Welcome to the Vascular Surgery and Vein Center

Welcome to the Vascular Surgery and Vein Center, a comprehensive vascular practice providing state-of-the-art care to patients throughout the tri-state area. Under the direction of board-certified surgeon Dr. Norman Chideckel, we utilize our advanced skills and many years of experience to help patients achieve clear, beautiful and healthy legs.

With our convenient Manhattan location, Dr. Chideckel offers patients a wide range of services to treat varicose and spider veins, deep vein thrombosis, and other vascular conditions, including:

Dedicated to helping patients achieve their desired results through the most effective and minimally invasive treatments available, Dr. Chideckel and his staff take the time to talk with each individual patient and address any concerns or questions they may have before undergoing treatment. Your comfort and satisfaction are among our top priorities.

To learn more about the services provided by Dr. Chideckel, please contact us to schedule an appointment. We always welcome new patients and look forward to meeting you.

Vascular Surgery & Vein Center
108 East 96th Street
Front 1
New York, NY 10128

Call us today at 212-993-6133 to schedule an appointment.

We now offer Telemedicine sessions. Please call us for more information or to schedule a Telemedicine appointment.

See Our Main Website At www.VeinsDoc.com
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Skin Care During Winter Months

In a recent blog posting, I addressed the issue of bleeding from spider veins, and the association with dry skin. The question is what can you do to prevent dryness of the skin.

Skin Care in Colder Weather

During the winter, colder weather months, there is a constant change occurring to or skin. When out in the cold the skin contracts, and upon reentry into a warm indoor environment the skin will reexpand. These temperature changes lead to dryness of the skin, and as result the skin may crack and predispose bleeding from spider veins on the surface of the skin. In order to protect the skin from these constant changes, it is important to moisturize the skin several times a day. In the morning, especially after a hot shower, and again at the end of daily activities. Any of the commercial available moisturizing creams or lotions is fine, and you may want to experiment to find the one that is best for you.

Stocking for Varicose Veins

If you have underlying varicose veins of any degree, then the use of a support/compression stocking will be of benefit to prevent swelling of the lower extremity. Appropriate placement of these stockings is crucial-placing them on the leg before they are dependent will give the maximum benefit. For the best outcomes, it would be recommended to put the stockings on before getting out of bed in the varicose vein treatment legs morning. However, being cognizant that this would not be doable for most people, it would be effective to elevate the legs for several minutes prior to placing the stocking. Also moisturization of the skin prior to placement of the stocking would be beneficial. So in practical terms, after showering, moisturize the skin, sit down and elevate the legs on a chair, and after several minutes when the moisture has had time to seep into the skin, put on the stockings.

If you do not have varicose veins, use of a support/compression hose may not be necessary. However if your job requires prolonged standing—doorman, hairdresser, chef or similar occupations, then support hose would be helpful to prevent swelling of the legs, and will also energize your legs during daily activities.

Bleeding Varicose Veins

One of the scariest varicose vein related issues is the sudden onset of bleeding. The bleeding episode may be the result of a local trauma, or more often than not it may occur spontaneously. It is very dramatic as the bleeding is profuse and pressurized to the extent that some patients have described it as “a geyser eruption”.

Spider Veins

The most common location is at the area of the ankle, where the venous pressure is at its maximum. Veins return blood flow, and it is at the level of the ankle that the process begins.

Bleeding Varicose Veins It is usually the “spider veins” that bleed, as the top layer of these veins is right under the surface of the skin. Dryness of the surrounding skin will predispose to a bleeding episode, so moisturization of the skin is of great benefit. In the colder months there is a greater potential due to the frequent temperature changes, from being outdoors in colder temperatures, to indoors in warmer temperatures with higher humidity causing increased dryness of the skin. Yet, even in the warmer months, the increased humidity may course dryness of the skin, and again the potential for bleeding from these varices. Very often people report that the bleeding occurred while showering or bathing, or even after exiting a swimming pool.

Larger, bulging varicose veins, rarely bleed externally, as the outer layer of the vein is deep to the skin, and therefore protected. These veins main complication is potential for blood clots or thrombophlebitis.

