Varicose Vein News | Truffles Blog

Summer Is Almost Over!

Well, we’ve almost made it through another summer in here in Georgia but shorts weather is far from over with warm temperatures lingering until October here in the south. So tell me, did you get those unsightly spider and varicose veins treated this year or did you put it off again?  Procrastinating a potentially expensive treatment or procedure is easier to justify when we think it’s just a cosmetic improvement but did you know those blue and purple veins can be a sign of a more serious condition?

Spider veins (those tiny little squiggles) and varicose veins (those larger bluish veins below the skin and the bulging ones, too) can be a symptom of Venous Insufficiency.  Simplified, this means that the veins and valves in your legs have been over stretched and no longer function as they should to move blood out of your legs and back to your heart. This results in increased pressure on the venous system, reflux of deoxygenated blooddownward and the stagnation of cellular waste in your legs. No wonder its uncomfortable!  Some common causes for this are genetics (“my mom had these veins”), prolonged standing (teachers, cashiers, factory workers, nurses, etc)pregnancy, and athletics. Once the “stretching” occurs, there is no real way for these veins to snap back into place. Compression socks and stockings can help support the veins (like Spanx for your legs) but there is no evidence that this will reverse the condition - and they look terrible with shorts!

Other symptoms of venous insufficiency include:

• Itching, flaking skin
• Numbness and tingling

While we cant change genetics or the past, the good news is that venous insufficiency can be managed very successfully with vein closure.  Current treatment options not only improve and often eliminate symptoms but they also can result in a much-improved appearance of the legs, ankles and feet.  The treatments are also pain free and require no downtime leaving your vacation days free to show off your vacation ready legs!

Even better news? Because venous insufficiency is a medical condition, most procedures to correct the problem are covered by insurance. If you have visible veins and are experiencing any of the symptoms mentioned above, you owe it to yourself to come in for a consultation and thorough evaluation.  During your appointment, we will examine your legs, document your symptoms, schedule any needed imaging and discuss treatment options. We will also submit our findings to your insurance company for approval prior to any procedures so there are no surprises!

Please don’t hesitate to call our office for any questions or to schedule your consultation.



Five things I Didn't Know about Vein Disease as a Primary Care Provider

As a nurse practitioner in general family practice, I’ve treated an enormous variety of medical conditions and illnesses. As is expected in general medicine, we practice with a broad brush and refer to specialists for more complex issues. Now, as I move into the specialty field of Venous Disease and Treatment, I’ve observed some very important elements of this chronic disease that are outside of the awareness of most general practitioners.

1. Tired, aching, heavy legs are not just symptoms of getting older. Though age is a contributing factor to venous insufficiency, the leg fatigue, aching, heaviness, swelling, throbbing, tingling and pain associated with venous disease is not just something that has to be accepted as a normal part of aging.  Other contributing factors are pregnancy and prolonged standing so venous disease can affect adults of all ages.
2. Venous Insufficiency affects approximately 40% of the population in the US.  Perhaps it’s genetics (one or both of your parents or siblings has varicose veins or other vein problems) or vein stressors due to lifestyle (you work on your feet, you’re an athlete, you’re a bit overweight) but whatever the reason, this number suggests that a HUGE number of people with venous disease and insufficiency are undiagnosed.
3. Spider veins are more than just a cosmetic blemish.  Prior to practicing in this specialty, I thought these little veins were purely an ugly annoyance I tried to cover during the warm months of the year (most of the year here in the south).  They were just leftover reminders of my pregnancy or of working as a floor nurse.  In fact, spider veins can be the first sign of an underlying venous insufficiency and can aid in early detection of a vein disorder. Increased pressure in the superficial venous system contributes heavily to the appearance of spider veins and may progress to their larger, uglier sibling – varicose veins!
4. Venous imaging should be a primary (rather than secondary) component of evaluating most cases of leg swelling (edema) and many cases of leg pain.  While there are many reasons for leg swelling and associated aching that must be ruled out during patient visit, providers often prescribe a diuretic (water pill), encourage patients to wear compression stockings and to be more active.  This is excellent advice but if the venous system is not examined by ultrasound as a component of treatment, effective treatment options may be overlooked and patients may struggle to manage these symptoms over the long term.
5. Treatment of venous insufficiency is almost always pain-free and is nothing like the barbaric “vein stripping techniques” of the past. Venous closure is most often performed either chemically or via endovenous ablation – which means that electromagnetic energy is used to close the vein from the inside rather than stripping the vein out.  Neither procedure is considered a surgical procedure and neither requires any down-time or missed time off from work!

