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How can varicose veins be treated?
How does Endovenous Laser Therapy work?
Why EVLT instead of other treatments for varicose veins?
How are large varicose veins treated?
How are spider veins treated?
What are sclerosants?
What is Interventional Radiology?
Who are Interventional Radiologists?
Advantages of Interventional Radiology vs. traditional Surgery?
Who should treat my varicose veins or spider veins?
Are the treatments painful?
What are the complications of vein treatment?
What is the after care following treatment?
Will the abnormal veins come back?
How many treatments will be needed?
What recovery is involved?
Are treatments expensive?
Schedule your San Diego Varicose Vein treatment today!
How can varicose veins be treated?
There are many different ways to treat varicose veins:
Compression stockings: For minor pain from varicose veins, compression stockings may help. The compression stocking will assist the vein in pumping blood up the leg and back to the heart. However, this treatment will not make the varicose veins go away.
Sclerotherapy: This is used commonly for the treatment of smaller varicose veins and spider veins. The technique involves injecting a small amount of a medicine (sclerosant) into the diseased vein. The medicine acts upon the lining of the vein to cause it to seal shut. Ultimately the vein is eliminated. The newer types of sclerosants are not painful when injected. The procedure is performed quickly and easily without the need for anesthesia.
Surgical Treatments: In the past, this was the only treatment available for large varicose veins. This involves the surgical removal of the diseased vein out of the leg. This requires an operating room, anesthesia, and recovery times may last weeks to months. A more recent version of this procedure has been developed known as ambulatory phlebectomy. This involves the use of multiple incisions in the leg to hook and remove the diseased vein in segments. Although more incisions are made than the standard vein treatments, the damage to the leg and the recovery time are less.
Endovenous Laser Therapy: Since the late 1990’s the use of lasers and radio-frequency (RF) treatments have become accepted alternatives to the surgical approach to treat large varicose veins. With Endovenous Laser Therapy (EVLT) a very thin fiber or catheter is inserted into the diseased vein through a small needle puncture in the leg, requiring only local anesthesia. The physician delivers heat energy utilizing the laser fiber or RF catheter. This causes the vein to close. The procedure can be performed in the physician’s office in less than one hour. Patients are able to resume their normal activities immediately.
How does Endovenous Laser Therapy work?
Endovenous Laser Therapy (EVLT) treats incompetence of the great saphenous vein. This vein courses along the inside of the leg, and is frequently the underlying cause of visible varicose veins all over the leg. When this vein is diseased it needs to be removed or sealed shut. Other veins in the leg then take blood back to the heart. Unlike surgical stripping, EVLT permanently closes off the vein while leaving it in place. The procedure involves the use of energy from an 810 nanometer laser delivered by a fine fiber-optic probe or radio-frequency energy delivered via a thin catheter.
The procedure is done in the office under local anesthesia. A special laser-tipped fiber or catheter is passed through a small sheath inserted into the great saphenous vein. As the device is activated, the resulting heat induces a reaction in the walls of the vein causing them to stick together. The varicosities associated with this vein then disappear as blood from the lower leg reroutes through the deeper circulation.
As only a slim sheath is needed to enter the vein, the whole procedure is performed through a tiny skin nick, so there is no post-operative scarring. Pressure is applied to the treated vessels using graduated compression hosiery (support stockings). These are usually worn for three to four weeks following EVLT treatment. The stockings come in different styles, sizes and colors.
Recovery from EVLT is rapid as there are no large surgical incisions or side effects of general anesthesia. Normal activities, including driving, can be resumed the net day. Patients should walk for at least 30 minutes a day following EVLT. Vigorous physical activity such as weight lifting and aerobics are not advised during this time.
Why Endovenous Laser Therapy (EVLT) instead of other treatments for varicose veins?
The key benefits of EVLT are the following:
- A simple procedure
- Performed under local anesthetic
- Minimally invasive, so minimal risk of scarring and postoperative infection
- Less than one hour examination and treatment time
- Rapid recovery with reduced postoperative pain
- Normal activities can be resumed immediately
- Excellent clinical and aesthetic results
How are large varicose veins treated at The San Diego Vein Center?
At The San Diego Vein Center, a detailed clinical evaluation including a venous ultrasound to map affected veins and abnormal valve function will be performed. A treatment plan will then be designed to meet the needs of the individual patient. Treatment may consist of a combination of endovenous laser therapy (EVLT) and ultrasound guided sclerotherapy. Compression stockings are prescribed following treatment.
How are spider veins treated?
Sclerotherapy is the best way to treat spider veins on the legs. A medication called a sclerosant, is injected directly into the tiny veins using a very fine needle placed with the assistance of a light-enhanced magnifying lens. This causes the walls of the vessel to become inflamed. The spiders will then disappear over a few weeks to months following treatment.
Repeated treatments may be necessary in order to take care of all of the spider veins and the associated reticular veins. Although each session may involve a large number of injections, the needle used is extremely fine so that pain is not generally a problem. Unlike older sclerosants, the ones used at the The San Diego Vein Center cause no pain at the time of injection. Immediately after injection, the spider veins will become red and slightly swollen, sometimes itchy for a few hours.
What are sclerosants?
Sclerosants are medications injected into veins which cause the walls to become inflamed and eventually seal off. The two newest and non-painful medications used are called sodium tetradecyl sulphate and polidocanol. Another substance used by some physicians is hypertonic saline. These saline injections are extremely painful, and much less effective. This substance is not used at The San Diego Vein Center.