What to do if the vein bleeds

Try not to panic – easier said than done.
Firstly, elevate the leg to reduce the venous pressure and gravity.
Secondly, apply local pressure to the area to control the bleeding.

VV3 These measures will usually control most episodes of bleeding. But, if after several minutes, the bleeding continues, please call 911 or any emergency medical system, as rarely the bleeding can be so excessive to potentially cause you to go into shock. At the emergency room or urgent care center a compression bandage most likely be applied, or often times a suture may need to be used to control the bleeding, at least temporarily.

Evaluation of the venous circulation will be the next appropriate step. If there is underlying varicose vein problems then that would need to be addressed, perhaps with an ablation procedure (this has been addressed in a previous blog). If there is no evidence of underlying venous abnormalities, then local care-sclerotherapy-to seal the surrounding veins would be of benefit. Even in those patients who have an underlying varicose vein problem, local sclerotherapy to temporize, until more definitive therapy is done, would be of benefit.

If it is recommended to you to wear a compression stocking, remember to place the stocking on the leg before it is dependent, and place a Band-Aid over the area of the bleed, to protect the formed scab, from being irritated by the stocking. It would also be advisable to maintain a Band-Aid over the area of the scab while sleeping, so that bedsheets do not irritate the area. As mother use to say “don’t pick at the scab”, because doing so will start the whole healing process all over again.

What Stockings Should I Wear?

Support Or Compression

Support or compression hose aid in vein blood flow return from the lower extremities. They also prevent swelling of the lower extremities, and energize the legs during daily activities. The questions often asked are which stocking are appropriate for me, and what is the difference between these stockings.

The appropriate grade level of stocking

Firstly, the stockings are graduated gradient stockings, meaning that the pressure is higher at the ankle, and lower at the level of the calf just below the knee. The pressure in the stocking is measured in mmHg, with support hose at 8–15 mmHg, and compression hose in various pressures depending on the grade (15–20, 20–30, 30–40, and 40–50mmHg). The appropriate grade level of stocking is determined by symptoms, and physical exam findings. The goal is to use the lowest degree of pressure that will be of benefit. The sizing of a compression stocking is determined by measuring the circumference of the ankle, and of the mid-calf. With support stockings, the size is usually determined based on shoe size.

These stockings function by a squeezing of the “muscle pumps” of the calf, which are the muscles of the forefoot and calf. This prevents blood flow and fluid from pooling at the area of the ankle. As such there is no generalized benefit in wearing a stocking above the level of the knee. There are exceptions though to this rule, for example – a woman who is pregnant would benefit from pantyhose, to reduce the pressure on the lower extremities by the enlarging uterus. Another exception would be in someone who has varicose veins of the calf and lower thigh, such that the upper portion of the calf high stocking may cause an irritation to these veins, and they would be benefited by wearing a thigh-high stocking.

I have been often asked-don’t these stockings stop my circulation? Of course the answer is that they do not, but people may notice an impression on the skin from the elastic band at the top of stocking. To prevent this and also to obtain the maximum benefit from the stocking, I recommend placing stocking on the legs when they are elevated. The ideal situation would be to put the stockings on before getting out of bed, but this is impractical, and it would be fine to put them on after showering, but first sit down and elevate the leg. Some people notice that their legs feel uncomfortable with the stocking, and this most likely occurs because they put the stocking on after the legs have been dependent for a good period of time. Another potential problem of placing stocking on after the leg is been dependent is that swelling may start to occur, and the stocking may then cause skin irritation.

Lastly, placing the appropriate stocking on the leg may pose a challenge, as the higher degree pressured stockings are more difficult to place. This is an issue in the elderly or people with limited mobility due to arthritic changes. In these situations, insisting on the appropriate pressure to manage an issue may not be doable, and as such the stocking will not be used leading to potential problems. It is best in these cases to use a lesser degree of pressure, following the adage “something is better than nothing at all”.

