Your initial visit will include detailed explanation of venous disease and its treatment. An examination is performed by Dr Hubach including the use of Doppler to listen to the flow of venous blood in the legs.
After this consultation and exam, Dr Hubach will be able to determine if further evaluation and testing is necessary or if the patient can begin treatment.
We find this initial consult is typically covered by insurance as an office visit when symptoms are involved.
If the initial consultation reveals the need for further evaluation, the patient is scheduled for an Ultrasound study.
The Ultrasound is done in the office by Dr Hubach or his highly trained staff - who are certified Registered Vascular Technologists (RVT). We maps out the venous system of the diseased leg, or legs, to find the location of the patient’s abnormal veins. He is then able to discuss a treatment plan, specific to that patient, at the time of the Ultrasound.
Holding the credential of an “RVT” shows that Dr Hubach has been tested in use of the Ultrasound and has passed the needed written exams to be certified. This is required by some insurance companies in order to reimburse for performing the ultrasound evaluation. Very few physicians hold this credential. He also holds the Registered Phlebology Sonographer (RPhS) credential, requiring further expertise in the field of venous disease and use of the Ultrasound. As a subject matter expert, he has assisted in the formation and oversight of this credential.
This is a procedure that is performed in the office with local anesthesia. It is typically used to treat abnormal veins under the skin that are considered the source vein to the visible changes and symptoms. Through a small needle puncture entry on the leg, LASER energy is able to be released inside the vein and close the targeted vein segment. Over time, the body absorbs the treated vein and it disappears. After the procedure, a compression hose is placed on the leg and the patient is sent for a walk.
Endovenous laser treatment is a minimally invasive, in-office treatment alternative to surgical stripping of the saphenous veins. Patients are able to walk immediately after the procedure and most individuals are able to return to work the next day.
Endovenous laser treatment is FDA approved and Dr Hubach was one of the first physicians in the country to start using this procedure.
Similar to EVLT, Radiofrequency ablation also relies on thermal (heat-based) damage to the vein, which leads to the immediate closure of the vein. A disposable catheter is inserted into the vein, and controlled heat collapses it. The vein is closed as the catheter is withdrawn.
This office-based treatment can help eliminate the underlying causes of leg pain.
Ambulatory phlebectomy is usually performed in a doctor’s office using local anesthesia.
After marking the location of the abnormal veins and cleaning the skin, the area surrounding the varicose veins are flooded with anesthetic fluid. Small 2 to 3 mm openings in the skin are then used to insert a small hook and the varicose veins are gently grasped and removed.
Ambulatory phlebectomy is often performed in conjunction with minimally invasive endovenous catheter procedures and sclerotherapy.
Ultrasound Guided Sclerotherapy (Echo-Sclerotherapy) is an in-office treatment alternative to surgical stripping. This is a procedure Dr Hubach has been using for more than 20 years. Ultrasound imaging is used to guide a needle into the abnormal vein and deliver medication to destroy the lining of the blood vessel and seal it shut. Ultrasound guided sclerotherapy is primarily used to treat large veins beneath the surface of the skin. Several different medications can be used including a newer agent, Varithena. The solution is typically foamed to improve effectiveness, safety, and visibility.
Sclerotherapy is a common treatment for small (spider veins) and medium size (reticular) veins. Sclerotherapy uses a small needle to inject a solution (called a sclerosant) into veins, which destroys or seals closed the unwanted vessels. Depending on the size and location of the veins, different types and strengths of sclerosants are used. Compression hose for one week after the treatment are beneficial to improve results.