What is Interventional Radiology?
Interventional radiology is a rapidly growing area of medicine. Interventional radiologists are physicians who specialize in minimally invasive, targeted treatments performed using imaging guidance. Interventional radiology procedures are an advance in medicine that replaces open surgical procedures. They are generally easier for the patient because they involve no large incisions, less risk, less pain and shorter recovery times.
Who are Interventional Radiologists?
Interventional Radiologists are medical doctors who have specialized in performing minimally invasive procedures that involve radiological imaging. Radiologists use equipment such as x-ray, magnetic resonance imaging, ultrasound and computed tomography to diagnose disease. Interventional Radiologists are Radiology subspecialists who are board certified and fellowship trained in percutaneous (through the skin) interventions using radiological imaging as a guide. Their specialized training is certified by the American Board of Medical Specialties.
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What are the advantages of Interventional Radiology over traditional Surgery?
- Most procedures can be performed on an outpatient basis
- General anesthesia is usually not required
- Risk, pain and recovery time are often significantly reduced
- The procedures are usually less expensive than surgery or other
alternatives
Who should treat my varicose veins or spider veins?
Varicose veins and Varicose Spider Veins are treated by a wide variety of different physicians with different specialties including surgeons, dermatologists and internists. The most important factor for choosing a treating physician is to find one who is knowledgeable and who has experience with the complexities of diagnosis and variety of treatment options available for varicose veins. To this end, the Interventional Radiologist is fellowship trained to perform minimally invasive, image-guided therapies in all blood vessels throughout the body. Endovenous Laser Therapy is a procedure which uses ultrasound to guide the needle puncture of the great saphenous vein, place a fine laser probe or catheter into it, and advance it to the precise location in order to safely deliver heat energy to the precise anatomic compartment. This procedure is simply an extension of techniques Interventional Radiologists use in our day to day practice. Furthermore, the Interventional Radiologist is specialized in diagnostic ultrasound which is essential in the evaluation and safe treatment of the patient with varicose veins.
Are the treatments painful?
Most patients report minimal to no pain while undergoing injection sclerotherapy or EVLT. For patients with heightened sensitivity or apprehensive patients, an anesthetic cream is applied prior to the procedure, and mild sedation is used.
What are the complications of vein treatment?
Fortunately, sclerotherapy and endovenous laser therapy have rarely been associated with any serious complications when properly performed. Common minor complications of these procedures include bruising, mild itching, tingling, tenderness and tightness in the treated leg for up to two weeks after the treatment. Mild pain is usually managed with non-steroidal anti-inflammatory agents such as ibuprofen. Allergic reactions from the sclerosant have been reported, but are extremely rare. Ulceration of the skin after sclerotherapy can occur. This will eventually heal leaving a small scar. Deep Vein Thrombosis is a very small risk following sclerotherapy of larger varicose veins. Patients who are predisposed to this complications are those who have blood clotting disorders such as thrombophilia. Lack of exercise, air travel and sclerotherapy performed after major operations are other reasons.
The following occur more frequently:
- Staining or brown pigmentation at the site of treatment. This occurs in about 30% of patients. In most cases this resolves but it may take many months.
- Clots. These may appear within the treated vessels. These are not dangerous but can be quite tender if they occur in larger veins. They can be removed through a needle prick if necessary, but left alone they will eventually be reabsorbed.
- Temporary bruising. Bruises at the injection sites are quite common but resolve within a week or so.
- Capillary matting. This is an increase in the number of fine red vessels around the injection site. It may disappear on its own, or can be treated by further injections.
What is the after care following treatment?
Pressure is applied to the treated vessels using graduated compression hosiery (support stockings). These are usually worn for seven to ten days following sclerotherapy and for three to four weeks following endovenous laser therapy. The stockings come in different styles, sizes and colors. Patients are able to return to normal daytime activities immediately afterwards. Patients are encouraged to walk for at least thirty minutes a day for the first few days following the procedures. Vigorous physical activities such as aerobic exercise are not advised.
Will the abnormal veins come back?
The recurrence of varicose veins after endovenous laser treatment is less than three out of one hundred patients. Following sclerotherapy for spider veins, there is a small percentage of patients in whom the natural tendency to form spider veins will lead to the formation of new clusters in other areas many months or years following treatment. It is recommended to treat those areas as they appear during a touch-up or maintenance session. In approximately 5% of patients there is a chance of having only fair results in which injected veins have not completely disappeared following treatment. Before and after photographs are taken so that patients may objectively assess their results
How many treatments will be needed?
The number of treatments required will vary with each individual, depending on the extent of visible varicosities and spider veins. A range of 1-8 treatments can be expected.
What recovery is involved?
Normal activity may be resumed immediately, with the exception of activities which may soak the dressings (i.e., swimming, bathing). Legs should be elevated during rest periods. Strenuous exercise may be resumed after the dressings have been removed. Wearing elastic stockings is highly recommended since this improves the cosmetic and functional results of the treatment.
Are treatments expensive?
Vein treatments are relatively inexpensive particularly when compared to other cosmetic procedures. If the veins are causing symptoms or there is medical necessity, many insurance plans will cover all or part of the treatment. An estimate of cost, with payment options will be provided at the time of your ultrasound evaluation.
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