NYC top vein surgeon talks about Vein Damage with Exercise

Potential Vein Damage With Exercise

In a past blog, I addressed the question as to the use of support stockings during exercise. As mentioned there has not been any proven scientific benefit to the use of support stockings during exercise, however, there has been evidence that using support stockings after exercise, during recovery, is beneficial. These seem to help with muscle recovery after aerobic activities.

I observe people working out at the gym, and as a vascular surgeon I have had the opportunity to evaluate patients at my office, who have sustained exercise related vein damage.

Firstly, with regards to upper extremity exercises, hyperabduction -or pulling the shoulders too far back, with weight lifting can cause a “scissoring” of the vein under the clavicle (collarbone). With repetitive motion, this may lead to an obstruction, or blockage, of this vein, causing swelling of the arm, and potential fatigue of the arm during daily activities. This issue has been mentioned in the previous blog with regards to varicose veins of the upper extremities.

Secondly, with regards to lower extremity exercises, using excessive weights-pushing to and past the limit-can lead to venous blood clots. Veins are a low flow blood vessel, and excessive pressure, stopping the blood flow for a small amount of time can lead to clotting. I have evaluated patients who have bench pressed upwards of 1000 pounds with their lower extremities who have developed as a result a venous blood clot.

Excessive straining during exercise may lead to a vein rupture, and or a bleeding episode, usually under the surface of the skin. It may also lead to the appearance of varicose veins, either of the upper or lower extremity, as the increasing muscle mass, push veins closer to the surface.

Words of caution:

Stay hydrated during exercise, with water, in order to maximize muscle performance. Energy drinks do have added electrolytes as well, and that may be of an added benefit.
Try using support stockings after exercise to aid in muscle recovery.
Eat a protein load within 30 minutes to an hour after the exercise to prevent muscle breakdown.

Remember that participating in exercise and aerobic activity is to help us stay fit. Pushing the limits may have more risk than reward.

If you have any questions or desire treatment for vein damage or injury, call Dr. Norman Chideckel, NYC’s top vein surgeon at (212)-993-613 today!

Doctor for Varicose Veins of the Arms

Varicose Veins of the Upper Extremity

In previous blogs we discussed the diagnosis, and treatment of varicose veins of the lower extremities. Varicose veins of the upper extremities are not often an issue, as there is little pressure exerted on the normal vein system of the upper extremities.

We have also discussed, in a previous blog, the question regarding noticeable hand veins. As mentioned, these are not truly varicose veins, but are more noticeable as result of the normal aging process.

However, there are times when varicose veins of the upper extremities occur. These are usually the result of a narrowing, or an obstruction of the vein blood flow return of the upper arm or chest. This can be the result of several possibilities.

One possibility is an anatomical abnormality which may cause pressure of the vein under the collarbone, causing a rerouting of the vein blood flow of the arm. As a result a vein pattern will be noticeable on the upper arm, and over the chest wall. The most common reason for this is a “thoracic outlet syndrome”, very often caused by a cervical rib. If this occurs in the dominant arm, the person may complain of fatigue of the arm limiting the ability to complete normal daily activities. Physical therapy may also be of benefit to strengthen the shoulder and chest muscles.

A second possibility may be as a result of a tumor in the chest, resulting in compression of the veins.

A third possibility, are in people who are undergoing chemotherapy treatment, who have had an access “port” placed in the vein leading into the chest.

As in all cases of varicose veins, the person who develops varicose veins of the upper arm should be evaluated to determine the underlying cause for the problem. Initially a venous duplex ultrasound will be performed, and if further evaluation is necessary, then an MRI is necessary to determine if there is an anatomical cause. If a blood clot is present, then standard treatment with anticoagulation therapy will be recommended. If there is no evidence of a blood clot, and an anatomical abnormality is found, then surgical correction may be necessary.

If you have any questions about varicose veins of the arms, please call NYC’s top varicose vein doctor Dr. Norman Chideckel at 212-993-6133, today.