If you are experiencing any of the symptoms mentioned and would like discuss your specific concerns in person, I would love to have you come in for a consultation. As we are a medical specialty practice, most visits are covered by your insurance – please check with them to see if you need a written referral from your PCP.



Sonographer to RN Degree Program

RVT to RN Degree Program

Why should a registered Sonographer have to go to school for two or even 4 years just to be able to inject a vein (and feel protected)? A Registered Nurse can come from a variety of backgrounds including but not limited to: med surge, ICU, CCU, home health, camp nurse (yes I looked it up), geriatric nurse and even a school nurse can perform sclerotherapy without training!  They can also pick up an ultrasound probe and with 12 months on the job training, sit for a Sonography credential. A physician simply has to sign a form, attesting to the experience. A nurse needs a letter and a Sonographer needs 121 credits, WTH?


The two careers are very similar in that registered nursing and sonography can be associate but are more commonly bachelor degree programs now.  I have provided information below on the curriculum, collected by a google search. You can compare the two side by side. I actually used a BSN program and an AS program in Sonography to appease all of the nurses who may stumble upon this blog.  Don't get butt hurt, we are not trying to take over your turf, just party on the same dance floor! I have bolded the common classes (anatomy and physiology) and have italicized those that are of equal difficulty (physics and statistics). 


"There are two common drugs used in Sclerotherapy (Asclera (Polidocanol) and sodium tetradecyl sulfate or STS). Is it really necessary to take 121 college credits to understand the pharmacology of these two compounds"? 


There is only one to three classes in the entire catalog that deals with pharmacology (one in this example, basic pharmacology).  All of the other areas have nothing to do with anything remotely associated with patient care in the vein or vascular setting that is not part of a vascular or sonography program. We don't give enema's, put in catheters or suppositories, but nurses don't have to .....well yeah they do! Mad respect for those nurses in the trenches! There are 9 specific areas below that deal with Sonography specific content. Looking at these two curriculum, how is it that a Nurse can become a Sonographer but there is not a College or University in America who provides a path for the Sonographer?


Why should a Registered Sonographer have to go to 2 years of college instead of taking a course in pharmacology? What if the Sonographer has shown his or her knowledge of pharmacology in the related field (phlebology)?  The Registered Phlebology Sonographer credential is 24% pharmacology, sclerotherapy and the treatment of veins. Even with this credential proving the knowledge of the individual, it is left in the "air" weather a Sonographer (RPhS) can perform sclerotherapy. I petitioned the state of Georgia and they responded "We do not regulate rules or laws for your profession". Who does? 


Who would you want to inject your veins?  Did you know that there is no certification for sclerotherapy, nope any nurse in America can perform it without training. That is crazy! Did you know that a Sonographer has to go to school for a minimum of 2 years, yet a physician has to have ZERO training to be able to perform ultrasound?


Bachelors in Science in Nursing (BSN)

While the program you choose may be set up differently from another, what remains fairly standard are the curriculum requirements for a Bachelors degreed nurse. Generally the curriculum you’ll get in a BSN program looks similar to this:

  • Anatomy and Physiology
  • Microbiology
  • Psychology/Anthropology
  • Statistics
  • Nursing Assessment
  • Nutrition and Diet
  • Life Span
  • Basic Pharmacology/Math for Medicine
  • Community, Family, Geriatric, Psych overviews
  • Nursing Theory
  • Nursing Research

Because the BSN is a full-fledged Bachelors degree you’ll complete a number of required courses, such as English/Composition, Art, Literature, History, Physical Education, and Social Sciences.

Clinicals in the BSN encompass a wide array of patient care facilities. Advanced clinicals allow you to choose among unique environments based on your interests and possible goals in the field. For example, you might spend the first part of your degree working in a local hospital, but during the latter part of your studies you may opt to pursue a clinical experience in a long-term care facility, a public health department, a psych facility and more.

Associate Degree in Sonography (RVT)

Core ultrasound classes may be divided into pre-professional (or pre-requisite) courses and those related to the profession of sonography. While ultrasound curriculum varies from school to school, here are some examples of common courses:

Pre-professional/Pre-requisite Ultrasound Courses

  • Physics
  • Algebra/Applied Mathematics
  • Computer Technology
  • Communications/English
  • Biology (Anatomy & Physiology, Microbiology)
  • Health Ethics
  • Psychology/Sociology
  • Medical Terminology
  • Professional Ultrasound Core Courses
  • Introduction to Sonography
  • Ultrasound Instrumentation
  • Ultrasound Physics
  • Sonography Patient Care
  • OB/GYN Ultrasound
  • Cardiovascular Sonography
  • Abdominal Sonography
  • Neurosonography
  • Clinical Internships and Labs

