In the convenience of our Vein Center and with our five Board Certified Vascular Surgeons, we can treat many venous diseases. We are fully equipped to perform the following venous interventions in our Vein Center:
Endovenous thermal ablation, also called laser therapy, is a newer technique that uses a laser or high-frequency radio waves to create intense local heat in the varicose vein or incompetent vein.
Heat is directed through a catheter to close up the targeted vessel. This treatment closes off the problem veins but leaves them in place so there is minimal bleeding and bruising.
Compared with ligation and stripping, many patients find that endovenous thermal ablation results in less pain and a faster return to normal activities, with similar cosmetic results.
The goals of treatment are to reduce symptoms and reduce the risk of complications from venous disease, including blood clots.
Patients who have large, symptomatic varicose veins and those with incompetent saphenous veins are candidates for this procedure. This procedure is essentially taking the place of “vein stripping.”
Each patient is evaluated, and treatment will be individualized for the patient’s circumstances.
This procedure is performed in our office based lab by a vascular surgeon.
Your doctor will discuss the specific risks and potential benefits of the recommended procedure with you. This is generally a very safe procedure. However, as with any surgical procedure, there are risks. Complications after endovenous thermal ablation may include bruising along the site of ablation, pain along the site of ablation, the development of a blood clot in the veins in the treated leg, and irritation of the nerves that run along with the treated veins.
Special precautions are taken to decrease these risks, and there may be other possible risks. When you meet with your doctor, please ask questions to make sure you understand the risks of the procedure and why the procedure is recommended.
Physical Examination
Your Doctor will:
Medical History
Your Doctor will want to know your medical history, including asking about any:
Ultrasound
Depending on which veins are involved, your doctor may request ultrasound imaging on the veins in your legs. Ultrasound is a painless procedure that uses sound waves to produce images of structures inside the body.
The Day Before
For 24 hours before the procedure, avoid shaving or applying any lotion to your legs. Wear loose, comfortable clothing to your appointment. You might even consider wearing a pair of shorts so that your legs are exposed.
In general, people having radiofrequency ablation just have to take a pill to calm them before the procedure. Some people have to stop taking certain medicines before the procedure, but that is not common.
A few days before the procedure, pre-procedure tests may be performed to ensure that it is safe to perform the procedure. Your healthcare team will provide specific instructions to help you prepare for the procedure.
You will receive a sedative and a regional anesthesia, or you may receive Intravenous anesthesia. Using an ultrasound to identify the location, your surgeon will insert a catheter into the vein to be treated. This is typically done just below the knee, but can occasionally be done at the level of the ankle. Using ultrasound, the surgeon will inject a solution of salt water and anesthetic agent along the length of the vein to be treated. Following this, radiofrequency ablation will be performed.
The procedure itself generally takes 20-30 minutes. This procedure is typically performed in the outpatient setting, and you can expect to be discharged home after the procedure is complete. Full recovery will take approximately one to two weeks.
After having a vein ablation procedure, most people are asked to:
Depending on the type of ablation procedure you have, you might be asked to wear special bandages or stockings called "compression bandages" or "compression stockings." These bandages or stockings will put steady pressure on your leg and can help prevent bruising.
Also depending on what type of procedure you have, you might have to go back to the doctor a few days after your procedure for a test called an ultrasound. This is to make sure you have not developed any blood clots in your leg.
Call your doctor or nurse right away if:
Sclerotherapy effectively treats varicose and spider veins. It's often considered the treatment of choice for small varicose veins.
Sclerotherapy involves injecting a solution directly into the vein. The sclerotherapy solution causes the vein to scar, forcing blood to reroute through healthier veins. The collapsed vein is reabsorbed into local tissue and eventually fades.
After sclerotherapy, treated veins tend to fade within a few weeks, although occasionally it may take a month or more to see the full results. In some instances, several sclerotherapy treatments may be needed.
Cosmetic purposes — to improve the appearance of varicose and spider veins
The procedure also can improve related symptoms such as:
Temporary Side Effects
Some side effects that may occur at the site of the injection include:
These side effects usually go away within a few days to several weeks. Some side effects can take months or even years to disappear completely.
Side Effects That May Require Treatment
Other complications are less common but may require treatment. These include:
Deep vein thrombosis carries a risk of pulmonary embolism (a very rare complication of sclerotherapy), an emergency situation where the clot travels from your leg to your lungs and blocks a vital artery. Seek immediate medical care if you experience difficulty breathing, chest pain or dizziness, or you cough up blood.
Sclerotherapy of telangiectasias and reticular veins is generally considered a cosmetic treatment and is not typically covered by insurance, though occasionally it will be reimbursed when treating veins which have hemorrhaged.
A few days before the procedure, pre-procedure tests may be performed to ensure that it is safe to perform the procedure. You may need to discontinue certain medications before the procedure. Your healthcare team will provide specific instructions to help you prepare for the procedure
Similar to vein Ablation, your doctor performs a physical exam and gathers your medical history.
Ultrasound
Depending on which veins are involved, your doctor may request ultrasound imaging on the veins in your legs. Ultrasound is a painless procedure that uses sound waves to produce images of structures inside the body.
The Day Before
For 24 hours before the procedure, avoid shaving or applying any lotion to your legs. Wear loose, comfortable clothing to your appointment. You might even consider wearing a pair of shorts so that your legs are exposed.
Sclerotherapy is typically done in your doctor's office and doesn't require anesthesia. It generally takes less than 30 minutes to complete.
