FAQ

What is endovenous thermal ablation (laser therapy) for venous disease?

Endovenous thermal ablation, also called laser therapy, is a newer technique that uses a laser or high-frequency radio waves to create intense local heat in the varicose vein or incompetent vein.

Heat is directed through a catheter to close up the targeted vessel. This treatment closes off the problem veins but leaves them in place so there is minimal bleeding and bruising.

Compared with ligation and stripping, many patients find that endovenous thermal ablation results in less pain and a faster return to normal activities, with similar cosmetic results.

Why is this procedure performed? Why do I need this procedure?

The goals of treatment are to reduce symptoms and reduce the risk of complications from venous disease, including blood clots.

Patients who have large, symptomatic varicose veins and those with incompetent saphenous veins are candidates for this procedure. This procedure is essentially taking the place of “vein stripping.”

Each patient is evaluated, and treatment will be individualized for the patient’s circumstances.

Where is the procedure performed and who performs this procedure?

This procedure is performed in the hospital surgical suite by a vascular surgeon.

What are the risks and potential complications of the procedure?

Your doctor will discuss the specific risks and potential benefits of the recommended procedure with you. This is generally a very safe procedure. However, as with any surgical procedure, there are risks. Complications after endovenous thermal ablation may include bruising along the site of ablation, pain along the site of ablation, the development of a blood clot in the veins in the treated leg, and irritation of the nerves that run along with the treated veins.

Special precautions are taken to decrease these risks, and there may be other possible risks. When you meet with your doctor, please ask questions to make sure you understand the risks of the procedure and why the procedure is recommended.

How do I prepare for the procedure?

A few days before the procedure, pre-procedure tests may be performed to ensure that it is safe to perform the procedure. You may need to discontinue certain medications before the procedure. Your healthcare team will provide specific instructions to help you prepare for the procedure.

What happens during the procedure?

You will receive a sedative and a regional anesthesia, or you may receive general anesthesia. Using an ultrasound to identify the location, your surgeon will insert a catheter into the vein to be treated. This is typically done just below the knee, but can occasionally be done at the level of the ankle. Using ultrasound, the surgeon will inject a solution of salt water and anesthetic agent along the length of the vein to be treated. Following this, either laser or radiofrequency ablation will be performed.

How long does the procedure last?

The procedure itself generally takes two to three hours. This procedure is typically performed in the outpatient setting, and you can expect to be discharged home several hours after the procedure is complete. Full recovery will take approximately one to two weeks.

What happens after the procedure?

Your surgeon will give you specific instructions you need to follow after the surgery until your incision heals adequately. Typically, patients should elevate the treated limb when not moving, keep the incisions clean and dry, avoid swimming or hot tubs and wear compression hose.

Compared with ligation and stripping, many patients find that endovenous thermal ablation results in less pain and a faster return to normal activities, with similar cosmetic results.

Are there any side effects of the treatment?

As with any surgical procedure, you will feel somewhat tired for a few weeks. In addition, you can experience pain and bruising along the site of the ablation. Rarely, you may experience some numbness or tingling along the shin. These typically resolve over a couple of weeks.

As with any surgical procedure, you will feel somewhat tired for a few weeks. In addition, you can experience pain and bruising along the site of the ablation. Rarely, you may experience some numbness or tingling along the shin. These typically resolve over a couple of weeks.

How do I gauge the results of the procedure?

Your doctor will discuss the results of the procedure with you, but outcomes are generally good.

 

Sclerotherapy

What is sclerotherapy?

Sclerotherapy is a medical procedure used to treat varicose veins and “spider veins.” During sclerotherapy, the physician injects a solution directly into the affected vein. The solution irritates the lining of the vessel, causing it to swell and stick together. Over time, the vessel turns into scar tissue that fades from view. Sclerotherapy is a well-proven procedure and has been used since the 1930s.

How is sclerotherapy done?

Sclerotherapy is performed in a doctor’s office. The treatment area is cleansed. The solution is injected directly into the blood vessel, using very fine needles. The number of veins injected in one session is variable, depending on the size and location of the veins, and the patient’s overall medical condition.

How successful is sclerotherapy in treating varicose and spider veins?

Sclerotherapy works well for most patients. It is estimated that as many as 50 percent to 80 percent of injected veins may be eliminated with each injection session. A few (less than 10 percent) of the people who have sclerotherapy do not respond to the injections at all. In these instances, different solutions or a different method, such as laser therapy, may be tried.

In general, spider veins respond to treatment in 3 to 6 weeks, and larger veins respond in 3 to 4 months. If the veins respond to the treatment, usually they will not reappear. However, new veins may appear over time. If needed, you may return for injections.

How will I know if I am a candidate for sclerotherapy?

Before the procedure, you will have an initial consultation with a vascular specialist who will evaluate your eligibility for sclerotherapy.

