Treatments & Procedures: Conservative Management

Before any type of invasive surgical procedure, it may be possible to control earlier stages of varicose veins disease by conservative means. These include:

• Weight control: Obesity has an adverse effect on the condition of venous circulation in lower extremities. The veins struggle to carry the blood up against gravity towards the heart. Varicose veins are much more common and more ominous in obese people.
  

• Lifestyle: Avoid standing still in one place or sitting with your legs hanging down for too long. Keep your legs elevated whenever possible.
  

• Occupation: People who stand behind a counter for many hours a day, for example barbers, hair stylists, cashiers and bank tellers, are at risk for varicose veins disease with serious complications.
  

• Pregnancy: Pregnancy affects the condition of venous circulation in the legs adversely and in many different ways. Pregnant women, especially those with varicose veins, need special care and appropriate support for their legs.
  

• Elastic compression stockings: Generally, people have a negative attitude towards compression stockings. In our experience a majority of patients, after wearing these stockings for a little while, feel very comfortable with them because their legs feel so much better. A variety of styles are now made with consideration of their appearance and comfort. This is a palliative measure often required by your insurance carrier for a period of up to six months, before definite treatment of your venous disorder can be undertaken.

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Endovenous Laser Therapy

Endovenous Laser therapy is performed for the treatment of large, bulging varicose veins and their underlying cause, venous reflux. With endovenous laser therapy, no surgery is required, and the entire procedure can be performed in about an hour.

Under local anesthesia, with the assistance of ultrasound, a small catheter is inserted into the great saphenous vein (a large vein in the inner thigh); a thin laser fiber is threaded into the catheter and laser energy is delivered through the fiber into the vein, causing the vein to close.

When finished, gauze pads will be placed over the site and a compression hose will be worn for several weeks.

After the procedure, individuals are able to walk and able to return to work or resume usual activities the next day. The affected veins disappear over a few months.

» Learn more about Endovenous laser therapy from evlt.com

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Phlebectomy

Microphlebectomy, sometimes called ambulatory phlebectomy or stab avulsion, is a minimally invasive method of treating varicose veins. Special mini-hooks are used to remove the vein through multiple tiny incisions that do not usually require stitches and leave minimal scarring. Recent advances have made it possible to perform the procedure using only local anesthesia and light sedation in a doctor's office as an outpatient. After the microphlebectomy, you will be asked to wear compression garments temporarily. The incisions typically heal within two weeks.

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Sclerotherapy

Visual Sclerotherapy is a standard treatment for small varicose, reticular and spider veins. The procedure involves injecting a sclerosing solution through a tiny needle into the vein, which then collapses and is absorbed by the body. Treatments involve one or more injections during one or more sessions, depending on the type, number and severity of the veins being treated. By the end of the treatment program, the veins will no longer be visible on the skin surface. Sclerotherapy also often relieves symptoms associated with enlarged veins and prevents further complications from occurring.

On average, two to three sessions are required, spaced four to six weeks apart. After each session, patients may have to wear bandages or support hose for a few days or weeks and are encouraged to walk or exercise to speed recovery. The procedure is outpatient. Bruising and swelling, if present, should fade within a week or two.

Sclerotherapy rarely produces more severe side effects such as scarring and ulcerations, although it cannot prevent the recurrence of vascular lesions.

Trans-illuminated Sclerotherapy uses a new technology known as side-trans-illumination or VeinLite, light generated by a halogen bulb travels through a high quality fiber into the VeinLite ring where its is directed into the skin at a fixed angle, providing uniform illumination and visualization of veins.

This method is able to uniformly trans-illuminate a small region of the skin so that much better imaging of the veins is achieved without shadows. Imaging veins during vein access makes for faster and easier access with minimum probing. This allowing you to visualize those hard-to-find veins in young and old patients and spider veins during micro-sclerotherapy.

Ultrasound-guided Sclerotherapy allows the physician to treat problem veins that aren't visible on the skin surface by monitoring veins on an ultrasound screen during the injection procedure. This allows for more complete treatment of the your condition of Venus Insufficiency, better resolution of symptoms and lowers the chance of recurrence.
Following the procedure you will be placed in a compression dressing or stockings and are encouraged to walk or exercise to speed up recovery. Bruising and swelling are rare but if present should fade within a week or two.

Foam Sclerotherapy is an exciting new option being offered by the Vein Center for the treatment of varicose veins. Until recently sclerotherapy solutions, called sclerosants, could only be used to treat small spider veins. If they were injected into larger vessels, they would be ineffective.

When air is mixed with a sclerosant, a foam solution is created. When injected into a vein, it will displace blood inside the vessel, allowing direct contact between the vein wall and the sclerosant. The end result is sealing of the vein and eventual absorption by the body eliminating it without incisions. It allows the closure of larger bulging varicosities, avoiding more invasive surgical procedures.

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Surface Laser Ablation

Surface laser is playing an increasing role in the treatment of spider veins but should not be used indiscriminately in all patients who present with spider veins. Improper selection of patients can lead to unsatisfactory results, complications or even the proliferation of veins that may be resistant to treatment.

The role of laser therapy in spider vein treatment may be considered appropriate in patients who are needle phobic, cannot tolerate sclerotherapy, are plagued by leg veins that are sclero-resistant or are susceptible to telangiectatic matting.

Ideal candidates for laser treatment of leg veins previously have undergone appropriate surgery or sclerotherapy for the treatment of varicosities, incompetent perforators and reticular veins, as well as sclerotherapy to clear the majority of superficial vessels.*

*N. Sadick and L Sorhaindo, Laser Treatment of Telangiectasias and Reticular Veins, in The Vein Book edited by Dr. John Bergan; Elsevier Academic Press Copyright 2007

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