Aspects of a Treatment Plan
Your treatment plan will be specifically designed and individually tailored for the extent and severity of your specific condition. Here are a few important aspects to remember. First, usually a combination of the treatment options described below may be necessary for your comprehensive treatment. Second, if the endovenous laser ablation and ambulatory phlebectomy are recommended, usually only one leg can be treated at one time. Third, a series of treatments over several appointments may be necessary. Forth, all treatments are performed in our office setting.
Conservative Treatment – Compression Stockings
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. These stockings will also help heal any skin inflammation or ulcerations which have developed. However, there has never been any evidence to show that compression stockings prevent the formation of 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.
Sclerotherapy & Ultrasound Guided Sclerotherapy:
Sclerotherapy is ideal for treating small to medium size varicose veins. It involves the injection of a solution into diseased veins with the intent to create scar tissue inside the vein that will seal it closed. The veins then shrink and gradually disappear. The solution used is extremely safe and relatively painless. Anesthesia and sedation are not needed. For deeper varicosities ultrasound is often used to "guide" the injections into the underlying diseased veins below the surface of the skin. This allows the medication to be administered to precise locations safely and accurately. Sclerotherapy is often done during post operative visits to eliminate any diseased veins that were too small or too deep to remove during surgery. Thus, surgery and sclerotherapy are often complementary, ensuring that all the diseased veins are eliminated with treatment.
Foam Sclerotherapy (Sclerofoam)
Foam Sclerotherapy is nothing more than injecting air mixed with a liquid sclerosing solution (sclerofoam) rather than just the liquid sclerosing solution into the veins to be treated. Both small and large veins can betreated using a foam technique with or without ultrasound guidance. The amount of foam used is limited toavoid side effects and both techniques may be used together to obtain optimal results. When injected inside a vein, the micro foam displaces the blood (rather than mixing with it) creating better contact with the vein wall. Improved contact between the medication and vein wall givesbetter and faster results. The expanded volume of the mixture also allows for less medication to be used at a weaker strength
Endovenous Laser Catheter Procedure
The Endovenous Laser Catheter procedure is performed right in the office. Under local anesthesia, a thin laser fiber (or catheter) is inserted into the vein through a tiny incision. The catheter delivers laser energy (heat) to the vein wall, causing it to heat, collapse, and seal shut. Most patients return to work and near normal daily activities the very next day. The catheter is used to treat large diseased veins inside the leg which are often the cause of unsightly varicose and spider veins on the surface. In some cases, other treatments including sclerotherapy, ultrasound-guided sclerotherapy, ambulatory phlebectomy or ligation are used in combination with Endovenous Laser to achieve the best possible results.
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 through very small (1/8 inch) micro-incisions. The micro-incisions are so small that they are closed with sterile tape and not stitches. Once healed they are rarely visible. Bruising will occur and will take a few weeks to go away. A compression bandage is worn for only 3 or 4 days. When removed patients are amazed how good the leg looks with the “ropey” veins gone. Then a compression stocking is worn for another week. Patients can return to normal daily activities including work the next day and walking is encouraged. Ambulatory Phlebectomy (Video - 1.8M)
Vein ligation is a minor surgical procedure where a large varicose vein is tied off through a small incision. This is necessary when veins are not working properly and the blood in them is leaking (refluxing) back down the leg. These incompetent veins are the source of most of the visible varicose veins seen on the surface of the leg. That is why; treating only the surface veins will not eliminate the source of the problem and will only lead to a poor result or a rapid recurrence of the original or a new problem. These refluxing (leaking) larger veins must be separated or disconnected from the rest of the healthy venous system. Ligation is performed in combination with Ambulatory Phlebectomy and/or Sclerotherapy which eliminates the source and the surface diseased veins.
After vein treatments
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 re-route blood to the deeper, healthier veins. A compression bandage is worn for only 3 or 4 days after endovenous laser ablation and ambulatory phlebectomy procedures. A shower bag is supplied for bathing with the dressing in place. Compression stockings are worn for short periods after all treatments to assist in healing and reduce any mild discomfort or swelling which may occur. Because mild sedatives are usually given during the endovenous laser ablation and ambulatory phlebectomy procedures you will need to bring someone to drive you home afterwards. You may drive yourself to all subsequent post-procedure visits because sedation and anesthesia are not needed. These post procedure follow-up visits are very important. During these visits (usually two) we assess the efficacy of our treatment and evaluate your body’s healing response to the therapy. Often it is during this period that additional sclerotherapy, with or without Ultrasound guidance, is performed to insure the best long term results possible.
Old Fashoned, Obsolete vein stripping
Historically, major surgery, commonly known as “vein stripping” was used to treat the larger varicose veins. Today, “stripping” is obsolete and rarely, if ever needed. This procedure is painful, requires a hospitalization and a general or regional anesthetic. The permanent scarring and lengthy recovery time from “stripping” was un-acceptable. Endovenous laser ablation and ambulatory phlebectomy procedures, with emphasis on esthetically cosmetic pleasing results without permanent scarring, has increasingly replaced the traditional Vein Stripping Surgery.