The endovenous laser treatment is performed right in the office.  Under local anesthesia, a thin laser fiber is inserted into the vein through a tiny incision.  The laser delivers laser energy (heat) to the vein wall, causing it to heat, collapse, and seal shut.  Most patients return to work and near normal daily activities the very next day.  The laser is used to treat large diseased veins inside the leg which are often the cause of unsightly varicose and spider veins on the surface.  In some cases, other treatments including ambulatory phlebectomy or ligation are used in combination with endovenous laser treatment to achieve the best possible results. For more information visit www.evlt.com.

What are spider veins?

Spider veins are abnormally dilated blood vessels in the skin. They usually appear on the legs but can also occur on the face and less commonly the chest, arms, and back. Contrary to what many physicians are taught, spider veins can cause the same symptoms as much larger varicose veins including itching, burning, heaviness, and fatigue in the legs. Although they may be symptomatic, spider veins usually do not lead to serious complications. In rare cases they can bleed profusely after being injured, but otherwise they are treated mostly as a cosmetic problem.

What causes spider veins?

Spider veins develop in two ways. First, tiny pre-existing veins can enlarge and become dilated over time.  Secondly, your body actually grows new veins where it doesn’t need them…in the skin.  Pregnancy, hormone-containing medications, and hormonal fluctuations may stimulate their appearance, thus, spider veins are more common in women.  They are not caused by crossing legs or by years of prolonged standing or sitting at work.  The tendency to develop abnormal veins is largely hereditary, and there is not much you can do to prevent them.  Support hose, exercise, and dietary supplements are helpful for symptoms, but the veins keep growing. In some cases, the appearance of spider veins may be an indication that there are larger diseased veins underneath.  The physician may use ultrasound to search for any larger diseased veins that may be causing your spider veins.  If larger diseased veins are found, they need to be treated first and eliminated or else spider vein treatment will be ineffective.

What are varicose veins?

Varicose veins are enlarged, weakened, dilated veins that have permanently lost their ability to carry blood from the legs back up to the heart against the force of gravity. As the blood falls back down the leg and pools due to gravity, the veins overfill giving them their typical unsightly bulging appearance. Varicose veins cause tired, heavy, aching, throbbing, swollen legs which are typically worse at the end of the day. Night time leg cramps and leg restlessness (sometimes called Restless Leg Syndrome) are also very common problems caused by varicose veins. Treatment of the diseased veins will eliminate these symptoms. If left untreated, varicose veins always worsen over time, and may lead to the formation of blood clots (thrombosis), inflammation of the vein (phlebitis) and inflammation of the skin (dermatitis), and finally ulceration.

What causes varicose veins?

Heredity is the number one contributing factor causing varicose veins. A genetic tendency causes veins to weaken and wear out over time. The greater this genetic tendency the sooner it will happen. So regardless of treatment, if you have a strong hereditary predisposition, you will probably form new problems as time goes on. Other contributing factors include pregnancy, obesity, hormone-containing medications, standing for long periods, and traumatic injury to the leg. In most cases, nothing can be done to prevent veins from wearing out, but if effective treatment is given early in the course of the disease, complications like phlebitis, blood clots and ulcerations can be prevented and symptoms relieved.

How are varicose veins treated?

Discussed below are several methods of treating varicose veins.  The procedure or combination of procedures is based upon the extent of your specific condition and your overall health and age.  The doctor will recommend an ultrasound examination to assess the severity and extent of your vein disease, most of which may not be visible on the surface of the leg. Without an accurate ultrasound map of your veins we cannot determine the source of your problem or treat it effectively.

Conservative Treatment

The most conservative way to manage varicose vein disease is wearing prescription-strength compression stockings.  Compression stockings help alleviate the swelling and pain caused by varicose veins.  These stockings will also help heal any skin inflammation or ulcerations which have developed.  However, there has never been any evidence to show that compression stockings prevent the formation of varicose veins.  Since the diseased veins that are causing the symptoms are not being eliminated, the compression stockings have to be worn indefinitely.  Some insurance companies are now requiring patients to wear prescription strength compression stockings for 3-6 months before they will consider reimbursement for treatment.

Ambulatory phlebectomy

Ambulatory Phlebectomy or “hook” phlebectomy is a micro-extraction procedure used to remove varicose veins, both large and small, which are close to the surface through very small micro-incisions.  The micro-incisions are so small that they are closed with sterile tape and not stitches.  Once healed they are rarely visible.  Bruising will occur and will take a few weeks to go away.  A compression bandage is worn for only 3 or 4 days. When removed patients are amazed how good their legs look with the “ropey” veins gone.  Then a compression stocking is worn for another week. Patients can return to normal daily activities including work the next day and walking is encouraged.

Ligation

Vein ligation is a minor surgical procedure where a large varicose vein is tied off through a small incision.  This is necessary when veins are not working properly and the blood in them is leaking (refluxing) back down the leg.  These incompetent veins are the source of most of the visible varicose veins seen on the surface of the leg.  These refluxing larger veins must be separated or disconnected from the rest of the healthy venous system.  Ligation is performed in combination with ambulatory phlebectomy which eliminates the source and surface diseased veins.