By Nancy DeVault, Staff Writer
For decades, Phlebology, the medical specialty devoted to disorders of the venous system,has been eclipsed by the bypasses, angioplasties, and stents used frequently and often excessively to treat arterial disease. The “red-headed step child” of medicine, Phlebology has steadily gained respect as being more complex and involved than previously appreciated. For 20 years, Dr. John Horowitz has been practicing vascular surgery in our community and has committed his entire practice to Phlebology. “Phlebology is the Rodney Dangerfield of medical specialties: it ‘Gets No Respect’” , says Dr. Horowitz. “For all of those years I spent practicing arterial and venous vascular surgery, patients with venous disease were looked at as the least glamorous and satisfying patients to care for. No one ever referred to the treatment of vein patients as ‘cool’. We had little to offer most patients. We also live in a culture dominated by the complications of lifestyle choices and atherosclerotic arterial disease. Heart attacks, stroke, and limb loss have become the intense focus of all vascular specialists”. Fortunately for the patients of Central Florida, that seems to be changing.
One might wonder, why would a wildly successful and skilled vascular surgeon that spent his life developing and refining skills in arterial surgery and endovascular therapies such as angioplasty and stenting decide to commit his practice to vein care? Phlebology has become an exciting and challenging discipline compared to its counterpart of 15 years ago. “I became one of the pioneers in minimally invasive vein therapy and developed an expertise in vein care really not seen anywhere before in Central Florida. The exciting advances in laser technology, the challenges of ultrasound guided techniques, and the opportunity to work with a population of patients with an interest in participating in their own care and improving their overall lifestyle has me completely engaged”, says Dr. Horowitz. “ I found myself progressively disillusioned with a healthcare system highly invested in procedures for arterial disease that were destined for failure and a need for re-treatment because we had done nothing to effect the root causes. The amount of resources we spend and the risks to people’s lives we take to stem the side affects is astounding. People are not engaged in their own care. We don’t have a healthcare problem, we have a culture problem! Since I have committed my practice to Phlebology, I find I can affect patient’s lives in a much more substantial way and engage them in their own care and the hope of a more active, fulfilling lifestyle.”
Phlebology is more commonly accepted and embraced as a bona fide specialty in many countries outside of the United States, such as the United Kingdom, but is on the rise in the United States as statistical data illustrates an increase of patients in the US treated for vein disorders. The Venous Disease Coalition notes that twenty-seven percent of the American adult population has some form of venous disease in their legs (source: Framingham study). In fact, it is estimated that at least 20 to 25 million Americans have varicose veins with women being three times as likely to be affected, most likely a result of physiologic changes during pregnancy, age, and menopause. To answer the patient demand surrounding vein care, Central Florida Vein and Vascular Center opened its doors in 2001 with locations in Ocoee, within Health Central’s Medical Plaza, and the Sandlake area, adjacent to Dr. Phillips Hospital.
Why has the treatment of venous disorders changed so much? To begin with, advances in technology have opened up elegant and minimally invasive pathways for vein patients to achieve care. Second, the ability to diagnose and characterize venous reflux, the root cause of venous insufficiency and symptomatic venous disease, has become much more sophisticated with high definition ultrasound. Vascular ultrasound has grown as a discipline itself and has a sub-specialty in venous disease. Lastly, over the years, providers have developed a greater understanding of the underlying causes of venous disease and the most appropriate methods of treatment. A greater commitment to developing ultrasound guided skills has also advanced this field greatly. Virtually all of the minimally invasive vein procedures performed at the Central Florida Vein and Vascular Center are ultrasound guided and percutaneous. Intense focus on education and training and the establishment of an independent Board of Phlebology have revolutionized the delivery of vein care.
Vein Patients are not Vain
When veins become varicose, enlarged and twisted, the results can be visually unflattering. While most patients admit to this fact, the truth remains evident in a multitude of Quality of Life studies that varicose veins and venous insufficiency are a significant source of symptoms and disability. There is a great deal of pain, fatigue and lower extremity limitations that stem from venous insufficiency. Many assume that opting for intervention is simply a cosmetic choice satisfying ones vanity; though some are seeking visible improvements, others are looking to address symptoms that may include leg aching, heaviness, fatigue, ankle swelling, muscle cramping, restlessness, itching or burning, and skin discoloration. Today’s advanced therapies get to the root of the venous reflux, which causes the vast array of symptoms and combats this true clinical issue. In most incidences venous insufficiency is not a dangerous condition, though varicose veins can lead to complications such as blood clots, bleeding, rashes and ulceration if not treated. However, the usual implications of vein disorders are painful, tired, swollen and heavy legs that impact patients’ quality of life. The modern vein care practiced at Central Florida Vein and Vascular Center eliminates the venous congestion of failed veins providing more effective venous blood flow.
According to Dr. Horowitz, recent studies show more than 58 percent of the women between the ages 18 to 49 said that the one thing they would most like to change about their legs was better stamina and energy. “Our practice values the opportunity to help our patients get back to doing what they love without physical limitations,” said Dr. Horowitz. “We’re able to help a wide range of patients achieve healthier legs. From the active mom whose legs became problematic with varicosities following her pregnancies, to the Baby Boomers that have been told to live with the leg discomfort they have, all patients show an improvement in symptoms and function once we treat their veins. “
Most vein care at Central Florida Vein and Vascular Center is authorized and covered by insurance providers. Approved treatments often commence with a conservative therapeutic approach. This period can range from two weeks to three months and include compression hosiery, weight loss, swimming pool therapy and pneumatic compression; however Dr. Horowitz explains that these conventional solutions rarely eliminate the venous insufficiently. In fact, compression hose are typically uncomfortable for patients, especially in the heat of Florida and merely offer the temporary results.
