Miller Vein named official Ambassador of the COVID-19 Workplace Safety Program

Miller Vein is proud to announce its status as an official Ambassador of the Covid-19 Workplace Safety Program through MIOSHA. We are thankful to our teammates for their diligent efforts and attention to detail in maintaining the highest level of patient safety.

To ensure the safety of our friends, families, coworkers and patients, we will continue to adhere to the CDC & Michigan Health guidelines as we navigate through these turbulent times.

I Need Hip (or Knee) Surgery and Vein Treatment. Which Should I get Treated First?

Every day we see patients with varicose veins, and these same individuals are often suffering from osteoarthritis (degenerative joint disease).  This should come as no surprise, since aging is a significant risk factor for both vein and joint disease.  As most people know, wear and tear eventually will weaken bones, joints, and the cartilage in between. Eventually, the pain caused by this degenerative process leads patients to a hip or knee replacement.

Many patients will ask us, “which problem should get treated first, my hip/knee or my veins?”  So, you may ask yourself, does the order really matter? Short answer is yes. Why?  The sequence of treatment may affect your risk for developing a blood clot!  Research has shown that untreated varicose veins are associated with an increased risk of deep venous thrombosis (DVT) after total hip replacement (also known as total hip arthroplasty or THA) or knee replacement (also known as total knee arthroplasty or TKA).  In fact, it has been demonstrated that treating vein disease decreases the chance of post-operative DVT by 50%.

Speaking of knee surgery, we have had the occasional patient with knee pain, thought to be arthritis actually turn out venous disease. For example, a 40-year-old female came to our office with varicose veins in both thighs extending to her lower legs. She had received two negative knee arthroscopes to assess her knee pain. This discomfort was bad enough that she had trouble playing with her young daughters. After we treated her veins, she was thrilled! She could play with her kids again. Also, she had the answer that had eluded her for years. Her knee pain was related to her veins.


Varicose veins are more than a cosmetic concern. Not only do they cause pain, aching, swelling and other lower extremity symptoms but they are a risk factor for blood clots after hip or knee surgery. Thus, it’s useful to receive appropriate vein treatment prior to these orthopedic surgeries.


Prophylactic GSV surgery in elderly candidates for hip or knee arthroplasty

Open Med (Wars). 2016; 11(1): 471–476.  Gennaro Quarto, Bruno Amato, Giacomo Benassai, Marco Apperti, Antonio Sellitti, Luigi Sivero, and Ermenegildo Furino

Does Previous Varicose Vein Surgery Alter Deep Vein Thrombosis Risk after Lower Limb Arthroplasty? Orthopaedic Surgery2012; 4:222–226 • DOI: 10.1111/os.12003

Anahita Dua, MD, Santiago Neiva, Alasdair Sutherland, MD(Hons), FRCSEd(Tr&Orth)

Can an Octogenarian Safely Receive Vein Treatment?

Varicose veins in the United States are a common problem. In fact, it is estimated that approximately 30% of the adult population have these irritating veins. Unfortunately, many physicians believe that these are only a cosmetic problem, especially when they care for an elderly patient. Nothing could be further from the truth!

Varicose veins are frequently associated with significant symptoms that cause many “functional” limitations. In other words, people have a problem carrying out their typical activities of daily living. It becomes difficult to do yard work, housework, or even to go shopping!

Furthermore, quality of life studies reveals that people with varicose veins often have scores (how they rate their quality of life) that are similar to those who have had prior heart attack, stroke, or a fractured hip. It’s a serious problem.

With this in mind, there was an interesting study that looked at how octogenarians did after vein ablation (closing a vein down) and compared them to younger patients. Of note, those who were over the age of 80 typically had far more cardiovascular co-morbidities (heart and vascular conditions). They also usually had more severe vein disease compared to their younger buddies.

So how did the octogenarians fare? Drum roll please… They did just as well as the youngsters. It was shown that vein ablation is both safe and effective in the elderly. Thus, age should not be used as a factor to deny these patients the care they deserve.

Safety and efficacy of venous ablation in octogenarians. Aurshina et al.
Journal of Vascular Surgery: Venous and Lymphatic Disorders, September 2019; p 685-692

What Science Says about Healing a Leg Ulcer

The most common cause of a leg ulcer is a faulty vein(s) that allows blood to leak or travel the wrong way in your lower extremity. A useful analogy to how of these leg ulcers form is to think of your vein as a leaking pipe and your skin is dry wall. Now imagine the leaking pipe is causing the dry wall to get wet and eventually rot. The damaged dry wall will crumble and maybe even develop an open hole.  This open hole is the venous ulcer.

While patching the dry wall may make your wall look okay, with time the wall will get wet again and you will be left with another hole! So before patching the wall, it’s really important to fix the leaking pipe. Similarly, if you want your leg ulcer to heal, you need to have the underlying “pipe” or vein, treated.

Excerpts from a testimonial of one of our patients, Marlene, who suffered from a non-healing leg ulcer sums up the experience of many people:

My personal experience with Miller Vein was finally my journey to healing. I had a venous leg ulcer. (Prior to Miller Vein) I probably had close to 40 visits altogether. The (prior) wound care clinic treated the ulcer with topicals, debriding and wraps… My lucky day (was when my) doctor handed me a Miller Vein card. My husband and I contacted them immediately. I had two office procedures. The wound proceeded to heal…

Notice that prior to definitive treatment, Marlene visited her wound care clinic up to 40 times. We hear stories like this all of the time. Instead of fixing the pipe, they had their dry wall worked on. But does science agree with this concept? I would say YES

In a trial conducted at 20 centers in the United Kingdom, 450 patients with venous leg ulcers were randomly assigned to either undergo early endovenous ablation of superficial venous reflux (closing down an unhealthy vein) or not. Both groups received compression treatment as part of their care. The results? Early endovenous ablation of superficial venous reflux resulted in faster healing of venous leg ulcers and more time free from ulcers.

The take home message is that veins are the most common cause of leg ulcers and when this is the case, early treatment will result in faster/longer lasting healing.

Ref: A Randomized Trial of Early Endovenous Ablation in Venous Ulceration  


Manjit S. Gohel, M.D. et al. published on April 24, 2018, at

Another Reason to Appreciate Health Care Workers: Vein Disease

Since the COVID-19 pandemic, the public in general has appreciated health care workers more than ever. Yard signs are still scattered about thanking these frontline caregivers. A recent study demonstrated that chronic vein disease is very common in these workers. This is in spite of the fact that they don’t have other cardiovascular comorbidities (i.e. heart or vascular conditions).

A large screening study of health care workers found that most hospital employees (a whopping 69%!) had signs and symptoms of chronic venous insufficiency (CVI). This means that they complained of leg swelling and also potentially had pain, aching, heaviness, or skin changes of their lower extremities.

CVI accounts for a loss of approximately 2 million workdays per year and almost 12% of healthcare workers seek early retirement because of symptoms.

Left untreated, CVI can progress to a leg ulcer. The annual cost of venous ulcer care is estimated to be $3 billion.

Ultrasound screening on these employees revealed that 82% had venous reflux (blood going the wrong direction in their legs). Also, up to 14% were noted to have increased risk for blood clot!

Long story short…We really need to take care of our frontline health care workers and institute appropriate preventative strategies.