Don’t Be Afraid
To Show Your Legs
Patients with veins that are cosmetically unappealing or who have symptoms are prime candidates for treatment. There are two common treatment options: conservative measures, such as compression stockings, or corrective measures that are minimally invasive such as injection sclerotherapy or thermal/chemical ablation. Many patients require a combination of treatments.
Endovenous Thermal Ablation
Endovenous thermal ablation is a minimally invasive, in-office treatment alternative to surgical stripping of the great or small saphenous vein that is insufficient and causing reflux or backward flow of the blood. After injecting a small amount of local anesthesia, we use ultrasound technology to guide the catheter into the vein. There are a few small needle sticks to the skin to anesthetize the area around the vein prior to using radio-frequency or laser technology to seal and collapse the vein. Following the procedure, a bandage or compression hose is placed on the treated leg. Patients are able to walk immediately after the procedure and most individuals are able to return to work the next day. This procedure usually takes less than hour in the office and is a proven technology with high success rates compared to previous surgical treatments.
Foam Sclerotherapy is used via ultrasound guidance and is another in-office treatment alternative to surgical stripping or thermal ablation. This technique is done with either a liquid or “foamed” sclerosant, while the doctor visually monitors the vein collapse on ultrasound. This enables treatment of veins that can’t be seen because they are below the surface of the skin and would otherwise require surgical removal. Ultrasound imaging is used to guide a needle into the abnormal vein and deliver medication to collapse the vessel.
Medical Adhesive Technology
The VenaSeal procedure an FDA-approved for use in the U.S. and utilizes a specially formulated medical adhesive that closes the vein after injection. This unique approach is performed under ultrasound guidance and requires one needle stick. Patients report minimal-to-no bruising post procedure and there is no need to wear compression stockings after the procedure. VenaSeal is currently covered by Medicare and may be covered by private insurance.
Ambulatory phlebectomy is a method of surgical removal of surface varicose veins. Ambulatory phlebectomy is performed using local anesthesia. The area surrounding the varicose vein clusters is flooded with anesthetic fluid. A needle is then used to make a puncture next to the varicose vein and a small hook is inserted into the needle hole and the varicose vein is grasped and removed. The punctures typically leave nearly imperceptible scars. After the vein has been removed by phlebectomy, a bandage and/or compression stocking is worn for a short period. Ambulatory phlebectomy is often performed in conjunction with endovenous ablation and is good for tortuous, bulky veins that are close to the skin.
Leg Swelling & Ulcers
Chronic venous insufficiency can manifest as leg swelling (lymphedema), skin discoloration (lipodermatosclerosis) and venous ulcers. These problems are difficult to treat and lead to significant patient dissatisfaction. Compression stockings are the mainstay of conservative treatment but venous ablation or sclerotherapy of the superficial veins or so-called “perforators” are well-studied treatments that can alleviate and prevent future development or progression of disease. A comprehensive duplex ultrasound of the legs will be completed in the office to map the veins that cause these problems.
Cosmetic Spider Veins
This treatment is great for spider veins, telangiectasias, and small reticular veins that are unsightly but asymptomatic. We inject an FDA-approved medication called Asclera (polidocanol) using a tiny, insulin or botox-type needle into the vein. This requires no anesthesia and causes minimal discomfort. Most patients require no more than thirty minutes per session and see results in as little as 2-3 treatments. You will need to wear compression stockings for 24 hours after treatment and then during awake hours for one week. Purely cosmetic treatments are typically not covered by insurance.