Prior to intervention, virtually all insurance carriers require an attempt at conservative therapy.
- Your physician may recommend that you elevate your legs above the level of your heart for at least 15 minutes, 3-4 times a day.
- You may be prescribed compression stockings. Compression stockings are tight, elastic stockings that squeeze the veins in your legs and stop the blood from flowing backward. These stockings can relieve pain and swelling and can effectively treat varicose veins in many patients.
- Conservative treatments are required before medical insurances will authorize any surgical procedures. If you have previously used conservative treatments, please be sure to indicate this on the patient history screening form.
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
Micro (Stab) Phlebectomy
- Micro or stab phlebectomy is a method of removing varicose veins on the surface of the legs. This procedure can be done in the office under local anesthesia. This procedure involves making tiny punctures or incisions through which the varicose veins are removed. The incisions are so small no stitches are required. Veins are very collapsible such that even large veins may be removed through the tiny incisions used in this technique. The patient is able to walk following the procedure.
- After treatment, compression bandages and/or compression stockings are worn. Your physician will advise you how long to wear any bandages or hose. Many physicians recommend that you elevate your legs above the level of your heart. This reduces pressure in the veins, increases the flow in the veins and reduces the risk of bleeding.
Light Assisted Stab Phlebectomy (LASP)
- Light-assisted stab phlebectomy (LASP) was developed at UCLA by the chief of vascular surgery, Dr. Peter F. Lawrence, to treat varicose veins and spider veins. With this technique, the surgeon makes a tiny incision near the varicose veins and threads a slender tube with a light source at its tip underneath the vein cluster. A mixture of saline, lidocaine and epinephrine is infused into the area, providing a further anesthetic and "plumps up" the veins so that they are easily visible. The lights of the operating room are turned off so that the surgeon can see the veins illuminated under the skin. The surgeon then makes a very small incision immediately adjacent to a varicose vein. Taking a size 7 crochet hook that has been filed down and modified for the procedure, the surgeon passes it through the incision, hooks a vein and pulls it through the opening. After turning on the operating-room lights, the surgeon assesses the vein, sets the crochet hook aside and grasps the vein at its base with a tiny mosquito clamp. Using a gentle circular motion, the surgeon dislodges the vein from the skin. Further incisions are made to remove remaining veins.
- The empty vein channels are then flushed with solution to help collapse them and prevent bruising and hematomas from any residual blood remaining in the channels. No sutures are used; this allows for continued drainage if needed. A compression dressing is applied to the affected area, and within an hour, the patient goes home with instructions to elevate the leg for 48 hours. The resulting scars look like small freckles.
Treatment of large varicose veins
- There are several methods to treat large varicose veins. You should make sure that you are treated by a physician who is familiar and certified in all forms of treatment, since each may be needed in selected patients. “When your only tool is a hammer, everything looks like a nail.” The traditional “stripping” is only occasionally used today, but is appropriate for patients with huge veins, veins that are very close to the skin and very tortuous veins. Stripping is the only way to prevent severe pigmentation under the skin in these circumstances. Methods that heat the veins, such as radiofrequency ablation or endovenous laser ablation are virtually identical and achieve similar results. The advantage of radiofrequency ablation is that the heat generator can be used to treat other veins, such as perforator veins, and has been approved for that purpose. Perforator closure is more difficult with the laser.
Radiofrequency Ablation/Closure Procedure
- Radiofrequency ablation is an alternative to surgical stripping, excision or removal of the saphenous veins that may be the underlying source of surface varicose veins. It treats the veins by heating them with radiofrequency (RF) energy, causing the veins to contract and then close. This minimally invasive procedure has a good success rate and low complication rate. Read more about the Closure Procedure and closureFAST catheter.
- To perform the procedure, the doctor uses an ultrasound machine to map the veins, and then numbs the area with local anesthesia. The doctor then places a needle into the lower end of the diseased underlying vein, through which a small sheath is put into the vein. A radiofrequency catheter is placed through the sheath and advanced to the upper end of the diseased vein. Local anesthesia is then delivered to the entire vein. The catheter heats the inside of the vein as the catheter is slowly withdrawn back down the vein.
- Many of our physicians may prescribe the use of compression stockings after radiofrequency ablation and ask that patients elevate the legs to the level of the heart. Strenuous exercises such as weight lifting, aerobics and running should be avoided for at least 1 week. After radiofrequency ablation, any remaining residual surface varicose veins may be treated with either sclerotherapy or stab phlebectomy.
- Radiofrequency ablation is known to yield better cosmetic results than ligation and stripping because it leaves only a single puncture as opposed to multiple incisions. Also, there is usually less bruising and pain than that associated with stripping. Contraindications to radiofrequency ablation include veins that are too large or tortuous (twisty).
- Possible side effects of radiofrequency ablation include, but are not limited to, areas of skin numbness, skin burns, blood clots and phlebitis, an inflammation of a vein.