What We Need To Know On Your First Visit?
- What are the primary goals with treatment? Is it cosmetic, medical or both (most common)
- Have compression stockings been used in the past?
- Any prior treatments? What effect did it have?
- Any history of blood clots?
- Family history and other relevant past medical history
Physical Exam
On the physical exam, our focus is on the overall health of the patient and the condition of the legs. This includes the distribution and size of spider and varicose veins. Characterizing the visible veins will help inform a proper ultrasound examination to see where pressure is building up inside the legs. This condition is referred to as venous insufficiency.  Feeder veins generally underlie the larger visible veins on the surface of the legs. Any skin discoloration, leg swelling, skin eczema or ulceration is also described.
What is Varicose Vein Ablation?
In the past, varicose veins were treated surgically with stripping or ligation procedures. Today, the procedure is minimally-invasive with no incisions or sutures. Instead, the direct feeder vein is collapsed using a tiny ablation wire that delivers heat directly inside the vein using an IV line. The vein is reabsorbed by the body over a period of time. There is little or no risk of bleeding with the way treatment is performed now.
With the target vein collapsed, blood is immediately re-directed from the diseased vein to healthy veins in your legs. The improved circulation eliminates the source of varicose veins, eliminates blood pooling in the legs, and promptly relieves symptoms of pain and heaviness.
What About VenaSeal?
We did consider VenaSeal as an alternative to vein ablation. Our clinic has great experience with this new technology, however opted for ablation for several reasons:
- The insurance coverage is still limited for VenaSeal
- Ablation still has more data to support its use for long-term efficacy. We are anxiously awaiting the long term results from VenaSeal.
A Case Study
In this article, we will review a recent case to help illustrate a common presentation for patients with symptomatic varicose veins. You might even find some of the details and images consistent with your own experience. We hope our illustrated case will help inform you on best practices for vein disease evaluation and treatment. Primarily, our purpose is to draw attention to the importance of a complete evaluation to improve both healthy living and cosmetic appearances.
History of Case
A 48 year old female with a history of hypertension presented to our clinic with spider and varicose veins on her legs.
The spider veins were clustered around the knee both on the inside and lateral side of her legs. There was a large varicose vein that started on the front of her right leg and wrapped to the side disappearing below the knee.
She had symptoms of leg heaviness, cramps and restless legs at night. This persisted despite using compression stockings advised by her primary care physician years ago.
She was advised by a local dermatologist that sclerotherapy alone was insufficient to treat her veins and that she needed to consult with a vein specialist.
Our patient was recommended a duplex ultrasound which revealed her right great saphenous vein (GSV) was dilated and directly feeding into her spider and varicose veins. The reflux time is the key assessment on the ultrasound and it demonstrates blood is pooling in the legs with gravity.
The treatment would succeed with ablation of the right GSV vein and subsequent targeted ultrasound-guided foam sclerotherapy of her tributary varicose veins. These 2 procedures represent the gold-standard of modern varicose vein treatment.
The recommended procedures were covered by insurance based on symptoms and ultrasound findings.
Each treatment lasted approximately 20-30 minutes and were completed with simple local anesthestic. The patient did not have to fast before her treatments. We performed her vein treatments in a relaxed setting in the office with her music playing. At the Vein Specialist Centers, all spider and varicose vein treatments are performed by our vein doctors only. There are no substitutes for the experience and skill of a board-certified physician.
At our vein clinics, all aspects of your vein treatment will be performed by the doctor only.
Our patient couldn’t believe how efficient and painless the treatments were. Compression stockings were recommended for 1 week post procedure with some minimal restrictions. She was able to return work the very next day.
What is Varicose Vein Ablation?
In the past, varicose veins were treated surgically with stripping or ligation procedures. Today, the procedure is minimally-invasive with no incisions or sutures. Instead, the direct feeder vein is collapsed using a tiny ablation wire that delivers heat directly inside the vein using an IV line. The vein is reabsorbed by the body over a period of time.
There is little or no risk of bleeding with the way treatment is performed now. With the target vein collapsed, blood is immediately re-directed from the diseased vein to healthy veins in your legs. The improved circulation eliminates the source of varicose veins, eliminates blood pooling in the legs, and promptly relieves symptoms of pain and heaviness.
What About VenaSeal?
We did consider VenaSeal as an alternative to vein ablation. Our clinic has great experience with this new technology, however opted for ablation for several reasons:
- The insurance coverage is still limited for VenaSeal
- Ablation still has more data to support its use for long-term efficacy. We are anxiously awaiting the long term results from VenaSeal.
