Dr. Adam Goldman recieved his BA from Columbia University in New York folowed by his medical degree from Albert Einstein College of Medicine in New York. He subsequently did his initial residency in Internal Medicine at Mount Sinai Medical Center in New York followed by his fellowship in Cardiovascular Diseases at Albert Einstein/Jacobi Medical Center. For the second half of his professional career he become focused on venous disease and aesthetic medicine. After additional specialty training, including studying with the world renowned expert and originator of tumescent anesthesia, he launched the Metropolitan Vein and Aesthetic Center. He is currently boarded in Internal Medicine, Cardiovascular Diseases and Interventional Cardiology. He is a member of the American Phlebology Society and the American Academy of Aesthetic Medicine.
This involves the use of some combination of compression stockings, weight loss, moderate exercise and leg elevation. Often conservative therapy will not yield an acceptable clinical result and further treatment is required. Most insurance companies want a doctor to document that these measures have been attempted and failed before allowing other treatments.
The next step if conservative therapy fails will likely involve one, two or possibly all three of the following treatments either on the same visit or subsequent visits:
- Ablation or removal of the diseased feeding veins
- Treatment of the larger surface varicose veins
- Treatment of the smaller veins-Telangectasias and Spider veins
Vein AblationThe next step in addressing symptomatic vein disease is to eliminate the major diseased vein or veins that are the root of the problem. Previously this was done via a major surgery. Today these veins can be treated using a minimally-invasive outpatient procedure. Utilizing ultrasound guidance, local anesthetic is applied to the vein. Then a thin catheter is inerted into the vein . Finally laser or radiofrequency energy is applied to the inside of the vein to cause it to close thus eliminating the diseased vein.
At the Metropolitan Vein Center we perform the most advanced therapies featuring both radiofrequency and high frequency laser energy.
Both modalities provide an excellent clinical result with minimal side effects. The particular treatment option is chosen based on the patient's anatomy. All patients are evaluated utilizing the most advanced ultrasound guidance with state of the art imaging.
Advantages of Catheter based therapies:
- Less postoperative pain than conventional surgery
- Faster recovery, typically resuming normal activities within a day
- Good cosmetic result
- Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing normal flow.
The next part of the treatment often involves the removal of the larger varicose veins on the surface of the leg. This is performed via tiny incisions in the skin after the application of a local anesthetic. The veins are then removed via a small instrument and gently pulled out with gentle lifing and traction. The small incisions are then covered with a sterile dressing and the patient is able to ambulate immediately.
If there are many large surface varicose veins often the procedure will need to be performed over more than one sitting to successfully remove all of the veins.
The most commonly used treatment for small diameter (5mm) veins, such as spider veins or telangectasias is sclerotherapy. In sclerotherapy, a liquid is injected with a tiny needle into the vein to causes inflammation of the vein walls. This causes the vein walls to collapse and stick to one another so that the vein disappears.
After injecting the solution it is important for the patient to wear a compression stocking for the first one to two weeks. This will improve the healing and ensure that the vein does not have a chance to refill with blood. Also sun exposure of the treated area must be avoided for one month and exercise for one week. Brown staining of the treated veins is common and may take up to a year to resolve completely. Other rare complications are skin ulcers or allergic reactions.
Small veins are effectively removed by sclerotherapy but new veins will often reappear if the underlying causes, incompetent blood vessels, are not treated.
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Adam Goldman, M.D.
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