You are among the many patients outside California who have discovered our unique setup which removes the big and ropey varicose veins in one single session in an office setting using strictly local anesthesia. Our national exposure was made possible to some of you through a simple computer search targeting the National Medical Library. The 7 published medical articles on the subject (the first in 1991 and the last in 1995) are also flagged through computers of most medical school libraries. The recent exposure, in the March 1995 issue of Allure Magazine, was certainly helpful as well. From 1996 this website will attract many more interested parties. We have operated on patients from Florida, Georgia, Texas, Ohio, New Hampshire, Colorado, Nevada, Washington, Arizona, etc.

Before contemplating making the trip to Encino (a suburb of Los Angeles), since not everyone knows the differences between types of veins, we would need a set of good photographs of your leg(s), front and back. It should be accompanied by a brief description of existing symptoms, as well as your height and weight. If your problem is unwanted hand veins, we would like to see a picture of your veins displaying the tops of your hands while the fingers are pointed towards the floor in order to congest the veins. Please mention medications you take for other conditions. Don't forget to flag your telephone number. After reviewing the pictures, I will personally call and talk to you.

ONLY AFTER THIS CONVERSATION SHOULD YOU CONTEMPLATE MAKING ARRANGEMENTS FOR YOUR VISIT.

Before the actual procedure, we need you for a consultation during which, besides the clinical examination, a Doppler Ultrasound venous flow study will be performed. Please remember the flow of blood in the varicosities is reversed, i.e. from up down rather from below up. We have to detect, with the help of the ultrasound test, the uppermost point in your leg where this reverse flow starts. In close to 80% of our patients this will be in your groin, in 8-10% behind the knee. As in the case of a water fall, this most upper point of downpour has to be capped or controlled (tied).

Only thereafter are the varicosities removed through tiny skin openings with the specially designed hooks as described elsewhere. Failure to properly control this point of downpour, or totally omitting this step, as may occur in the hand of a surgically unskilled practitioner, will lead to early failure of the procedure. Therefore, when treating your varicose veins, submit yourself only to the care of a general or vascular surgeon who is uniquely qualified to perform this delicate procedure. Lately, I am aware of some non-surgeon physicians that advertise the procedure although they are incapable of performing the most important part of the procedure: control of the downpour. If they omit this due to their incompetence your varicose veins will soon reoccur. If they attempt to do it, you can be severely injured, with serious repercussions to your leg. The groin or for that matter the area behind the knee (also called popliteal fossa) are delicate areas to operate, and only surgical specialists have properly learned this during their lengthy surgical residency program. It is unfortunate, but there are many unskilled practitioners preying on you, the naive patient.

We will also have you fitted with an elastic stocking that will serve as a bandage for one week after the procedure. This could be done in your geographic area, or in the supply pharmacy close to our Center.

We prefer to see you the day before surgery, have the procedure the next day and the following day you will be able to fly back home. You will have no stitches to remove, no other doctors to see. You will not be incapacitated at all. You will be able to immediately resume normal daily activities including sporting activites. In over 1800 procedures performed since May 1990, we haven't had to give a single certificate of leave of absence, because no complications were encountered and no recurrences were seen. Patients are literally ecstatically happy with the results.

Patients in a hurry can arrange to be seen in a morning and after being fitted with the stocking, operated in the afternoon and return home the next day. However, these arrangements have to be made well in advance. Patients with two leg problems will have surgery on two consecutive days.

The fee for consultation is $95 and the fee for the Doppler Ultrasound test is $200. You will receive a superbill ready to be sent to your carrier for your reimbursement.

The fee for one leg surgery varies from $1200-2500. There are no other fees! These fees are less, in our area, than the 20% co-payment patients have to pay if operated in a hospital setting! (The in-hosptial surgery fees in our area can be close to $15,000.00!) We do not accept assignment of insurance benefits. We will, however, give you a superbill to assist you in insurance reimbursement. Sometimes after reviewing the photographs, I can give you the accurate procedural codes and fees to possibly obtain a preapproval authorization. We gladly will submit on your behalf a letter of necessity after we read your letter, saw your picture of your legs and talked to you on the telephone. We do accept either Major credit cards, (not American Express), cashier's checks and/or money orders for payment.

