Dr. Kenneth Harper is a general surgeon specializing in the treatment of vein disease. In 1997, after identifying the need for comprehensive venous care, Dr. Harper began to study the latest advances in the evaluation and treatment of venous disease. Over the ensuing years he has traveled across the country studying and training with specialists in the field of venous disease.
Two hallmarks of Dr. Harper’s practice are his strong emphasis on patient care and education. Because of his commitment to provide his patients with the best vein care, Dr. Harper continues his own education and is committed to educating other physicians in the treatment of venous disorders. Dr. Harper’s vein practice, The Vein Specialist of Central Georgia, continues to grow as he emerges as a leader in the field of venous care.
Veins1: Could you describe some of the different areas you specialize in as a general surgeon?
Dr. Harper: I have several focuses in my practice. I work with patients with vein diseases, such as spider veins and varicose veins. They account for 60 percent of my practice. This number has grown steadily because there is such a great need for vein care. The remainder of my practice is divided equally between breast problems, hernias, and gallbladders. I am also starting a hair restoration program.
Veins1: It appears that you have a strong emphasis on patient care in your practice. Could you describe your practice philosophy?
Dr. Harper: My philosophy is to treat the whole patient, not just the symptoms that brought them into the office. I am interested in their physical, spiritual, and emotional needs. As far as patient care, I am committed to world-class care in a hometown environment.
Veins1: How did you first become interested in vascular surgery and treatment?
Dr. Harper: As part of general surgery, I had training in vascular surgery, and did arterial vascular work for a number of years. But the field of venous disease was ignored in my medical school training and residency. In 1997, I developed an interest in the use of lasers for treating spider veins. I studied extensively about laser applications and surgery and started to see patients with spider vein problems. A lot of these patients also had varicose vein problems. This is when I identified a need for comprehensive venous care for my patients. In order to become educated in all areas of venous disease, I traveled extensively, studying and working with world-recognized leaders in the field of phlebology.
Veins1: What prompted you to create your practice, the Vein Specialist of Central Georgia, and how did studying across the country help advance your knowledge in the area of phlebology?
Dr. Harper: There are specialists from various backgrounds and experience involved in the care of patients with venous disease. Many of these physicians still use techniques or practices that were introduced more than 50 years ago. Patients who undergo older types of vein treatments are often left with large scars and high reoccurrence rates of their varicosities. I wanted to develop a center of excellence that provided the latest and best methods of treating vein disease, realizing there was so much more that I could offer my patients.
Veins1: Is it important for patients to have their spider and varicose veins treated for health reason as well as cosmetic reasons?
Dr. Harper: For patients with varicose veins, the longer they wait to seek treatment the more likely it is that they will develop complications. These complications may include: swelling, pain, superficial vein thrombosis, ulcerations, discoloration of the skin and scarring. Therefore, it is better to treat the patient at an early stage, rather than waiting for the disease to progress.
Veins1: How are patients suffering from spider or varicose veins typically evaluated when they first come into your office?
Dr. Harper: First we obtain a thorough medical history and review any previous treatments and diagnostics studies. Then a specific vein examination is completed. Examination of the veins includes visual inspection of the legs, palpation, listening to their legs with a Doppler, and examining their legs with a Duplex ultrasound.
Veins1: Could you explain the Doppler to our readers?
Dr. Harper: The Doppler is a handheld device that is used as a screening tool. It looks like a pencil, and allows you to listen to the blood flow in the veins. You can hear the venous blood flow and determine if the veins and their valves are functioning properly. In order for the blood to get from your foot to your heart, it has to travel against gravity when you are standing or sitting. When you walk, contracting your leg muscles and pressing your foot on the floor forces blood up the veins. Normal venous valves close in order to prevent the blood from refluxing or falling back down that vein.
With the Doppler, I hear the flow of blood up the vein and if there is no second sound then the valves are considered normal. If a second sound is heard, it is referred to as venous reflux.
When a patient has spider veins, we listen to them with the Doppler to find out if they have reflux. If they don’t have reflux, we usually go straight to sclerotherapy or laser therapy to treat the spider veins. If reflux is present, then we need to do a more extensive evaluation such as a Duplex ultrasound before we make definitive treatment recommendations. This Duplex ultrasound serves as a map of the veins and the problems that are present.
Veins1: What did you dislike about the treatment of varicose veins in the past?
