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Want to learn about varicose veins prevention and other important venous disease modalities? We can help!

Q: What are varicose veins?

Varicose veins are enlarged, bulging veins that are rise from the skin. They are most commonly found on the legs. They may cause swelling, itching, aching, and (in advanced cases) ulceration. In healthy veins, blood is kept from moving backward by tiny one-way valves. However, these valves may fail, potentially due to weight gain, pregnancy, trauma, or a sedentary lifestyle. If a valve is incompetent, the vein beneath it experiences a higher amount of pressure, causing it and the veins nearby to fail and dilate..

Q: What are the symptoms of varicose veins?

Varicose veins are discolored (usually dark blue) and are most likely to be found on the inside of the legs or the backs of the calves. However, they can be found anyplace on your legs, all the way from your groin to your ankles. They bulge out from underneath your skin, often feeling ropey. They may cause an achy feeling or a sensation of heaviness in your legs, as well as muscle cramping, swelling, burning, throbbing, or itchiness. Your legs may feel worse after a prolonged period of standing or sitting, while elevating the leg may make them feel better. In advanced stages, varicose veins may lead to ulceration on the ankles.

Q: How are varicose veins diagnosed?

Your initial evaluation will vary from physician to physician. They will question you about any vein-related symptoms. After the initial exam is complete, your physician may decide that further testing is in order. These tests include duplex ultrasound exams of the legs. These non-invasive procedures use sound waves to evaluate the function of the valves in the veins of the leg. These tests are very important in diagnosis, and can improve the effectiveness of any treatment. At this time a treatment plan is developed.

Q: How are varicose veins treated?

There are both non-invasive and invasive methods that are used to treat varicose veins. Non-invasive methods (often referred to as conservative treatments) include regular exercise, weight management, wearing compression stockings, elevating the affected leg, avoiding tight clothing, and avoiding sitting or standing for long periods. Phlebectomy and endovenous therapy are two forms of invasive treatments. Phlebectomy allows a doctor to remove varicose veins through  series of very small incisions. Endovenous therapy uses a controlled amount of heat or chemicals to cause the vein to swell shut.

Q: What is endovenous laser therapy?

Endovenous laser therapy is a new technique that uses a laser to destroy the vein. It is an in office procedure and may be done under local anesthesia. It takes no more than 45 minutes. A laser fiber is inserted into the vein under ultrasound guidance. Next, the vein is anesthetized using local anesthesia. The fiber is then connected to the laser generator and slowly withdrawn from the vein, sealing it and stopping the venous reflux. Possible adverse reactions are numbness and tingling, and venous thrombosis (blood clots) in the legs. Patients may have bruising and mild pain for up to 2 weeks.

Q: What is radiofrequency ablation of varicose veins?

Radiofrequency ablation – the Closure Procedure – is similar to endovenous laser therapy. A radiofrequency probe is placed in the vein under ultrasound guidance. Then the vein is anesthetized using local anesthesia. Next, the vein is heated along its entire length by slowly withdrawing the probe from the vein. This causes the vein to clot and close, stopping the reflux. Radiofrequency ablation is an outpatient procedure, can be performed under local anesthesia, and takes about 45 minutes. Possible complications are numbness, tingling, and blood clots in the legs. Patients may have bruising and mild pain for up to 2 weeks.

Q: What are venous stasis ulcers?

A skin ulcer, caused by a venous reflux disorder is called a venous stasis ulcer. It is an irregularly shaped wound with well-defined borders, surrounded by red or dark and thickened skin. Venous ulcers vary in size and location, but are usually found on the inside of the lower leg above the ankle.

Q: What are medical grade compression stockings?

Compression stockings or socks, which are now available in a variety of styles and fashion colors, are recommended for early treatment of venous insufficiency. They compress the lower leg and lessen the swelling and the formation of new varicose veins. They come in various strengths and are fitted by a trained person. The physician will tell you at your first visit the strength that is needed. They are worn as treatment of varicose veins and after treatment to assist in the healing process and maximize results.

