Lower Extremity Venous Disorders
Issues with leg veins are among the most common conditions experienced by Americans. Approximately 80 million people in the US have vein disease. For some, these veins are simply a cosmetic issue, but for others, these veins are causing symptoms affecting their daily activity. The following information will help explain the conditions and treatment options available.
What are the Functions of Veins?
Veins are blood vessels that return blood back to the heart from all parts of the body. A major challenge for leg veins is that the blood needs to get back to the heart against the force of gravity when standing. In this position, blood is pumped upward by calf muscle contractions when you walk. The leg veins have one-way valves to keep blood moving upward. When valves do not close properly, they allow blood to flow backwards and pool in the veins of the lower leg. This pooling leads to increased pressure and volume within the veins which, over time, causes them to dilate (get wider) and elongate (get longer). Significantly bulging varicose veins are often due to leaking veins higher in the leg and located beneath the skin surface; most often, this underlying vein is the saphenous vein, which is only visible with the aid of an ultrasound. These dilated and elongated veins in the skin are known as telangiectasia (or spider veins) and dilated and elongated veins below the skin are known as varicose veins. Spider veins appear as small diameter red, purple or bluish web like veins. Varicose veins are larger deeper veins that can protrude resulting in a rope-like appearance.
Treatment Options for Veins:
During your consultation, your physician will determine the best treatment plan based on your condition and health history. This may include one or a combination of the following treatments:
Endovenous Laser Treatment (EVLT) Endovenous laser treatment, (EVLT), also known as Endovenous laser ablation (ELA), is a minimally invasive technique to eliminate varicose veins. The procedure is performed in the office using local anesthetic. Our patients experience little to no pain or scarring and a short recovery period. The laser is inserted through a small IV and seals closed the vein that causes the varicose veins. The procedure takes about 1 hour and patients are instructed to immediately walk and resume most of their usual activities. EVLT is effective in more then 95% of patients. If it does not work it can often be repeated.
Non-Thermal Approaches for Saphenous Ablation
Non-thermal ablation is a method of minimally invasive vein closure utilizing glue or an irritant drug. The options include; Venaseal™, Clarivein®, and Varithena® and are procedures that are at the forefront of varicose vein care. The procedures are performed in the office. A tool is inserted through an IV in the vein and used to treat the vein that causes varicose veins. The procedure takes about 1 hour and patients are instructed to immediately walk and resume most of their usual activities. Advantages of non-thermal techniques include fewer needlesticks during the procedure and less post procedure pain and bruising.
Venaseal – Results from the clinical trial of the device demonstrates 95% vein closure at two years with very rare complications.
Clarivein – Results from the early trials of the device demonstrate 97% vein closure at 1 year post procedure.
Varithena Foam – Results from clinical trials show 95% vein closure rate at one year.
Microphlebectomy
Ambulatory phlebectomy, also known as microphlebectomy is a minor procedure that can be used to eliminate larger varicose veins. This procedure is performed in the office. The veins are removed through tiny nicks in the skin and can be done at the same time as EVLT. No stitches are necessary, the scars are barely visible and patients are extremely satisfied with the aesthetic outcomes. The procedure takes about 1 hour and patients are instructed to immediately walk and resume most of their usual activities.
Sclerotherapy
Sclerotherapy is performed as an in-office procedure to eliminate spider veins and small to medium size varicose veins. Injections with needles smaller than those used for flu-shots are performed directly into the abnormal veins. Following this 15–20 minute treatment, the patient can resume nearly all activities. A support stocking is worn during the daytime for one week after the procedure which aids in the closure of the veins.
EVLT, CLARIVEIN, MICROPHLEBECTOMY AND VARITHENA
Important Procedure Information
How Should I Prepare?
Eat a regular breakfast and/or lunch before coming to our office.
You do not need to have anyone come with you to the procedure. Unless you elect to take a light sedative.
