Treatment Options

Compression Therapy

This is the most conservative treatment option for varicose and spider veins. It consists of stockings, panty hose, bandages, and other devices that exert graduated compression on your legs for the purpose of improving circulation, therefore alleviating the symptoms of venous insufficiency and retarding the progression of the disease. Compression is also used as adjuvant treatment to enhance the effectiveness of other treatment modalities. The degree and type of compression will vary depending on your specific condition. Most compression stockings and garments are provided at all of our facilities.

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Sclerotherapy

This procedure is indicated for the treatment of bluish veins and spider veins. A special foam is injected into the abnormal vein to irritate, collapse, and ultimately destroy the vein. It is virtually painless. Over a period of weeks, the vessel turns into scar tissue that the body will reabsorb slowly fading from view. It will eventually become barely or not visible at all.

The number of treatment sessions is determined by the extent of your condition. Sessions usually last one half hour. You will be required to wear compression stockings or panty hose for one week after treatment to assist in the healing process and help avoid complications. Most patients can expect 75-95% improvement in treated vessels. However, the fading process can sometimes be slow and perfection is seldom achieved.

Even when it is performed by a highly skilled phlebologist, there are a number of possible side effects and complications, which include:

Bruising
These form at the site where the needle penetrated the skin. They disappear within 2-3 weeks and depend on the patient's own pre-disposition and capillary fragility.

Hyperpigmentation
These are brown spots on the skin at the site of a previously treated vein. It is composed of hemosiderin, an iron-based pigment which is a by-product of blood. This usually fades in weeks to months. It persists longer than one year in only 1% of patients.

Swelling
This is a self-limiting condition which usually resolves within days to weeks. Its incidence is reduced by the use of compression stockings or panty hose following sclerotherapy treatment.

Superficial Thrombophlebitis
This is the term used for inflammation of a vein. It is less common and is not considered a serious condition. It manifests itself by small areas of redness and tenderness. It is successfully treated with compression, local heat, and non-steroidal anti-inflammatory medication like ibuprofen.

Lumps
These are actually blood clots in the treated veins, and it is a normal process in the destruction of the vein. They are not dangerous and your phlebologist may elect to drain the blood out of these clots a few weeks after treatment to aid in the healing process. These will always disappear.

Telangiectatic Matting
This is the appearance of new, tiny red veins near the sites of injection of larger veins. Also referred to as "blushing", it is more common in the thighs, but may develop in any area of the leg. It usually resolves spontaneously within months, but it may require injection treatment.

Localized Allergic Reaction (Urticaria)
It is a very common condition with any type of sclerosing solution. It usually does not last more than 30 minutes and can be treated with topical steroid creams.

Systemic Allergic Reactions
These can vary in severity, and very rarely are life-threatening. They can be treated with oral anti-histamines, steroids, and/or epinephrine.

Nerve Damage
An uncommon complication due to inadvertent trauma to nerves from the needle stick or from injection of the nerve. Symptoms include numbness, localized pain, or referred pain along the trajectory of the damaged nerve. This may take months to resolve.

Deep Vein Thrombosis
This is caused by the introduction of the sclerosing foam into the deep vein system. An experienced phlebologist will eliminate this complication by accurately measuring the volume and concentration of the sclerosing foam per injection site. Furthermore, immediate ambulation is prescribed, practically reducing the probability to nil.

Cutaneous Necrosis
This is manifested by ulceration of the skin or sloughing, and is caused by one of three phenomena, and does not necessarily imply physician error:

1. Leakage of the sclerosing foam from the injected vein into the surrounding tissues.
2. The presence of an arteriovenous anastomosis. This is an undetectable connection between a vein and an artery. As the sclerosing foam is injected into the vein, it travels through the anastomosis into the artery, damaging tissue dependent on that artery.
3. Direct injection into an arteriole. These may look identical to venous spiders to the naked eye and are present within venous spiders in a small percentage of patients.

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Ultrasound-Guided Sclerotherapy

With this technique, sclerotherapy is done while the doctor visually monitors the vein on an ultrasound screen. This enables treatment of veins that can't be seen because they are below the surface of the skin that would otherwise require surgical removal.

