy?
Sclerotherapy is still the gold standard for treating spider veins and large blue reticular veins. This is done using tiny hair  thin needles that feel like mosquito bites to inject medication into said veins, to irritate its inner lining causing it to constrict and close. The spider veins disappear usually three weeks after the injection. After removing varicose and/or spider veins can they come back? When thinking of veins, think not only of a tree, but of a river. You must treat the  source of the flow first. For example, the larger veins must be treated before you can treat the tiniest branches (spider veins). When done in this manner the treatment is permanent, unless there is a change in the patientís clinical setting,  such as a pregnancy, excessive weight gain, change of occupation (which may require excessive standing or lifting) or  trauma to the leg.

As a forward thinking physician who keeps up with the latest options available, can you share the latest trends  with our readers...
Surface lasers are again coming into fashion for the treatment of spider veins. This is usually for doctors who delegate  the procedure to a nurse, rather than perform the procedure themselves. Sclerotherapy is still the gold standard.


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