News & Articles

Sudden Bleeding from Varicose Veins

As vein problems first develop, people are somewhat concerned of their appearance or their vague symptoms such as end-of-the-day leg achiness.  However, no one likes the bulging or obvious leg veins or the webbed discoloration of spider veins.   For the most part, concerns end here until varicose vein problems progress.  As blood back flow and pooling increases, veins can become engorged and become exaggerated and distended surface veins.  While such veins don’t immediately affect overall health, one potential problem we see in our clinic is patients who have sudden bleeding from a surface varicose or spider vein.  This can be quite alarming.

The untreated varicose veins have a higher than usual risk of a spontaneous rupture and bleeding.  Varicose veins, over time, grow larger, and as the vein wall stretches out, they weaken.  These weakened veins are also under high pressure due to back flow (or reflux which is the underlying problem).  The result of this high pressure condition can be a spontaneous burst and heavy bleeding.  Patients often worry they have ruptured an artery because of the forceful pulsating-like high blood flow from the vein.

We often hear of these incidents when a new patient contacts our office the day after a bleeding incident.  A patient will describe that a sudden bleed occurred during a warm shower.   The dilation or relaxation of the vein with warm water allows more blood to pool in the veins.  Patients also report bleeding incidents at night while sleeping.  They are awakened when they feel sudden, warm moisture around an ankle.  Those patients on blood thinners can lose a significant amount of blood, especially if it occurs during sleep.

In a state of near panic, patients or family members often call emergency services that transport the individual to the emergency room.  Bleeding has usually subsided with elevation and external pressure during transport.  We commonly see these patients the day following their emergency room visit.  With duplex venous ultrasound we are able to locate the refluxing or incompetent saphenous vein leading to the problem or surface varicose or spider vein.  We then provide our patients individualized  treatment plans and recommendations.

Patients with sudden varicose vein bleeding, usually require scheduling of procedures such as a thermal vein ablation with or without microphlebectomy to treat the problem. Patient instructions on managing bleeding, were it to recur before an upcoming vein treatment, are emphasized.  Placing a wrap, applying pressure and elevating the leg will, most often, stop the sudden bleeding.

If you or someone you know has experienced bleeding from a superficial varicose vein, it is important to see a vein specialist.  Prevention is key; through  appropriate diagnosis and treatment, sudden bleeding from a bulging varicose or spider vein can be avoided.  This is a familiar occurrence with varicose veins and is one we commonly manage at Minnesota Vein Center.


Free Vein Screening: August 2017

August free vein screening

We’re in the midst of another beautiful Minnesota summer, but the best weather, in our opinion, is yet to come. When the humidity clears, the leaves start to turn, and the sun isn’t as strong, being outdoors in Minnesota is idyllic. Before those days come, stop in for a visit to get your varicose and venous disease questions answered and get on the path to less pain, swelling, and throbbing in your legs.

You’re invited to our August Free Vein Screening Event.

Request an appointment from 9 a.m. to 5:00 p.m. on Monday, August 7 or Tuesday, August 8 at Minnesota Vein Center. Remember, varicose and venous disease are hereditary conditions; left untreated they may result in more serious problems. Please share this Free Vein Screening Event with your friends and family who may also seek relief.

Free vein screenings include a history, exam, and ultrasound. Screenings are approximately 20 minutes. To request your free vein screening appointment, please complete the form below or call us at 651-765-8346. We look forward to seeing you in August!


This event has ended. Thank you to everyone who made this screening a success. Check back often for more vein screening opportunities.


6 Tips for Choosing a Vein Specialist

If you are searching for the right physician and facility to have vein treatment or wondering what to consider when choosing a vein specialist, you may have several questions to answer.  You will want a highly qualified doctor and a specialty vein clinic and staff to perform all of your vein procedures. In your search, you will discover that veins are treated by dermatologist, internists, interventional radiologist, surgeons and others specialists. How do you find the best doctor – the right fit for you?   Here are important factors to consider.

Find a vein specialist who:

  • Is a board certified physician but who also specializes in varicose vein and spider vein treatment
  • Has experience treating patients with your specific condition and all leg vein conditions
  • Accepts your insurance. The physician is credentialed through major insurance companies
  • You feel comfortable talking with and one who listens and answers your questions
  • Has a vein practice and the clinic  is solely dedicated to vein care.  The physician is also credentialed by a local hospital
  • Provides a comprehensive evaluation and treatment plan and is also able to treat the more complicated vein conditions. 


Six Tips for Choosing a Vein Specialist:

1. Review Recommendations:

You may start by creating a potential list of specialists.   Friends, family and co-workers may be an excellent source of information when it comes to recommendations because they often have first- hand experience with someone in whom they have developed trust.  Sites that show patient satisfaction ratings, which may give you insight into their experience can be helpful. Your private physician or nurse practitioner may rely on their own referral system but often they will share with you reports of their patient experiences. 

