Dr. Derek de Grijs, MD, RPVI, is a Nashville native and a vascular surgeon at Middle Tennessee Vein Clinic in Franklin. After growing up in Nashville, he attended Georgetown University where he studied English and psychology in addition to his pre-med studies and played on the baseball team. “I had so few great moments!” he jokes about his college diamond days. But on a serious note, he adds, “I wanted to study more of the sciences as an undergrad, but it wasn’t feasible because the classes I was interested in conflicted with my baseball commitments.”
However, as an undergraduate he held various volunteer and paid positions at Georgetown University Hospital and, specifically, its renowned Wound Care Center. There he made connections and gained exposure to vascular and wound care surgery. After graduating, he attended medical school in Memphis, followed by a general surgery residency with much of his time spent on vascular service, “and it became a passion of mine, treating these types of complex and chronic problems.”
Recently we met with him to discuss the services and care he and his colleagues provide at Middle Tennessee Vein Clinic.
Let’s get right to the point: Varicose veins. What are they and why should someone schedule an appointment with you?
A varicose vein develops when the valves inside a vein fail to do their job effectively, thus impeding the flow of blood back to the heart, a condition often referred to as venous insufficiency. This is what causes large, bulging varicose veins as well as smaller, pesky spider veins. Blood collects in the veins, causing bulging or swelling, with a deep blue or purple color. Usually, the immediate concern is appearance because they typically occur in the lower extremities that are often exposed. This can progress to include swelling, heaviness or pain.
Prior to an initial consultation, you could try to treat varicose veins by wearing compression stockings. But if you arrive at a point where you need to wear them every day to mitigate swelling, fatigue, and/or pain that’s when you
should call for an appointment so that we can assess your condition.
What are the possible side effects if varicose or spider veins are left untreated?
Initially, there are few medical complications. However, by the time you are seeing the outward signs of venous insufficiency, your venous circulation has likely been abnormal for years and will tend to get progressively worse. Severe swelling that’s not addressed for a period of years can lead to a decrease in skin integrity which can result in wounds and ulcers that require immediate evaluation. The primary point to keep in mind is that vein issues in the legs are highly treatable with early intervention. Good outcomes are still possible for those who wait, but the long-term prognosis is better when treated early.
Does health insurance cover the cost of varicose vein treatment?
Yes, most commercial and Medicare based insurance plans cover the cost of treatment of symptomatic varicose veins, with few exceptions. Of course, what everyone wants to know is what their treatment will entail and what a successful outcome looks like.
The treatment of venous disorders of the leg varies greatly from patient-to-patient and involves a thorough evaluation to customize an individual treatment plan tailored to give each patient the best results possible. Procedures to treat varicose veins and spider veins of the legs are quick, office-based procedures with very little recovery and downtime. These procedures include heat-induced closure of malfunctioning veins, injections or sclerotherapy of smaller spider veins, or the use of micro-incisions to individually remove varicose veins. Often a combination of these procedures is used to ensure the best result from both a cosmetic and comfort perspective.
As a vascular surgeon, do you treat conditions that can be deemed more serious and that require immediate attention?
First, in the event of an emergency, you should seek treatment at an emergency center. But we do treat conditions such as abdominal aortic aneurysms (AAA) which occur when weakness in the wall of the aorta causes part of the abdominal aorta to expand or bulge, and potentially burst. The good news is that the treatment has come a long way. Twenty-five years ago, it was a high-risk surgery with a large abdominal incision, followed by a week of hospital recovery. Now, it’s a 90-minute procedure performed in the state-of-the-art hybrid operating room at Williamson Medical Center. It involves two small incisions in the groin area. The patient is held overnight for observation and typically goes home the next morning.
Other conditions we treat include carotid artery disease, peripheral artery disease, pulmonary embolism, DVT and other deep venous disorders, pelvic congestion syndrome, and uterine fibroids. While these are serious conditions, I want to stress that in many cases the patient will experience symptoms before an emergency arises.
What percentage of your patients are women and what percentage are men?
Probably 70-80 percent of the patients we see for lower extremity vein issues are women. There are physiologic reasons for this such as pregnancy, estrogen exposure and genetics. Men tend to disregard their varicose veins because, frankly, they just pay less attention to the appearance of their legs and put off treatment for many years despite what often ends up being quite advanced symptoms. But whether you’re a woman or a man, it’s important know that varicose veins and venous insufficiency is a progressive disease. It’s very treatable, but the long-term results and outcomes are better when addressed early.
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