Dr Roger Bonau

As a Vein Specialist Surgeon at The Surgical Clinic, I treat patients who have many types of problems with veins and arteries, but Varicose Veins are the complaint that has enormous health risk for patients and a large economic cost to the work force when the condition is left untreated. The idea of Varicose Veins is a lot bigger deal than a cosmetic appearance of your legs!

Varicose veins constitute an increasing problem in the United States. The presence of superficial venous insufficiency and the accompaniment of pain, heaviness, and swelling affects up to 40% of the population. More severe complications include thrombophlebitis, hemosiderin deposition, and venous stasis ulcerations. Untreated, these complications not only lead to costs in the hundreds of millions in health care dollars, but also in time lost in the workforce.

Today, we have a variety of treatment options available. These include radiofrequency closure, endovenous laser ablation, mechanical and chemical closure (MOCA procedure), and foam sclerotherapy (Varithena). Microphlebectomy is also an excellent option for the varicose veins themselves. The Vein Centre is the only comprehensive facility in Nashville that offers all these options to patients. All treatments are done in the outpatient setting and most are performed under local anesthesia. In addition, Intravenous sedation is offered to many patients. Results of these treatments have been excellent. Over 10,000 procedures have been successfully accomplished.


Chronic venous insufficiency can be caused by deep or superficial venous problems. Deep venous insufficiency is most commonly caused by primary valve incompetence and deep venous thrombosis. More recently, it has been shown that valvular incompetence is a possible sign of proximal venous obstruction. Most commonly, the cause is venous narrowing at pelvic arterial branch point, predominantly at the aortic/inferior vena cava bifurcation (May-Thurner). Most patients present with isolated left limb swelling. Ultrasound and CT scanning are usually done predominantly to rule out other extrinsic causes of obstruction including tumor and lymphadenopathy. In the absence of these lesions, venography and intravascular ultrasound (IVUS) are the diagnostic test of choice. Treatment is usually done at the time of venography if indicated. The treatment of choice remains large diameter stents placed in light of narrowing. Long-term patency is excellent.

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