Registered Phlebology Sonographer (RPhS) Exam Matrix

  • Regulatory and Compliance Standards (e.g. OSHA, HIPAA, informed consent, medical records)
  • Medical ethics
  • Medical terminology
  • General anatomy
  • Cardiovascular anatomy and physiology (normal and abnormal)
  • Venous anatomy, physiology, and pathophysiology
  • Vascular hemodynamics
  • Venous disease process and progression
  • Diagnosis and treatment of lymphatic disease
  • Basic math and statistical skills (formulas, exponents, decimals, scientific notation)
  • Basic pharmacology
  • History and physical
  • Vascular signs and symptoms
  •  Risk factors (family history, genetics)
  • CEAP classification
  • Pre- and post-treatment Basic Life Support (BLS) Safety practices for patients and staff
  • Universal precautions/infection control
  • Sterile procedure
  • Ergonomics Ultrasound physics
  • Ultrasound instrumentation
  • Ultrasound modalities (e.g., spectral Doppler, color Doppler, B-mode)
  • Vascular anomalies and normal variances Nonsurgical interventions (e.g., medications, risk factor modification)
  • Sclerotherapy (visual and ultrasoundguided) 
  • Compression therapy
  • Physical therapy Open-surgical venous procedures Minimally-invasive venous procedures
  • Thermal ablation
  • Phlebectomy Other testing modalities (e.g., CT, MR, plethysmography)
  • Exam correlation with other imaging modalities
  • Complications of venous treatment
  • Examination Matrix This examination matrix is provided to illustrate the general distribution of questions and the relative weight or emphasis given to a skill or content area on the examination.
  • Content Category Approximate Percentage of Examination

A. Maintain Information, Facility, and Safety 6%
B. Patient Diagnosis 22%
C. Performance of Diagnostic Testing 35%
D. Conservative Treatment / Therapy of Patients 9%
E. Minimally Invasive and Invasive Treatment of Patients 27%
Total 100% K

Who will be the institution to get the message?

Registered Vascular Sonographer RVT to Registered Nursing Program

Will an administrator of a nursing program have the courage to start a Sonography to RN program, or an RVT to RN program? I would love to sit down and explain all of the advantages this pathway would provide. Increasing access in rural communities, reducing costs, providing a more comprehensive treatment option especially for the vein patient and providing equity between the two fields that both have shortages and are in need of qualified individuals.  

Brian Sapp, RVT, RPhS is a dedicated vascular professional (Sonographer) who is passionate about vascular testing, vascular diagnosis and vein disease. The views published in this blog are not the views of Truffles Vein Specialists, however he does make a good point. Please leave a comment and discuss this topic while trying to respect the views of others. Thank you for visiting our blog


Is The Gold Standard Causing Misdiagnosis

Is The Gold Standard in Venous Duplex Causing False Negative Exams?

Venous duplex ultrasounds are performed in the transverse and sagittal planes. Due to compression ultrasound being the gold standard most Sonographer's perform transverse compression first and focuson distal augmentation when assessing with Doppler. Most Sonographer's do not let the Doppler run and evaluate for phasicity or spontaneity the key indicators of a proximal obstruction. 

With compression established it is natural for the Sonographer to have mentally checked negative and perform augmentation to simply to complete protocol. 

When performing venous duplex ultrasound to evaluate for deep vein thrombus or DVT compression of the veins in the transverse plane is the gold standard.  It has been well established that thrombus should be identified in both planes. Compression ultrasound combines real-time imaging of the deep veins with venous compression to diagnose deep vein thrombus.  

Doppler ultrasound uses a Doppler waveform and provides information above and below the level of the site sampled. Augmentation (squeezing the body part distal to the area being investigated) is typically performed to evaluate a distal obstruction, however studies suggest that it provides no useful data.  The Intersocietal Accreditation Commission IAC requires Doppler of the contralateral common femoral vein to evaluate for inflow discrepancies, however most hospital ultrasound departments don't hold this accreditation.  
Continuous pulsatile flow in the left common femoral vein suggestive of proximal compression or thrombosis.
The left common femoral picture above is of a patient who had a pulmonary embolism and had a negative bilateral venous duplex at a hospital.  The pictures that follow demonstrate bilateral high grade iliac vein compression that was missed. 
High grade right external iliac vein compression on a patient that was told they had a negative for venous problems and had suffered a pulmonary embolism.
Right EIV compression.
Left mid common iliac compression by the left common iliac artery with scarring
Left mid common iliac compression by the left common iliac artery with scarring

To solve this problem we suggest evaluating with Doppler without augmentation allowing enough time to pass to evaluate phasicity and spontaneity. It adds one more picture to the exam and very little time in comparison of the value gained.  This can be done at the beginning or after compression. We suggest looking at the Doppler first, there is a lot of information that can be seen that many miss.  

