Just the Facts
Venous insufficiency is the most severe form of vein disease. It can lead to changes in skin color, dermatitis, swelling, scar tissue formation in the skin and even the fat below the skin, as well as the formation of actual ulcers in the skin. Chronic venous insufficiency tends to affect the lower half of the leg, especially the tissues near the ankle.
Venous Insufficiency Treatment Options
Endovenous Laser Ablation
EVLA is a procedure that safely and effectively cures venous insufficiency. By treating the disease process, the symptoms of venous disease — including varicose veins — disappear. Unlike painful varicose vein surgery of the past, EVLA vein treatment shuts down veins from the inside by use of laser and ultrasound technology — all with minimal discomfort. Our initial assessment will include an ultrasonic evaluation of your veins. In real time our experts will make an accurate diagnosis, and an appropriate and effective customized treatment plan can be developed for you. EVLA involves entering the vein and treating the diseased vein from within. Using cutting edge ultrasound technology, the diseased vein is identified and entered using real-time ultrasound guidance.
A small catheter (or IV) is inserted into the vein. This catheter is then advanced within the vein to treat the entire length of diseased vein. At this point, local anesthesia (also called tumescent anesthesia) is injected around the vein. This solution of local anesthesia serves two purposes. First, the vein itself as well as the surrounding tissues are anesthetized and become numb. Secondly, the fluid around the vein helps to protect the surrounding tissues from any collateral injury from the heat of the laser. Once the anesthesia has been injected around the vein, the laser is activated and the vein causing the patient's symptoms is completely ablated. Long-term follow-up of patients treated in this fashion indicate that less than 5% of patients have a recurrence of their disease.
Unlike surgical vein stripping where there is significant down time, patients treated with the EVLA procedure and/or with sclerotherapy usually have no down time, and can normally resume normal activities immediately. Exercise is not only permitted following the EVLA procedure, it is encouraged. Immediately after the EVLA procedure, we encourage patients to walk for 20 minutes. We find that patients who use their leg muscles every day after the EVLA procedure have faster healing, less discomfort, and fewer complications. The simplest and most effective form of exercise to optimize leg vein function is walking. We often have our patients abstain from swimming and bathing (showering is okay) for 5 days following the EVLA procedure.
Radiofrequency ablation (RFA) is a minimally invasive procedure which uses segmental radiofrequency energy to provide an even and uniform heat to contract the collagen in the vein walls, causing them to collapse and seal the vein closed. Blood is then re-routed through healthy veins back towards the heart.
The procedure involves inserting a catheter into the diseased vein through a small incision below the knee and threading the catheter through the vessel. The catheter delivers energy to the diseased vessel causing it to collapse. Blood flow is then naturally redirected to healthy veins as the recovery process begins. The treated vein becomes scar tissue and is eventually absorbed by the body.
Based on certain anatomic considerations, your surgeon will select either EVLA or RFA as the energy source to use in closing your abnormal vein.
Unlike surgical vein stripping where there is significant down time, patients treated with the RFA procedure and/or with sclerotherapy usually have no down time, and can normally resume normal activities immediately. Exercise is not only permitted following the RFA procedure, it is encouraged. Immediately after the RFA procedure, we encourage patients to walk for 20 minutes. We find that patients who use their leg muscles every day after the RFA procedure have faster healing, less discomfort, and fewer complications. The simplest and most effective form of exercise to optimize leg vein function is walking. We often have our patients abstain from swimming and bathing (showering is okay) for 5 days following the RFA procedure.
Sclerotherapy involves the injection of a chemical agent into diseased veins. These veins typically are the smaller spider veins or slightly bigger reticular veins and even some larger varicose veins. The agent is injected directly into the vein and causes damage to the lining of the vein, which eventually causes the vein to completely disappear. Depending on the size of the vein, the solution can be agitated causing it to foam prior to injection. Foam sclerotherapy is very effective for some of the larger vessels.
We use only the latest agents for injection — those that have been clinically proven to be effective. We have carefully chosen agents that are very low-risk and have extremely high efficacy. In addition, we adjust the concentration of the medication based on each individual patient. The procedure is essentially pain-free. We use extremely small needles for the injections. Most patients do not feel the needle enter the vein. The solution itself does not cause any discomfort and the procedure is typically nearly painless. Typically, the veins that are visible represent the tip of the iceberg. There are usually veins slightly deeper and somewhat bigger that are the actual source of the spider veins that are visible. Rather than simply injecting the visible veins, we strive to address the source of the problem. This not only results in much better long-term results; the cosmetic benefit is improved as well. Usually this requires the use of the vein viewer. This allows us to see those veins not visible to the naked eye. These veins tend to be the actual culprit and if they are not treated, the end result will be sub-optimal.
After the procedure there are no restrictions and any activities can be resumed.