A Huge Disturbing Fact about Varicose Vein Treatment

A Huge Disturbing Fact about Varicose Vein Treatment

You Won’t Believe what is NOT Happening with Varicose Vein Treatment here in Pittsburgh

Varicose vein treatments have moved from hospitals to doctor’s offices. There is no need to go to a hospital or surgery center any more to have your varicose vein treatment.

In the past, the only option was to have your varicose veins stripped. That was always done in a hospital under a general anesthetic in an operating room.

Now with modern minimally invasive techniques including the laser, everything can be done in an office setting. That is good but it also creates a big problem.

Varicose vein centers need a “watch dog” to ensure quality of care

Most vein doctors are practicing on varicose veins in their private offices without any oversight at all. There is no “watch dog”.

The only nationally approved and accredited vein treatment center in Pittsburgh is directed by John Happel MD. Dr. Happel’s vein center’s accreditation is voluntary. Applying for vein center accreditation is like volunteering for a proctoscopic exam.

The JCAH inspects hospitals. Only the IAC inspects vein centers. The IAC stands for Intersocietal Accreditation Commission. All vein centers are now located in doctor’s offices and not in hospitals. This IAC review includes an on-site visit just like a hospital.

The seven major vein societies in the United States created this inspection process so that doctors can “police our own”. The government cannot do it. Nobody would even want that. Government control of medicine is a huge mess.

How Does the Inspection Process Start?

Recently, a panel of vein treatment experts visited our vein center. Before the performance of an on-site review, we submitted a comprehensive application. Requirements include a detailed review of selected patient procedures. All 39 pages of the standards can be downloaded at the following link:


These standards are quite long, very strict and very exhaustive. 

They look closely to see if vein centers do unnecessary ultrasounds. They also examine whether or not the vein treatment center does unnecessary laser procedures.

Patients often come to me for a second opinion. When patients only have spider veins and another vein center recommends that their saphenous veins be lasered, that is unnecessary surgery. That is very wrong. You may need your saphenous veins for possible life-saving heart bypass.

Venous Ultrasound is Necessary with Varicose Vein Treatment

Is the ultrasound testing certified?  We are ACR accredited for ultrasound testing.  Is the doctor certified to read the venous ultrasounds? Dr. Happel has the highest vascular ultrasound interpretation credentials through ARDMS. It is called the RPVI.

Learn more about what it means to be a Registered Physician for Vascular Intepretation here.

There are no higher credentials for a doctor reading and interpreting your venous Doppler ultrasound.

Venous Doppler ultrasounds are necessary when considering treatment for varicose veins. Varicose veins are the big, ropey veins that cause symptoms like pain, ache, and heaviness.

Dr. Happel also has all of the credentials to perform venous ultrasounds and is an RVT (registered vascular technologist.) Read more about these additional vascular ultrasound credentials that Dr. Happel has achieved here.

How does a vein center achieve the IAC seal of approval? 

A comprehensive application is just the start. That is just to qualify for the on-site exam.

Now on to step two. A proctoscopic exam at this point would be a walk in the park.

But there’s more.

The Vein Treatment Inspection Check List

  1.  The on-site exam was next. The IAC reviewed our safety measures. Defibrillation equipment or AEDs are part of this inspection. Inspection of oxygen tanks is mandatory. They make sure that there is an updated medication kit for emergencies. Are any medications expired? Autoclaves and protocols for sterilization must be in top order.
  2.  The lasers must be FDA approved. All medication used for vein treatment must also be FDA approved. That is important because some vein centers use non-FDA approved medicine from compounding pharmacies. That is unsafe. Some centers use medications for sclerotherapy imported from other countries. That is illegal. Read more about that here.
  3.  Quality improvement protocols are checked. They checked to see if we perform regular staff meeting minutes. During the on-site inspection, they observed all the major types of procedures that we do. They observed one patient consultation, one sclerotherapy treatment, and saphenous vein laser procedures. They examined our sterile technique.
  4.  How About Continuing Vein Treatment Education? They made sure that we are doing up-to-date continuing medical education for the entire medical staff. Not just the doctor. They reviewed the doctor’s credentials with a fine-tooth comb. We passed with flying colors.
  5.  Where did the doc get his vein training?The Mayo Clinic was where Dr. Happel trained in vascular surgery and veins.Two thumbs up.
  6.  A minimum number of documented vein procedures have to be under the doctor’s belt. Some self-proclaimed vein doctors come from emergency room or family practice backgrounds. Some are heart doctors. Some are x-ray doctors. Many decide to treat veins instead of practicing in the field in where they trained.  The IAC strictly regulates this to prevent on-the job training. They don’t permit any learning-on-the-job nonsense.

What does Final Vein Center Approval Mean?

The IAC finally grants accreditation only to a few select vein treatment centers. They must provide truly safe and the highest quality care. Accredited vein treatment centers must comply with national standards. IAC accreditation is a “seal of approval” that patients can depend on.

Dr. Happel’s certificate states that the Intersocietal Accreditation Commission (IAC) has approved his center for Varicose Veins and Superficial Vein Treatment and Management.


In summary, when you schedule a vein center procedure, you are strongly encouraged to inquire as to the accreditation status of the vein treatment facility.

Not all vein centers are the same. Don’t leave your vein treatments to just any doctor.

Doctors in Pittsburgh who have absolutely no training in venous disease perform varicose vein treatments in most of our vein centers every day. That is the sad truth!

You will not believe it but many people choose the vein treatment facility that is the closest or the one that advertises all of the time on television.

Do your research. It is very hard to fix botched vein treatment problems.

Call us at 724-969-0600 to learn more or contact us by clicking here.

About The Author

Dr. John Happel

Dr. John Happel has been in practice as a surgeon since 1986 in the Pittsburgh region. He specializes in vascular surgery and has subspecialized in the treatment of varicose and spider veins since 1999. Dr. Happel is board certified in vascular surgery and recertified in vascular surgery in 2012. He was chosen in 1985 to fulfill the position for the vascular surgical fellowship at the world renowned Mayo Clinic.