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Vein Treatments

When is vein treatment recommended?

Varicose and spider veins may require medical treatment. Generally, if you are having leg symptoms such as pain, swelling, heaviness, or discoloration, treatment will be recommended if is believed to be caused by abnormal blood flow in your veins.

There are some conditions that are more serious in which it is critical to have your veins treated as soon as possible including ulcers and leg vein infections.

 

Are you a candidate for vein treatment?

Many factors contribute to the presence of venous reflux disease, including:

  • Age
  • Gender
  • Family history
  • Leg heaviness and fatigue
  • Skin changes and skin ulcers

Using ultrasound to scan your leg(s), your physician will determine if superficial venous reflux is present.

Contact us now to determine your candidacy for vein treatment or the Closure procedure.

 

What is the difference between cosmetic surgery and medical necessity?

Physicians have been debating the treatment of varicose veins for well over two thousand years – the legendary Hippocrates himself wrote about them in the fifth century BC – but today both medical necessity and health insurance are major factors in determining the course of treatment for the condition.

When varicose or spider veins are treated for the exclusive purpose of improving the patient’s appearance, it is considered cosmetic surgery and will not be covered by the patient’s health insurance or Medicare. Virtually all procedures addressing spider veins will fall into this category.

If, however, the varicose veins are causing symptoms like pain, swelling, fatigue or other symptoms that affect the patient’s ability to work or function normally, or if the underlying venous reflux disease is producing complications like skin ulcers or blood clots, a physician can determine that treatment is required to restore or preserve the patient’s health and well-being, and is therefore considered a medical necessity. Under those circumstances, most health insurance and Medicare plans will cover the procedure.

 

What are the treatment options?

The goals of treatment are to reduce symptoms and reduce the risk of complications. Since not all varicose and spider veins require medical treatment, the goal of treatment may be simply to improve the appearance of the affected areas.

Wearing properly fitting support hose (also called compression stockings) is the most conservative approach for treating varicose veins, especially when the veins are symptomatic. Compression stockings can be purchased at some pharmacies and medical supply stores and come in various styles including below-the-knee, above- the-knee and pantyhose styles. They also come in different compressions varying from 8 to 10 mmHg, up to 40 to 50 mmHg. Your doctor can recommend the compression that is right for you. Most insurance companies require patients to wear compression stockings for several weeks before approving further treatment.

Other types of conservative management include:

  1. Weight loss
  2. Increasing physical activity
  3. Avoiding long periods of sitting or standing
  4. Leg elevation

If you do not achieve satisfactory relief of symptoms with conservative treatment, or if the appearance of the veins is bothersome, further treatment may be indicated. Treatment options may include sclerotherapy, endovenous (from inside the vein) vein closure with laser or radiofrequency, and possibly other minor in-office procedures.

 

Sclerotherapy

Sclerotherapy involves a sclerosing solution that is injected directly into the blood vessel with a very fine needle, causing the vein to seal shut.

Spider veins are small red or blue blood vessels that appear at the skin's surface. They are commonly found on the legs but can also be found on the face or other areas of the body.

The treated vein will collapse and fade from view. Depending on the size of the vein, several treatments may be needed several weeks or months apart. Sclerotherapy can be used on all skin types.

Sclerotherapy involves the injection of a solution directly into the varicose veins or spider veins that cause them to collapse and disappear. Several sclerotherapy treatments usually are required to achieve the desired results.

Foam sclerotherapy is a variation of the procedure performed under ultrasound guidance that involves the injection of a foaming agent mixed with a sclerosing agent. The foaming agent moves blood out of the vein so the sclerosing agent will have better contact with the vein wall.

Sclerotherapy is a simple in-office procedure that is usually more appropriate for isolated spider veins than larger varicose veins.  It is frequently performed for cosmetic reasons.

 

The VNUS Closure™ Procedure - ClosureFAST Procedure

Radiofrequency (RF) endovenous ablation is a minimally invasive procedure for treating venous reflux disease, using RF to heat and seal diseased veins thereby reducing or eliminating existing varicose veins. With the VNUS ClosureFAST™ catheter, the only RF ablation device on the market today for the treatment of venous reflux, radiofrequency energy is delivered through a heating element seven centimeters long to heat the collagen within the vein walls and cause the shrinkage and collapse of the vessel.

The Closure™ procedure is generally performed using local anesthesia, typically in a physician’s office or an outpatient surgical facility. The ClosureFAST catheter is inserted into the vein through a tiny incision below the knee. Guided by ultrasound imaging, the physician treats each 7cm. segment of vein with a 20-second burst of RF energy, causing the vessel to shrink around the catheter. The physician withdraws the catheter, treating each segment until the entire vessel has been sealed. An average 45cm length vein can be treated in this manner in three to five minutes.

 

In a clinical trial comparing Closure to laser, patients treated with Closure experienced less pain, less bruising and fewer complications with the Closure system.1 And one-year clinical data has shown the ClosureFAST™ catheter to be more than 97.4% effective in preventing reflux recurrence.