Brian Sapp, RVT, RPhS is the owner of Registered Vascular Solutions, Inc. and a partner at Truffles Vein Specialists. He provides hands-on training, vascular consulting and education. 

Advantages of Vein Treatment Before Knee Surgery

Advantages of Vein Treatment Before Knee Surgery

Jason, a recently retired administrator, came to Truffles Vein Specialists before proceeding with a left total knee replacement.  He had experienced chronic knee pain and mild swelling for nearly a decade, however it had progressively worsened since his retirement.

“It’s true, when you retire, you find yourself suddenly more busy.  With  my new and busy schedule, my left knee became very swollen,” he said.  “I developed a bulging lump on the inside and behind my right knee and I had difficulty even playing golf. I found myself not wanting to travel as I could only sit or drive for short periods of time”.

He made an appointment with her Orthopedic Surgeon to evaluate his problem which he assumed was the result of his glory days back in high school.  He also saw his Primary Care Physician who was concerned his problem could be related to venous disease.  He was then referred to Truffles Vein Specialists for venous disease assessment and was surprised by what Dr. Feldman discussed and the results of the diagnostic ultrasound. 

“They did an ultrasound of both my legs and found the valves of my superficial vein was allowing the blood to flow backwards,” Jason reported.  ” Brian explained what a normal vein looked like and showed me my leaking vein starting at my groin and went all the way down to just above my ankle. There were large varicosities that were under the skin hidden from sight. I had never really noticed the patterns around my left ankle. I had significant vein disease in both legs."

Knee arthritis and venous insufficiency often are seen in the same patient because both conditions affect the same population, patients over 40.   Therefore, patients expected to have knee surgery, such as a knee replacement or arthroscopy and who have any signs of venous disease such as swelling or varicose veins should actively seek a venous evaluation prior to major orthopedic surgery.

Research has shown that patients who have their venous problems addressed prior to knee replacement or arthroscopy have a better outcome.  Patients can decrease their postoperative risk of leg swelling and deep vein thrombosis when venous disease is addressed first.  With pre-existing swelling, bulging veins or the skin changes of venous disease, vein treatment obviously improves the post-op wound healing process for these orthopedic surgical patients.

Forty million adults are affected by venous insufficiency, including one out of three people over the age of fifty.  Treatment by closing defective veins is minimally invasive, taking approximately one hour with rapid recovery times.  This vein treatment enhances a patient’s chance of a good post-operative knee replacement or knee procedural outcome.

If you have knee discomfort and are considering or are scheduling an orthopedic evaluation, be sure to consider your vein health.  If you have varicose veins, swelling, leg heaviness or skin discoloration – or have other signs or symptoms of venous insufficiency, request a vein specialist to evaluate your venous status.  Remember that you may enhance your orthopedic procedure outcome by first caring for your venous health. In some cases the pain and discomfort in the leg.  

Leg Swelling

Swelling of the legs is abnormal and should be evaluated by a physician if it occurs more than occasionally after a long day of sitting or standing. Pain or tenderness in the legs associated with swelling is an especially important reason to seek evaluation.  Read more >>>>

Tired Achy Legs

Pain or tenderness in legs is not a normal condition.  One of the most common causes of pain in the lower extremity is venous insufficiency, a condition in which the veins stretch over time and the one-way valves in the veins fail.  This valve failure allows venous blood to flow down the leg due to the effect of gravity.  Read more ....


The Poorest Advice about Vein Treatment Ever!

Mild varicose vein in the back of the leg. Varicose veins are not a cosmetic but medical problem. Vein treatment options in Atlanta, Georgia.

You’ve heard it before…maybe even from your doctor ”varicose veins a cosmetic issue, you do not need treatment, it can make it worse”. Please read this next sentence very carefully and slowly. Varicose vein disease is a medical condition, any advice to the contrary is inaccurate and is not supported by evidence based medicine. 

To completely understand why the treatment of venous disease is so important, it is essential to know what causes them. Varicose veins are are enlarged, bulging, distended veins in the legs that may or may not be seen by the naked eye. Varicose veins develop when pressure in the venous system increased due to venous blood pooling in the veins. This happens over time due to gravity or valve dysfunction. This stagnant blood is depleted of oxygen and is carrying waste products. This is why varicose vein disease and restless leg syndrome are related. Chemically these waste products cause all kind of problems to the circulatory system. 