Bring the stockings that were prescribed at the time of your consultation. You can purchase these stockings from our staff. Do not wait until the day of the procedure to purchase the stockings since we may not have your size in stock.
You may want to bring a pair of flip flops or casual sandals with you to the office and a warm sweater, as the room will be cool. Please note that we will use betadine soap to clean the area prior to the procedure, and light clothes and underwear may be stained.
If you take aspirin, Plavix, or a blood thinner, please continue to take them as normal. We generally recommend that you do not stop taking your regular medication.
The procedure may take 30 minutes to an hour, during which you will be laying down in one position.
Be prepared to walk 10 minutes each hour for four hours after the procedure.
You should be prepared to purchase Dermaka cream to apply to the legs for two weeks twice daily after the procedure. Cost is $35.
What Should I Expect During The Procedure?
In our preparation room, we will have you change into a pair of loose-fitting shorts.
An ultrasound will be performed, and the vein segment(s) to be treated will be marked on the skin with a temporary surgical marker.
The marked area will be cleaned and sterile drapes will be placed on your legs.
Important Post-Procedure Information
What Should I Expect After The Procedure?
Your leg that was treated will be wrapped for 72 hours.
You will continue walking throughout the rest of the day in smaller intervals, avoiding any long periods (30–45min) of sitting or standing.
You should continue walking throughout each day for 2 weeks, avoiding long periods of idleness. On average, you will be walking a total of at least one or two hours a day.
Should pain medication be needed on the day of the procedure and for the following days, Tylenol or Ibuprofen can be taken.
How Long Do I Need to Wear The Leg Wraps?
The leg wraps may be removed in 72 hours and you may take a regular shower after. Some secretion of numbing fluid along the area of the treated vein should be expected. After your shower, simply pat those areas dry. If the ACE bandage is too tight, you may loosen it.
After a shower, a fresh stocking should be put on and worn for a total of two weeks, except to sleep and shower.
What Are My Activity Restrictions And Recommendations?
After the procedure, you may immediately resume all of your usual activities except for vigorous gym workouts, heavy weight lifting or long hot baths for the first 2 weeks following the procedure. You may swim after the entry site of the catheter and skin nicks have closed (approximately one week).
Frequent walking is strongly recommended for at least 2 hours a day, spread out throughout the day, the first 2 weeks following the procedure.
Prolonged idleness for more than 30 minutes should be avoided. Walking around the office and standing up on your toes is recommended at work.
Regular exercise routines may be resumed 2 weeks after the procedure.
You should not fly in an airplane for a couple of weeks after the procedure. If you must fly please let us know; we will ask you to come in for an ultrasound to ensure that you can do so safely.
Avoid sun exposure until the skin nick is fully healed to prevent pigmentation Covering the skin nick with a band-aid is suggested if you decide to go into the sun before it’s fully healed. Sun-block is not sufficient to prevent skin staining.
We will want to see you for a 1 month follow-up to assess your response to treatment.
Will I Feel Any Discomfort After The Procedure?
Bruising after the procedure is expected and will last several weeks.
Some soreness over the treated vein may occur after the procedure for about 1–3 days which may require at most some Tylenol or Advil. Warm compresses can be used if necessary.
In most cases, the treated vein will develop a pulled muscle feeling, with some stiffness. This pulled muscle feeling usually develops 5 days following the procedure, and improves in about one week. The pain you will feel is normal and indicates that the vein is closing properly.
The soreness will be most apparent after sitting or lying for a period of time. Stretching the leg, wearing the stocking, and walking will be helpful. If necessary, to prevent pain, Advil or Motrin can be taken.
It is normal to have soreness, slight swelling and redness along the treated area. These symptoms will disappear within the first few weeks.
Does My Body Need The Vein That is Being Treated?
No, the vein that is being treated is an abnormal vein. The abnormal vein is causing your normal veins to work harder to return the leaking blood back to your heart. Eliminating abnormal veins enables normal veins to work more efficiently.