 

Laser Vein Treatment

If you want to safely and effectively remove unwanted spider veins, our Laser Vein Treatment may be your answer. Laser Vein Treatments are a fast, effective way to treat superficial small and medium sized spider veins. The laser uses a focused beam of light to selectively target the pigments of the blood to heat the unwanted vein. This seals off the vein, leaving the nearby skin tissue undamaged. The treated vein then dissolves and fade from view. We use the ClearScan™ laser to precisely treat visible vessels, broken capillaries, spider veins and vascular lesions. Your treatment will be tailored to match your condition and desired results. The procedure may take a few minutes to half an hour depending on the size of the area being treated. There should be little to no discomfort, but this varies from patient to patient and depends on the depth of the treatment. There is no need for anesthesia. There is little risk associated with this treatment, although multiple treatments may be necessary depending on the desired results. Recovery time depends on your actual treatment but there is virtually no downtime and you may resume moderate activity immediately. You may experience some redness and you will need to avoid direct sun exposure unless using a sun block of at least SPF 15.

 

Endovenous Laser (EVL)

Endovenous laser ablation (EVL) is a minimally invasive surgical procedure that uses laser heat to treat varicose veins. Laser energy is delivered to the inside of the great saphenous vein via an optical fiber that is inserted into the vein. When the laser is fired, it emits thermal energy at over 700 degrees Centigrade, perforating and destroying the vein walls and boiling the blood inside the vessel. The laser is repeatedly or continuously fired as the laser fiber is gradually withdrawn along the course of the vein, until the entire vessel is sealed by thermal damage and blood clotting.

Clinical data from one-year and two-year follow-up studies has shown EVL to be over 90% effective in keeping veins sealed, meaning less than one in ten patients experienced a recurrence of their venous reflux.

Studies indicate that the laser procedure is frequently uncomfortable for patients. In September 2003, the Journal of Vascular Surgery reported that two-thirds of EVL patients had post-operative pain, sometimes lasting several weeks, and more than half used prescription pain medication. Also, the laser energy frequently perforates the vein walls, forcing blood into the surrounding tissues and causing bruising and discoloration that can last weeks. Symptoms of pain and bruising are significantly higher with laser than with the radiofrequency-based VNUS Closure procedure, as confirmed by an independent comparative study.

Physicians performing EVL have experienced an additional drawback to the technique – the absence of technical feedback during the procedure. Unlike the VNUS™ ClosureFAST™ catheter , EVL devices do not provide the real-time data on variations in vein size or blood volume that would allow the physician to adjust how the laser energy is delivered or how fast the optical fiber is withdrawn. The lack of guidance can result in vein wall perforations or large blood clots.

 

Endovenous Ablation

Endovenous thermal ablation has replaced major surgery and the goal standard for treating varicose veins. In recent years, surgery was the only option and often resulted in a very difficult recovery with significant pain and bruising that often lasted for weeks.

Furthermore, the veins often came back. This type of procedure was referred to as “vein stripping”. Although, this is still done by some surgeons, the new non-surgical ablation techniques have proven far more comfortable and recurrence of veins is infrequent. Endovenous ablation means closing the vein off by using either laser or radiofrequency to deliver heat from the inside of the vein. Early laser treatments, although non-surgical proved to still be uncomfortable when done in the office without general anesthesia. However, quite recently, higher wavelength lasers (ie. 1320), have made laser ablation much easier. Radiofrequency ablation is another option that has proven to provide outstanding outcomes with virtually no discomfort during or after the procedure. Bruising is rare and people typically may return to work the day after the procedure.

 

Phlebectomy

Phlebectomy involves surgically removing medium to large varicose veins near the skin surface by inserting a surgical instrument with a hook through small incisions made in the skin and pulling the veins out in segments. The Phlebectomy procedure may be performed as a stand-alone procedure or performed in conjunction with saphenous vein treatment.

 

Comparing Vein Treatment Options

 

The VNUS Closure™ Procedure

Endovenous Laser

Vein Stripping & Ligation

Method of action

Collagen contraction resulting in a fibrotic seal1

Boiling of blood resulting in a thrombotic occlusion2

Surgical removal

Multi-center registry

97.4% closure at 1 year3

None

No multi-center studies

Post-operative bruising

4%4

2%5

38%4

19%5

Return to normal activities within 24 hours

89.1% of patients6

80.5% of patients5

69.8% of patients5

46.9% of patients5

* These results were obtained using the VNUS Closure™ and ClosurePLUS™ RF products with expandable electrodes.

1. Pichot O, et al. Role of duplex imaging in endovenous obliteration for primary venous insufficiency. J Endovasc Ther. 2000;7:451–9.

2. Proebstle TM, et al. Endovenous treatment of the greater saphenous vein with a 940 nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser generated steam bubbles. J Vasc Surg. 2002;35:729–736.

3. Dietzek A, Two-Year Follow-Up Data From A Prospective, Multicenter Study Of The Efficacy Of The ClosureFAST Catheter, 35th Annual Veith Symposium. November 19, 2008. New York.

4. Morrison, N. Poster presented at American Venous Forum Meeting, February 2003.

5. Lurie F, et al. Prospective Randomized Study of Endovenous Radiofrequency Obliteration (Closure) Versus Ligation and Vein Stripping (EVOLVeS). J Vasc Surg. 2003;38:207–14.

6. Morrison N. Presented at the Union Internationale de Phlebologie, Rome, September 2001.

 

Does insurance cover the cost of vein treatment?

Many insurance companies cover the cost of treating varicose veins, but generally not spider veins. The best thing to do is to check with your insurance company or call our office and we can help you find this information.

 

Ways to reduce problems with varicose veins:

  1. Avoid wearing tight-fitting undergarments and clothing that constricts the waist, groin or legs.
  2. Avoid prolonged standing or sitting
  3. Exercise
  4. Weight loss
  5. Leg elevation