Your arterial and venous systems work in conjunction and the body regulates blood flow through an intricate physiologic function called auto regulation. To demonstrate this simply squeeze your finger tip, it will turn white and quickly return to its normal color. Arterial blood flow normally is a high pressure system and venous is normally a low pressure system. Arterial blockage changes the pressure on the arterial side and varicose vein disease increases pressure on the venous side. Both of these can be devastating to the circulatory system. Increased venous pressure from the pooling of blood causes red blood cells and fluid to leak into the tissues of the leg causing painful swelling and staining of the skin. The red blood cells in the tissue contribute to the chronic inflammation and hyper pigmentation or skin discoloration. This skin discoloration is usually around the inner mid to lower calf and on the inside of the ankle. This is not due to tanning, working outside and it is a sign of chronic venous insufficiency. There is no magic answer as to what causes varicose veins, but there are a few factors that increase your chance in developing them:






Lifestyle:Prolonged standing or sitting

Leg injury or trauma


Medical insurance pays for vein treatment.  Read that again! Insurance covers vein treatment!  Why would your insurance company pay for your to receive vein treatment if it was cosmetic?  Insurance companies pay for medical varicose vein treatment because is saves them money, yes they are in business to make money. See the advanced stages of vein disease includes wound treatment, skin grafts, hospitalizations, infection, etc. Now this doesn't happen to everyone with varicose veins, however the cost of prevention is less than that of treating chronic vein disease. Those who do not seek treatment for varicose veins will most likely continue to experience symptoms of pain, fatigue and swelling of the legs and/or ankles. If left untreated, venous disease can cause other health problems including blood clots, venous eczema, skin breakdown, and ulcers.  

It is estimated that 1 in 3 Americans have either spider or varicose veins.  Each year 4 to 5 million visit a physician because of leg vein-related problems. While the unsightly appearance of diseased veins may be the first symptom of complaint, if left untreated more severe symptoms can set in impacting daily quality of life. Symptoms of varicose veins can include:




Swelling of the leg or ankle


Restless Leg Syndrome


Skin Pigmentation


In summary, if you have symptoms of varicose veins take action. If you are unsure of the severity of your condition, take a free vein screening from the privacy of your home or schedule a consult with Dr. Paul Feldman sooner than later to determine if treatment is necessary.

Truffles Vein Specialists has a team of vein experts ready and willing to help you look and feel better. There are a variety of options for treatment all of which are done in office in relatively an hour with little to no down time. Call (678.833.1444) to schedule an appointment today to discuss your symptoms and discover if treatment is necessary.


You Can't Outrun Your Vein Problems

The weather is nice and the days are longer. It’s the perfect chance to get in a nice long run after work and relieve stress. Runners are usually dedicated individuals, who stick to a pound the pavement routine, but that continuous impact can result in runners not only developing knee and ankle injuries but also varicose vein disease. Running doesn't cause varicose veins, but similar to pregnancy, it provides an environment in which those predisposed may develop the disease faster. 

Runners often suffer less symptoms of venous diseases than non runners, initially. As you run you are pumping unoxygenated blood out of the leg, even with varicose vein disease. Venous Disease is common among runners because the increased volume of blood damages the valves in the veins, which makes it harder for the blood to properly circulate through the legs at rest. This may sound like a contradiction, but having the disease, and being symptomatic, are two entirely different things. 

Runners usually become symptomatic after an injury or if they stop running routinely.  They are no longer able to move large amounts of blood flow through the venous system. The muscles of the legs contract and push the blood back up the leg, but without a properly working valve, the blood goes back towards the feet. This is known as reflux or venous insufficiency. 

For runners, the appearance  of veins may worsen after a run because the leg has had a high volume of blood, often resulting in a bulging vein in the back of the calf. This bulge comes from the gastrocnemius veins in the calf. The pooling of blood in the veins creates a heavy sensation and can also cause the legs to swell and feel tired. Any avid runner knows there is nothing quite like the beloved “runners high”, but venous disease can take away that feeling of conquering the world and instead, replace it with one that feels like you are now carrying the weight of the world. In addition to feelings of discomfort, runners, who suffer from venous disease, are also at a higher risk of developing blood clots during long flights or car rides because they have lower resting heartrates. While having a lower resting heartrate is definitely something to brag about in the world of fitness, it can be dangerous for those suffering from venous disease because it means the blood isn’t being pumped as fast. The combination of damaged valves, blood that circulates the body at a lower rate, and lack of movement, due to travel, creates the perfect environment for a blood clot. Marathoners know there is nothing quite like the excitement of race day after training for months, eating right, and of course buying those colorful new sneakers to show off, but all of that could end suddenly if a blood clot were to develop. Blood clots can be life threatening if not properly identified. Runners, and fellow athletes alike, need to immediately address any venous problems they experience. For more information on venous disease, and to get a personalized plan from a board certified surgeon, visit or call 678-833-1444 to make an appointment. Remember, venous disease is a medical condition that most insurance companies cover. 


