Vascular and Vein Associates



Dr. Gonsalves and Dr. Pare have been working together for nearly twenty years. They began their friendship and professional relationship during general surgery residency and medical school respectively at Tufts Medical Center in Boston, Massachusetts in 1993. While Dr. Pare was completing his general surgery residency at Tufts Medical Center, Dr. Gonsalves completed his vascular surgery fellowship training in Tampa, Florida. Subsequently, in 1998, Dr. Gonsalves returned to the Merrimack Valley to join and then start his own vascular surgery practice. Meanwhile, Dr. Pare completed his vascular surgery training at Tufts Medical Center in 2002.

They maintained their friendship throughout this time, and their professional paths crossed once again when in 2002 Dr. Pare joined Dr. Gonsalves’ vascular surgery practice. Their personal relationship has fostered a professional relationship that is unique. Most of their major and more complicated vascular surgical cases are routinely performed with both of them involved assisting one another. It is rare even at teaching hospitals to have two board certified vascular surgeons operating in the same case at the same time.

They take great pride in the uniqueness of their vascular surgery practice which includes a comfortable and low-stress clinical environment fostered by a friendly office staff. Their main professional goal is delivering high quality, comprehensive vascular care through their open and honest communication with their patients supported by their technical skills.

Meet Our Doctors

Varicose Veins

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What are varicose veins?

It is perfectly normal to have visible veins on your legs and arms. Varicose veins are veins under the skin of the legs that have become larger and more tortuous than normal. They are not the same as spider (thread) veins. These are tiny veins in the skin itself. Although unsightly, these do not cause any trouble and treatment for these is not covered by insurance.

What causes varicose veins?

Blood flows down the legs through the arteries and back up the leg through the veins.  There are two main systems of veins in the legs, the deep veins which carry most of the blood back up the legs to the heart and the superficial veins under the skin, which are less important and can form varicose veins.  All of these veins contain valves, which should only allow the blood to flow upwards.  If the veins become stretched, these valves no longer work properly.  Blood can then flow backwards down the veins and this can produce a head of pressure when standing, walking about or sitting.  Lying down or putting your feet up relieves the pressure and usually makes the legs feel better.  The trouble people get from their varicose veins is very variable.

Who can get varicose veins?

What are the symptoms of varicose veins?

Many people have no symptoms at all, except for the fact that the veins are noticeable, and they may cause embarrassment.  Other than cosmetic problems, the commonest symptoms from varicose veins are:

These symptoms are not necessarily serious but can be treated if they are sufficiently troublesome. Although varicose veins can get worse over the years, this often happens very slowly. It is best to leave them alone until they cause trouble.

Are varicose veins dangerous?
Varicose veins can cause serious problems. This includes ulceration of the skin, chronic leg swelling, cellulitis (soft tissue infection), bleeding and phlebitis (superficial clots). In some people the high venous pressure causes damage to the skin near the ankle which can become brown and eczematous. If these changes progress, or if the skin is injured, an ulcer may result.  Varicose veins can become inflamed, hard, painful and tender. This is called superficial thrombophlebitis (or bleeding as a result of traumatizing a varicose vein. Any complication of varicose veins is a good reason to visit your GP to request referral to a specialist.

What treatments are available for varicose veins?

Various treatments are available for varicose veins depending on their location, severity and your fitness for surgery. Your surgeon will discuss the options with you in the outpatient clinic after examining you. A painless duplex ultrasound scan may be required before deciding what treatment is required.

Conservative treatment: This consists of advice to you about lifestyle, exercise, leg elevation and the use of compression hosiery.

Endovenous Laser/Radiofrequency Ablation: New techniques have recently been developed which avoid the need for surgery, while offering considerable shorter recovery. This is an office based procedure which takes less than one hour.

Varicose Vein before and after picture 2


The venous system is made up of a network of veins, including:

  • Superficial veins – veins located close to the surface of the skin.
  • Deep veins – larger veins located deep in the leg.
  • Perforator veins – veins that connect the superficial veins to the deep veins.


The Closure procedure is performed on an outpatient basis. Using ultrasound, your physician will position the ClosureFAST catheter into the diseased vein through a small opening in the skin. The tiny catheter powered by radiofrequency (RF) energy delivers heat to the vein wall. As the thermal energy is delivered, the vein wall shrinks and the vein is sealed closed. Once the diseased vein is closed, blood is re-routed to other healthy veins.

Following the procedure, a simple bandage is placed over the insertion site, and additional compression may be provided to aid healing. Your doctor may encourage you to walk, and to refrain from extended standing and strenuous activities over a period of time.

Most patients who undergo the Closure procedure typically resume normal activities within 1-2 days.

Frequently Asked Questions

Q: Is the Closure procedure painful?
A: Patients generally report feeling little, if any, pain during and after the procedure.

Q: How quickly can I resume normal activity?
A: Patients are encouraged to walk immediately following the procedure, and most patients resume normal activities within 1-2 days.

Q: How soon after treatment will my symptoms improve?
A: Most patients report a noticeable improvement in their symptoms with 1-2 weeks following the procedure.

Q: Is there any scarring, bruising, or swelling after the procedure?
A: Most patients report minimal to no scarring, bruising, or swelling following the Closure procedure.

Q: How is the Closure procedure different from endovenous laser?
A: In the only head-to-head trial of its kind, the ClosureFAST catheter showed statistical superiority over 980nm endovenous laser. Patients treated with the ClosureFAST catheter experienced less pain, less bruising, fewer complications and realized quality of life improvement up to four times faster than those treated with endovenous laser ablation.

