Vascular Radiology & Vein Treatment
Unsightly varicose veins can cause considerable discomfort and may progress over time to more serious conditions that can be treated with minimally invasive therapies in our office to minimize the disruption to our patients’ busy lives.
Varicose veins are caused by incompetent one way valves in the leg veins. When working correctly, they are supposed to prevent blood from pooling in our legs with gravity failing. When the veins allow blood to flow back down the leg instead of up to the heart, the veins dilate to accommodate the extra blood. Because veins are thin walled pliable structures they often get tortuous and enlarged bulging from under the skin. This can also lead to smaller superficial “spider veins” which are smaller veins that get dilated closer to the skin surface.
In addition to the cosmetic changes patients may experience symptoms of:
- Bulging veins typically apparent behind the knee, calf and ankle
- Aching pain
- Swelling or fatigue in the legs
- Skin changes, including ulcers
Over time, or if left untreated, these symptoms may progress to more serious complications of venous reflux including:
- Inflammation (phlebitis)
- Blood clots (e.g., DVT)
- Ankle sores or skin ulcers
To determine if you are affected by this condition and have incompetent one way valves, a focused history and physical as well as ultrasound can be performed. This documents the presence of reflux and helps assess if you are a candidate for minimally invasive therapies.
Here’s what to expect from the VenaCure EVLT(TM) procedure:
- Our Interventional and Vascular Radiologist uses ultrasound to map out your vein.
- Local anesthetic(Lidacaine) is applied.
- A thin laser fiber is inserted through a tiny entry point, usually near the knee.
- Laser energy is delivered to seal the faulty vein.
- Immediately after the procedure your leg will be wrapped tightly and compression hose will be worn
- Walking for 20 minutes immediately after the procedure is encouraged. Normal daily activity can be resumed; just avoid rigorous activities such as gym workouts.
- There may be minor soreness and bruising. Any discomfort can be treated with over-the-counter, non-aspirin pain relievers as necessary. Approximately on the 5-7 day, you will experience a “pulling sensation”.
- 45-60 minute outpatient office procedure
- Uses only local anesthetic
- Excellent Success rate(90%)
- No/minimal scarring
- No Hospitalization
- Lower complication risk than operative hospital based procedures
- Fast return to normal activities
- Reimbursable by most health insurance plans
If you choose not to get treatment for your varicose veins, they will probably slowly worsen over the years. If you are currently not symptomatic, more often than not they will become symptomatic over time and interfere with patient comfort. Late stage changes including ulcers and skin changes can also arise over time.
FACTS ABOUT VARICOSE VEINS
Varicose veins affect 40% of women and 25% of men. The cause is multifactorial with the most common causes being:
- Heredity: If your parents or grandparents had the problem, you are at increased risk.
- Gender: Women have a higher incidence than men in part as a result of female hormones and their effect on the vein walls.
- Pregnancy: The increased effect of increased blood volume and hormonal changes during pregnancy contribute to the vein wall changes and vein size increase.
- Age: The tissues of the vein wall lose elasticity over time causing the one way valve system to fail because of incomplete closure.
- Prolonged Standing: If you have to stand for prolonged periods of time it can cause increased volume and pressure in the lower limbs due to gravity effect.
- Obesity: Increases in weight often is accompanied by increased abdominal pressure which can worsen vein problems.
VARICOSE VEIN PREVENTION
As a result of the nature of the underlying conditions discussed above it is impossible to “cure” varicose veins but there are some measures that can be taken to alleviate symptoms and discomfort from existing varicose veins and prevent progression:
- Regular exercise to improve leg circulation and strength
- Avoid prolonged standing and sitting by alternating periods of activity with rest.
- Control weight
- Avoid wearing clothing which restricts blood flow to the groin or calf
Endovenous Laser Therapy requires no preparation except bringing your prescription strength compression stockings with you. Our physician will write you a prescription for these at your consult appointment.
What does EVLT stand for?
EVLT stands for EndoVenous Laser Treatment
How does the procedure actually work?
A laser fiber is fired inside and along the length of your faulty, varicose vein. The laser energy damages the vein walls, shrinking them closed so that blood can no longer flow through.
Is loss of this vein a problem?
No. There are many veins in the leg and after treatment the blood in the faulty veins will be diverted to normal veins with functional valves. The resulting increase in circulation will significantly relieve symptoms and improve appearance.
What are the side-effects and complications of this procedure?
EVLT like all minimally invasive procedures, can potentially have some slight bruising, which commonly disappears within the first few weeks. With EVLT, you will feel a delayed tightness (or “pulling” sensation) 4-7 days after laser treatment which is normal and expected following a successful treatment.
All surgical procedures involve some element of risk and have the potential for complications. This should be balanced against the risk of complications if your varicose veins remain untreated. Consult your physician for further information.
Am I at risk from the laser?
You will be given a pair of special glasses to wear to protect your eyes, however this is just a precaution against accidental firing of laser energy outside the body.
What are the alternatives to this treatment?
Surgery (called ‘Ligation & Stripping’) is the traditional treatment, but it can be quite painful and often has a long recovery time. It is performed in a hospital, involves general anesthesia, leaves a scar, and has a fairly high recurrence rate (on average 10-25%).
Other alternatives include ultrasound-guided sclerotherapy (injection therapy) and radio frequency electrosurgery. Injection therapy for the saphenous vein has a high recurrence rate frequently requiring retreatment and is generally limited to smaller varicose and spider veins. Radiofrequency electrosurgery is more limited in the range of patients it can treat and the treatment time is longer than EVLT.
How successful is EVLT?
Clinical data with up to 5 years of follow-up show success rates of 93-98%. This is much higher than surgical ligation and stripping, radiofrequency electrosurgery, and injection sclerotherapy. Market researchers predict that, based on its superior efficacy and lower morbidity, endovenous laser treatment will soon become the new ‘gold standard’.
How much does it cost?
EVLT, when medically necessary (e.g., for relief of symptoms), is commonly reimbursed by most carriers (including Medicare), limiting the cost to the patient. Many insurance carriers require you to follow conservative therapy (compression stockings) for a period of time usually 3 – 6 months. Contact your specific insurer for details.