United HealthCare and Humana Purchasing Property for Tomato Farms

The truth about varicose vein treatment, green tomatoes, United Healthcare, Aetna and the ridiculous natural remedies on Facebook.

Everyone is looking for a quick fix. We all want that magical cure that saves us time and money. I know I wish I could find that magical weight loss drug that helps me drop inches without sweating it out at the gym and counting calories, but the truth is that quick fixes don’t work. The same can be said for varicose vein treatments. The only way to get rid of varicose veins once and for all is to see a specialist, like Dr. Paul Feldman at Truffles Vein Specialists, so you can get a personalized treatment plan that will work. While the initial price may seem steep, it is actually a medical condition covered by your insurance. Let’s be honest, do you really think insurance companies like United Healthcare and Humana would provide coverage for vein treatments if it was as easy as soaking your legs in green tomato juice? While sites like Pinterest and Facebook may be great time killers, and provide awesome recipes, they are not the place to seek medical advice. Check out the list below for the craziest at home remedies that don’t work.

Crazy Vein Remedies that DO NOT WORK:

                1. Bathe your legs in green tomato juice

                2. Apply undiluted apple cider vinegar to the veins

                3. Apply cayenne pepper, mixed with warm water, to the veins

                4. Massage the vein with a mixture of olive oil and water

                5. Apply sliced garlic cloves to the veins using bandages

                6. Make a clay mask and apply to the area

                7. Apply a rag soaked in witch hazel to the area


Varicose vein treatment is a medical condition and is covered by most insurance companies including United Healthcare and Humana, if any of these remedies worked they would require you to do them before paying for vein treatment. It is as simple as that. For more information about vein disease follow @vascularcme on Twitter or like our Facebook page.


Who is Performing the VenaSeal Procedure in Atlanta?

VenaSeal in Atlanta has only been performed by the top vein specialists. Dr. Paul Feldman of Truffles Vein Specialists is one of the few in the south to have been selected to perform this state of the art procedure at his Fayetteville, Georgia location.


You will find that many vein providers advertise the new VenaSeal procedure, however there are only two physicians in the Atlanta area who have actually performed the treatment. Dr. Ricotta in Roswell, Georgia and Dr. Feldman in Fayetteville, Georgia are the only vein doctors to actually perform the procedure at the time of this publication. For those on the south side, who prefer to avoid the task of navigating Atlanta traffic, Dr. Paul Feldman at Truffles Vein Specialists is now offering the VenaSeal procedure. There are plenty of other vein treatment facilities that advertise VenaSeal, and some may be working toward performing the procedure, however there are also a lot of vein centers who will not perform this premium vein treatment due to its upfront cost. When calling to schedule an appointment it is important to ask if they have any experience in performing the VenaSeal procedure.   

Truffles Vein Specialists is a premier vein center located in Fayetteville, Georgia convenient to Peachtree City, McDonough, Griffin, Senoia and Newnan. Dr. Paul Feldman is a board certified surgeon who performs VenaSeal, endovenous ablation, as well as other medical and cosmetic vein procedures. Vein disease is a medical condition and is often covered by medical insurance. The VenaSeal procedure is not currently covered by insurance at this time.



Is there a Topical Treatment for My Varicose Veins?

Dr. Paul Feldman is a Piedmont Clinic physician who provides state of the art outpatient vein treatment at Truffles Vein Specialists. He is one of the first vein doctors to perform the VenaSeal procedure and the first in the Piedmont system.

Natural treatments for varicose veins can be found all over the internet. As a vein specialist, I am astonished at the naivety of the general public when it comes to this condition. It is hard for me to remember a time when I didn’t understand venous anatomy and physiology. I was recently discussing venous disease with my daughter and her friends, who are all very smart and headed to college, when I realized all of those basic anatomy lessons in school had long been forgotten. They didn’t understand the difference between arterial and venous disease even though they are taught about circulation multiple times during middle school and high school. It occurred to me that instead of looking at this topic from that of an insider, I needed to look at it from the consumer’s point of view. The truth is that if veins are not your profession, or unless you have had a major medical vein related incident, then they just an area of the universe that doesn’t require any thought or attention.