2. Confirm Credentials and Experience

Take time to research the doctor’s credentials and their experience.  Look for a physician who is board certified in internal medicine, dermatology, vascular medicine or surgery and is also certified as a Phlebologist (Venous and Lymphatic Medicine Physician.) You will want to know the doctor treats varicose veins and spider veins on a regular basis.  How long have they been treating veins and how many procedures do they perform each month.   Does the physician have special credentials in ultrasound (RPVI, RVT or RPhS) and is he/she recognized by the American Board of Venous and Lymphatic Medicine.

Confirm the physician is in good standing with state and federal agencies and that the physician has no history of malpractice claims or disciplinary actions.  A hospital affiliation means a higher level of physician credentialing.

3. Evaluate the Clinic/Center:

Do you feel comfortable with the clinic’s physical layout and is it clean and comfortable.  Does the center have a stable and dedicated staff that is very familiar with venous disease?  Do you speak with the same staff each visit?  Does the staff have a dedicated registered vascular ultrasonographer (RVT) full-time employee who specializes in venous ultrasound and diseases?  Is the clinic accredited by the Intersocietal Accreditation Center (IAC) which ensures best practices in venous diagnostics and care?  Does the clinic have additional staff such as nurse practitioner, specializing in venous disease (RPhS), who can thoroughly answer questions, guide your care and help you with pre- and post- procedure issues or questions?

4. Look for Current Technology:

Lower extremity vein conditions or disorders do require a specialist.  The venous anatomy of the legs, pelvis and abdomen has variations that require an experienced hand and eye.   Ultrasound equipment is ever- advancing, this improves the diagnosis of venous conditions.  Treatment modalities also improve over time.  A high quality vein center should offer many alternative techniques and technologies to manage venous conditions and complicated cases including incompetent perforator veins.

Ablation treatment options should include thermal (laser and radio frequency) and non-thermal (Clarivein and VenaSeal.)  To treat tributary varicosities, the specialist should be highly skilled at phlebectomy and also ultrasound- guided (chemical) sclerotherapy.  Superficial (spider vein) sclerotherapy and non invasive Veinwave or VeinGogh technology should be available.  As a patient consumer, you should feel free to ask the staff about the diagnostic and treatment options offered by their facility.

5. Interview the Vein Specialist:

During your first visit, take the time to go over the questions you have listed and take note of how comfortable you feel talking with the physician.  Does he/she seem to respect your opinion and answer your questions in a way you can comprehend?

You might ask these questions:

  • Do you often see or treat patients like me?
  • How many treatments, like the one I need, do you do in a month/ in a year?
  • What is the usual outcome with a procedure for someone like me?
  • Have you ever had a procedure you could not complete? (This answer should be ‘no’.)

6. Explore Insurance Benefits:

Learning from your insurance provider or the clinic about your insurance coverage is a practical matter.  Vein procedures/surgeries are typically covered under insurance.  The type of coverage, of course, depends upon the plan you have selected from your employer.  Often times a vein treatment facility may state that your insurance policy does not cover your procedure.  Such facilities or physicians may not possess credentialing through one or more insurance companies (often for complicated reasons.)   Be certain to clarify with an alternative clinic or your insurance provider if this occurs.

Make the Wise Choice

We are very fortunate today in that treatment of vein disorders are minimally invasive and they are easily performed in the office setting.  Patients do walk out following their treatments and they do return to their normal activity very soon thereafter.   The best outcomes occur when you chose your vein specialist wisely.

Not all vein care is equal.  Take advantage of our tips for choosing a varicose vein specialist as you begin your search.  A little homework can mean dramatically better treatment options and treatment outcomes.   At Minnesota Vein Center you’ll find that high quality setting and vein specialist  you seek. Contact us and we can assist in your search.


May 2017, Free Vein Screening Event

Minneapolis Free Vein Screening 2017

You’re invited to a May Free Vein Screening Event. Request an appointment from 9 a.m. to 5:00 p.m. on May 1-4 and May 8-11 at Minnesota Vein Center.

Varicose and venous disease are hereditary conditions; left untreated they may result in more serious problems. Please share this event with your friends and family.

Free vein screenings include a history, exam, and ultrasound. Screenings are approximately 20 minutes. To request your free vein screening appointment, please complete the form below or call us at 651-765-8346. We look forward to seeing you in May!


This event has ended. Thank you to everyone who made this screening a success. Check back often for more vein screening opportunities.

Mothers and Varicose Veins

variocose vein doctor st paul

Why do women get varicose veins?