Q: What are spider veins?

Spider veins are small red, blue or purple veins that appear on the surface of the thighs, calves and ankles. They may appear as a group of veins radiating outward from a central point, in a pattern that resembles branches on a tree or they may appear as thin separate lines. Spider veins may be isolated or associated with “feeder” veins. They can also be associated with larger underlying varicose veins. Certain factors contribute to the development of spider veins, including heredity, pregnancy, hormonal factors, weight gain, and occupations or activities that require prolonged sitting or standing, and trauma.

Q: How are spider veins treated?

People often seek treatment for spider veins because of cosmetic concerns. However, it is also common for spider veins to cause symptoms, such as aching, heaviness, and itching and night cramps. A common form of treatment for spider veins is Sclerotherapy. This is an in-office procedure where veins are injected with a solution, using small needles, which causes them to collapse and fade from view. The procedure typically improves not only the cosmetic appearance but associated symptoms as well. Generally three sessions are required to obtain maximum benefit and patients are required to wear compression hose after treatment.

Q: What is sclerotherapy?

Sclerotherapy is the injection of small amounts of dilute detergent solution into visible veins to cause inflammation in the vein wall. The patient then wears compression stockings. The walls of the vein stick together and the vein is no longer viable. Multiple treatments are required and it may take up to six weeks for the veins to fade. Because sclerotherapy treats only visible veins, more may form later in life. So return appointments for rechecks are required on a yearly basis. Sclerotherapy is usually not covered by medical insurance, as it is considered to be a cosmetic procedure.

Q: What type of results can I expect?

Most veins will lighten and/or disappear. Sclerotherapy DOES NOT yield perfect results. Improvement usually occurs, but perfection may not be achieved. As long as you expect improvement and not necessarily perfection, you should be satisfied. Full results may not been seen for weeks.

Q: Are results usually permanent?

The effect on the veins treated usually lasts. However, new areas of veins can develop over time. Sclerotherapy treats the problem at this time. It does not prevent new veins from showing up in other areas.

Q: What are the side effects of sclerotherapy?

Certain side effects may be experienced after sclerotherapy. Larger injected varicose veins may become lumpy and hard for several months before resolving. Raised red areas may appear at the injection sites and should disappear within a few days. Brown lines or a spot (hyperpigmentation) on the skin may be noted at the site of injection, possibly caused by a form of iron that escapes from the injected veins. In most cases, they disappear within 3-6 months, but can be permanent about 5 percent of the time. Bruising may occur around the injection site and can last several days or weeks. Your legs may look worse before they look better. Occasionally, a small ulcer can develop at an injection site. This can be painful and take several weeks to heal.

Q: How many treatments are needed?

The Dr. will perform a thorough evaluation of your veins. At that time we will give you an estimate of sessions needed to obtain your goal. Occasionally areas may need additional re-treatment or “touch ups”.

Q: Do I have to elevate my legs after the procedure, how long?

First, we encourage all patients to walk as much as possible after the procedure. However, while you are resting or if you plan to be stationary for an extended period of time, elevating your legs is important to help reduce swelling and prevent any remaining blood from pooling in the treated vein. If you are going to be sitting for a while, your legs should be elevated as much as possible for the first week after the procedure. You do not have to sleep with your legs elevated.

Q: How long do I have to wear compression stockings

Compression stockings are essential to a successful recovery and prevent adverse side effects after surgery. You must wear compression stockings for the first 24 hours after the procedure. After that time, you should continue to wear them during the treatment and you may continue at your discretion. They help to prevent new spider veins from forming.

Q: Will my insurance cover sclerotherapy?

Typically treatment of spider veins and reticular veins (blue veins) are considered a cosmetic treatment and therefore most insurance companies WILL NOT cover the treatment. At the time of your consultation, The Doctor will determine if your vein treatment is cosmetic or medically necessary.