Based on this, I can see why the average person, who suddenly notices veins popping out of his/her legs, and now has to choose between an expensive surgery or an inexpensive topical cream, would choose the cream. Vein disease is a medical condition and is relatively expensive to treat when compared to any over the counter product or natural supplement. The problem is these creams and natural remedies are really nothing but fool’s gold. Vein disease is due to venous valve failure and is a mechanical problem. The valves are damaged and no longer work correctly. Everyone, who has had a leaking faucet at home, understands that there isn’t anything you can spray or rub on a leaking faucet to make it stop. You either fix the faucet or shut off the water. In the vein world, we only know how to close the veins (essentially turning off the water).


Finding the right facility for vein treatment can often be a daunting task. At Truffles Vein Specialists, we make finding the right vein treatment plan easy. Clients can take comfort in knowing their veins will be treated by Dr. Feldman, a board certified surgeon, with years of experience. In addition, clients will find a more personalized approach to veins with each patient receiving personalized care and their own treatment plan. Truffles Vein Specialists has the latest in vein treatment technology. Many people prefer to avoid anesthetic whenever possible, but some vein facilities still operate with the idea that sedation is a must. At Truffles Vein Specialists, we use the latest technology to ensure the procedure is as painless as possible. Gone are the days of having to take days off work and feeling groggy for days after, instead, at Truffles, you will find a quick in and out procedure performed by the most competent staff. 


Varicose Vein Treatment Options in Fayetteville, Georgia.

Venous disease is 5 times more prevalent than arterial disease or (PAD). Up until the late 1990's there were very few options for treating and managing varicose vein disease. Confounding the lack of treatment options was the lack of attention that most medical providers put toward the diagnosis or management of the disease. In 2016, there are still medical practitioners who fail to identify vein disease by clinical symptoms. 

Dr. Paul Feldman a board certified plastic surgeon who has treated veins cosmetically for two decades and decided to provide a comprehensive approach to vein treatment, a marrying of the medical and cosmetic in one setting. The result is a truly comprehensive vein treatment clinic located in Fayetteville, Georgia. 

Dr. Feldman provides state of the art treatments for closing the large truncal saphenous veins such as VenaSeal, foam sclerotherapy, endovenous ablation (radio-frequency), laser therapy for small surface veins, micro-phlebectomy and visual sclerotherapy. Currently he is one of two providers who have performed the VenaSeal procedure in Atlanta. He is the only surgeon to perform VenaSeal in South Atlanta.  He was chosen by Medtronic due to his comprehensive and innovative approach to vein treatment. Dr. Feldman treats patients from all over Atlanta, however has an office very convenient to Peachtree City, McDonough, Fayetteville, Stockbridge, Newnan, Tyrone and surrounding areas.





The Next Generation Vein Treatment is Here and Offered at Truffles Vein Specialists





Brian Sapp












MAY 6,  2016

The Next Generation Vein Treatment is Here and Offered at Truffles Vein Specialists


VenaSeal™ Closure System, The Least Invasive Procedure to Treat Vein Disease


Fayetteville, GA, May 6, 2016 Truffles Vein Specialists, a comprehensive vein treatment center located in the suburbs of Atlanta will now offer patients the latest breakthrough in varicose vein treatment. Dr. Feldman is the second provider in the greater Atlanta area to provide this advanced vein treatment option.  VenaSeal, which is recently FDA-approved. VenaSeal is a product of Medtronic, the global leader in medical technology, and has had great success in Europe and Canada. Proven extremely safe and effective, VenaSeal is the only procedure option for treating vein disease that is non-tumescent, non-thermal, and non-sclerosant. This translates to less potential complications, little-to-no pain and extremely fast recovery. VenaSeal’s website summarizes the advantages of using VenaSeal including minimal-to-no bruising, no multiple needle sticks (since there is no tumescent anesthesia), and no need to wear compression stockings post-procedure.  

Vein disease is a medical condition in which valves in the superficial veins stretch out and become damaged. Once damaged, they are unable to control the back flow of blood in the legs. Consequently, blood begins refluxing and causing symptoms such as leg pain, heaviness, cramps, swelling, varicose veins, skin changes and even ulcers.