Women and men both develop varicose veins but when looking closely at the scientific studies we learn that women tend to be at a higher risk than men for developing, bulging, dark, and painful vessels.  The reason may very well be associated with the hormone progesterone.  Progesterone is produced by men as well as by women, but levels are much higher in women.  Studies indicate pregnant women with varicose veins had higher progesterone levels compared to pregnant women, during the same trimester, with lower progesterone levels, and who had no varicose veins.

Other studies which look closely or microscopically at the saphenous vein wall, the large veins that begin to enlarge in both men and women then causing smaller varicose veins and spider veins, actually have special progesterone receptors.  These sensors make the vein wall more sensitive to the effects of the progesterone hormone.

How does progesterone cause varicose veins?

Not only does the hormone progesterone contribute to the regulation of menstruation and the reproductive cycle, it affects bone health and causes blood vessel walls to relax.  When vein walls relax the vein valve moving blood upwards also begins to relax.  The blood flowing backward then exerts pressure on the vein wall pushing on the sides of the vessel, making them weak.  Since women have significantly higher levels of progesterone than men, researchers believe this is one reason women are more prone to developing varicose veins.

There are many factors which affect the risks of developing varicose veins.  Awareness of the hormone factor, pregnancy and genetics and more, may help to understand the mothers and the female predisposition.  Regardless of gender, though, varicose veins cause discomfort.  Left untreated, varicose veins can cause more serious problems.

Keeping closely aware of your personal leg vein health, is important.  Allowing easily treated vein conditions to worsen can result in complications of skin discoloration, skin thickening and leg ulcers.  As May approaches, and as we recognize women and mothers, May will be dedicated to public awareness at our Minnesota Vein Center, North Oaks/St. Paul office.  Call for a consultation with Dr. Pal.

Varicose Veins, Increasing Public and Physician Awarenss

Varicose Vein St Paul Dr. Pal

Varicose veins and spider veins are very common in both men and women.  Today, patients have access to a number of effective varicose vein treatment options.  Advancements in technology and medicine have led to the development of effective, minimally invasive treatments that produce optimal results and minimal downtime.

Patients today may find themselves in a very confusing landscape as they seek expert venous care. There is a surge of non-vein specialists attempting to add vein treatments to their broad array of medical services.  Venous disease and their treatments, however, require expertise, special credentials and skills, equipment and a highly experienced team for best practices and patient outcomes.

Minnesota Vein Center, as a focused vein specialty center for over 12 years, has responded to this change through our dedication to physician and public education.  Our goal is to increase public awareness regarding venous disease, its manifestations and presentations and appropriate and ethical disease treatments.

Recently, to increase public awareness, we were invited to publish informational content in Minnesota Health Care News, March 2017 edition.  In April we will be reaching out to Physician’s, Epidemiologists, Occupational Medicine staff at local large corporations in group presentation.  We also invite the public in May 2017 to Minnesota Vein Center starting May 1st through May 11th to visit our center for on-site screenings and vein health information.  Venous disease and disorders continue to be overlooked even in the year 2017.   We strive to bridge this obvious awareness and vein information gap by helping physicians and nurse practitioners and the patient as a consumer to find  correct diagnosis and  appropriate treatment and care.

Read more in the  Minnesota Health Care News, Varicose Vein   March 2017 article by Dr. Pal and Jacqueline Pal, CNP.

1st International College of Phlebology Veins Meeting, London U.K.

vein treatment meeting St PaulOur Vein Center’s team, Jacqueline Pal, CNP, and Dr. Pal returned Monday following a special invitation to participate in The College of Phlebology  1st International Veins Meeting, London, U.K.  The meeting was held March 15 through 17th.  Professor Mark Whiteley, Vascular Surgeon served as Chair of the conference.

The program was quite unique in that it included live procedures which were streamed from adjoining procedural suites.  We attended their excellent scientific session and also a hands-on workshop. As part of the international audience, we were able to observe and question the actual operating physicians during live procedures .  These procedural cases included endovenous surgery, including perforator vein ablation and live abdominal and pelvic ultrasound in search of more complicated higher vessel abnormalities.  This event also streamed a pelvic vein embolization procedure on a female patient with pelvic pain due to her pelvic (vein) congestion syndrome.  We found it helpful to view the procedure with a patient’s perspective in mind (she was able to talk with us) but it also was as an excellent update in current best vein disease practices.

A second session concentrated on the science and developments in venous surgery.  This session included cellular biology (histology) and venous blood flow dynamics; It also included new techniques in vein treatments and aesthetic vein treatments.  We especially appreciated those talks with our colleagues regarding the actual vein wall response to the various types of lasers or catheter fiber treatments and the various sclerosing agents (sclerotherapy drugs) and their cellular effects on the vein wall.  How the vein wall may react on each individual patient basis in the vein wall was a topic we found interesting and helpful . These factors affect patient treatment outcomes and should be considered in vein treatment decisions.