During The Procedure
For the procedure, you'll lie on your back with your legs slightly elevated. After cleansing the area to be treated with alcohol, your doctor will use a fine needle to slowly insert a solution into the appropriate vein.
The solution, usually glycerin, works by irritating the lining of the vein, causing it to swell shut and block the flow of blood. Some solutions contain a local anesthetic called lidocaine.
Eventually, the vein will become scar tissue and disappear. Sometimes a foam version of the solution may be used, particularly when a larger vein is involved. Foam tends to cover more surface area than liquid.
Some people experience minor stinging or cramps when the needle is inserted into the vein. If you have a lot of pain, tell your doctor. Pain may occur if the solution leaks from the vein into surrounding tissue.
Once the needle is withdrawn, your doctor applies compression and massages the area to keep blood out of the injected vessel and disperse the solution. A compression pad may be taped onto the injection site to keep the area compressed while your doctor moves on to the next vein.
The number of injections depends on the number and size of veins being treated.
After The Procedure
You'll be able to get up and walk around soon after the procedure. Walking and moving your legs is important to prevent the formation of blood clots.
You'll be asked to wear compression stockings or bandages — usually for about one to two weeks — to maintain compression on the treated veins.
Most people return to their normal activities on the same day. Your doctor will probably advise you to avoid strenuous exercise for one to two weeks after the procedure.
You'll also want to avoid sun exposure to the treated areas during that time. The inflammation caused by the injections combined with sun exposure can lead to dark spots on your skin, especially if you already have a dark skin tone.
If you were treated for small varicose veins or spider veins, you can usually expect to see definitive results in three to six weeks. Larger veins may require three to four months. However, multiple treatments may be needed to achieve the results you want.
Veins that respond to treatment generally don't come back, but new veins may appear.
Your doctor will likely schedule a follow-up visit about a month after the procedure to check the procedure's success and decide whether further sessions are needed. Generally, you need to wait about six weeks before undergoing another sclerotherapy session.
Studies of sclerotherapy as a treatment for varicose and spider veins indicate that it has an overall success rate of about 60 to 80 percent in eliminating treated veins.
Sclerotherapy is the treatment of choice for the majority of superficial leg veins. Candidates for laser and light therapy are those who do not tolerate or fail sclerotherapy or who have small superficial vessels that are too small to cannulate with a sclerotherapy needle.
Multiple treatments are typically required to achieve the desired effect, and alteration in skin pigmentation can occur.
Neodymium-doped: yttrium aluminum garnet (Nd:YAG) lasers emit light at a wavelength of 1064 nm is used in our office. This longer wavelength penetrates to deeper levels and, with long pulse durations, can be used to treat veins from 0.3 to 3 mm in diameter. Because of lower absorption in pigment, Nd:YAG lasers are less likely to cause pigmentary changes and are safer to use in darker skin types.
Preparation for Laser therapy is similar to sclerotherapy
For 24 hours before the procedure, avoid shaving or applying any lotion to your legs. Wear loose, comfortable clothing to your appointment. You might even consider wearing a pair of shorts so that your legs are exposed.
Sclerotherapy is typically done in your doctor's office and doesn't require anesthesia. It generally takes less than 30 minutes to complete.
Treatment proceeds by first cooling the skin over the vessels and then activating the laser/light over the target vessel(s). You may feel anything from a very mild sting to a strong pinching and burning sensation when the laser is activated.
After The Procedure
You'll be able to get up and walk around soon after the procedure. Walking and moving your legs is important to prevent the formation of blood clots.
You'll be asked to wear compression stockings or bandages — usually for about one to two weeks — to maintain compression on the treated veins.
Most people return to their normal activities on the same day. Your doctor will probably advise you to avoid strenuous exercise for one to two weeks after the procedure.
You'll also want to avoid sun exposure to the treated areas during that time. The inflammation caused by the injections combined with sun exposure can lead to dark spots on your skin, especially if you already have a dark skin tone.
Common local reactions associated with laser therapy include pain, redness, swelling, bruising, and itching. These are transient and usually resolve quickly.
Pain — Treatment is usually well tolerated. Pain is short lived and usually lasts only seconds to minutes after treatment.
Bruising — Purpura and ecchymosis are due to vessel wall rupture resulting in leakage of blood into the surrounding tissue. These reactions are most likely to occur with short pulsed laser treatments and usually occur within minutes of treatment.
Pigmentation — Hyperpigmentation and hypopigmentation are common in patients with dark skin and usually develop within three weeks after treatment. Hyperpigmentation, which is due to hemosiderin deposition, is usually temporary but may last up to one year or can be permanent. Hypopigmentation may also be permanent.
Telangiectatic matting — As with sclerotherapy, telangiectatic matting consists of multiple, fine dilated vessels in the area of laser treatment.
Thrombophlebitis — Thrombosis has been reported in the superficial veins following laser therapy. It may take up to six weeks to resolve but rarely has sequelae.
Deep vein thrombosis is exceedingly rare and is more likely related to factors not directly associated with the technique.
Use of the Nd:YAG laser results in clearance of more than 75 percent of veins in the majority of sites, and results are maintained for at least 12 months following treatment.
Laser therapy of telangiectasias, reticular veins, and small varicose veins is generally considered a cosmetic treatment and is not typically covered by insurance.
No, not usually. Your doctor will recommend which procedure would work for the type of vein problem you have.