Management of Venous Thrombosis

Blood Clots

Venous thrombosis, or blood clots, is treated with anticoagulation therapy. Historically the treatment has consisted of Heparin initially, delivered intravenously, or by subcutaneous injection, and then long term treatment with Coumadin (warfarin) an oral anticoagulation tablet. The reason that treatment begins with Heparin, which is delivered into the blood stream, is so that the patient is immediately protected. The Coumadin dosage usually takes several days to reach a protective level in the blood stream.

The use of Coumadin requires frequent blood tests to monitor the blood level so that you are adequately protected. If the levels are not adequate you are at risk of developing a pulmonary embolism, and if the levels are too high you may be at risk of bleeding. Initially these blood tests may be done weekly, until an adequate level, known as INR, has been stabilized.

Medications

Certain medications may interfere with the adequate levels of Coumadin in your blood system, and certain foods may also interfere with obtaining adequate blood levels. Coumadin counters the effect of vitamin K, which naturally protects us from bleeding when we sustain an injury. So foods that are rich in vitamin K should be eaten in moderation while on Coumadin. Also, since the Coumadin is detoxified (broken down), in the liver, it would be wise not to drink alcoholic beverages for the duration of time that you are on this medication.

Women who are pregnant, and those who are breast-feeding, should not be using Coumadin, as it will pass through to the fetus, or newborn. This group of patients is being treated with an injectable form of Heparin, as it does not have that issue.

Recently, newer oral anticoagulation medications have been FDA approved, and are currently being used on the market. These medications, give adequate protective anticoagulation therapy, but do not require the blood testing that is required when using Coumadin. You may have seen television advertisements regarding these newer medications, Xarelto, and Eliquis. As with any other medications that are prescribed, please have a discussion with regards to their usage and safety with your healthcare provider.

If you have any questions about venous thrombosis, call the top vein doctor in NYC, Dr. Norman Chideckel.

Blood Clot in the Vein

Very often people may be confused, at no fault of their own, with regards to medical terms. The issue of “blood clot” is an example of this issue.

Blood clot can also be referred to as phlebitis, thrombosis, or thrombophlebitis. All of these carry the same meaning that is blood trapped in a vein.

The next issue then is to differentiate between a superficial and a deep vein blood clot, as their treatment will be different. Superficial vein blood clots are readily visible on the surface of the skin. They present as a firm, red streak over the anatomical course of the vein. This is so because it is an inflammatory reaction which causes the red discoloration and it is firm because blood is trapped inside the blood vessel. Deep vein blood clots are not visible, as these veins are located deep to the surface. They most often cause swelling and discomfort of the extremity, as again blood is trapped inside the blood vessel, not allowing the blood to flow out of the extremity and back to the heart.

It is important to be evaluated as soon as possible for either of these situations so that the diagnosis can be made and the appropriate treatment can be organized. The “gold” standard test is known as a venous duplex ultrasound. Again to avoid any potential for confusion, this test may also be referred to as a Doppler, sonogram, or ultrasound.

In a future blog, I will deal with the management of superficial vein thrombosis, and deep vein thrombosis.

If you have any questions about blood clots in the vein, call NYC best vein doctor, Dr. Norman Chideckel today!

Varicose Veins of the Face

Telangiectasia

Varicose veins of the face, most commonly spider veins, also known as telangiectasia, are small dilated blood vessels, 0.5-1 mm in diameter. These will occur near the surface of the skin, and are often seen on the face, around the nose, cheek, and chin. They will most often be red or pink in color. These do not pose a health risk, but may reflect an underlying medical issue, but most of the time these are just a cosmetic nuisance.

The causes of these spider veins may be due to congenital or acquired factors. Of the congenital causes the list would include a port wine stain, hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome), as well as others that are beyond the scope of this blog. Of the acquired causes, the more common reasons are acne rosacea, environmental damage caused by prolonged sun or cold exposure, pregnancy, or perhaps an underlying liver abnormality.

Treatment

Treatment of spider veins of the face, is most often accomplished with localized treatment, and can be accomplished with the use of thermocoagulation with Vein-Gogh (ohmic thermolysis), using a very fine needle to deliver radiofrequency current into the vein thus sealing the vein. Use of lasers, most commonly IPL is also a viable treatment option. Sclerotherapy, the most common treatment option for spider veins of the lower extremities, is not recommended in the area of the face.

