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 sclerotherapy, ultrasound-guided sclerotherapy, 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.
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.
How are spider veins treated?
Sclerotherapy is the treatment of choice for spider veins. Sclerotherapy is an injection treatment used to eliminate small to medium size varicose veins and spider veins. Although these superficial fine veins are connected with the larger venous system, they are not an essential part of it, so eliminating them will not affect your circulation. The majority of these veins present as a cosmetic problem. In this rather simple procedure, veins are injected with a sclerosing solution, which causes them to collapse and fade from view.
What to expect from sclerotherapy?
Sclerotherapy can enhance your appearance and your self-confidence, but it’s unrealistic to believe that every affected vein will disappear completely as a result of treatment. We treat both legs, front and back, during each session. This results in a gradual cosmetic improvement all over rather than treating one area at a time. Initial treatments will focus on the most heavily involved areas or the most symptomatic areas. The average patient usually requires 3 to 6 treatment sessions. Significant cosmetic improvement can usually be expected near the end of the prescribed treatment course. In most cases it has taken years for these veins to develop. They will not go away over night. It will take weeks or months to eradicate them.
What are the risks related to sclerotherapy?
Serious medical complications from sclerotherapy are extremely rare when a qualified practitioner performs the procedure. However, they may occur. Risks include the formation of blood clots in the veins, severe inflammation, adverse allergic reactions to the sclerosing solution and skin injury that could leave a permanent scar. A common cosmetic complication is pigmentation irregularity- brownish splotches on the affected skin that may take months to fade, sometimes up to a year. Another problem that can occur is “telangiectatic matting,” in which fine reddish blood vessels appear around the treated area, requiring further injections. Common side effects include itching, hyperpigmentation, telangiectatic matting, pain and bruising. Rare side effects include ulceration at injection site, allergic reaction and pulmonary embolus/deep vein thrombosis.
How to prepare for sclerotherapy?
You will receive specific instructions from your physician on how to prepare for your treatment. Carefully following these instructions will help the procedure go more smoothly. You’ll be instructed not to apply any type of moisturizer, sunblock or oil to your legs on the day of your procedure. You may want to bring shorts to wear during the injections, as well as your physician-prescribed support hose (also available for purchase in the office), and slacks to wear home. Discontinue Aspirin and Ibuprofen for ten (10) days before injections to reduce bruising. When scheduling your procedure, keep in mind that your legs may be bruised or slightly discolored for some weeks afterward. You probably won’t be comfortable wearing shorts, a swimsuit or mini skirts until after your legs have cleared up a bit. Sun exposure and tanning bed use are discouraged the first two weeks after each treatment.
Will insurance pay for sclerotherapy?
Sclerotherapy is considered a cosmetic procedure; therefore your insurance company will not cover this service. As such, payment is due in full prior to procedure. We will not file your insurance for sclerotherapy due to its cosmetic nature.
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.
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.
Sclerotherapy and ultrasound guided sclerotherapy
Sclerotherapy is ideal for treating small to medium size varicose veins. It involves the injection of a solution into diseased veins with the intent to create scar tissue inside the vein that will seal it closed. The veins then shrink and gradually disappear. The solution used is extremely safe and relatively painless. Anesthesia and sedation are not needed. For deeper varicosities ultrasound is often used to “guide” the injections into the underlying diseased veins below the surface of the skin. This allows the medication to be administered to precise locations safely and accurately. Sclerotherapy is often done during post operative visits to eliminate any diseased veins that were too small or too deep to remove during surgery. Thus, surgery and sclerotherapy are often complementary, ensuring that all the diseased veins are eliminated with treatment.
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.
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 and/or sclerotherapy which eliminates the source and surface diseased veins.
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Screening and Treatment Options
Recovery from Endovenous Laser Treatment
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Hints, Tips & Accessories for Compression Stockings
Applying & Removing Calf Length Closed & Open Toe Stockings
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Vein problems can range from unsightly spider veins to venous diseases resulting in painful varicose veins and even ulcers. Though we use state-of-the-art diagnostic and laser treatment options, Paragon Vein Care & Aesthetics begins with a thorough exam and the most conservative treatment methods possible. Our vein care specialists develop a personalized plan of care for each patient to address their symptoms and the severity of their venous disease.
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Jeffrey S. Schmidt, MD, FACS
Education West Virginia University – BS
Medical School West Virginia University – MD
Residency Fairview Hospital and The Cleveland Clinic Foundation
Certification American Board of Surgery (1995)
The National Procedures Institute, Pittsburgh, PA
The Vein Clinic, Jacksonville, FL
Guilford Technical Community College, Greensboro, NC
OSHA Compliance Training Certification (S.P.I.C.E)
Certified Sclerotherapist for all patients, cosmetic and medical.
Tammy has extensive, clinical venous clinical experience, having worked in the specialty for over 20 years. She provides sclerotherapy for spider veins and consultation on a variety of other cosmetic procedures.
Nicole Ramos, RVT, RPHS, RDMS, RDCS
New York University, New York City, NY
Suffolk County Community College
Laser Venous Ablations
American College of Phlebology
Society of Diagnostic Medical Sonography