Varicose and Spider Veins
Varicose Vein Treatments
The most important initial step in managing varicose vein disease is the use of compressive therapy. Compression stockings improve the efficiency of venous return and prevent blood pooling in the legs. The use of stockings may alleviate many symptoms associated with varicose veins and inhibit disease progression. However, stockings will not eliminate the existing varicose veins and will not correct the underlying problem.
Other steps that may provide symptomatic relief are leg elevation, use of over-the-counter pain medications, such as Ibuprofen or Tylenol, avoiding hot baths, and avoiding the use of constrictive clothing around the calves and thighs.
Sclerotherapy a varicose vein treatment that involves the injection of a liquid directly into abnormal veins using a small needle.
The liquid causes damage to the wall of the vein and eventual closure of the vein. Sclerotherapy typically works best for small veins (less than 5mm. in diameter). This technique is used for veins that are visible at the surface of the skin. Ultrasound-guided sclerotherapy can be used for treatment of deeper veins which are not directly visible.
After sclerotherapy, patients are kept in a compression stocking to assure that the treated vein is sealed. The visible veins then disappear over time. Sclerotherapy is often associated with brown discoloration of the vein. This skin discoloration may last for up to one year. Sclerotherapy usually requires multiple treatments. Sclerotherapy may cause redness and burning at the injection site. This typically passes quickly. Rare complications such as skin ulceration and allergic reactions may occur.
These varicose vein treatments involve the use of heat to damage the abnormal vein and permanently seal it. This is accomplished by use of laser ablation or radiofrequency ablation. In both techniques, the device is introduced directly into the abnormal vein, typically the great saphenous vein. The device then heats and damages the wall of the vein causing permanent closure. This prevents the abnormal vein from creating a high venous pressure lower in the leg.
We are one of the few practices to offer both endovenous laser ablation and radio frequency (RF) ablation. Both are outpatient procedures which uses only local anesthesia. A small catheter is placed in the vein through a tiny nick in the skin. This prevents post-operative scarring. The laser fiber or RF catheter is inserted through this catheter. The device is activated and then withdrawn through the vein and removed. The patient is then placed in a compression dressing and stocking.
The primary indication for this treatment is the presence of great saphenous vein insufficiency. This is a simple, safe procedure that minimizes the risks of post-operative scarring and infection. The procedure is painless and allows rapid recovery and return to normal activity. Clinical results are excellent.
We have extensive experience with both laser ablation and radio frequency ablation for treatment of a wide range of superficial venous abnormalities. However, we also offer other minimally invasive procedures and non-invasive therapy. Total vein care is our goal. After a through evaluation, treatment is tailored to your specific needs.
Phlebectomy, or ambulatory phlebectomy, is a varicose vein treatment technique used to remove bulging superficial veins. This is not vein stripping. After injecting an anesthetic solution around the abnormal veins, the vein is removed through small incisions (about 2 mm.). This procedure is performed under local anesthesia and requires no stitches.
The patient is placed in a compression dressing and stocking immediately after the procedure. The procedure is essentially painless and provides immediate cosmetic improvement and symptomatic relief. Ambulatory phlebectomy is performed commonly in association with laser ablation. This provides the best possible results since the ablation procedure removes the source of venous reflux and the phlebectomy removes the visible bulging veins.
Stripping and ligation has been the standard varicose vein treatment for great saphenous vein insufficiency for many years. This has been replaced by the endovenous techniques over the past decade. Vein stripping requires incisions at the groin and in the lower leg.
The saphenous vein is tied off in the groin and the vein is connected to a rod which is then pulled down the leg, or stripped, as it is removed through the incision in the lower leg. This procedure typically requires general anesthesia and has a longer recovery time. It is also associated with more pain, possible nerve damage, and poor cosmetic results. In addition, the risk of recurrence of varicose veins after vein stripping is approximately twice that of the endovenous techniques.
As part of a major research center, we have access to resources and new varicose vein treatments and therapies unavailable to most practices. We are currently one of a few sites evaluating a new drug, Varisolve (BTG International). This is a proprietary microfoam scleroscant which offers minimally invasive treatment of great saphenous insufficiency. The Phase II trial has been completed, and a Phase III trial will begin soon.
Each patient undergoes a thorough history and physical examination. Many patients will then undergo a detailed venous duplex exam. This ultrasound examination allows us to accurately diagnose the problem and tailor a specific varicose vein treatment for each patient's needs.