Any of the treatment options listed above will be successful in the treatment of the spider veins; however, they will not prevent the development of new spider veins in the area. To prevent new vein development, using SPF creams prior to prolonged sun or cold exposure would be of great benefit. Perhaps, as mentioned in a previous blog, increasing flavonoid intake in the diet may be of benefit to strengthen blood vessel walls. If there is an underlying medical condition as the source of these veins, that issue should be addressed under the care of your medical doctor.

If you suffer from varicose veins of the face call the top varicose vein doctor in NYC, Dr. Chideckel today!

I Have A Blood Clot

If you have a “blood clot”, or are concerned that you may have a blood clot, what should you do?

Firstly, seek medical attention, as this may pose a serious health issue. The diagnosis is made by a test known as a venous duplex ultrasound, also known as a sonogram, ultrasound, or Doppler, of the extremity. This will allow visualization of the veins of the extremity to determine if a clot is present. It would also differentiate between a superficial vein blood clot or a deep vein blood clot, as well as the location of the highest portion of the clot.

Once the diagnosis has been established, a treatment plan will be decided upon. The reason that blood clots of the vein are of concern, is due to the potential of developing a pulmonary embolism. This is when a blood clot from the extremity travels to the blood vessel in the lung, thereby stopping blood flow to that portion of the lung, and causing chest discomfort, and shortness of breath. This can be a fatal situation.

In general, superficial vein blood clots do not cause a pulmonary embolism, but there are exceptions to this rule. At certain points in the extremity the superficial veins connect to the deeper veins, so a clot located at the connection point or close to this connection point are of greater significance.

Deep vein blood clots do pose a significant risk of causing a pulmonary embolism, probably one out of twelve people, and therefore all patients will be treated. The treatment protocol is using anticoagulation drugs, also known as blood thinners. These medications do not destroy the clot, but prevent the clot from becoming larger, and preventing the possibility of a pulmonary embolism. However, only certain patients with a superficial vein blood clot will require treatment with the anticoagulation medications. Those are in situations where the clot is progressing up the extremity, or are located near to the deeper vein connections, or at the deeper vein connecting points. Most patients with a superficial vein thrombosis are treated by conservative management, which may include the use of a compression hose, local warm or cold compresses for symptomatic relief, and homeopathic remedy-Arnica gel which can be rubbed into the affected area. The symptoms and the associated clots usually resolve within a short period of time, probably 2-3 days, but may persist longer in certain cases.

If you have any questions about blot clots, call NYC’s top vascular doctor, Dr. Norman Chideckel today!

Hand Veins

Many patients have come for consultation with regards to prominent veins of the hands. Are these varicose veins? Should they be treated as other varicose veins are treated?

These are the questions, that a vein specialist is often asked. Hand Veins

Hand Veins

As we age the veins on the hand become more noticeable. That is so because, our skin turgor (tightness of the skin), reduces as part of the normal aging process. As a result these veins become more prominent, and pose a concern to many people. These veins are normal, and have potential for use perhaps for intravenous access, or for use to obtain blood for routine blood testing. Unlike the varicose veins of the lower extremities, then, these veins serve a useful purpose.

Varicose veins of the upper extremity are rare, and if they develop, an evaluation is necessary to determine their cause. Is there an anatomical abnormality that is causing a compression, which is not allowing for normal vein blood flow return to occur, causing a “back up”. Many possibilities exist that can cause this to occur, and these will be addressed in a future blog.

So if one treats these veins, you are potentially destroying something that has important potential uses. The underlying issue that needs to be addressed is to increase the skin turgor, perhaps, by adding “collagen fillers” as is being used to treat these issues on the face. Having said that, if you, and you’re vein specialist make the decision to treat these veins, the options of sclerotherapy, or endovenous laser ablation do exist as are being used to treat varicose veins of the lower extremities.

If you have any questions about the veins of the hands or arms, or any other veins, call New York’s leading vein specialist, Dr. Norman Chideckel today!