The Vein Center
Specializing in the treatment of the full spectrum of venous disorders.
Small spider veins are treated with sclerotherapy (injection of a chemical sclerosant to close the vein). Typically, the treatment plan can be decided after a consultation and physical exam. This is a cosmetic procedure and not covered by insurance.
Large varicose veins and chronic venous insufficiency are treated with an outpatient endovenous laser procedure (EVLT – EndoVenous Laser Therapy) to close the greater saphenous vein. Smaller varicose veins are treated with foam sclerotherapy. This procedure involves injection of a chemical foam sclerosant into the vein, and results in closure of the vein. Prior to having EVLT or foam sclerotherapy, patients typically undergo an ultrasound procedure to study the vein anatomy and assess the function of the venous valves. EVLT and foam sclerotherapy are covered by Medicare and most PPO insurance plans.
Vein Center Video
Chronic Venous Insufficiency
The return of venous blood from the legs back to the heart is accomplished by the leg's "muscle pump" and the vein's numerous valves. Normal veins in the legs (as well as arms) contain one-way valves that permit the blood to flow from the periphery back toward the heart. These valves are necessary because of our upright posture, and the effect of gravity, which would otherwise cause the blood to pool in our feet and legs. The "muscle pump" is made up of muscle groups in the calf. When these muscles contract, blood is forced upward toward the heart, through the one-way valves. The blood cannot flow "backwards" toward the feet, because of the presence of the valves. When the muscles relax, the valves prevent the blood from flowing back down to the feet. The empty veins in the feet and legs can now accept new blood coming from the feet, and the process repeats. Large varicose veins are formed when the valves in the legs malfunction. The valves become "incompetent," or, begin to leak. As a result, blood can leak back down to the feet and legs, because of the action of gravity. This causes the veins to become distended, and further valves to leak because of the increase in size of the vein channel. Over time, these veins become large, "ropy," and visible to the naked eye. The word "varicose" comes from the Greek word for "cluster of grapes," which these veins can come to resemble. Varicose veins can cause discomfort, and typical symptoms include pain, burning, heaviness, or tingling.
EVLT
One way that varicose veins are treated is by surgical stripping. In this procedure, a surgeon excises the vein out of the leg through an incision, removing it permanently. Another technique for treating varicose veins involves use of a laser. In this technique, known as endovenous laser therapy (EVLT), a small laser catheter is inserted into the vein and laser energy is applied to the inner wall of the vein, causing the vein, to close permanently. The EVLT procedure takes about an hour and is done in a doctor's office. After and EVLT procedure, the patient can walk immediately and may return to work the next day. Mild bruising of the legs and mild pain are normal after an EVLT procedure. Compression stockings must be worn for several weeks after an EVLT procedure, in order to assure complete closure of the vein. EVLT and vein stripping are usually performed on large varicose veins, such as the Great Saphenous Vein, which runs down the inner aspect of the leg from the groin to the foot, and the Small Saphenous Vein, which runs down the back of the calf.
Click here to see photos of before and after EVLT
Click here to see more photos of before and after EVLT
Foam Sclerotherapy
Another very successful technique for treating varicose veins involves using a chemical compound known as a "sclerosant". The sclerosant, which is prepared as a foam, is injected into the vein with a small needle. This chemical interacts with the inner lining of the vein wall and causes the vein to spasm and close. The foam property of the chemical causes it to stay in contact with the vein wall, rather than washing away with the venous blood flow. In the ensuing hours, the vein channel clots and permanently closes. Foam sclerotherapy is a very simple procedure that takes about half hour, is done in a doctor's office, and involves minimal discomfort. Following foam sclerotherapy, the patient must wear compression stocking for several days. Foam sclerotherapy is typically performed on the small and medium sized varicose veins.
Spider and Reticular Veins
Superficial, small blue or red-blue spider veins, also called telangiectasais, are a result of reflux into tiny venules in or just below the skin. Reticular veins, also called feeder veins, often supply such telangiectasias.
Spider veins may have no associated symptoms but pain, especially pain which is aggravated by prolonged periods of sitting or standing, along with itching or altered sensations, are common.
Treatment of spider veins (and any associated reticular feeding veins) are treated with sclerotherapy. If the spider veins are supplied by a reticular vein, successful permanent results will only be achieved if the reticular vein is also injected. Occasionally, a diagnostic study using special illumination techniques may be useful to identify these deeper reticular veins.
Diagnostic Study
Diagnostic studies used to evaluate venous insufficiency prior to or as part of treatment may include the following:
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Handheld Doppler - A portable handheld device which uses Doppler ultrasound to detect reflux flow in the veins with an audible flow signal.
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Ultasound Vein Mapping - A full study performed in the Vascular Ultrasound Laboratory which provides a full picture of the vein pattern and connections, the size of the veins, and the direction and magnitude of flow.
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Vein Light - A handheld device which transilluminates the veins by using a bright light held against the skin. This allows visualization of veins up to about 5mm below the skin surface.
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Vein Viewer® - A portable device that uses an infrared signal to identify the veins and project an image of the underlying veins onto the skin. This allows visualization of veins up to about 8mm below the skin surface.
Links to websites for patient access*
*Medical information found on mimg.com or related links is provided for general patient information only, and may not be relied upon as a substitute for professional medical care.