Q: How is the Closure procedure different from vein stripping?
A: During vein stripping, incisions are made in the groin and calf, and a stripper tool is threaded through the diseased vein, to pull the vein out of the leg. With the Closure procedure, only one small incision is made at the insertion site and the vein is then closed and left in place. This minimally invasive approach virtually eliminates pain and bruising associated with vein stripping surgery.

Q: Is the Closure procedure covered by insurance?
A: The Closure procedure is covered by most health insurances for patients diagnosed with venous reflux.

Varicose Vein before and after picture 1

“I feel 100% better. My leg looks fantastic! I’m going to wear my daisy duke shorts in the summer!” Arlene L.

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Healthy leg veins contain valves that open and close to assist the return of blood back to the heart. Venous reflux disease develops when the valves that keep blood flowing out of the legs and back to the heart become damaged or diseased. As a result, vein valves will not close properly, leading to symptoms of:

  • Varicose veins
  • Pain
  • Swollen Limbs
  • Leg heaviness and fatigue
  • Skin changes
  • Ulcers


Many factors contribute to the presence of venous reflux disease, including:

  • Age
  • Gender
  • Family history
  • Heavy lifting
  • Multiple pregnancies
  • Standing profession

Using ultrasound to scan your leg(s), your physician will determine if venous reflux is present.


  • Relief of symptoms
  • Outpatient procedure
  • Can be performed under local anesthesia
  • Most patients resume normal activities within 1-2 days
  • Good cosmetic outcome with minimal or no scarring, bruising or swelling

Vascular Conditions



Vascular and Vein Associates have photographed several procedures to educate patients on the different surgeries. Please be advised that the surgery photographs are graphic in nature and may not be suitable for all visitors.

Abdominal Aortic Aneurysm Repair
This patient had a 6 cm abdominal aortic aneurysm. As is the case 30% of the time, he required open abdominal aortic aneurysm repair with aortobifemoral bypass rather than endoluminal abdominal aortic aneurysm repair (EVAR) due to anatomic features.

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Femoral Popliteal With Graft
This patient had painful cramping in his calf, due to occlusion of his superficial femoral artery. Due to severe varicose veins, a prosthetic Gore-Tex graft was used for the conduit.

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Femoral Tibial Bypass With Saphenous Vein
Due to severe, long segment blockages resulting in numbness in the foot, this patient required a longer bypass than most – from the groin to the lower calf. The blockages in the artery were bypassed with his saphenous vein.

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Axillobifemoral Bypass
This patient had cramping of his feet while sleeping at night due to severe blockages of the iliac arteries of the pelvis, requiring a bypass to the legs. Because of multiple abdominal surgeries, advanced age, and anatomical features, the graft originates in the axillary artery in the chest rather than off the aorta.

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Femoral Popliteal Bypass Revision
This patient had a bypass narrowing (stenosis) detected by surveillance ultrasound. Left unchecked this could have resulted in preventable bypass failure. Graft stenosis are treated surgically or endoluminally (with a balloon). His bypass required a surgical patch.

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Carotid Endarterctomy
This is a patient with carotid stenosis who had an episode of right hand weakness, and ultrasound revealed 80% left carotid stenosis. The surgery was performed to prevent stroke which occurs if further debris breaks off and travels to his brain.

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Arteriovenous Graft For Dialysis
As is the case in about 25% or patients, this patients had no suitable vein for dialysis access. A Gore-Tex graft was placed for peripheral dialysis access.

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Transposition of Cephalic Vein Fistula
Due to deep veins, this woman after a successful fistula required the fistula vein be mobilized and brought closer to the skin to be reliably accessed.

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Vascular and Vein Associates, P.C. – Surgical Case Analysis: 3 Years



Carotid Surgery

Carotid Endarterectomy  232
TOTAL  232
Stroke-CVA  2
Myocardial Infarction (heart attack)  0
Death  1

Elective Aortic Surgery

Endovascular and Open Repair  89
Dialysis  1
Myocardial Infarction (heart attack)  0
Death  1

Lower Extremity Arterial Surgery

TOTAL  148
30 Day Post Surgery Limb Loss  2
Myocardial Infarction (heart attack)  0
Death  0

Meet Our Staff


Hospital and Network Affiliations

Holy Family Steward Health Care NetworkHoly Family Steward Health Care Network
Steward Health Care Network (SHCN), the second largest physician network in Massachusetts, provides world class care to more than one million patients annually.

Lawrence General HospitalLawrence General Hospital
Lawrence General was esblished in 1902 with a modern facility that laid the foundation for its role in the health of the community over the next century and beyond. Dr. Gonsalves and Dr. Pare’ operate regularly at Lawrence General.

Beth Israel Deaconess Physician OrganizationBeth Israel Deaconess Physician Organization (BIDPO) BIDPO
promotes the highest quality of coordinated patient care, patient safety and cost effective care among its participating providers through our integrated and coordinated managed care contracts and related medical management programs.

Commonwealth of Massachusetts Board of Registration in Medicine Commonwealth of MA Board of Registration in Medicine
The Commonwealth of Massachusetts Board of Registration in Medicine serves the public by awarding licenses to qualified physicians to practice medicine and health care in Massachusetts.

The American Board of SurgeryThe American Board of Surgery
The American Board of Surgery is an independent, nonprofit organization founded in 1937 to certify surgeons who have met a defined standard of education, training and knowledge.

Tufts University School of MedicineTufts University School of Medicine
Tufts University School of Medicine has been a national leader in medicine since its founding in 1893. Both Dr. Gonsalves and Dr. Pare’ are graduates of Tufts.

This list is not meant to be exhaustive.  Although these are the most common, we do take many other insurances.


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