A third session was run by the Leg Ulcer Charity of the UK .  This was a very good review and update on how to evaluate, differentiate, treat and monitor (venous) leg ulcers.  We are certainly looking forward to the roll-out of the soon-to-be launched mobile ‘Medopad’ app.  This tool will help patients to communicate and to monitor their own venous wounds closely using a phone app and sharing with their physicians, nurse practitioners or nurses to enhance an organized approached to  healing.

Not only did we enjoy the smaller conference venue, the international faculty and international participants, we  reconnected with familiar faces (professional friends) and were even able to do a bit of self-guided touring by way of Westminster to Buckingham Palace.  It’s nice returning to Minnesota with new technical information and ideas to advance our patient care and we feel refreshed from a rewarding international experience.


What is Ambulatory Microphlebectomy

micro-ambulatory phlebectomy varicose veins minnesota vein center

There are many effective options for treating varicose veins today. While technology like laser and radiofrequency energy can be a good choice for some patients, others may need those bulging vessels actually removed by a physician. The good news is that surgical vein stripping, which involved considerable discomfort and an extended recovery period, is no longer used for this purpose. Instead, vein specialists have turned to a less invasive procedure known as ambulatory microphlebectomy which provides excellent results without pain, downtime or an overnight stay in a hospital.

Understanding Ambulatory Microphlebectomy

Ambulatory microphlebectomy is a minimally-invasive procedure used to remove large varicose veins from the leg in small sections. The procedure is performed using micro-incisions that do not require any sutures and leave no visible scarring afterward. Through these incisions, a special micro- tool is used to grasp the vein and remove sections.

Candidates for Ambulatory Microphlebectomy

Ambulatory microphlebectomy is generally recommended for patients with bulging, protruding varicose veins that are causing physical symptoms as well as their unsightly appearance. Symptoms might include:

  • Heaviness or aching in the lower leg
  • Swelling of the lower leg and foot
  • Restless legs or leg cramps at night
  • Skin irritation around the swollen vessel

If this condition is left untreated, it can continue to worsen and keep you from enjoying certain activities due to discomfort and embarrassment. Skin changes may begin to include discoloration of the skin and the formation of open sores around the ankle, known as venous ulcers. The good news is that by removing the affected veins from the leg entirely, we can also effectively eradicate the symptoms, prevent further complications and improve your quality of life overall.

Fast Treatment, No Downtime

Ambulatory microphlebectomy is performed in our office as an outpatient procedure. Patients are given local anesthetic to keep them comfortable during the treatment. Tiny incisions are made along the length of the vein to be removed, and then sections are excised using a special hook that grasps the vein and eases it out of the leg vein. Most ambulatory phlebectomy procedures take one hour or less to perform, depending on the number of veins to be treated.

After the procedure, you may be able to return to your activities right away. However, most patients wait until the next day to resume their schedules. You will likely be advised to wear compression stockings for seven days after treatment, which increases  blood flow and promote healing to the treatment area. There should be little discomfort, bruising or swelling after the procedure.

Superior, Long-Lasting Results

The results of ambulatory microphlebectomy can be seen right away and will continue to improve in the days following treatment as the leg fully heals. It is also likely you will experience relief from uncomfortable symptoms almost immediately following your procedure. Because the affected vein is removed, the results of ambulatory microphlebectomy are considered permanent.

If you are suffering with large, painful varicose veins, there is no reason to suffer any longer. Contact the Minnesota Vein Center today at 651-765-8346 to find out if ambulatory microphlebectomy is the right treatment for you.

Do I need varicose vein treatment?

If you have pain, swelling, heaviness or achiness in your legs, ankles, or pelvis you may have varicose veins (venous insufficiency.) Typically, those with varicose veins also suffer from pain and achiness while sitting, standing or walking for long periods of time. You may experience the achiness and pain in the evening or when you are laying down in bed for the night.

The pain and achiness may be something that you experience occasionally or on a daily basis. The use of Ibuprofen and Tylenol may give you some relief of the pain and achiness. Venous insufficiency is a disease and should be treated by professionals who specialize in comprehensive varicose vein management including diagnosis and treatment.

Jan/Feb 2017 Free Vein Screening Event

We are offering Free Vein Screening appointments from 9 a.m. to 5:00 p.m.  every  Monday-Thursday from Monday, January 23rd through Thursday, February 16th at Minnesota Vein Center.

Varicose and venous disease are hereditary conditions; left untreated they may result in more serious problems. Please share this event with your Friends and Family.

Free vein screenings include a history, exam and ultrasound. Screenings are approximately 20 minutes. To request your free vein screening appointment, please complete the form below or call us at 651-765-8346.


This event has ended. Thank you to everyone who made this screening a success. Check back often for more vein screening opportunities.