Vein Treatment Frequently Asked Questions

Endovenous Laser Therapy (EVLT) treats incompetence of the great saphenous vein. This vein courses along the inside of the leg, and is frequently the underlying cause of visible varicose veins all over the leg. When this vein is diseased it needs to be removed or sealed shut. Other veins in the leg then take blood back to the heart. Unlike surgical stripping, EVLT permanently closes off the vein while leaving it in place. The procedure involves the use of energy from an 810 nanometer laser delivered by a fine fiber-optic probe or radio-frequency energy delivered via a thin catheter.

The procedure is done in the office under local anesthesia. A special laser-tipped fiber or catheter is passed through a small sheath inserted into the great saphenous vein. As the device is activated, the resulting heat induces a reaction in the walls of the vein causing them to stick together. The varicosities associated with this vein then disappear as blood from the lower leg reroutes through the deeper circulation.

As only a slim sheath is needed to enter the vein, the whole procedure is performed through a tiny skin nick, so there is no post-operative scarring. Pressure is applied to the treated vessels using graduated compression hosiery (support stockings). These are usually worn for three to four weeks following EVLT treatment. The stockings come in different styles, sizes and colors.

Recovery from EVLT is rapid as there are no large surgical incisions or side effects of general anesthesia. Normal activities, including driving, can be resumed the net day. Patients should walk for at least 30 minutes a day following EVLT. Vigorous physical activity such as weight lifting and aerobics are not advised during this time.

The key benefits of EVLT are the following:

• A simple procedure
• Performed under local anesthetic
• Minimally invasive, so minimal risk of scarring and postoperative infection
• Less than one hour examination and treatment time
• Rapid recovery with reduced postoperative pain
• Normal activities can be resumed immediately
• Excellent clinical and aesthetic results

A detailed clinical evaluation including a venous ultrasound to map affected veins and abnormal valve function will be performed. A treatment plan will then be designed to meet the needs of the individual patient. Treatment may consist of a combination of endovenous laser therapy (EVLT) and ultrasound guided sclerotherapy. Compression stockings are prescribed following treatment.

Sclerotherapy is the best way to treat spider veins on the legs. A medication called a sclerosant is injected directly into the tiny veins using a very fine needle placed with the assistance of a light-enhanced magnifying lens. This causes the walls of the vessel to become inflamed. The spiders will then disappear over a few weeks to months following treatment.
Repeated treatments may be necessary in order to take care of all of the spider veins and the associated reticular veins. Although each session may involve a large number of injections, the needle used is extremely fine so that pain is not generally a problem. Unlike older sclerosants, the ones used at the MGR’s FeelNu Medical Spa and Wellness Center cause no pain at the time of injection. Immediately after injection, the spider veins will become red and slightly swollen, sometimes itchy for a few hours.

Sclerosants are medications injected into veins which cause the walls to become inflamed and eventually seal off. The two newest and non-painful medications used are called sodium tetradecyl sulphate and polidocanol. Another substance used by some physicians is hypertonic saline. These saline injections are extremely painful, and much less effective. This substance is not used at MGR’s FeelNu Medical Spa and Wellness Center.

Most patients report minimal to no pain while undergoing injection sclerotherapy or EVLT. For patients with heightened sensitivity or apprehensive patients, an anesthetic cream is applied prior to the procedure, and mild sedation is used.

Fortunately, sclerotherapy and endovenous laser therapy have rarely been associated with any serious complications when properly performed. Common minor complications of these procedures include bruising, mild itching, tingling, tenderness and tightness in the treated leg for up to two weeks after the treatment. Mild pain is usually managed with non-steroidal anti-inflammatory agents such as ibuprofen. Allergic reactions from the sclerosant have been reported, but are extremely rare. Ulceration of the skin after sclerotherapy can occur. This will eventually heal leaving a small scar. Deep Vein Thrombosis is a very small risk following sclerotherapy of larger varicose veins. Patients who are predisposed to this complication are those who have blood clotting disorders such as thrombophilia. Lack of exercise, air travel and sclerotherapy performed after major operations are other reasons.
The following occur more frequently:

• Staining or brown pigmentation at the site of treatment. This occurs in about 30% of patients. In most cases this resolves but it may take many months.
• Clots. These may appear within the treated vessels. These are not dangerous but can be quite tender if they occur in larger veins. They can be removed through a needle prick if necessary, but left alone they will eventually be reabsorbed.
• Temporary bruising. Bruises at the injection sites are quite common but resolve within a week or so.
• Capillary matting. This is an increase in the number of fine red vessels around the injection site. It may disappear on its own, or can be treated by further injections.

Pressure is applied to the treated vessels using graduated compression hosiery (support stockings). These are usually worn for seven to ten days following sclerotherapy and for three to four weeks following endovenous laser therapy. The stockings come in different styles, sizes and colors. Patients are able to return to normal daytime activities immediately afterwards. Patients are encouraged to walk for at least thirty minutes a day for the first few days following the procedures. Vigorous physical activities such as aerobic exercise are not advised.

The recurrence of varicose veins after endovenous laser treatment is less than three out of one hundred patients. Following sclerotherapy for spider veins, there is a small percentage of patients in whom the natural tendency to form spider veins will lead to the formation of new clusters in other areas many months or years following treatment. It is recommended to treat those areas as they appear during a touch-up or maintenance session. In approximately 5% of patients there is a chance of having only fair results in which injected veins have not completely disappeared following treatment. Before and after photographs are taken so that patients may objectively assess their results.

The number of treatments required will vary with each individual, depending on the extent of visible varicosities and spider veins. A range of 1-8 treatments can be expected.

Normal activity may be resumed immediately, with the exception of activities which may soak the dressings (i.e., swimming, bathing). Legs should be elevated during rest periods. Strenuous exercise may be resumed after the dressings have been removed. Wearing elastic stockings is highly recommended since this improves the cosmetic and functional results of the treatment.

Vein treatments are relatively inexpensive particularly when compared to other cosmetic procedures. If the veins are causing symptoms or there is medical necessity, many insurance plans will cover all or part of the treatment. An estimate of cost, with payment options will be provided at the time of your ultrasound evaluation.