About Treatment of Venous Disease
Varicose Veins and Venous Reflux
Spider Veins
About Treatment of Varicose Veins and Venous Reflux
At Yellowstone Vein Center, we are pleased to offer a variety of minimally invasive, virtually painless, and effective therapies. One or more of these may be appropriate for you. These are described in some detail below.
The goal of all the therapies that we offer is get rid of the abnormal veins which are serving little purpose (actually worse than useless, as they flow the wrong way), while leaving the healthy veins intact. This can be done by removing the abnormal vein (phlebectomy). Alternatively, the vein may be left in place and damaged from the inside with heat (laser therapy) or chemical irritation (sclerotherapy) so that it clots and scars down. Each of the treatments described below is most effective and safe in certain situations or conditions, but less desirable in others. Therefore the treatment plan is developed for you only after your Yellowstone Vein Center physician reviews the results of your medical history, physical examination, and ultrasound. The treatment is tailored to provide the optimal result based on your specific anatomy and the extent of the disease. As a result some patients may need only one mode of therapy, and while others may need all of the therapies that we offer, directed to treat the various components of their venous disease.
Laser Therapy/Ablation
Yellowstone Vein Center offers the most modern and effective treatment for varicose veins, utilizing laser therapy to close off the largest veins (most commonly the greater saphenous vein, or GSV) that usually are the primary cause of venous reflux and varicose veins. Although not used primarily for the direct treatment of superficial varicose veins, the laser is the most effective and safe way to treat the underlying problem of venous insufficiency or reflux. After appropriate evaluation, including a complete medical history, physical exam, and ultrasound mapping of the veins of the legs to determine the refluxing segments, a patient may be considered an appropriate candidate for percutaneous laser ablation. Some insurance companies may require a trial of conservative care prior to approving payment for laser therapy.
In this procedure, the refluxing vein is accessed and a small laser fiber is introduced into the vein. This is advanced to the top of the refluxing segment, and after giving more local anesthesia (numbing medicine) around the vein the laser is turned on and slowly withdrawn. The local heat generated by the laser on the inside of the vein seals the vein closed.
The procedure usually takes less than one hour, and typically provides immediate relief of symptoms. You may immediately return to normal activity. Compression stockings must be worn for two weeks following the procedure. Some bruising and minor soreness is expected, usually treated with over the counter pain medications (such as Advil, or ibuprofen).
As opposed to traditional surgical therapy, the procedure is virtually painless, and is performed though a small incision less than 1/8th inch in size. In addition, patients can usually return to work the same day, instead of weeks of bed rest with traditional surgical therapy. Surgical therapy also has a relatively high recurrence rate, from 10% to 25%, as compared to less than 5% with laser therapy. Careful mapping of the venous anatomy prior to intervention also contributes to the effectiveness of the targeted therapy.
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Ambulatory Phlebectomy
Many patients also benefit from having focused removal of large bulging veins just under the skin in the thigh and calf, usually done at the same time as the laser ablation. This is called ambulatory phlebectomy. Using small incisions (1/8 inch or less), these abnormal veins are removed though the skin under local anesthesia. If these large superficial veins are left in place, and closed by other means (such as sclerotherapy), there may be significant inflammation and skin discoloration.
Although in some patients this may be primary therapy, in most patients this is performed in conjunction with laser ablation of underlying refluxing veins. This is almost always done at the same time as the laser ablation.
Sclerotherapy (with or without Ultrasound guidance)
For some dilated or varicose veins, as well as spider veins, sclerotherapy may be utilized either alone or in conjunction with therapies described above. For these selected veins, which are usually smaller veins, injection of a medication, a sclerosing solution, will be recommended. This simple procedure is quick and simple and relatively painless. More than one treatment may be needed to achieve the desired result if extensive varicosities are present.
Ultrasound is frequently utilized to find these abnormal veins when they are not immediately under the skin, to determine the length of the abnormal segment being treated, and to assess any connections to normal veins that they may have. This enhances the ability of the physician to target the treatment to the abnormal segment or segments.
Microthrombectomy
Following laser ablation and/or phlebectomy, some focal clots may persist in the veins and become irritated or swollen. Although not dangerous, if left untreated focal darkening of the skin can develop as well as persistent local irritation. Our staff will look for this when you come back 1-5 days after the treatment. If present, microthrombectomy may be recommended. This involves using a needle to make a tiny incision, through which the clot will be expressed from the vein to facilitate healing.
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About Treatment of Spider Veins (Telangectasias)
Sclerotherapy
The primary mode of treatment for spider veins is sclerotherapy. In this procedure a tiny needle is used to access the small veins just under the skin and small amounts of medication are injected into the vessels, resulting in clotting and scarring of the abnormal vein networks. Although this requires multiple needle punctures, the discomfort is minimized by the small size of the needle. Successfully treated spider veins may take a month or more to resolve completely, therefore we recommend a minimum of four weeks between treatment sessions.
Spider veins can also, on occasion, be resistant to therapy, requiring two or more treatments of a given lesion to obtain a satisfactory result. In addition, there are limitations to the amount of medication that it is appropriate to inject in a given treatment session, due to the potential for adverse reactions. For patients with extensive telangectasias or resistant spider veins, multiple treatments may be required. Your Yellowstone Vein Center physician will give you an estimate of the number of sessions required for a satisfactory result (80-90% treatment) prior to initiating therapy.
As spider veins have a hereditary predisposition, treatment does not reduce the risk of having new telangectasias develop. Periodic follow up treatments may be needed, at the discretion of the patient.
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