Vein Treatments

Treatment Options for Spider Veins 

Traditional Sclerotherapy

The most common treatment method of treating spiders is by direct injection of a sclerosant agent administered using tiny (27 -30 gauge) needles. Several years ago the FDA began to address the problems associated with carcinogenic impurities found in sclerosing agents made in foreign countries and in compounding pharmacies here in the United States. In November of 2004 the FDA granted a manufacturing license to the Bioniche Company to manufacture Bioniche Sotradecol (sodium tetradecyl sulfate) and this is exclusively distributed by the AngioDynamics Company in the United States. At the same time they withdrew the “grandfather” approval of Hypertonic Saline which was much more irritating and had a higher association of ulcerations (slow healing sores). It is not illegal to use Hypertonic Saline as long as your physician discloses beforehand that this is no longer FDA approved for this purpose, though it may be their personal preference and discloses to you the reasons for not using an FDA approved agent. In March of 2010 the FDA also approved Asclera (Aethoxysklerol or Polidocanol) for the treatment of uncomplicated spider veins.

Sclerotherapy creates a therapeutic inflammation of the inner lining of the vein causing it to contract, close and be reabsorbed; typically over a 2 month period of time. These treatments take anywhere from 10 to 20 minutes and it may take 2 to 4 treatments to close a large area. The new FDA approved agents are painless when injected into the vein may cause temporary discoloration or staining and have a smaller risk of ulceration if the small needles penetrate through the spider veins and the solution is injected into the surrounding tissue. As with anytechniquedriven therapy, physician judgment, experience and competence are the major determinants of success. The biggest reason for unsatisfactory results or early recurrence occurs when the treating professional fails to consider deeper underlying reasons for venous insufficiency and persists or is limited to surface injections: if the only tool you have is a hammer, then the whole world looks like a nail.

The Advanced Laser Vein Care Technique for Spider Veins

The Dornier 940 nm wavelength topical laser uses a 0.5 mm beam to precisely target the tiny spider vein. The laser energy is absorbed by the red/blue colored hemoglobin molecules in the blood cells and produces a minute amount of heat energy which is passed on to the inner lining of the vein causing the spider vein to shrink and close. This method avoids the risk of needle injury and spillage of the agent (extravasation) in to the surrounding tissue. After the tiny surface spiders are treated, Foam Sclerotherapy is then used to close the deeper feeding vessels (reticular veins) supplying the spider vein complexes. This dual modality technique gives a faster and more complete resolution to large areas and minimizes possible staining at the skin level. The majority of people who have laser treatments have minimal discomfort and satisfying results. However, this is a staged process and initial bruising which is common to all types of therapies should be expected. Laser treatments and sclerotherapy are good treatments for spider veins but not a cure. Total (100%) clearing of the spider veins is not a realistic goal. A treatment session lasts approximately 30-45 minutes and sessions can be scheduled 24 hours apart. Special vein lights allow visualization of feeding veins that may not be visible to the naked eye and can lead to recurrence if not treated. The special vein lights also make treatments more efficient by identifying the root vein for the entire area and by eliminating this first, you prevent the need for multiple closely spaced injections. The entire effect is reinforced by use of compression stockings.

Treatment Options for Large Varicose Veins

Microphlebectomy

Microphlebetomy is the art of removing twisted veins close to the surface of the skin through tiny (micro) incisions under local anesthesia. I was fortunate enough to have learned this technique at the Copa d’Or Hospital, located in the Copacabana district of Rio de Janeiro, Brazil. Using this technique, I have delivered continuous vein segments up to 25 cm long from one site. The value of this technique is being able to remove all of the major residual side branches from endovenous ablated Great or Small Saphenous Veins to achieve that polished look, instead of waiting months for the residual veins to subside in size. Furthermore, Microphlebectomy is the preferred approach for treating varicose veins on the outside of the thigh and calf (Lateral Subdermic Plexus) and over the shin. In contrast to Sclerotherapy for large veins, the results are immediate and the healing time is measured instead of months.

Endovenous Laser and Radiofrequency Ablation Technique with:

Dornier 940 nm (D940) Laser (EVLA, EVLT, ELAS)

Venefit, formerly called VNUS ClosureFast (VNUS, RF)

We now have the ability to introduce a small flexible catheters directly into the diseased Varicose Vein and close the vein under local anesthesia in the doctor’s office. Continuous duplex ultrasound allows us to determine the position of the catheter within the vein and monitor the results of the treatment to ensure optimal results and safety. There is no longer a need to undergo a “horrible” stripping and ligation in the hospital.

These technologies require only a simple vein puncture to gain access and eliminate the need for unsightly groin and multiple leg incisions. This minimal access approach reduces the risk of hematoma, neuroma, seroma, painful incisions, unsightly scarring and nerve injury at the ankle and foot level. Most patients can resume normal activities the next day and return to work within 1 or 2 days instead of suffering weeks of painful recovery waiting for the swelling to go down and the wounds to heal. Because these technologies are so precise there is minimal discomfort during and after the procedure and they result in little to no permanent scarring.

Medicare and most PPO insurance companies approve endovenous ablation (laser or RF technology) to the Great Saphenous Vein (the vein that runs down the inside of you thigh and calf) and Small Saphenous Vein (the vein that runs down the back of the calf).
Learn more about Dornier Medilas 940 nm (D940) here: (insert link to website here)
Learn more aboutVenefit VNUS ClosureFast here: (insert link to website here)

Microfoam Chemical Ablation with Varithena 

This is the only FDA approved foam treatment for Varicose Vein disease of the Great Saphenous Vein (GSV) system of the leg.  It is ideal for extremely complex veins which have been very difficult to treat with the laser and radiofrequency (VNUS/Venefit) catheter systems.   The Varithena system does not require a catheter delivery or any form of mechanical manipulation to close the vein.  The unique properties of this patented microfoam (1% polidocanol in a Nitrogen and Oxygen foam) make it highly visible on Duplex Ultrasound and allow the foam to be massaged into the diseased side branches of the affected varicose vein.  The patented microfoam agent has been demonstrated by the FDA to be highly effective and greatly minimize risk for distant foam embolization and deep vein thrombophlebitis (DVT).

Furthermore, unlike laser and radiofrequency ablations which require a form of heat energy, the Varithena system does not depend upon a heat source andisvirtuallypain free.  This means no painful local infiltration injections along the course of the treated vein and no post op discomfort.  This system has not been approved for treatment of disease in the Small Saphenous Vein (SSV) which runs along the back of the calf.  The Varithena system is covered by certain PPO’s.   Microfoam endovenous ablation is suitable for patients with complicated problems, patients with skin changes around the ankle and patients who have multiple medical problems that would have prevented them from undergoing corrective venous surgery.

Which is System is Best for you?

This is best answered after a detailed consultation and duplex ultrasound examination to determine your degree of reflux, the size of your veins, the location of the veins, the condition of your skin, the extent of your symptoms and any unique risk factors that you may have experience. In short, once you understand your situation we can make an appropriate decision and use a variety of techniques to best achieve the relief you need and the improvements that you desire. I am equally familiar with Laser, Venefit, and Varithena systems. Microphlebectomy can be a useful adjunct to your needs. I will determine what is the best combination of procedures so that we can stay within your resources, insurance coverage and make this as cost effective as possible. If you have been treated for your venous problems elsewhere and have had complications and recurrences, please bring this to my attention. Phlebology is a rapidly expanding field and I love to stay on top of the newest developments to better help my most challenging patients.