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Treatment Options...
Compression Therapy
Compression therapy is the most conservative treatment option for varicose and
spider veins. It consists of stockings, panty hose, bandages and other devices
that exert graduated compression on your legs for the purpose of improving
circulation, therefore alleviating the symptoms of venous insufficiency and
slowing the progression of the disease. Compression is also used as adjuvant
treatment to enhance the effectiveness of other treatment modalities. The degree
and type of compression will vary depending on your specific condition. Your
physician will determine what type of compression garment you will use in your
treatment.
(TOP)
Sclerotherapy
This procedure is indicated for the treatment of bluish veins and spider
veins. Special liquid and/or foam is injected into the abnormal vein to collapse and
ultimately destroy the vein. It is virtually painless. Over a period of weeks,
the vessel turns into scar tissue that the body will reabsorb slowly fading from
view. The vein will become barely visible or not visible at all. The number of
treatment sessions is determined by the extent of your condition. Sessions
usually last 30 minutes to one hour. You will be required to wear compression
stockings or panty hose for one week after treatment to assist in the healing
process and help avoid complications. Most patients can expect 75-95%
improvement in treated vessels.
(TOP)
Ultrasound-Guided Sclerotherapy
With this technique, Sclerotherapy is performed while the physician visually monitors the vein on an
ultrasound screen. This enables treatment of veins that can't be seen because
they are below the surface of the skin that would otherwise require surgical
removal. This procedure is best suited to treat specific incompetent veins. Not
all patients may require this treatment modality. The procedure is painless and
quick. Expect to be bandaged for 24 hours, with subsequent use of compression
stockings or panty hose for an additional week.
(TOP)
Ambulatory Phlebectomy
This is a technique of varicose vein removal through tiny
punctures or incisions under local anesthesia. It is indicated for the treatment
of bulging varicosities that would not respond very well to Sclerotherapy due to
the thickness of the vein wall. Incisions measure 1-2mm., therefore no sutures
are required, and scars are not visible after 3-4 months. Patients walk
immediately and most drive home themselves. Prescription pain medication is not
required. Normal daily activities are resumed immediately, except for strenuous
exercise. Expect to be bandaged for 72 hours, with subsequent use of compression
stockings or panty hose for an additional 10 days during the day only. The major
advantages of this procedure include:
Closure Procedure
Developed by VNUS Medical Technologies, a thin catheter is used to
deliver radiofrequency energy to the vein wall, causing it to collapse and seal
shut. The Closure Procedure eliminates the need for ligation and stripping of
the great and small saphenous veins, a traumatic and painful operation with a
long convalescence. With this procedure, there is no surgery, no sutures and no
unsightly scars. It is minimally invasive, done under local anesthesia,
cosmetically appealing and provides fast relief of symptoms. Patients return to
their normal activities within 24 hours.
(TOP)
Endovascular Laser Treatment (EVLT)
Developed by an interventional radiologist, this minimally invasive
procedure delivers laser energy to the vein wall causing it to collapse and seal
shut. EVLT employs true
state-of-the-art technology and is the latest FDA approved procedure (February,
2002) for the treatment of varicose veins. EVLT offers excellent functional and
cosmetic results. The procedure is performed under local anesthesia in less
than one hour. Patients return to their normal activities within 24 hours.
(TOP)
Laser/Light-based Treatment
This procedure is indicated for the treatment of spider veins and may be performed in place of
Sclerotherapy or in addition to Sclerotherapy. Intense pulsed light is delivered to the involved vein(s).
This intense energy destroys the vein. The destroyed tissue is reabsorbed slowly
over time and will fade from view. Light based treatment is virtually painless. (TOP)
Potential Treatment Complications
All procedures are performed by a board certified physician specialized in vascular intervention
and the treatment of vein disease. Even when performed by a
vein specialist there are always possible side effects and complications, which include:
Bruising - Bruises may form at the site where the needle penetrated the skin. Typically, bruises disappear within 2-3 weeks.
Hyperpigmentation - These are brown spots on the skin at the site of a previously treated vein. This usually fades in weeks to months. It persists longer than one year in only 1% of patients.
Swelling - Swelling is reduced by the use of compression stockings or panty hose following
treatment. This is a self-limiting condition, which usually resolves within days to weeks.
Superficial Thrombophlebitis - Or, inflammation of a vein. It is less common and is not considered a serious condition. Small areas of redness and tenderness may present. It is
most commonly treated with compression, local heat and medication containing ibuprofen or extra strength Tylenol.
Lumps - These are actually blood clots in the treated veins, and it is a
normal process in the destruction of the vein. They are not dangerous and your
physician may elect to drain the blood out of these clots a few weeks after
treatment to aid in the healing process.
Localized Allergic Reaction - It is a very common condition with any type of sclerosing solution. It usually does not last more than 30 minutes and
may be treated with a topical steroid.
Systemic Allergic Reactions - These can vary in severity, and very rarely are life-threatening. They can be treated with oral anti-histamines, steroids, and/or epinephrine.
Nerve Damage - An uncommon complication due to inadvertent trauma to nerves from the needle stick or from injection of the nerve. Symptoms include numbness, localized pain, or referred pain along the trajectory of the damaged nerve. This may take months to resolve.
Deep Vein Thrombosis - Blood clots within the deep leg veins are a rare
complication of varicose vein treatment. Post procedural compression and
ambulation significantly reduce the risk of DVT Furthermore, immediate
ambulation is prescribed, practically reducing the probability to zero.
Cutaneous Necrosis - This is manifested by ulceration of the skin or sloughing, and is caused by one of three phenomena, and does not necessarily imply physician error:
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Leakage of the sclerosing agent from the injected vein into the surrounding tissues.
The presence of an arteriovenous anastomosis. This is an undetectable connection between a vein and an artery. As the sclerosing
agent is injected into the vein, it travels through the anastomosis into the artery, damaging tissue dependent on that artery.
Direct injection into an arteriole. These may look identical to venous spiders to the naked eye and are present within venous spiders in a small percentage of patients. (TOP)
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