The VenaSeal Closure System works by delivering a specially formulated medical glue or adhesive agent that closes down the diseased veins. The blood then re-routes to healthy veins and symptoms improve. “VenaSeal is another great treatment option for our patients, and we are pleased to be the first to offer it to residents of Fayette, Coweta, Fulton, Henry and surrounding counties. As the leader in Atlanta, we continue to give patients early access to the best solutions in vein care. We are committed to providing the least invasive approach to vein disease along with the highest quality of care. We strive to provide a complete vein solution to our patients that assist in making them feel and look better. This is something we promise and deliver to our patients every day,” says Dr. Paul Feldman, Founder and Medical Director of Truffles Vein Specialists.  

VenaSeal is now an additional treatment option at Truffles Vein Specialists. Other vein treatments offered at Truffles include radiofrequency ablation, phlebectomy, sclerotherapy, laser and ultrasound guided sclerotherapy. All patients are given a tailored treatment plan based on their diagnosis. Many vein treatments are also covered by Medicare and insurance although VenaSeal is currently a cash pay treatment. Truffles Vein Specialists is a leading vein center led by a plastic surgeon and award winning vascular and vein imaging sonographers specializing in outpatient vein treatments. Truffles Vein Specialists is dedicated to providing the most comprehensive, least painful approach to the diagnosis and treatment of vein disorders using the most advanced, minimally invasive procedures available. Dr. Paul Feldman and Brian Sapp, RVT, RPhS of Truffles Vein Specialists is committed to championing awareness and relief from vein disease. Truffles Vein Specialists is located in Fayetteville, Georgia. For more information about vein disease and Truffles Vein Specialists, please visit or call 678.833.1444




Truffles Vein Specialists “Feel and Look Better!”

If you would like more information about this topic, please contact Brian Sapp at 678.833.1444 or email Kristina Walker at



Five Things You Need to Know about Vein Treatment

When it comes to vein treatment there is a lot of information on the internet. Most of the information is formulaic and doesn't really give the patient the keys or a list of items to reference when choosing the best vein provider.  

1. Modern vein treatment is performed in the outpatient setting with no general anesthesia.

Vein treatment have progressed from the operating room in 1999 to predominately being performed in the physicians office setting. The utility and advances in the use of local anesthetic eliminates the need for general anesthetic. Many people initially desire general anesthesia when it is available, however for vein treatment it is not necessary and actually causes more problems.  Anesthesia can cause permanent memory loss and while the risk of injury due to anesthesia is very low it is a concern. The other advantage of having the patient awake is they can give immediate feedback if there is any discomfort. 

2. No Stitches!

Historically vein stripping was performed and the patient would have stitches (up to 200) all over the legs. Today endovenous ablation allows for treatment without stitches. They don't even include stitches in the surgical packs from the manufacturer, instead the include steri-strips basically a fancy band-aid. The advantage of the modern technique is to eliminate scars and improve the pain and appearance of the legs after treatment, stitches cause scars and you don't want that.

3. Advanced Vascular and Vein Testing

Venous ultrasound varies from facility to facility and even from sonographer to sonographer. Vein diagnosis is greatly influenced by the quality of the venous testing at the facility. The type and quality of equipment used also impact the quality of diagnosis. Often new vein practices will use older or out dated equipment. There are facilities using equipment that is 10+ years old or cheap laptop machines that do not have the image quality of newer equipment. At Truffles we have a dedicated Registered Vascular Technologists and Registered Phlebology Sonographer who have over 19 years of dedicated experience. We also have state of the art Philips Affinity ultrasound systems. 

4. Comprehensive Vein Treatment

Many surgeons and physician dabble in veins. They only are interested in performing lucrative procedures and don't offer all of the secondary treatments that are required to optimize treatment. Some facilities that do focus on veins often are still procedure driven and not patient oriented. It is important to find a provider who is interested in treating you and your condition. 

5. Vein Disease is a Medical Condition

Varicose veins are not just a cosmetic concern; they often result in physical symptoms. Signs of venous insufficiency include: varicose veins; leg swelling; skin changes, such as redness or a brownish staining and a whitish loss of skin pigment; and ulcers on the legs. Symptoms of venous insufficiency include: leg and pelvic pain or cramping; a feeling of throbbing, aching or heaviness in the legs; leg fatigue; and restlessness. 

At Truffles Vein Specialists we value your business and want to provide you the highest level of service. Please feel free to contact us regarding your vein condition. Dr. Feldman and the staff at Truffles Vein Specialists provide comprehensive vein treatment at our Fayetteville, Georgia office. 


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Address: 874 West Lanier Avenue, Suite 120A

Fayetteville, Georgia 30214




Fax: 678.833.1425

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Truffles Vein Specialists / 874 W Lanier Avenue/ Suite 120A / Fayetteville / 30214