Treatment Options for Varicose Veins

Step by Step Procedure Guide for Laser Ablation, Phlebectomy & Staged Procedures

No treatment:

Some patients opt not to treat their varicose veins. They may live their entire life with varicose veins and never develop complications more serious than a chronic dull ache.

Compression Hose:

Compression hose aid in the treatment of varicose veins by helping to squeeze the blood back out of the legs by means of an upward gradient compression. In many cases this will relieve discomfort.

Ultrasound Guided Sclerotherapy:

Under the guidance of ultrasound a needle is inserted into the greater saphenous vein and a chemical is injected directly into the diseased vein. This chemical irritates the vein wall causing it to collapse and scar down.

Endo Venous Ablation:

A catheter is inserted into the greater saphenous vein at the level of the knee. This is done using a large gauge needle, although sometimes a small incision may be needed to locate the vein.  A laser fiber is then fed up the catheter into the proximal portion of the greater saphenous vein.  The laser fiber is slowly withdrawn as it fires energy into the vein causing damage to the vein wall. This damage results in the greater saphenous vein closing down.

Ambulatory Phlebectomy:

After Endo Venous Laser Therapy has destroyed the proximal greater saphenous vein the branches of the varicose veins are surgically removed. This is done through tiny incisions with an instrument that resembles a crochet hook. The veins are hooked and pulled out of the leg. The incisions are closed with steri strips.  No sutures are required. In most cases you can return to work the following day.

Ligation and Stripping:

The traditional surgical method used to remove varicose veins. This procedure involves numerous incisions requiring suturing and a prolonged recovery period.

A Treatment Plan Designed For Your Individual Case

Following your initial consultation, the doctor will recommend a course of therapy to address your specific problems.

If your ultrasound exam shows that you do not have reflux, then your problem will be one of only a cosmetic concern. We offer Injection Sclerotherapy and Laser treatments for cosmetic spider veins.

If your exam shows that you do have reflux, then your veins will be of a medical concern. We will contact your insurance company and supply them with the necessary documentation to precertify you for treatment.

We will do our best to help facilitate this, although we will ask you to keep in contact with your insurance carrier as well. Unfortunately, some carriers refuse authorization. If this is the case we can review fees with you and arrange financing if necessary.

The treatment of varicose veins requires a staged treatment plan.

The first stage of treatment involves destroying the main vein (the tree) with laser energy. When this vein has been closed, often the larger branches (your visible varicose veins) decrease considerably with time.

Several months after your initial laser surgery we will see you back in the office and perform a post operative ultrasound. At that time we will evaluate the bulging veins to see what further treatment might be needed.

It may be necessary to do another in office surgery where we actually remove the branch varicosities, or injections may be all that is needed. In some cases, no further treatment will be needed.

Stage One: Greater Saphenous Vein Ablation

Prior to the laser procedure we will rescan your leg and take measurements of the vein. We will out line the course of the Greater Saphenous Vein with a marking pen.

The "X" will mark the desired insertion site for the catheter.

Next we will clean your leg with an antibacterial solution and prepare a sterile field.

It is important to keep your hands on your chest, under the drape. This will prevent you from contaminating the sterile field.

At this point we will insert the catheter at the level of the knee and feed it up to the groin. We will inject more local anesthetic above the knee. This is done to eliminate pain when the laser is fired, as well as compress the vein and thermally protect the surrounding nerves.

After the anesthesia has been given above the knee, we will insert the laser fiber into the catheter. This will be done utilizing ultrasound to assure the proper positioning of the laser fiber prior to firing the laser.

A bright light will also be visible through the skin. This light is from the aiming beam, as the laser light is invisible.

To prevent any damage to the eye from the laser, we will put on safety goggles. The likelihood of damage to the eye is almost non-existent. We would have to point the laser directly in your eye at close range to harm the eye. We will then withdraw the laser slowly as it is being fired. You may experience an odd taste or smell during this part of the procedure.

The greater saphenous vein will be injured by the laser energy resulting in closure.

After the laser is withdrawn we will cover the insertion site with a steri-strip and 4x4 gauze.  Over this simple bandage we will apply a thigh high compression hose. You are to wear the hose around the clock for the first 72 hours then during the day for the following ten days, removing it only to shower.

We will see you back in the office in one week. Post operatively you will have a significant amount of bruising, this is to be expected. We will prescribe an anti-inflammatory medication to be taken for the first ten days.

After two weeks you may remove the compression hose If some of the remaining bulging varicosities persist, we may follow up your laser procedure with a minimally invasive surgical procedure preformed in the office to remove the bulging branches.

Stage Two: Ambulatory Phlebectomy

Prior to beginning the procedure we will mark the veins which are to be removed while you are in standing position.

Next we will begin injecting the local anesthetic. This part of the procedure is uncomfortable, but following the local anesthetic you should not encounter pain. You will feel a tugging and pulling sensation. Should you experience pain, please inform us and we will administer more local anesthetic. We do not expect you to be uncomfortable.

Next we will clean your leg with an antibacterial solution and prepare a sterile field.

It is important at this point to keep your hands on your chest, under the drape sheet. This will prevent you from contaminating the sterile field.

We then proceed to the Ambulatory Phlebectomy where we will actually pull the bulging varicosities out by hooking them with a crochet like instrument. This will be done through tiny incisions that will not require any suturing.

The veins that have been pulled from your leg will be appropriately discarded.

The tiny incisions will be closed using steri-strips. A bulky dressing will be applied over the steri-strips. Your compression hose will go over the entire dressing. This will stay in place, including the hose, for three days.

You will need to keep the dressing dry. Cover your leg with a large plastic bag before showering.

After three days the dressing will be removed. You must leave the steri-strips in place for one week. You will continue to wear the compression hose for the next ten days, during the day, removing them to sleep.

At one week post-operatively there will be residual bruising, but you will already begin to see the vast change in the appearance of your leg. You will find yourself asking, “Why did I wait so long to have something done?”

One Month Post Operative

At one-month post operative, most if not all of the bruising will have cleared.  The small stab wounds have healed and will continue to lighten with time. Those unsightly bulging varicose veins are just a memory!

Remember though, varicose veins can be an ongoing problem for you. The body is always trying to repair itself by creating new veins. It will be important for us to follow you yearly with an ultrasound exam. The ultrasound exam will help us locate any new veins that are developing and we can treat them with injections before they get worse.