What Questions Do You Have?

What are Varicose Veins?

Varicose veins are dysfunctional/incompetent veins in the lower extremities. Vein wall injury allows the vein to elongate and dilate, leading to an increase in vein diameter, valve dysfunction, reflux, and the visual manifestations of varicose veins.

What causes Varicose Veins?

It is currently believed that a dysfunctional venous system can result from injury to vein walls and venous valves. This type of injury entails acquired severe inflammation exacerbated by factors such as heredity, obesity, female gender, pregnancy and a standing occupation.

Will insurance cover my treatments?

Spider veins are cosmetic in nature and therefore, NOT covered by insurance. Varicose veins, on the other hand, may be covered by PPO insurances and Medicare, subject to their medical guidelines and criteria. If you would like to find out more about insurance coverage, please contact our office and our staff will be happy to assist you.

Why do I need an ultrasound exam?

The first step in finding the right treatment for damaged veins is finding its source. A Doppler Duplex Ultrasound Scan provides a visual window, revealing the diseased, refluxing veins beneath the skin’s surface. With this diagnostic capability, we can pinpoint the exact cause of varicose veins and customize a treatment plan for each individual patient – and each damaged vein. Because the problem is dealt with at its source, the treatments are quicker, more effective and less painful than traditional methods, such as vein stripping.

What is Endovenous Laser Ablation (EVLA)?

This is a well-tested procedure that replaces vein stripping. Under duplex ultrasound guidance, a laser fiber is inserted into the dysfunctional vein and positioned at the base of the terminal valve. Laser energy is then delivered to the tip of the fiber while it is slowly withdrawn. This process enables shrinkage and ultimately closure of the vein wall.

What can I do to prevent varicose veins?

While you cannot entirely prevent varicose veins, there are quite a few ways to improve your vein health. Physical activity, such as walking, swimming or cycling, is a wonderful way to pump blood up the leg against gravity to improve circulation. Compression hose also helps improve circulation by preventing blood from pooling in the leg veins.

What is compression therapy?

Compression therapy such as compression stockings is a fundamental strategy in the treatment of venous dysfunction. Despite recent therapeutic advancements in leg vein treatment, compression remains a simple, effective, and inexpensive modality. It is used as a primary treatment as well as an adjunct when other treatments are employed.

Why would a superficial clot dissolve, but not a deep vein clot?

I have a deep vein clot and a superficial clot. The superficial clot is almost completely gone. I had another ultrasound at 6 months, and the doctor said nothing is dissolving with the deep vein. Why wouldn’t the deep vein not dissolve? Sometimes clots do not dissolve and form scar tissue which is permanent. If this happens in the deep system and leads to a condition called post-thrombotic syndrome. This can create lifelong issues for that leg. If the blood flow is somewhat compromised a stent can be placed on occasion to open up that vein.

Do I have Spider Veins or Varicose Veins?

My husband has had at least 6 superficial blood clots in the last 3 months. What could be causing these so often? Is there a deeper problem? He has been evaluated at the ER for this and they confirmed they are superficial. We are waiting for insurance to kick in next month, but thought I would see if I could get any more info beforehand. If he has varicose veins it could simply be due to this. On the other hand, he could have a clotting disorder and would need to have a workup for this. This is often done by a hematologist and is a blood test.

Can I take a 12-hour flight if I have CVI? What should I do to prevent DVT?

I was diagnosed with CVI last year. I have heavy, achy legs all the time. I am wearing 20-30 mmHg thigh-high compression stockings daily. My parents are overseas. I know I will not take flight unless absolutely necessary. If I need to take a 12-15 hour flight for an emergency situation, is it safe? A business class seat is a must and so is walking in the cabin every hour, but what else can I do to prevent DVT? The compression hose is fine. The business class seat and frequent walks is nice but not essential. You can do frequent leg motions like "pumping the gas pedal" in an economy seat.

What causes frequent superficial blood clots?

About Dr. Hoyle

Dr. Hoyle has been practicing Phlebology (Specialty with Vein Disorders) for 15 years. He was the first physician in Orange County to perform endovenous laser ablations. He was also the first doctor to perform micro phlebectomy and the first to utilize tumescent anesthesia for vein procedures. He has been an invited lecturer at Chapman University and appeared twice on the TV show “Health Matters”. He has also been interviewed on the radio show “Straight Talk MD”. Dr. Hoyle is an expert reviewer for the Medical Board of California and served for several years as a consultant at the VA hospital in Long Beach. Dr. Hoyle was among the first 200 doctors in the U.S. to pass the exam to obtain Certification by the American Board of Lymphatic and Venous Medicine. He has also passed the examination for Registered Physician in Vascular Interpretation (R.P.V.I.) by the American Registry for Diagnostic Medical Sonography.

Dr. Hoyle was one of the first physicians to use Varithena in Southern California. He has become a spokesman and physician trainer for the company and has given a presentation at the American College of Phlebology annual Congress in November 2017. In September 2017 he traveled to Medicare headquarters in Baltimore Maryland to discuss coverage and reimbursement for Medicare recipients. Recently he was asked to participate in a meeting with the medical director for Blue Shield of California regarding coverage for Varithena treatment.

A Canadian transplant from Toronto, with a medical degree from the University of Western Ontario, Bruce Hoyle has lived and worked in Orange County, California for most of his career. He holds an MBA degree from the University of California, Irvine. Dr. Hoyle is the chairman of the ACP's Coding and Reimbursement Committee and serves on the American Medical Association's CPT Advisory Panel. He has also served on the board of the ACP Foundation.

In 2012 Dr. Hoyle was elected a “Fellow” of the American College of Phlebology.
In 2013 Dr. Hoyle wrote a chapter revision in the American College of Phlebology’s textbook “Fundamentals of Phlebology.”
In 2013 he completed a white paper for the American College of Phlebology, “Guidelines for Treatment of Superficial Venous Disease”. This document was produced mainly for the insurance industry in the hope of creating more uniformity to medical necessity for treatment of superficial venous disease.
In 2015 he spoke to Medicare Administrators for 12 states regarding coverage of the Clarivein device (mechanochemical ablation).
Recently he agreed to serve as an advisor to the AMA CPT editorial panel.

In 2012 Dr. Hoyle was elected a “Fellow” of the American College of Phlebology.
In 2013 Dr. Hoyle wrote a chapter revision in the American College of Phlebology’s textbook “Fundamentals of Phlebology.”
In 2013 he completed a white paper for the American College of Phlebology, “Guidelines for Treatment of Superficial Venous Disease”. This document was produced mainly for the insurance industry in the hope of creating more uniformity to medical necessity for treatment of superficial venous disease.
In 2015 he spoke to Medicare Administrators for 12 states regarding coverage of the Clarivein device (mechanochemical ablation).
Recently he agreed to serve as an advisor to the AMA CPT editorial panel.

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