Conservative treatment:

The most conservative way to manage varicose vein disease is wearing prescription-strength compression stockings (usually knee length, but sometimes thigh length hose are needed). Compression stockings help alleviate the swelling and pain caused by varicose veins. Unfortunately, once you remove the stockings, you will have varicose veins. Since the diseased veins that are causing the symptoms are not being eliminated, the compression stockings have to be worn indefinitely. Some insurance companies are now requiring patients to wear prescription strength compression stockings for 3-6 months before they will consider reimbursement for treatment. Compression stockings have come along way from the old thick stockings your grandmother used to wear.

Old Fashioned Vein Stripping Surgery:

Surgery used to be the only way to treat the larger varicose veins. Traditional surgery commonly referred to as “stripping” is now rarely needed. This procedure is painful, requires a hospitalization and a general or regional anesthetic. The cost of this procedure is about 4 times the cost of the new, EVLT treatment. The permanent scarring resulting from “stripping” is also unacceptable as is the lengthy recovery time, risk of infection, and loss of blood.

Newer Advanced Out Patient Surgery Techniques:

Micro-Surgery or Ambulatory Phlebectomy

'Phlebectomy' means 'to remove veins'. 'Ambulatory Phlebectomy' or “hook” phlebectomy is a micro-extraction procedure used to remove varicose veins, both large and small, which are close to the surface of the skin. In an out-patient setting, under local anesthesia, very small micro-incisions (1/8 inch) punctures are made, and portions of veins are gently pulled out using surgical hooks, similar to crochet hooks. These “stabs” are closed with a steri-strip (a small sterile tape), not sutures and are rarely visible once healed. The leg will be wrapped with an elastic bandage and when discharged, you can go about your activities of daily living that afternoon. Pain is usually managed with mild analgesics.

Because mild sedatives are given you will need to bring someone to drive you home afterwards. Contrary to the old-fashioned regimens of bed rest after vein treatment, our patients are instructed to walk as much as possible in the days following each treatment. This helps to minimize the risk of depp vein thrombose.

Bruising will occur and will take a few weeks to go away. The compression bandage is worn 1 to 4 days until after a post op visit. When removed patients are amazed how good the leg looks with the “ropey” veins gone. Then a compression stocking is worn for another 2 weeks or so to assist in healing or swelling and reduce any mild discomfort.

We will follow you with a 2 week office visit to assess the efficacy of our treatment and evaluate your body’s healing response to the therapy.

Vein Ablation with Endovenous Laser Treatment (EVLT)

The newest technique for varicose vein treatment is endovenous laser treatment or EVLT, FDA approved in January 2002. The EVLT procedure treats the incompetence of the greater saphenous vein located close to the surface of the inner thigh. Unlike surgical stripping, EVLT permanently closes off the vein while leaving it in place. The energy/heat from a laser delivered by a fine fiber-optic probe shrinks and closes off the faulty vein so blood cannot flow through it. This eliminates vein bulging at its source.

There is no general anesthesia or hospitalization. This procedure takes place is less than an hour in an out patient surgical setting. You will be given a mild sedative. The tissue surrounding the saphenous vein will be injected with a small amount of local anesthetic similar to a type used by dentists to numb the treatment area. Most patients feel very little or no pain.

The probe is guided into place using ultrasound to visualize the vein. As it is only the probe and a fine sheath which is needed to enter the vein the whole procedure is performed via a tiny skin nick, so there will be no post operative scarring.

In some cases, the lower, small leg vein branches may be treated with an ambulatory phlebectomy and or sclerotherapy, making the combination with endovenous laser treatment very powerful.

Following the 45 minute procedure, the leg is wrapped with a compression bandage and you will walk before you leave. Because mild sedatives are usually given during the procedure you will need to bring someone to drive you home afterwards. You will be able to resume your activities of daily living the next day. No more 2 week recovery time! We will see you in the office in 1-3 days to remove your bandage and to perform an ultrasound to ensure closure of the greater saphenous vein. You will wear compression stockings for 2 weeks. Walking is encouraged to help reroute the vessels to the deep venous system. You will notice bruising along the greater saphenous vein (the inner thigh) however this fades within a few weeks. We will follow you with 2 or 3 subsequent office visits at 3 and 6 month intervals to assess the efficacy of our treatment and evaluate your body’s healing response to the therapy.

Published clinical studies show that EVLT has a 98% initial success rate with excellent long term results. Our patients find that not only are they proud of the way their legs look, they find that they no longer have the tiredness, heaviness or pain in their legs.

Please visit http://www.evlt.com to learn more about the laser.

Treatment for Spider Veins

Older methods of spider vein treatment involved injecting normal saline or other sclerosing medications directly into the vein irritating both tissue and vein. We use newer, more effective Foam Sclerotherapy, air mixed with a liquid solution called Sodium Tetradecyl Sulphate. The foam solution, injected inside the vein with a very tiny needle, displaces the blood (rather than mixing with it) creating better contact with the vein wall, causing it to immediately appear lighter in color. Mixing the solution with air also reduces the amount of medicine needed to close the vessel. The vein lining is irritated, causing it to collapse, blocking it from getting more blood. Within a few weeks the vein disappears.

Each treatment session takes about 30 minutes. Initial treatments will focus on the most heavily involved areas or the most symptomatic areas. The tiniest spider veins may disappear quickly; however, larger veins require a few weeks to improve in appearance and some veins may look worse before they look better. No treatment can eliminate 100% of all spider veins. Improvement of 70-80% is realistic. Normal healing can take several weeks, so your treatment sessions will be separated by at least 4-6 weeks to allow for healing to occur. The average patient usually requires 3 to 6 treatment sessions. Significant cosmetic improvement can usually be expected near the end of the prescribed treatment course. Most patients are pleased even after the first session as the treated veins are noticeably clearer and the skin continues to improve with each successive treatment. But we always remind our patients that it has taken years for these veins to develop they will not go away over night. It will take weeks or months to eradicate them

We ask that you avoid aspirin, Vitamin E and alcohol for several days prior to your treatment to minimize bleeding during the procedure. On the day of your treatment you will be asked not to use moisturizers, sun-block or oil on the affected area.

Sedation and local anesthesia are not needed. Spider vein treatments are relatively painless. Most patients report minimal pain and say the injections feel like a mosquito bite or tiny ant bite. A cotton ball and compression bandage is applied to each injected site. After one area is injected and taped, the doctor will proceed to the next area. Compression stockings are worn for several days after each treatment to assist in healing and reduce any mild discomfort which may occur. Three companies that manufacture compression stockings are Sigvaris, Mediven, and Jobst.

All patients are instructed to walk as much as possible in the days following each treatment. You may drive yourself to and from your appointments and go right back to work and resume your normal routine immediately following your treatment. Sun exposure and tanning bed use are discouraged during the first 2 weeks after each treatment.

Occasionally, “telengiectatic matting”, a new network of fine weblike veins, may appear around the treated area. Hyper-pigmentation, discoloration and blotchiness is another side effect. This occurs when some of the blood is displaced into the skin and the iron pigmentation from the blood “stains” the affected area. This will look like a light brown patch, similar to a sun spot, but should fade over time. Avoiding direct sunlight can minimize this. More rarely, sclerotherapy can lead to blood clots or inflammation in the veins. Allergic reactions to sclerosing agents have also been reported.