Vein Duplex Scanning

This is usually done on the first visit in the office using B mode ultrasound and color Doppler to visualize veins and to determine if the blood is abnormally refluxing back down the vein. It is the diagnostic tool to determine the etiology of the varicose veins, so that treatment can be anatomically and physiological accurate. It is non invasive and usually a covered expense by the insurance companies.

Ultrasound Guided Sclerotherapy

Using B mode ultrasound, the deeper superficial veins that are acting as feeders can be visualized and a sclerosing solution injected to obliterate the vein.

Sclerotherapy

This is the injection through a very small needle of a solution that irritates the inside of the vein and this causes inflammation of the vein. By adding a compression stocking, this compresses the vein, sealing it shut. It eventually scars down and can be reabsorbed. There is minimal pain and discomfort. The patient can resume normal activity immediately after the procedure. Exercise and aerobics can resume in 2-3 weeks. Graded compression is necessary for 3 days to 3 weeks depending on the size of vein injected.

The number of treatments depends on the size and the number of the veins.The patient returns 3-4 weeks later for evaluation and touch ups. Sometimes your legs look worse before they look better. The solution injures the vein and the body heals itself. Everything is discussed with the patient before proceeding. Estimates of time, number of injections and approximate cost are discussed.

Side Effects of Sclerotherapy

1. Hyperpigmentation

This is a brown discoloration of the skin where the vein was injected. This usually fades with time, sometimes as long as 6 months to 1 year. It almost always looks better than the purple veins. Sometimes blood gets trapped in the injected vein and needs to be drained to get the best and fastest result.
2. Matting

Occasionally, the body forms new spider veins around the ones just injected, and these also need to be injected.
3. Pain

Stinging occasionally occurs but severe pain is extremely rare.
4. Ulceration

Rarely a skin breaks down and a scab forms which heals with a small scar after 6 to 8 weeks.
5. Allergies

Allergic reactions are extremely rare.
6. Deep Vein Thrombophlebitis

Very rarely a clot can form in the deep veins. This is extremely rare.

Surgery

The goal of surgery is minimal pain, minimal scarring, outpatient procedure, quick return to work, and cosmetic excellence.

Radiofrequency VNUS FAST CLOSURE

When the greater saphenous vein is incompetent and acting as a feeder to the remaining branches, it should be obliterated. The older more traditional technique is to strip the greater saphenous vein from the groin to the knee. This works but is painful and takes time to recover.

Choices of Locations of Therapies

1. In office
2. In outpatient hospitals or surgery centers.

These depend on insurance and patient's request plus physician input.

Choices of Anesthesia

1. General anesthesia - rarely
2. Spinal or Epidural - rarely
3. Conscious sedation

- Most frequent
- A short acting IV narcotic is given and monitored by an anesthesiologist in an outpatient hospital or surgical center setting
4. Local anesthesia

- Used in office procedures.

Postoperative Observations and Instructions

1. A postoperative compression dressing will be used x 48 hours. Then a prescription support stocking will be used x 2 weeks during the day time and an additional 2 weeks while exercising. You may purchase these stockings from our office or a medical supply business
2. After surgery you are encouraged to ambulate or elevate the leg.
3. Normal activity may be resumed immediately. Exercise should wait 1-2 weeks. Up and down stairs are fine.
4. You may go back to work within 1-5 days.
5. You will be seen in the office approximately 1 week postop.
6. You will have black and blue bruising which will resolve in 4-6 weeks or less.
7. You will have some bulges or knots under the skin. These will disappear in 4-6 weeks.
8. Your tiny incisions will heal in 2-4 weeks and "disappear" in 9-12 months.
9. Your pain will vary with individuals but usually is none to mild to minimal.

I suggest using extra strength Tylenol if needed but a prescription for Vicodin will also be given to you.

Complications are rare but can include

1. Bleeding - you will get brusing.
2. Clotting - this is rare and preventable with postop. ambulation and / or elevation.
3. Infections - extremely rare.
4. Poor healing - one or two of the tiny incisions may not heal as well as the rest, but they all heal extremely well.
5. Skin burn - if the radiofrequency VNUS catheter is used, this theoretically could burn the skin. This is extremely rare, because special precautions are taken.
6. Nerve injury - the long saphenous nerve goes along side the long saphenous vein and this can be rarely injured causing some numbness which is usually temporary. Also some of the little sensory nerves on the varicose vein can be injured, but again this is usually temporary and rarely a problem.
7. Deep Vein Thrombophlebitis - a blood clot can theoretically occur after we are working on the superficial veins. This is very rare and ambulation and or elevation is encouraged to prevent this.