"I underwent sclerotherapy at the Radia Vein Center at Mill Creek. This was performed by Dr. R. DeFrang and I have been very pleased with the outcome. I would highly recommend this procedure."

Joyce Watson

Frequently Asked Questions

Q: What are the causes of varicose veins?
A: Abnormally dilated veins, otherwise known as varicose and spider veins, are caused by abnormally high pressure within the affected vein. In most cases the cause of this high pressure is hereditary. Larger varicose veins have abnormal valves that fail to keep blood flowing toward the heart. Blood flowing downward, instead of upward, in the legs causes the vein walls to stretch out until the vein bulges from the skin surface.

Q: Are varicose veins and spider veins caused by crossing your legs, working on concrete floors or gaining weight?
A: The most important causes are thought to be hereditary predisposition (the body characteristics you inherited) and hormonal effects such as those present during puberty and pregnancy. Other factors probably contribute very little.

Q: Who is at risk for varicose and spider veins, and what are the symptoms?
A: Both spider veins and larger varicose veins affect many adults at some time in their lives. Associated symptoms can include aching, throbbing, excessive fatigue, itching, burning, a restless feeling in the legs and cramping. Unaware that any non-surgical remedy is available, many vein disease sufferers resign themselves to their discomfort and altered lifestyle.

Q: Is surgery the only option for bulging varicose veins?
A: There are several non-surgical options for treating varicose veins. The best treatment depends upon several clinical factors.

One conservative treatment is the wearing of support stockings (to be put on before getting out of bed in the morning and worn all day). While support hose will NOT make the veins go away or prevent them from worsening, they may provide symptomatic relief. However, treating the veins directly may be preferable to a lifetime of wearing unattractive and cumbersome stockings.

Injection of medication into veins is known as sclerotherapy. It has been a successful method of treatment for more than a century. The treatment causes the vein walls to gradually seal shut and disappear. It is minimally invasive and virtually painless. When sclerotherapy is done on an outpatient basis, anesthesia is not necessary, and you may resume normal activity immediately. If the veins are too small skin laser is a possibility.

Endovenous Laser Ablation is another treatment option. The procedure of laser therapy is done in our offices and there is no need for general anesthesia. ELA requires no hospitalization, and you can return to normal activity within a few days. There is minimal discomfort and no scarring.

Q: Why should I get treatment for my varicose or spider veins?
A: Some patients choose to eliminate unsightly veins for cosmetic reasons, while others require treatment for medical reasons. Without treatment, in either case, the size of abnormal veins will slowly increase. Phlebitis, thrombosis (blood clots), spontaneous bleeding and skin ulcers are potential complications of varicose vein disease.

Q: How do I decide which treatment is right for me?
A: An educated and informed patient achieves the most satisfactory outcome. As our patient, you are a member of the treating team and understanding your own condition is essential for getting the best results.

Before any treatment is recommended or any estimate of cost is made, we ask you to visit us for an initial evaluation. At that time you will receive educational material, have a full history taken, undergo a complete examination of your veins and may have a duplex ultrasound evaluation of the circulation in your deep and superficial veins. After this examination has been completed, you will have a complete understanding of the nature of your vein condition and the options for treatment. If our treatment is not appropriate for you, alternative recommendations will be made.

Q: Could I have skin laser treatments for my spider veins?
A: We use sclerotherapy for spider veins because it works better for all but the smallest spider veins. That is because our 30 gauge needle is too big for the very tiniest vein.

Q: Should I wait until after I am done having children before having my veins treated?
A: While pregnancy can cause new dilated veins due to hormonal changes, treatment between pregnancies makes later pregnancies much more comfortable, improves self-image, decreases the chances of superficial phlebitis and slows the progression of new varicose veins.

Q: Wouldn't closing varicose veins just redirect flow into normal veins and make them become varicose?
A: Because varicose veins have abnormal blood flow, surrounding veins already compensate. Treatment of abnormal veins removes the poorly functioning, symptomatic vein, while the normal surrounding veins continue to worsen.

Q: Doesn't your body need all of its veins?
A: Your body hasn't used these veins effectively since they became abnormal. There is no reason to keep them.

Q: Does exercise hurt my veins?
A: Anything that keeps the leg muscles in good shape is probably good for your veins in that the leg muscles are the pumps that keep vein circulation going.

Q: What will happen at the initial consultation?
A: Your doctor will begin with a physical exam and a complete medical history. He will need to know the medications you're currently taking, any history of blood-borne diseases, and whether or not you are pregnant or nursing. Be sure to tell your doctor about any discomfort you may be having, such as pain, itching or swelling. In some cases, tests such as ultrasound or Doppler may be performed.