“Proper vein care requires working from the inside out. We work to find the root of the problem by identifying the location and severity of the venous insufficiency, which is not always visible through the skin,” explains Dr. Horowitz. “ I think this is what separates a true Phlebology practice like ours from those that dabble in vein care
Vein, Vein Go Away
As a dedicated vein care facility, the Central Florida Vein and Vascular Center offers a uniquely comfortable patient experience. The dated high-risk treatments of surgical stripping are now completely obsolete. Central Florida Vein and Vascular Center offers convenience with safe, minimally invasive procedures conducted through an outpatient, office-based setting, followed by a shortened recovery period. Veins of any size can be treated non-surgically through minimally invasive outpatient techniques including Endovenous Laser Treatment (EVLT), Ultrasound Guided Foam Sclerotherapy, Vein Lite Sclerotherapy, Spider Vein Sclerotherapy and Aesthetic Laser Services.
Central Florida Vein and Vascular Center’s treatment approach typically combines two office-based procedures, Endovenous Laser Ablation and Ultrasound Guided Foam Sclerotherapy, to provide management of leg swelling and problematic veins of any size. These procedures require no incisions to heal, require minimal downtime and are highly successful when performed by a trained Phlebologist. The saphenous reflux, the root cause of secondary varicosities is treated with Endovenous Laser Ablation, the most common catheter-based technique performed at the Central Florida Vein and Vascular Center. Patients receive local anesthesia, allowing the physician to guide a laser fiber (see inset) through the skin and into the insufficient vein, visible through ultrasound guidance. During the procedure, which spans 15-20 minutes, Dr. Horowitz and his surgical team use a laser called VenaCure, medically designed tool specifically for treatment of varicose veins by AngioDynamics, Incorporated. The laser light heats the vein causing it to seal off from the inside. As a result of delivering laser energy to the targeted insufficient vein, the vein is sealed and the reflux pressure is reduced, thus eliminating swelling and pain with improved blood circulation. Following the procedure, patients experience no down time and may be able to visually see dramatic improvements immediately.
Endovenous laser therapy carries an impressive 98 percent success rate for this advanced technique. As opposed to surgical stripping, the vein remains in place but is sealed closed and cannot allow retrograde, refluxing venous blood to leak to the surface veins. The secondary veins, also known as the superficial veins which are visible just under the skin, are then treated with Ultrasound Guided Foam Sclerotherapy. A tiny needle is injected using high definition ultrasound, to introduce a medicated solution that irritates the lining of the vein. The chemical causes the veins to collapse or seal shut. Superficial veins handle less than five percent of blood flow so patients’ general health is not affected. These techniques offer little trauma and pain afterwards, a quick recovery, and excellent long term results while avoiding the risks and poor cosmetic outcome of surgical vein care.
Training for a Standard of Care
Dr. Horowitz was among the first physicians practicing in the Central Florida region to solely commit to the field of Phlebology with specific intention to treat venous disorders including varicose veins, spider veins, edema and skin changes, and wound care of arteries and veins. Because of his dedication to the evolving techniques and applications of Minimally Invasive Vein Therapy, physicians throughout the Southwest region of the United States have sought his direction. Countless doctors have observed and studied the specialized approaches performed at Central Florida Vein and Vascular Center and explored the benefits of a dedicated vein care center. Dr. Horowitz, who has authored numerous journals and book chapters, also presents regularly at medical conventions and society meetings regarding the latest groundbreaking and cutting-edge treatments in the evolving discipline of vein care
Central Florida Vein and Vascular Center has performed nearly 10,000 procedures. Thanks to a demand for vein care in the Metro Orlando area, Central Florida Vein and Vascular Center hopes to offer additional office locations as a convenience to new and existing patients. Because lifestyle behaviors are contributing factors to the development of insufficient veins, Dr. Horowitz says an expansion could also include a multidisciplinary focus to incorporate more natural and holistic treatment options for patients to consider, in addition to maintaining specialized conventional treatments proven to address venous disorders. Statistics show that people who are obese and those leading sedentary lifestyles tend to be at a greater risk of developing malfunctioning veins and accompanying symptoms; therefore preventive therapies and weight management is a key factor.
“As physicians, it’s our job to not only treat the acute condition of the patient in which we specialize. As a medical community, we need to evaluate the total health of patients and not overlook any conditions – mild or severe – that impact one’s quality of life and overall health,” says Dr. Horowitz, who is committed to debunking the common myths of vein care. “Vein interventions do hold clinical significance because our patients feel and see the difference – physically and emotionally.”
Central Florida Vein and Vascular Center Locations
10000 W Colonial Drive, Suite 495
Ocoee, FL 34761-3436
7350 Sand Lake Commons Blvd., Suite 3322
Orlando, FL 32219
Monday -Thursday 8 a.m. – 4:30 p.m.
Friday 8 a.m. – 4 p.m.
Phone: (407) 293-5944
Thanks to reformed treatment options, patients no longer need to feel embarrassed about their veins or minimalize the magnitude of their pain. Hear what patients are saying on Central Florida Vein and Vascular Center’s social media channels.