You are not eligible for sclerotherapy if you are pregnant, breastfeeding, or are bedridden. You must wait at least three months after delivery before you can be considered for this procedure. You can have sclerotherapy if you take birth control pills. If you have had a blood clot in the past, your eligibility will be determined on an individual basis, and will depend on the extremity and the cause of the clot.

Veins that are potentially usable for future surgical bypass procedures (such as the saphenous vein for coronary artery bypass graft surgery) will generally not be considered for injection, unless they are already deemed unusable.

Will my insurance cover sclerotherapy?

Insurance companies do not provide coverage for sclerotherapy when it is performed for cosmetic reasons. Some insurance companies cover sclerotherapy for specific medical conditions. Your insurance company may request a letter from your physician concerning the nature of your treatment. Please contact your insurance provider to verify coverage before you consider the procedure.

What to do before the procedure

Medications: Prior to sclerotherapy, certain medications should be avoided. Please follow these guidelines:

  • Tetracycline or Minocin®, both antibiotics, may possibly cause a staining of the skin if taken 7 to 10 days before or after sclerotherapy. Ask your doctor about other antibiotic medications you may take, or ask for safe guidelines for discontinuing these medications. If you are required to take an antibiotic before any invasive procedure, such as dental procedures, colonoscopy, or surgery, please inform your physician.
  • Do not take aspirin, ibuprofen (i.e, Advil® and Nuprin®) or other anti-inflammatory medications for 48 hours before and after sclerotherapy, because these medications may interfere with the action of the sclerosing agent or increase bleeding. Tylenol® (acetaminophen) is permitted. Ask your doctor for specific guidelines before discontinuing any medication.
  • Prednisone decreases the effectiveness of the sclerosing agent. Ask the doctor who prescribed your prednisone if it can be safely discontinued for 48 hours before the sclerotherapy procedure.
  • Other guidelines before the procedure
    • No lotion should be applied to the legs before or after sclerotherapy.
    • We recommend that you bring a pair of shorts to wear during the procedure.
    • If you have compression hosiery (support stockings) from previous treatments, please bring them with you so we can make sure they will provide adequate support after the procedure.

    How will I feel?

    Mild discomfort may occur when the veins are injected, and a cramping sensation may be felt for 1 to 2 minutes when larger veins are injected.

    How long will the treatment last?

    The sclerotherapy procedure takes about 30 to 45 minutes.

    What are the side effects of sclerotherapy?

    Side effects of sclerotherapy may include the following:

    • Larger injected veins may become lumpy or hard for several months before resolving.
    • Raised, red areas may appear at the injection sites and should disappear within a few days.
    • Brown lines or spots on the skin may be noted at the site of the injection, possibly caused by a form of iron that escapes from the blood in the injected veins. In most cases, they disappear within 3 to 6 months, but they can be permanent about 5 percent of the time.
    • Bruising may occur around the injection site and can last several days or weeks.
    • Temporary tiny blood vessels may develop at the treated area. This is called revascularization, “flares,” “mats,” or “blushing.” They may appear days or weeks after the procedure but should fade within a few months and usually do not require further treatment.
    • Allergic reactions to the sclerosing agent may occur at the time of the injection and are rarely serious. Symptoms include itching and swelling.

    Other side effects rarely develop after sclerotherapy. If you have any of these rare side effects, please contact your physician immediately:

    • Inflammation within five inches of the groin
    • Sudden onset of a swollen leg
    • Formation of small ulcers at the injection site
    • Red streaking, especially in the groin area

    What happens after the treatment?

    After the treatment, you will be able to drive yourself home. You may resume your regular activities and are encouraged to walk.

    You will be instructed to wear support hosiery or compression wraps to “compress” the treated vessels. Support stockings purchased from a department store may not be adequate if a heavy compression stocking is prescribed.

    For 48 hours after the procedure, please follow these guidelines:

    • Avoid aspirin, ibuprofen, and other anti-inflammatory medications. Tylenol may be used if needed for pain relief.
    • Do not take hot baths or sit in a whirlpool or sauna. You may take showers, but the water should be cooler than usual.
    • Wash the injection sites with a mild soap and lukewarm water.
    • Do not apply hot compresses or any form of heat to the injected areas.
    • Avoid direct exposure to sunlight (including sun tanning and tanning beds).

    Call your physician if you have any concerns or questions after the procedure.

    References
    • Weiss RA, Weiss MA. Chapter 249. Treatment for Varicose and Telangiectatic Leg Veins. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Dallas NA, eds. Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: McGraw-Hill; 2012.www.accessmedicine.com. Accessed 4/19/2013
    • National Heart Lung and and Blood Institute. Explore Varicose Veins. Accessed 4/19/2013
    • Radiological Society of North America. American College of Radiology via Radiologyinfo.orgSclerotherapy. Accessed 4/19/2013
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