Vascular and Varicose Vein FAQs Answered by Dr. Omar Hamdallah

Dr. Omar Hamdallah is a highly experienced Consultant Vascular and Endovascular Surgeon in Amman, Jordan. He is specialized in the comprehensive diagnosis and treatment of conditions affecting the arteries, veins, and lymphatic system. Dr. Hamdallah is known for utilizing minimally invasive, catheter-based techniques to treat complex diseases like Peripheral Artery Disease (PAD), aneurysms, and severe varicose veins, with a commitment to limb preservation and optimal patient outcomes.

Jordan Vascular Clinic offers a full spectrum of modern vascular treatments, focusing on the latest minimally invasive procedures. Our core services include:
Venous Disease: Endovenous Laser Ablation (EVLT), VenaSeal (vein glue), Radiofrequency Ablation (RFA), and Sclerotherapy for varicose and spider veins.
Arterial Disease: Angioplasty, Stenting, and Atherectomy for Peripheral Artery Disease (PAD) and arterial blockages.
Diabetic Foot Care: Advanced surgical and non-surgical interventions for Diabetic Foot Ulcers and wound management.

You should schedule a consultation if you experience symptoms such as persistent leg pain or cramping (especially when walking), non-healing wounds on the feet or ankles, severe leg swelling, bulging blue or purple varicose veins, or any change in skin color or temperature in your limbs. Early diagnosis by a vascular specialist is crucial for preventing progression to serious conditions like blood clots or limb loss.

Varicose veins occur when the one-way valves inside the leg veins fail, allowing blood to flow backward and pool (venous reflux). This causes the veins to swell, twist, and bulge.
Common symptoms include:
-Visible, rope-like blue or purple veins.
-Aching, heaviness, or cramping in the legs.
-Itching around the vein.
-Swelling in the ankles and feet.

The “best” treatment is highly individualized, determined by a comprehensive ultrasound examination. However, the international best practice and most frequently recommended modern treatments are minimally invasive endovenous procedures, which have largely replaced surgical stripping. These include:
1) Endovenous Laser Ablation (EVLT)
2) Radiofrequency Ablation (RFA)
3) VenaSeal Closure System (Vein Glue)
These procedures are performed on an outpatient basis under local anesthesia, offering immediate relief and a fast return to daily activities.

Both VenaSeal (medical adhesive closure) and Radiofrequency Ablation (RFA) are highly effective, minimally invasive treatments for sealing off varicose veins, but their mechanisms differ primarily based on temperature and anesthesia. RFA is a thermal procedure that uses controlled heat energy delivered via a catheter to collapse the vein wall, which necessitates the injection of a large volume of tumescent anesthesia along the length of the vein to protect the surrounding tissue from burns. In stark contrast, VenaSeal is a non-thermal technique that uses a proprietary medical glue to bond the vein walls together, meaning no heat or tumescent fluid is required; this non-thermal approach is a significant benefit, as it often allows the patient to avoid the use of post-procedure compression stockings entirely, unlike RFA which typically mandates their use for optimal results.

Modern treatments like EVLT and VenaSeal have a very high initial success rate (often over 95%). However, no vascular treatment can guarantee that new varicose veins will never form. Treated veins are permanently closed, but new veins may develop over time from a new source of vein leakage (reflux) elsewhere in the leg. This risk is minimized by addressing all incompetent sources during the initial treatment and maintaining a healthy lifestyle.

Peripheral Artery Disease (PAD) occurs when atherosclerosis (plaque buildup) narrows the arteries supplying blood to the limbs. The most common symptom is claudication, which is:
1) Pain, cramping, or aching in the legs, calves, or buttocks.
2) The pain occurs while walking or exercising.
3) The pain resolves quickly with rest.
Other symptoms include coldness in the lower leg or foot, non-healing sores, and a weakened pulse in the feet.

PAD is typically diagnosed through a physical exam and non-invasive tests. The most common diagnostic tool is the Ankle-Brachial Index (ABI).
The ABI test involves comparing the blood pressure measured at your ankle to the blood pressure measured at your arm. A low ratio (typically below 0.90) indicates reduced blood flow to the limbs and confirms the diagnosis of PAD. Further imaging like duplex ultrasound or CT angiography may be used to locate the exact site and severity of the blockage.

The technical success rate for percutaneous angioplasty and stenting—meaning successfully opening the blocked vessel—is typically high, ranging from 85% to over 95%, particularly for shorter blockages.
The long-term patency rate (how long the vessel stays open) varies based on the artery’s location and length of the blockage, but it offers a crucial, minimally invasive option to restore blood flow, alleviate pain, and prevent amputation.

The choice between bypass surgery and a minimally invasive procedure (like angioplasty/stenting) depends on the patient’s overall health and the characteristics of the blockage:
–Bypass Surgery is Preferred when: The artery blockage is very long, complex, or located in an area where stents historically perform poorly, or when prior endovascular treatments have failed.
–Stenting is Preferred when: The blockage is short, localized, and the patient may not be fit for major surgery.
The goal is to provide the most durable and least invasive solution for the patient’s specific anatomy.

The vascular surgeon is the most critical specialist in diabetic foot care. Their role is to restore blood flow to the foot through angioplasty, stenting, or bypass surgery.
Without adequate blood flow, a diabetic foot ulcer cannot heal, leading rapidly to severe infection and potentially amputation. By quickly revascularizing the limb, the vascular surgeon creates the necessary environment for the wound care team to successfully heal the ulcer and save the limb.

Critical Limb Ischemia (CLI) is the most severe form of PAD and is a vascular emergency. It indicates a severe and prolonged lack of blood flow that threatens the viability of the limb.

Signs that require immediate medical attention:
Rest Pain: Persistent, severe pain in the feet or toes, especially at night when lying flat.
Non-Healing Wounds/Ulcers: Sores or black tissue (gangrene) that will not heal.
Pallor or Coldness: The limb appears pale, blue, or feels significantly colder than the opposite limb.

If you suspect CLI, seek emergency care immediately at Jordan Vascular Clinic or the nearest specialized hospital