For accommodation the closest excellent hotel is the Radisson Valley Center (formerly Hilton) at (800) 333-3333 or (818) 981-5400. Please mention that you are Dr. Goren's patient. There is a reduced fee available for a room (double, occupancy) at $105 (plus tax), weekends at $95 (plus tax). Situated on Ventura Blvd., the hotel is exactly 1 mile from the office. Validation in our building is guaranteed. You can visit Radisson's Website at www.radisson.com/shermanoaksca.

Encino is a suburb of Greater Los Angeles and is located in the San Fernando Valley. We are 20 miles North of the International Airport (LAX) and the same distance North-West from Downtown Los Angeles. Another alternative, the Burbank Airport, also in the San Fernando Valley is located closer by a few miles than LAX.

Please do not hesitate to call should you have any additional questions at (800) SEW-VEIN i.e. (1-800-739-8346)

We believe that our expertise in the minimally invasive varicose vein surgery the AMBULATORY PHLEBECTOMY is unsurpassable for the following reasons:

We have done over 1800 cases since May 1990 (10 years). We do the procedure strictly in our office, and not hospital; - We use only loco-regional anesthesia, (as at the dentist)- Stitches and scars are totally eliminated,- There is no convalescence and loss of income,- You will leave the office 15 minutes after surgery, - We are cost efficient ( total fees are $1200-2500 for one leg) and- We have extensively published in the surgical literature on venous subjects, varicose vein surgery included.

Some of you may have or will, however, consult other practitioners. Firstly, do not let yourself be talked into having injection treatment for varicose veins by anybody. We suggest, for your own benefit, to ask the surgeon whom you are considering following questions: Where will the surgery be done? What anesthesia will be used? Will you have scars and stitches on your legs? How long will you be out of work and convalesce at home after surgery? Could you sustain permanent nerve damage? What is the total fee for the procedure?
If you find out that: you will be operated in a hospital setting, you will have general or spinal/epidural anesthesia, you will have scars and stitches on your legs, that you may sustain permanent nerve damage; you will convalesce 2-3 weeks in your home and that you will be unable to work for that period of time, the chances are, that you will have the medically good but old fashioned traumatic STRIPPING surgery. Moreover, the total fee, surgery, hospitalization and general anesthesia included,will be close to a whopping .... $10-12,000.00.! The co-payment of 20% that you may be responsible for could be more than our fee. Please understand that this old form of surgery, can be a very traumatic experience. In many cases it also represents an unnecessary overkill and may also result in ugly scarring.

Please do not fall for injection treatment for varicose veins as it has a 60-100% failure rate. Make sure that your surgeon is well qualified to do this procedure. No other specialties are qualified to perform this very delicate surgery on your leg. The following articles have been published by us on the subject:

Goren G, Yellin AE Surgery for varicose veins:
The ambulatory stab evulsion phlebectomy.
Am J Surg. 1991; 162:166-74. Also printed in "Year Book
of Vasc Surg" John Porter Editor, Mosby Publ. 1993; 385-7
Goren G. Primary varicose veins: hemodynamic principles of surgical care. The case for the stab evulsion technique VASA 1991; 20: 365-68
Goren G. Taming varicose vein surgery. Phlebology 1993; 8:136-8
Goren G, Yellin AE. Invaginated axial stripping and stab avulsion (hook) phlebectomy: a definitive outpatient procedure for primary varicose veins.
Amb. Surgery 1994; 2:27-35
Goren G, Yellin AE. Invaginated axial saphenectomy by a semi-rigid stripper: Pin Stripping.
J Vasc Surg 1994; 20:970-7
Goren G. Invaginated Pin-stripping. Phlebology 1994; 9:173-4
Goren G, Yellin AE Minimally invasive surgery for primary varicose veins: Limited invaginated axial stripping and tributary stab avulsion.
Ann Vasc Surg 1995;9:401-14
Goren G, Yellin AE The hemodynamic principles of varicose veins therapy.
Dermat. Surg. 1996; 22: 657-60
Goren G, Yellin AE Cryostripping: an alternative to Perforate-Invaginate Stripping? Letter to Editor Ann Vasc Surg; 11:326-28

Updated: October 1998.