We provide staged treatment that begins with an initial consultation. During your first visit there is a full evaluation of the veins in your legs. This evaluation includes venous Doppler ultrasound examination of both legs. We will locate and map all varicose veins and design an individualized comprehensive therapy to address all your needs. The initial consultation with vein mapping takes about 45-60 minutes.
Treatment begins with conservative therapy. The conservative therapy consists of a 3 month trial use of specialized compression stocking. During the 3 month long trial of compression stockings we will submit all of our findings including photos of your varicose veins and a list of your symptoms to your insurance company. If the 3 month trial use of compression stocking fails, then we will obtain a pre-authorization letter from your insurance company and schedule you for an outpatient procedure. There are three primary treatment options.
Most varicose veins are treated by Endoluminal Laser Ablation (EVLA). This is performed by applying local anesthetic to the veins and then inserting a small laser filament or tube into the damaged varicose vein. The very thin laser tube is then slowly withdrawn through the vein while it emits light energy that shrinks and seals the walls of the vein together. Normal blood flow is restored as the blood is redirected from the collapsed sealed varicose vein into deeper healthy veins. This procedure takes approximately 30-60 minutes. There is a small amount of pain at the beginning of the procedure when the local anesthetic is applied with a small needle. The laser ablation is painless. After the procedure there may be some mild discomfort treated with ibuprofen for several days and there can be mild bruising or stiffness that can last up to 1 week. Most patients return to work in 1 to 2 days.
In some cases the damaged varicose veins are too small for the laser ablation filament or tube to pass through the length of the vein. For these smaller veins Mico-Phlebectomy is performed. A local anesthetic is applied to the varicose veins. After the veins are numb, micro incisions, each about the size of the width of a ball point pen are made over the varicose veins. The varicose vein are then carefully removed through the incisions. There is a small amount of pain at the beginning of the procedure when the local anesthetic is applied with a small needle, but the micro-phlebectomy procedure is painless. After the procedure there will be mild discomfort treated with ibuprofen for several days. There will also be mild bruising and stiffness that can last up to 1 week. Most patients return to work in 1 to 2 days. In most situations, for patient convenience, the laser ablation therapy and micro-phlebectomy are preformed in the same setting as a combined procedure. All the procedures are performed with mild sedation to increase patient comfort and improve patient experience.
For some patients the Duplex Ultrasound mapping of the veins reveals that the cause of the visible varicose veins and symptoms are actually very small underlying hidden veins located more deeply in the skin and that are not visible. These hidden veins are often treated using Ultrasound Guided Sclerotherapy. For this procedure ultrasound is used to guide the injection of a medication into the damaged veins which otherwise can not be seen by the naked eye. The injected medication blocks and seals the vein. An extremely tiny needle is used for this injection and there is minimal pain. The procedure takes less than an hour and patients may resume normal activities immediately following the procedure.
After your vein treatment you will be scheduled for a follow up clinic visit with Doppler ultrasound of the veins in the leg to confirm that the treated veins remain closed and that no new varicose veins are developing. The first follow up visits will be scheduled for 3 days after the procedure. Additonal follow up visits will be schedule after 4 weeks, 3 months, 6 months and 1 year following the procedure.