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Treatment Methods

The legs of a man running on a road

After a comprehensive evaluation that includes an ultra-sound examination of the veins, our vein specialists will determine the optimal treatment for each patient's needs.

Treatments include:

Ambulatory Phlebectomy

Ambulatory phlebectomy is a vein removal procedure that involves removing unwanted varicose veins from the legs. This procedure is performed in the physician’s office. Prior to the procedure, a numbing solution is placed around the vein. Tiny incisions are then made in the skin to remove the veins in small segments. No stitches are required and, with the exception of wearing a compression bandage for seven days, patients can return to their normal activities within 24 hours of treatment.

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Compression Therapy

Treatment for varicose veins depends on the cause and severity of the condition. In many cases, multiple modalities are used. Compression stockings are the most conservative treatment.

Compression stockings improve the signs and symptoms of varicose veins by providing graduated compression therapy to help control leg swelling and discomfort. These stockings are specially designed to apply more pressure in the ankle area and gradually decrease the pressure applied to the thigh area to direct venous blood flow back to the heart.

The amount of pressure required by a compression stocking depends on the patient, the severity and type of venous disease being treated; therefore they are filled by prescription at most medical supply stores.

Every surgical option requires that you wear prescription grade compression stockings to assure that you have the best results. Your insurance company may also require that you wear the compression stockings for a specific period of time to be considered a candidate for surgery. It is recommended that you contact your insurance company to confirm their criteria.

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A surgeon performing a varicose vein procedure

Sclerotherapy is a medical procedure used to treat varicose veins and “spider veins”. During this procedure, a very small needle is used to inject special medications into diseased veins that cause the veins to shrink and gradually disappear. The needles used are very small and feel like a mosquito bite. Most people find this treatment relatively painless. Sedation and local anesthesia are not required. Sclerotherapy is performed in the physicians office.

Scleratherapy works well for most patients. The spider veins treated with sclerotherapy are permanently destroyed and will be reabsorbed by the body, so they cannot come back. However, nothing can be done to prevent your body from forming new spider veins. Excessive standing, crossing the legs, or being overweight does not cause them. It is mostly hereditary. But new spider veins can be treated just as effectively as the previous ones with additional sclerotherapy.

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RF Ablation

Venoclosure and EVLT are very similar techniques. In venoclosure, the greater saphneous vein is accessed using ultrasound for guidance. A radiofrequency fiber is placed in the vein and advanced to the level of the groin. Radiofrequency energy is used to destroy the lining of the greater saphenous vein. Once the endothelium, or lining of the vein is ablated, this “tricks” the body into thinking that the vein is dead and the body converts the dysfunctional vein into a fibrous scar. Blood does not flow through the scarred vessel and instead blood is re-routed to normal veins with functioning valves back to the heart.

Venoclosure and EVLT provide the same end result as stripping without the pain, long recovery time and loss of work from vein stripping. Endovenous ablation has the added benefit of being more durable with a 94% success rate at two years versus a 60% success rate for vein striping.

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Endovenous laser treatment (EVLT) is a minimally invasive procedure used to treat varicose veins. EVLT is performed in the physician’s office under local anesthesia. This procedure is an alternative to surgical stripping of the great saphenous vein. Instead of removing the saphenous vein, it is sealed closed in place.

The EVLT procedure generally takes less than 30 minutes to perform. The procedure involves numbing the skin on the inside of the knee. An ultrasound is then used to guide a small laser fiber into the abnormal vein. The laser heats the lining within the vein, damaging it and causing the vein to collapse, shrink and eventually disappear.

Patients are instructed to wear compression stockings following EVLT and they are able to walk immediately. Light exercise is permitted and patients can return to work the following day. The majority of patients experience significant improvement of their symptoms within two weeks.

Most insurance companies recognize venous insufficiency as a chronic medical condition therefore will cover the cost of the EVLT. Patients are advised to contact their insurance company to see if they qualify for coverage.

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Vein Stripping

A picture of a foot with varicose veins

Large varicose veins can be removed by a surgical procedure know as vein stripping. During this procedure, the surgeon will make two small incisions at the ankle and groin and a series of microincisions along some of the branches of the veins on the leg. The surgeon will then cut and tie off the varicose veins connected to the saphenous vein (main leg vein), then remove the saphenous vein from the leg. Removing the vein ends the cycle of backward blood flow. This procedure is performed as an out patient surgery under general anesthesia and requires a six week post-operative recovery.

Vein stripping is less painful than it sounds, and does not disturb the circulation process in the leg. Blood circulates to the heart through other veins, and the disconnected varicose veins eventually die off and are absorbed by the body.

The benefits of the procedure include the removal of unsightly veins and relief from leg pain, throbbing, swelling and other related symptoms.

After the procedure patients are instructed to elevate their legs when sitting or lying down. They are also encouraged to walk as much as possible, beginning the day after surgery. Patients are also told to wear compression stockings after surgery.

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