After your examination, your doctor will explain the different options available to you, the procedure itself, its risks and limitations, and the costs.

Be sure to ask all the questions you have about the procedure. Also ask for, and follow up on, patient references. Learning everything you can about your options, risks and benefits is the key to making an informed decision

 

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Sclerotherapy

Q: How is sclerotherapy performed?
A: Sclerotherapy is performed by injecting small amounts of medication into the unwanted vein to cause its closure. Your doctor will apply antiseptic to the area, then inject a solution into the affected veins with a very fine needle. Each injection covers about one inch of the vein. During the procedure, you may feel a slight pinch as the needle is inserted and a burning sensation as the solution is injected. Next, cotton dressing and compression tape will be applied to the area. After one area is injected and taped, the doctor will proceed to the next area.

Q: How many treatments will I need?
A: Many patients require only a single session. If you have many veins requiring treatment, multiple sessions may be required.

Q: How does sclerotherapy work?
A: The solution displaces the blood in the vein, causing the vein to appear lighter in color as well as irritating the inside lining of the vein, causing it to collapse. External compression with bandages keeps the vein closed and prevents blood from flowing to it. Within a few weeks to a month, depending on the size of the vein, the unused vein is absorbed by the body and disappears from view. Anesthesia is not necessary and the procedure is done in the office. Although not painful, individual injections can cause a light burning sensation, lasting a few seconds.

Q: How long does the procedure take?
A: Sclerotherapy normally takes 5 to 30 minutes, depending on the number and length of the veins. A series of treatments at bi-weekly or monthly intervals may be required for extensive numbers of veins.

Q: Will I need to stay in a hospital?
A: No. Because anesthesia is not necessary, the procedure is performed in the doctor's office.

Q: How will I feel after sclerotherapy?
A: After treatment is complete, you may experience some temporary itching or cramping. Your leg will be wrapped with a compression bandage. When the compression wrap is removed, you may notice bruising and discoloration. This will gradually fade over a period of several weeks.

Q: Can I exercise after treatment?
A: Although you should avoid activities that put pressure on the treated area (such as heavy lifting or jogging) for a few days, your doctor will probably suggest a regular walking program to increase circulation and promote healing.

After a few days, exercise is not only permitted, it is encouraged. We find that people who use their leg muscles every day after treatment have faster healing, fewer complications and less discomfort. The simplest and most effective form of exercise for good vein function is walking.

Q: Does sclerotherapy cause stains on the skin?
A: Temporary brownish discoloration is common. It is caused by a pigment called hemosiderin that is released in the skin from veins that are in the process of disintegrating. These stains can take from several weeks to several months to fade, depending on the size of the veins, the type of skin and the individual's healing ability.

Q: Are the results of treatment with sclerotherapy temporary?
A: While it is possible for someone with a hereditary predisposition to develop new varicose veins after either surgical or non-surgical treatment, injection sclerotherapy is extremely effective in permanently closing off existing varicose and spider veins. Veins lighten after each treatment.

Q: What is the long-term outcome like for most people?
A: Most patients report a high degree of satisfaction with the procedure and relief at no longer having to hide unsightly veins. The treated areas are noticeably clearer and in most cases the skin continues to improve with each successive treatment.

Q: What are the risks and limitations?
A: Occasionally "telangiectatic matting," a new network of veins, appears around the treated area. If this occurs, these veins usually disappear with time, although it may take several months. Discoloration and blotchiness is a more common side effect, but this usually fades over a period of time. Avoiding direct sunlight can minimize this. Call your doctor if you experience excessive pain or leg swelling. More rarely, sclerotherapy can lead to blood clots or inflammation in the veins. Allergic reactions to sclerosing agents have also been reported. Bruising is not uncommon and often will fade within a few days or, rarely, within a few weeks. In order to minimize these risks, it is important that you follow all of your surgeon's instructions, both before and after surgery.

If you have recently been pregnant, ask your surgeon about delaying the procedure, since spider veins caused primarily by pregnancy often resolve on their own.

Q: How much does sclerotherapy cost, and will insurance cover it?
A: Costs vary, depending on how many treatments you require. Generally, this is not covered by insurance, but you need to check with your insurance company.

Q: What kind of specialist should you see for this kind of treatment?
A: Patients with venous problems have traditionally been referred to vascular surgeons because the only treatment available was surgical. While non-surgical treatment may be offered by any physician who has the proper training and experience, there is no formal training program in this country for sclerotherapy or endovenous laser treatment. You should question your physician thoroughly about his or her background and experience.

