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The minimally invasive endovenous approach constitutes a great advance for treating the deeper vein of the leg, the saphenous vein, when it does not function normally and causes varicose veins. This new method has replaced traditional stripping surgery for the vast majority of patients with severe varicose veins in the leg. The therapy is called endovenous because it is performed within the vein itself, by means of a catheter- a very thin, flexible tube. Once inside, the catheter sends out radiofrequency or laser energy that damages, shrinks, and seals the vein wall. Veins on the surface of the skin that are connected to the treated saphenous vein are then removed with a technique called micro-phlebectomy. Healthy veins around the closed vein restore the normal flow of blood in the leg. As this happens, symptoms from the varicose veins improve. The procedure is done in our office with local anesthesia. Patients are able to walk immediately after it is done, and generally return to normal activity in a couple of days. Endovenous treatment of varicose veins has been used for several years with excellent results.
How successful is endovenous therapy?Many clinical studies that document the success of endovenous therapy in patients have been published in the medical literature. The success of the procedure is over 95%. Like any medical treatment, however, endovenous therapy has certain risks. But the problems associated with these risks happen in less than 1% of patients treated with the endovenous procedure.
What should I expect after the endovenous procedure?After the procedure you will wear a special support stocking for 2 weeks. There will be some bruising, which is normal, and will completely resolve in 4-6 weeks. You may also experience some mild discomfort, tingling and/or tightness in the treated leg, which should go away in 1-2 weeks.
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The word phlebectomy means "to remove veins". Mini-phlebectomy
is a procedure in which large varicose veins are removed through
small multiple punctures. The procedure is performed in the
office under local anesthesia and often following the endovenous
procedure. Using only a needle, small punctures are made over
the veins and with the use of a special hook instrument,
the veins are removed. The wounds require no stitches and
when healed, the scar is barely visible.
The major advantages of mini-phlebectomy are the disappearance
of large varicose veins with excellent cosmetic results and
relief of symptoms. After treatment, a compression dressing
is worn for 2-3 days. Patients walk out of the office and
may resume their normal daily activities immediately following the procedure.
Complications of mini-phlebectomy are quite rare, less than 1%,
but can include minor bleeding, dark pigmentation and temporary numbness.
Bruising and swelling are to be expected immediately after the procedure
and will disappear in two to four weeks.
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Ultrasound Guided Sclerotherapy is used to treat larger veins
which may not be visible through the skin, but are diseased
and require treatment in order to eliminate symptoms or
to heal a wound. Since these veins may not be visible,
ultrasound is used for guidance to access the veins and
under direct vision the veins are injected. Similar to
sclerotherapy, UGS may require several treatment sessions
to eliminate abnormal veins. Following treatment, the leg
is wrapped with a compression bandage and a stocking for 2-3 days.
The patient returns in one week for a venous ultrasound to evaluate
success of the treatment. At this time repeat injections may be required.
Minor complications of sclerotherapy are not uncommon and
include phlebitis, dark pigmentation and failure of treatment.
More serious complication are very rare ( < 1%) and include
deep vein thrombosis and allergic reaction.
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Sclerotherapy is an office procedure which involves injection
of a "sclerosing" solution (which is FDA approved) into the vein
and causes the vein wall to swell, stick together, and seal shut.
This process stops the flow of blood, and the vein turns into scar tissue.
In a few weeks, the vein should fade. Following treatment the leg
will be wrapped with a bandage and a compression stocking.
The patient returns to the office in two weeks for evaluation
of treatment and possible additional injections.
This procedure is used for treatment of telangiectasias, spider veins
and reticular veins. The same area may need to be treated more than once.
Your doctor will advise you of the estimated number of treatments required
to obtain good results. Most patients can expect a 50-80% improvement after
appropriate treatment. Single treatment does not eliminate diseased veins,
and patients need to be compliant with the number of sessions that are
recommended to obtain the best results.
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