Referred to by some vein centers as COMPASS^TM, it has been an established practice in the field of phlebology for many years. Unfortunately, it is too often used to treat thick-walled veins like the greater and lesser saphenous veins, yielding very high recurrence rates. This procedure is better suited to treat incompetent veins of the perforator vein system, and selected tributary and anastomotic veins that can easily be left behind after a surgical procedure. They can be safely and effectively eliminated with this procedure. Not all patients may require this treatment modality. The procedure is painless and quick. Expect to be bandaged for 24 hours, with subsequent use of compression stockings or panty hose for an additional week. Potential side effects are similar to those seen with conventional sclerotherapy.

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Ambulatory Phlebectomy

It is the technique of varicose vein removal through tiny punctures or incisions under local anesthesia. It is indicated for the treatment of bulging varicosities that would not respond as well to sclerotherapy due to the thickness of its walls. It is done at our facilities under local anesthesia without the need for hospitalization. Incisions measure 1-2mm., therefore no sutures are required, and scars are not visible after 3-4 months. Since it is minimally invasive, patients walk immediately and most drive home themselves. Prescription pain medication is not required. Normal daily activities are resumed immediately, except for strenuous exercise. Expect to be bandaged for 72 hours, with subsequent use of compression stockings or panty hose for an additional 10 days during the day only. In summary, the major advantages of this procedure include:

• Minimally invasive, no stitch, no scars technique
• Superior cosmetic result
• Immediate ambulation
• Rapid recovery, return to normal activity
• Less painful
• Lower cost

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Closure Procedure

Developed by VNUS Medical Technologies in California, a thin catheter is used to deliver radiofrequency energy to the vein wall, causing it to collapse and seal shut. It is minimally invasive, done under local anesthesia, cosmetically appealing, providing fast relief of symptoms, with return to normal activities within 24 hours.

Vein Care Specialists, Ltd. Introduced the Closure procedure to the Midwest in May, 1999, and have performed hundreds of cases since then on many satisfied patients. We were one of the original four centers in the country to perform this procedure. It has virtually eliminated the need for ligation and stripping of the long and short saphenous veins, a traumatic and painful operation with a long convalesence. With Closure, there is no surgery, no sutures, and no unsightly scars.

In our practice, our data shows a 92% success rate after five years, which is comparable to the traditional vein stripping. There have been no long-term side effects or complications. These may include numbness or tingling along the treated area, bruising, phlebitis (inflammation of the vein), infection, and skin burns. Blood clots in deep veins have been reported in the literature, but have been non-existent in our experience.

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Endovenous Laser Treatment (With the new CoolTouch CTeV Laser)

True state-of-the art technology with the newest, most gentle, patient-friendly, and safest laser approved by the FDA in January of 2005. Vein Care Specialists, Ltd., was one of the first centers in the country to offer this technology.

Similar to the Closure Procedure, laser energy is delivered to the vein wall to cause it to collapse and seal shut. Done at our facilities, under local anesthesia, in less than an hour, with return to normal activities within 24 hours, and excellent functional and cosmetic results.

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Ligation and Stripping

This is the traditional surgical method of treating varicose veins. Due to modern technology, it should not be done in this day and age. It is a barbaric and traumatic procedure, with a high complication rate and a long recovery period. Furthermore, due to large residual scars, it is cosmetically unacceptable.

This procedure is not offered at our facilities since EVLT, CoolTouch CTeV, and Ambulatory Phlebectomy, have replaced it.

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Trivex (Trans-illuminated powered phlebectomy)

This is a relatively invasive surgical procedure for the removal of varicose vein clusters. It uses a Roto-Rooter-type vacuum and a light source for visualization and removal of these veins. Some disadvantages include:

• Needs to be done in a surgical facility or hospital.
• Usually requires IV sedation, delaying ambulation, thus increasing risks of  complications.
• Requires two relatively large incisions (approx. one inch long), therefore resulting in residual scars.
• Higher incidence of nerve trauma.
• Longer recovery period.
• Higher cost.

Trivex is not offered at our facilities since Ambulatory Phlebectomy is a much better option.

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