Dr. Michael Probstfeld, a native of southern California, is a graduate of Chapman College and the University of California at Irvine Medical School. Certified by the American Board of Surgery, Dr. Probstfeld is a member of the American Medical Association, a fellow of the American College of Surgeons, a member of the Tucson Surgical Society and the American Society of General Surgeons.
Veins1: Why did you become a doctor and why did you decide to go into vascular care?
Dr. Probstfeld: I was enamored with using my hands to help people, to see the results of what I was doing. And the challenge, the mental challenge. That’s why I became a surgeon. As for why I went into treating veins, there were several reasons. First of all I saw a need for it. There was a big niche, patients were always coming and wanting their veins treated. And also I saw many other physicians weren’t particularly interested in that area, so I felt that was something that could be developed, and an area I could develop some expertise in.
Veins1: You have said that your greatest contribution to vascular care is the employment of the TriVex system to treat symptomatic cluster veins. Describe symptomatic cluster veins for our readers.
Dr. Probstfeld: Those are the prominent varicose veins that are often seen in the lower extremities, particularly below the knee but also above the knee, that look like worms or snakes or ropes underneath the skin. They’re clusters of abnormally dilated veins, and they can cause aching and heaviness, and certainly cosmetic distress to patients because of their appearance.
Veins: Do they have additional complications?
Dr. Probstfeld: The whole pathophysiology of the disease can result in other complications. Usually the problem starts from the greater saphenous vein, one of the main superficial veins of the legs. The valves become sort of leaky or incompetent and the blood flow is reversed or abnormal in that particular vein. As such, the blood flows the wrong way and causes a high venous blood pressure in the lower part of the leg. The result of that can be damage of the skin of the lower leg and ultimately can lead to breakdown of the skin and ulcer formation. So to treat those veins you can go a long way toward preventing those complications.
Veins1: How does the TriVex system work?
Dr. Probstfeld: TriVex actually is the brand name for a powered phlebectomy system. The operation for superficial varicose veins is a two-pronged approach. The first approach is treating the main saphenous vein, which can be done in many different ways, either with stricting, or with the pin method that I use, or endovenous systems using radiofrequency or laser, which I am going to be employing shortly.
Now, the clusters are the branches off of that main venous system, and those can be treated either with pulling them out, called stabovulsion, or with a powered phlebectomy, the TriVex method. The way TriVex works is that a cannula or a small tube is placed underneath the skin and some saline solution is placed underneath the skin to sort of make room to work. And then another small tube which has a little grinder on the end is placed under the skin and it engages the vein or captures it, if you will, and kind of grinds it up and sucks it into a suction chamber, basically just pulls it right out.
The advantage of the TriNex is it can be done with a minimum of incisions, it can be done very quickly, and it offers more complete removal of the cluster veins than other methods.
Veins1: What is your current focus in vein care?
Dr. Probstfeld: I’m developing my own vein care practice and expanding it. In fact, I’m setting up a separate corporation or institute which I’m titling the Southern Arizona Laser and Vein Institute. I’m going to be developing my vein practice further under that moniker. Basically it’s going to be a place where I see patients exclusively with lower extremity vein disease; that way I can offer them more direct attention for their particular problems, and sort of a more comprehensive approach for all their lower extremity vein problems.
I’ll probably be employing other techniques for treating the saphenous vein, likely the endoluminal venous ablation with a laser. A laser fiber is placed into the saphenous vein to sort of seal it closed, instead of actually removing the vein, just sealing it closed. That’s the next step in minimally invasive treatment of vein disease. That along with other methods for removing the clusters, such as TriVex, I think gets me closer to the cutting edge of treating symptomatic varicose veins.
Veins1: What do you see as the most important upcoming trends in vein care?
Dr. Probstfeld: I do think that more and more patients and physicians are recognizing the need to treat symptomatic varicose veins. I think traditionally for many years many patients and physicians have felt that lower extremity varicose vein disease was principally a cosmetic issue, and therefore patients weren’t getting the care that they needed and deserved. But I think the patients are becoming more educated as are the primary care physicians to realize that this is a true disease process.
As in many areas of surgery, we’re going toward a more minimally invasive approach. Instead of doing the big stripping operations and making multiple incisions on the legs, we’re going to less and less incisions, and even using needles to place catheters into the veins to sort of seal the veins instead of even removing them. So I guess that is the current trend, toward minimally invasive procedures and toward education that this is truly a disease and not a cosmetic issue.
Veins1: Are there other new technologies, in addition to TriVex, that are taking strides toward a more minimally invasive system of treatment?
Dr. Probstfeld: The radiofrequency ablation system and the endovenous laser system are two that are being most widely used for the greater saphenous veins. As far as cluster veins, I think TriVex is the newest technology for treating cluster veins. Some people are also using the laser either alone or in conjunction with sclerotherapy to treat the spider veins.