What is laser intravascular vein ablation?

This procedure has revolutionized treatment of  lower extremity varicose veins.  Presence of reflux and disease in the vein is confirmed with an ultrasound evaluated by a board certified radiologist. Then access is gained into the vein usually close to the knee through a hole not much bigger than a pencil tip.  The laser device is introduced and the vein is closed( ablated ) using laser light.  The tissues have been anaesthetized prior to the procedure.  The procedure usually takes less than 1 hour.

What is sclerotherapy?
Sclerotherapy is a non surgical office procedure that can treat most diseased surface veins. Medication is injected into a vein using an extremely tiny needle. The medication closes down the vein walls so that they stick together and are gradually reabsorbed by the body. Getting rid of these diseased veins actually improves the circulation and makes the legs healthier.

What will happen in the first consultation?
 

What causes vein problems?
Veins carry used blood to the heart through one-way valve systems. When there is a weakness in the vein wall or a faulty valve, the valve stretches and no longer closes properly. The veins become filled with blood that can’t flow normally, causing pain, swelling, discoloration, sores that won’t heal, blood clots and other problems.

What types of vein problems does our Vein Clinic treat?
Spider veins and varicose veins are the most common. Other vein problems include chronically swollen legs, recurrent infections, thrombophlebitis, and pregnancy-related problems.

How many treatments are required?
The endovenous laser ablation requires only one treatment.  Depending on the type and severity of the varicose veins, you may need few sessions of sclerotherapy. The larger vessels only require a few (3 or 4) well placed needles with a stronger solution. They must be treated first. The smaller spider veins may require many points of injection with a weaker solution. The injections will be stopped at any time if the patient so requests. The number of injections is less important that the type of sclerosing agent used, its dosage, the site of the injections. Most patients experience moderate discomfort similar to an allergy of tetanus shot with each injection..

Why MyVein Clinic?
Dr. Malek, Harvard and UCSF graduate, and Dr. Padidar, Stanford graduate, are the most recognized endovascular specialists in Santa Clara county.  They have more than eleven years of combined experience in the field and have helped many patients to say goodbye to their varicose vein and spider vein problems.

Diagnosis & Treatment
Diagnosis starts with a careful history and physical exam. Diagnostic tests are often needed to evaluate the extent of disease. If treatment is indicated, for endovenous laser ablation it takes 45 minutes and 20 minutes for sclerotherapy. The number of treatments depends on the severity of the problem.

Discomfort after treatment is rare. Most patients leave our office and go directly back to work. We recommend that patients walk as much as possible after each treatment.

Insurance Coverage
The diagnosis and treatment of significant problems due to diseased veins are often covered by your insurance. Spider veins are considered "cosmetic" and usually are not covered. Our evaluation can usually tell whether diseased veins are causing medically significant problems or whether the problem is strictly cosmetic.

What are the most common side effects?
All medical treatments entail a certain degree of risk. This will be discussed during you first visit and consent to treatment must be signed before the injections are started. Fortunately, when injections are undertaken by well trained professionals, complications rarely arise.

Spider Veins:
In the first few days itching, bruising, aching, redness and swelling are common. Most of these symptoms resolve spontaneously. You may take Tylenol (acetaminophen), but do not take ASA or related compounds (aspirin, naproxen, and ibuprofen) since they may increase bleeding. It may help to elevate the legs and rotate the ankles. Some patients (particularly those with fair skin) notice small red circles or brown lines after treatments. These are due to the pigment of blood or inflammation and usually resolve within 1 month. 90% of the discoloration's resolve with 1 year. A superficial blood clot may develop at the injection site which causes a lump. This will disappear in 2-8 weeks. A small superficial ulceration of the skin overlying the injected vessel may occur. It will usually leave a small scar. "Matting" refers to the development of new tiny blood vessels in the treated vessel. This temporary phenomenon occurs 2 to 4 weeks after treatment and usually resolves within 4 to 6 months. It occurs in up to 18% of women receiving estrogen therapy (for menopause) and 2 to 4 % of all patients. You will be monitored at the clinic for an allergic reaction (very rare) which can include hives, shortness of breath and swelling around the airway. If this occurs at home, seek medical attention immediately.

Varicose Veins:
In addition to the side effects listed above there are several complications which are unique to varicose vein treatment. Phlebitis may develop at the site of injection as a firm nodule. This resolves with elevation of the legs, application of a cool pack, rotation of the ankles, tensor bandage and aspirin for 48 hours after treatment. Deep Venous Thrombosis (DVT) is a very rare complication, seen in approximately 1 out of every 30,000 patients treated for varicose veins greater that 3 to 4 mm in diameter. DVT will be recognized by pain and swelling of the entire foot. The possible dangers of DVT include the possibility of a pulmonary (lung) clot and post phlebitis syndrome, in which the blood clot is not carried out of the legs, resulting in a permanent swelling of the legs. If the sclerotherapy solution becomes lodged in an artery instead of a vein, its occlusion may cause an interruption of the blood supply to an area outside of the limb.

What should I do before a treatment?
Do not take aspirin, ibuprofen or other arthritis medicine for 2 days before and after you treatment because these medications can increase bruising. Do not drink alcoholic beverages or smoke for 2 days before and after your treatment. They may impair healing. Shower and wash your legs thoroughly with an antibacterial soap. Do not shave your legs the day of your appointment. Do not apply any cream or lotion to your legs, including tanning cream. Bring loose fitting shorts to wear during the treatment. Eat a light meal or snack 1 - 1½ hours before your appointment. If you sometimes get lightheaded during medical procedures, consider bringing someone to drive you home.

What should I do after a treatment?
Spider Veins - Your legs will be covered in cotton balls attached with tape, so you are advised to wear dark colored loose fitting clothing to the session. Remove the cotton balls after one hour. Resume normal activities. Avoid alcohol, ASA, and hot baths for 48 hours.

Varicose Veins - If the veins are large, you may be asked to wear your compression stocking for 48 hours. Walk or keep active for a half hour after the session to maximize results. Bring comfortable walking shoes. If traveling more that 30 minutes to the office, have someone drive you so that you can move your feet and legs as the passenger. Avoid tanning until the end of treatment and all the bruises have disappeared, otherwise you tan color may be irregular. Do not use self tanning lotions for at least one month (it can cause unsightly streaking). Maintain normal activities but avoid strenuous physical activities such as high-impact aerobics or weight lifting for the first 48 hours. Avoid prolonged standing and hot baths for 1 week. Cool your legs with cold water after each shower. Most people can return to work immediately after a treatment.

What can I do to prevent varicose veins from coming back after a treatment?

Varicose veins are a chronic illness and are subject to recurrence, but there are some steps that you can take:

1. Compression stockings are highly recommended and come in a variety of colors and styles. Use them when you legs ache, for long trips or for prolonged walking or standing.  Our doctors will prescribe the correct strength and size for you.

2. Wear comfortable shoes with a 1 - 2 inch heel (running shoes are best).

3. Avoid wearing girdles and ordinary knee high stockings.

4. Exercise regularly. Avoid standing for long periods and if you do, flex your muscles or sit/lie down with your legs up.