- Vein Problems
Endovenous Laser Treatment
To effectively diagnose a patient showing symptoms of varicose veins, a physician will conduct a duplex ultrasound to determine if saphenous vein insufficiency is present. This is the most frequent cause of varicose vein formation. Once diagnosed, the physician will decide if endovenous laser treatment is an appropriate solution.
The endovenous laser treatment is a 30-45 minute in-office procedure with no down time or scarring. The physician will determine the particular treatment procedure that is most appropriate for the patient. Generally, the skin is numbed before treatment. The vein is accessed percutaneously under ultrasound and an introducer catheter is inserted into the vein. The laser filament is inserted through the introducer. Once inside the vein, the placement of the laser filament is verified using ultrasound and by visualizing the aiming beam of the laser. Saline with lidocaine (numbing) solution is then infiltrated surrounding the entire vein. The laser is then slowly withdrawn as it emits energy. This laser energy seals the vein shut.
Once the procedure is complete, a compression dressing is placed on the treated leg for 2 days followed by 1 week of compression stockings. Under normal conditions the patient may return to work the following day.
The following are common physician recommendations:
- Wear compression stockings for a period of one week all the time, then 3 more weeks during the day
- Abstain from high impact activities such as running or step aerobics for a period of 3 weeks
- Walking is encouraged, as it will aid in the healing process.
A repeat ultrasound will be done in 3-7 days to check the deep leg veins, and again in 4 weeks to ensure that the treated veins are sealed. Occasionally, a treated vein will reopen, requiring either injection of foam sclerotherapy or repeat laser treatment. 98% of treated veins are sealed shut at 1-year follow-up.
As with any procedure, some mild side-effects might occur. You may experience a slight redness to your skin tone in the treated area, which will fade away within a few days. You might also notice a slight swelling in the treated area.
Click Here to view before and after photos
Ambulatory Microphlebectomy
Microphlebectomy is often performed in the office as an adjunct to laser closure of the saphenous or other malfunctioning truncal veins. The source of the vein reflux is treated first, and then, any remaining varicose veins can be removed directly. Under local anesthesia, small 2-3 mm incisions are made, and the underlying varicose veins are removed. No suture is needed to close the incisions, and the scarring is very minimal to none. The leg is wrapped with dressings for 2 days and then compression stockings are worn for 1 week.
The following are common physician recommendations:
- Wear compression stockings for a period of one week all the time, then 3 more weeks during the day
- Abstain from high impact activities such as running or step aerobics for a period of 3 weeks
- Walking is encouraged, as it will aid in the healing process.
Some patients with very large varicose veins may still be treated on an outpatient basis in the hospital with the TriVex powered phlebectomy system. This technique also uses a few small incisions to allow removal of massive varicose veins. The recovery is similar to ambulatory microphlebectomy, but there is more bruising possible.
Click Here to view before and after photos
Surface Laser Treatment
Surface laser treatment is used to eradicate spider veins. The laser beam is externally pointed at the veins to be treated, and the laser light energy is used to close the veins.
Skin pigmentation can impact the effectiveness of any laser, therefore the patient should have no sun exposure four weeks prior to treatment to guard against blistering and scarring.
Although discomfort is mild, some form of cooling may be used to increase the patient’s comfort. Cooling may be achieved through the use of ice, a cool air device or topical anesthetic. The duration and number of sessions will vary depending on the severity of the condition and the location. Many facial veins can be treated in one session; however, most conditions on the leg require three to five treatments to ensure all spider veins are treated. These treatments are spaced four to six weeks apart.
Unlike most physicians who use only sclerotherapy, our doctors use the double injury method when treating spider veins on the leg. This technique treats the spider veins with the D940 SkinPulse S laser, followed by an injection of sclerosing solution into the associated reticular or “feeder” vein. Laser energy is applied first through a hand piece that is very small and lightweight. Spot sizes are easily interchangeable and come in 0.5, 1.0, and 1.5 millimeter sizes, depending on the size of the veins. By injuring the veins with the laser first, the vein spasms and less sclerotherapy is required. The benefit of the double injury method over sclerotherapy alone is a quicker resolution and a significant decrease in the risk of skin staining. Staining appears as brownish discoloration on the skin.
Once the procedure is completed, it is recommended that compression stockings be worn for three to five days. As with any procedure, some mild side-effects might occur. These side effects include slight redness to the skin tone or mild swelling in the treated area.
Common recommendations for the patient:
- Stay out of the sun and tanning beds for 4 weeks before and after surface laser treatment
- Wear compression stockings for a minimum of three to five days
- Abstain from high impact activities such as running or step aerobics for three weeks
- Walk at a moderate pace, as it will aid in the healing process
Although discomfort is mild, some form of cooling may be used to increase the patient’s comfort. Cooling may be achieved through the use of ice, a cool air device or topical anesthetic. The duration and number of sessions will vary depending on the severity of the condition and the location. Many facial veins can be treated in one session; however, most conditions on the leg require three to five treatments to ensure all spider veins are treated. These treatments are spaced four to six weeks apart.
Click Here to view before and after photos
Sclerotherapy
Sclerotherapy is an appropriate treatment of small- to medium-sized reticular veins that feed spider veins, or small varicose veins that remain after the endovenous laser treatment of reflux in the large saphenous veins. Occasional patients will also have perforator veins (connection between the deep and superficial veins) that are causing a skin ulcer. These are also well-treated with injection sclerotherapy.
Either visually or with ultrasound guidance, a tiny needle is used to inject foamed sclerosant into the vein. The lining of the vein then swells and eventually seals shut. The vein will usually fade in a few weeks. As with laser treatment, this procedure may take three to five treatment sessions. Staining, or brown discoloration on the skin, is a possible side effect to sclerotherapy and may take six months or longer to fade.