 

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Endovenous Laser Ablation (ELA)

Q: Are there different types of lasers?
A: This is a very important point. Laser is a special type of light which can be tuned to different frequencies in order to affect different targets. Vascular lasers target the pigment in blood, so that blood vessels can be destroyed without affecting surrounding skin.

Q: How does the ELA actually work?
A: The laser energy damages the vein walls, causing them to collapse, shrink and close off so that blood can no longer flow through the damaged vein.

Q: What happens before and during the procedure?
A: Before the procedure, you will be given a mild sedative to relax you, and local anesthesia will be used to numb the area. You'll wear special eye goggles to protect against accidental exposure to laser light. During the procedure, a small laser fiber is inserted into the damaged vein and positioned with ultrasound guidance.

Q: Is there scarring? Does it hurt?
A: Laser treatment requires just a tiny puncture or incision, so there is minimal risk of scarring. Patients report only very mild discomfort.

Q: Where is ELA performed? Do I have to go to the hospital?
A: The procedure is performed in the doctor's office. Typically only a single laser treatment is required per leg. Laser therapy is often combined with sclerotherapy to fully treat varicose and spider veins.

Q: What about after ELA?
A: Following treatment, you may resume normal daily activities immediately, except to avoid aerobics, jogging or prolonged periods of sitting and standing for the first 48 hours. Compression stockings should be worn for two weeks. During the healing process, while the vein collapses and closes off completely, the skin will appear discolored and bruised, which may last three to six weeks. You may experience mild discomfort in the inner thigh, where the abnormal vein has been treated.

Q: Is losing the vein a problem?
A: No. The vein is usually doing more harm than good. It is not a problem to remove these veins as the deep venous system will take over the blood flow of these veins.

Q: What are the potential complications of the procedure?
A: Deep vein thrombosis, recurrence, skin lesions.

Q: Am I at risk from the laser?
A: No. You will be given a special pair of glasses to protect your eyes in case of accidental firing of laser outside the body.

Q: What is the alternative treatment?
A: The traditional treatment has been surgical ligation and stripping of the saphenous vein. This involves at least two surgical incisions to pull out the damaged vein. ELA has a shorter recovery period, lower cost, and no scarring compared to surgery. Traditionally, surgical ligation or vein stripping was the treatment for varicose veins, but these procedures can be quite painful and often have a long recovery time. In addition, there are high rates of recurrence with the surgical procedures, on average 10 to 25 percent.

Q: How successful is ELA?
A: Early results have been excellent with success rates equal to or greater than conventional surgery. ELA will treat the cause of most varicose veins, but additional therapy may be necessary.

Q: What are the benefits of vein laser treatment?
A: The treatment takes less than an hour and provides quick relief of symptoms. You can return to normal activity sooner than with surgery. There may be minor soreness or bruising, which can be treated with over-the-counter pain relievers. There is no scar, because the procedure does not require a surgical incision, just a nick in the skin, about the size of a pencil tip.

Q: Are there any stitches?
A: No.

Q: Can the laser burn my skin or me?
A: The laser works under the skin inside the veins. Only these veins are affected by the laser. With the local anesthesia around the veins, no sensations are felt.

Q: What is the down time for being off work and exercise?
A: The laser procedure is performed through a small opening that does not even require stitches. Most people will return to work in a couple of days. Strenuous exercise (jogging, etc.) is not recommended for one week.

Q: How long does the procedure take and am I put to sleep?
A: The laser procedure itself takes less than one hour. Local anesthesia is all that is required.

Q: Will I feel pain and is there pain afterwards?
A: The laser procedure requires only local anesthetic and the patients do not feel any pain when the laser is working. Several days after the operation some tightness will be felt in the thigh. Advil or ibuprofen is all that is needed for the discomfort.

Q: Will there be bruising?
A: Yes. Bruising occurs in the thigh in most patients and it usually resolves in 1 to 2 weeks.

Q: Can I see a difference instantly?
A: Many patients feel a difference immediately, with loss of the aching and heaviness in their leg. When the laser procedure is combined with microphlebectomy (i.e., removing the dilated varicose veins) the leg will look flat immediately.

Q: Can I eat prior to ELA?
A: Yes. Meals and medication are to be taken even on the morning of your operation.

Q: Will I have medication to relax me?
A: Yes. We offer a relaxing pill for the procedure as well as the local anesthesia.

Q: How much does ELA cost, and will insurance cover the procedure?
A: Most insurance policies don't cover the expense of elective cosmetic surgery for varicose veins. However, in many cases, if you have signs or symptoms, most insurance companies cover the treatment. The cost of the co-payments and deductibles varies with insurance companies. Check with your carrier for specifics. We will bill your insurance companies as a courtesy but you will be responsible for your balances.

 

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