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Vein Therapies – WR Adult Procedures

Varicose Veins

Venous insufficiency is a very common condition resulting from decreased blood flow from the leg veins up to the heart, with pooling of blood in the veins. Normally, one-way valves in the veins keep blood flowing toward the heart, against the force of gravity. When the valves become weak and don't close properly, they allow blood to flow backward, a condition called reflux. Veins that have lost their valve effectiveness, become elongated, rope-like, bulged, and thickened. These enlarged, swollen vessels are known as varicose veins and are a direct result of increased pressure from reflux. A common cause of varicose veins in the legs is reflux in a thigh vein called the great saphenous, which leads to pooling in the visible varicose vein below.

Endovenous Laser Ablation
This procedure is used for treatment of venous insufficiency, a disorder of the greater saphenous vein in 80% of patients. In this condition the vein flow is reversed or “refluxes” when you are standing up. The result is that over the years the veins near the surface of the skin enlarge and eventually become varicose veins. The older treatment for this disorder was the so-called “vein stripping” procedure that was performed in the operating room and required admission to the hospital. The new treatment is much less invasive and is performed on an outpatient basis in our clinic. A small catheter is inserted into the vein requiring treatment using ultrasound images for guidance. A laser is inserted through this catheter and is used to heat the inside of the vein which destroys the vein and prevents reflux in the future. The entire procedure is performed under local anesthesia with minimal discomfort. This procedure does not affect arterial flow to or venous flow from the leg as this occurs in a deep group of blood vessels.

What to expect if you are scheduled for Endovenous Laser Ablation

Before Procedure:

• You will receive a prescription for a sedative (such as Xanax) the night before and the morning of the procedure.
• You will need someone to drive you to and from the procedure.
• Bring your prescription compression stocking(s) with you. It is important that the stocking(s) be applied after the procedure to apply compression to your leg.
• You should be well hydrated before the procedure, so drink plenty of fluids. Do not eat for a few hours before the procedure.

After the Procedure:

• Most patients are able to return to work the following day. If you are on your feet for most of the day, or very active, you might need to take a day or two off before returning to work. Some patients do better working half days for the first week or so.
• Leave the compression stockings and dressing on for the first 48 hours. Some patients find the stocking compression painful to their foot. If this is the case, you may cut away this part of the stocking with scissors. (Just cut the toe portion of the stocking away, leaving the heel part intact. If the heel section is cut off, the stocking will slide up your leg.)
• After 48 hours, you can remove the stocking and dressing to shower and for sleeping.
• Continue to wear the stocking during the day for a total of two weeks.
• The procedure produces inflammation in the treated vein that will make it sore. You may take ibuprophen 800 mg (four over the counter tablets) three times per day. This will reduce the inflammation as well as treating the discomfort.
• Call us if there are any problems or questions at 919-854-2180. Any questions that cannot be answered by our nurse will be referred to the on-call physician.

You will need to see us back in the clinic two weeks after the procedure. If you need an additional procedure we may perform it at this time.

Microphlebectomy
This procedure is used for treating varicose veins too large to treat with sclerotherapy (injection of a special solution) or topical laser therapy. Multiple very small incisions are made in the skin under local anesthetic, and the vein is removed with a special instrument. Other than mild stinging from the local anesthetic, this procedure is painless. For very long veins or multiple veins, we sometimes will do this procedure in two settings.

What to expect if you are scheduled for Microphlebectomy

Before the Procedure:

• You will need someone to drive you to and from the procedure.
• If you feel like you need sedation during the procedure, contact our nurse, Dottie Karpow, at (919) 854-2180 and request a prescription for this. Please take this medication one hour before your scheduled procedure in order for it to take effect.
• Bring your prescription compression stocking(s) with you. It is important that the stocking(s) be applied after the procedure to apply compression to the leg.
• You should be well hydrated before the procedure, so drink plenty of fluids. Do not eat for a few hours before the procedure.

After the Procedure:

• It is not unusual for there to be some bleeding through the dressing while you are upright immediately after the procedure. If this occurs, simply lie down, elevate the leg above the level of your heart and have someone apply gentle pressure for about five minutes to the bleeding site with a dry washcloth. Wait 30 minutes or so before getting up again. If the bleeding starts again, repeat. This does not indicate a serious problem. Feel free to call us if you have concerns.
• Most patients are able to return to work the following day. If you are on your feet for most of the day, or very active, you might need to take a day or two off before returning to work. Some patients do better working half days for the first week or so.
• Leave the compression stockings and ace-wrap dressing on for the first 48 hours. Some patients find the stocking compression painful to their foot. If this is the case, you may cut away this part of the stocking with scissors.(Just cut the toe portion of the stocking away, leaving the heel part intact. If the heel section is cut off, the stocking will slide up your leg.)
• After 48 hours you can remove the stocking and ace-wrap. Carefully remove the gauze pads so that you do not pull the small adhesive strips from the skin. You may gently clean the skin with soap and water, taking care not to rub off the adhesive strips. After a week it is OK to bathe and shower normally. The adhesive strips can be removed at this time if they have not already fallen off.
• Continue to wear the stocking during the day for a total of two weeks.
• Some segments of the vein will not be removed. There will be local inflammation in these segments which may be uncomfortable. You may take ibuprophen 800 mg (four over the counter tablets) three times per day. This will reduce the inflammation as well as treating the discomfort.

Call us if there are any problems or questions. Any questions that cannot be answered by our nurse will be referred to the physician. You will need to see us back in the clinic two weeks after the procedure. If you need an additional procedure we may perform it at this time.

Treatment of Spider Veins (Sclerotherapy and Topical Laser)
Sclerotherapy is the injection of a solution into the vein (we use Sotradecol which is an FDA-approved drug for this therapy) that causes the vein to “sclerose” or clot off, becoming permanently occluded. In our practice this therapy is used for veins too small to remove by phlebectomy and too large to treat comfortably with the topical laser. The procedure is associated with minimal discomfort, as a very small needle is used and the sclerosing solution injection is painless. We prefer not to use this technique for treating “spider veins,” as there is risk of developing hyperpigmentation at the treatment site.

Topical or superficial laser therapy uses a special laser (different from the laser used for saphenous vein ablation) to treat small superficial veins called telangiectatic varices, better known as “spider veins.” A special, safely formulated anesthetic cream is applied to the skin an hour or so before the treatment. The laser is then aimed at the lesions and the small veins are coagulated beneath the skin. The laser we use for this delivers almost all its energy beneath the skin and there is little risk of depigmentation even in deeply pigmented individuals as the laser energy is not absorbed by the skin pigment.

What to expect if you are scheduled for Sclerotherapy and Topical Laser

Before the Procedure:

• You will arrive at the Wake Radiology Interventional Services Cary office where anesthetic cream may be applied 15—20 minutes prior to your procedure.
• You do not need anyone to drive you.

After the Procedure:

• Expect redness in the treated area to resolve over several weeks. At 12 weeks, the treatment site will be assessed to determine if any areas require a second treatment. Remember that it may take up to 1 year for appropriately treated spider veins to resolve.
• Avoid intense sun exposure for 4 weeks. If you cannot avoid sun exposure, be sure to use heavy sunscreen (SPF 30), reapply as necessary, and do not allow yourself to burn.

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