Dr. Harper: I did not like the amount of time the surgery took, the fact that patients had to be put to sleep, and that patients were often left with large scars on their legs which were sometimes as unsightly as the varicose veins themselves. Also, the incidence of reoccurrence was extremely high and the patient experienced a lot of post-operative pain. It was not uncommon for them to tell me that they were in bed for several days and were out of work for three or four weeks. Today people want to be awake for their surgery. They want to be able to go back to work in a day or two and they don’t want to have a lot of pain. The old type of veins surgery did not meet any of these criteria.
Veins1: Can you briefly describe the options available to patients prior to TriVex and some of the advantages TriVex offers?
Dr. Harper: The treatment of varicose vein disease involves correcting the underlying cause of the problem and removing the visible varicose veins. The underlying cause is usually reflux in the lesser or greater saphenous vein. The visibly damaged veins are the bulgy or varicose veins in the leg. These veins are usually branches of the greater or lesser saphenous vein.
The traditional method of treating the greater saphenous vein is stripping. The vein would be stripped from the ankle to the groin, but now new diagnostic tests have allowed us to determine exactly how much of the vein is bad and to remove only that part. This is done with limited stripping or newer techniques involving radio frequency or laser catheter ablation.
Then you are left to treat the bulgy varicose veins. In the past, these were removed through numerous incisions. It was not uncommon for a patient to have between 15 and 20 incisions from the knee to the ankle, leaving large scars.
Another method that is used for removing the branch varicosities is microincisional phlebectomy. In this procedure, tiny incisions, about 2mm in length, are made and the varicosities are individually removed with micro hooks. These patients have minimal scaring and heal well. The disadvantage of microincisional phlebectomy is that you have to trace out the veins beforehand and you only remove the ones that have been individually marked. The process is often very tedious and time consuming, many times taking 2-3 hours.
This is where the TriVex procedure comes in. A new procedure, developed by Dr. Gregory Spitz, allows the surgeon to actually visualize the varicose veins and remove them through small incisions. It is possible to remove all the visible veins from the thigh to the ankle through three or four tiny incisions. You can be sure that the veins were removed and the process is much quicker. TriVex is a major advancement in the treatment of varicose veins.
Veins1: What criteria do you use to help patients decide which procedure is appropriate and/or necessary in treating branch varicosities?
Dr. Harper: If patients have one small area of varicose veins, we may be able to treat it with microincisional phlebectomy. However, if there is an area with extensive varicosities, which would require multiple incisions, I encourage them to consider Trivex Phlebectomy because they will have fewer incisions and better long-term results.
Veins1: Have you had very many patients with bilateral varicose veins return to have their other leg operated on?
Dr. Harper: Yes. When patients have extensive bilateral varicose veins we typically do one leg per session. They return for the other leg within four to six weeks. To date, we have not had a patient with bilateral varicose veins decide not to return for surgery on the other leg. This fact speaks volumes for their satisfaction in the result of their surgery.
Veins1: What feedback have you gotten from your patients about the TriVex procedure?
Dr. Harper: My Trivex phlebectomy patients have been very pleased with the results. They are surprised that all of their varicose veins can be removed through just a few small incisions. Many of my patients have recommended us to their friends suffering from varicose veins. These word of mouth referrals have not only helped my practice grow but have helped to educate others about the new treatments for varicose vein disease.
Veins1:How soon after the surgery do you advise patients to return to work and normal activity?
Dr. Harper: They can go back to work the next day, but realistically most take a couple of days off of work.
Veins1: In your opinion, how has the procedure improved the quality of life for your patients?
Dr. Harper: Not only do my patients feel better because they have less pain and discomfort, they also feel better about the way they look. It is not unusual to have the women tell me that they have not worn shorts or skirts in years because they felt so self-conscious about their legs. After the TriVex procedure, they are so excited when they come back and their legs look great that they want to go shopping for a new wardrobe.
Once their vein disease is under control, most patients become more active. They are able to walk and exercise without pain or swelling. Thus many patients will lose weight and in general their health will improve.
Veins1: Are you currently working to train other physicians in the TriVex procedure?
Dr. Harper: Yes I am. I am on the TriVex training board to introduce this procedure to new physicians. We discuss the evaluation and treatment of varicose veins and the treatment options for each patient. It is rewarding to see these physicians incorporate TriVex into their clinical practice.
Veins1: Where do you see varicose vein care heading in the next 5 years?
Dr. Harper: There are a number of doctors now that are being educated on the current methods of vein treatment. As technology advances, physicians need to be trained correctly so that they can provide their patients with the best care.
I see the continued development of centers of excellence in vein care across the country. Like the “Vein Specialist of Central Georgia,” these centers will lead to improved patient care as many more patients with venous disease will access these centers for treatment. It is an exciting time to be involved in the field of venous disease.