No matter what treatment option is best for you, compression hose will be necessary for at least a short period of time. This is most important to achieve the desired outcome, but unfortunately, patient compliance is not always optimal. You will be measured for your stockings at the time of your office visit and we keep most sizes in stock. Special patterns, colors, and designs can be ordered if you desire.
The strength of compression as well as the recommended duration of use varies depending on the problem we are treating. Although compression stockings may not be the most comfortable, and can be warm in summer months, they are most important for a successful outcome. If fashion is important, we have access to companies that handle many colors and style. The stockings may be knee high, thigh high, or pantyhose, depending on the area to be treated.
Sclerotherapy involves injecting a solution into the vein that destroys the vein wall. With larger veins this is usually done under ultrasound guidance and the solution may be mixed with air to cover a larger area of the vein. This is called foam sclerotherapy. Sclerotherapy is widely used for spider veins and involves injecting liquid through a tiny needle under direct vision. In the past, this was painful and not very effective; however, today we have much better drugs to choose from and the procedure is almost completely painless. Depending on the extent of the problem, the treatment may require only one, or possibly several sessions. A realistic expectation is the resolution of 85% of your spider veins. You should also keep in mind that additional spider veins usually develop over time and you may require a yearly “touch up”. Most spider vein therapy is considered cosmetic and therefore not covered by insurance. Cost is not excessive however and most patients are very pleased with the outcome. Support hose are recommended for a short time after each treatment session.
Large ropey veins just under the skin are usually best treated by phlebectomy. After anesthetizing the area, a tiny incision (needle hole) is made in the skin through which a vein hook (similar to a knitting or crochet needle) is used to actually remove the vein in question. This could involve as many as 20 tiny punctures, but these do not require sutures and are closed with small pieces of steristrip. If you have multiple phlebectomies, you may be asked to limit activity and elevate the treated leg for the day of the procedure only. Cosmetic results from phlebectomy are excellent.
Ablation involves destroying the inner lining of the vein so that it becomes fibrosed and later reabsorbed by the body. This can be done with chemicals, radiofrequency or laser. Chemical ablation is widely used in Europe; however, in the United States radiofrequency and laser are more popular. The catheter to be used is inserted into the vein to be treated under ultrasound guidance and actually seals the vein by destroying the inner lining with heat generated either by radiofrequency or laser energy. The vein has usually completely disappeared by 6 months and can no longer be detected by ultrasound. The veins selected to be treated in this fashion are usually large veins whose valves are incompetent resulting in venous hypertension in the lower leg. Causes of valve incompetence may be prior thrombophlebitis or more commonly are hereditary.
All procedures are performed in the office under local anesthesia and sedation. After most procedures your leg will be wrapped with a dressing and ace wrap which will be worn for 48 hours. After 48 hours you will remove the dressing and put on your support hose which will be worn for two weeks after ablations. After sclerotherapy alone hose are worn 5-7 days.
It is estimated that over 80 million people suffer from venous disease in the United States alone, and that 4.6 million work days are lost each year. So this is obviously not just a cosmetic issue. Typical symptoms include aching legs especially after long periods of standing, leg swelling, restless legs, and occasionally cramping. Symptoms usually improve with leg elevation and may improve with walking or exercise. Visible signs may include bulging veins, unsightly spider veins, skin discoloration, or even ulceration.
Why do some people develop varicose veins and others do not? Good question. The most common cause of venous problems is heredity. If one of your parents or grandparents suffered with this problem, there is a better than even chance that you will also. Other contributing factors include prior deep or superficial vein clots, multiple pregnancies, obesity, occupations requiring prolonged standing on hard surfaces, and the wearing of high heeled shoes. Quite often the underlying cause is the poor function of valves inside the vein. When functioning properly these small valves should allow blood to flow up toward your heart, but not in the opposite direction toward your feet. This causes increased pressure in the veins of your legs which in turn results in the symptoms as well as the physical findings.
How do we fix the problem? Good support stockings of at least 20-30mmHg will certainly help with symptoms, but they are not always comfortable and practical to wear and do nothing to treat the underlying problem. The goal of effective therapy is to correct the elevated venous pressures or (venous hypertension). That’s where ablation comes in using chemicals, laser, or radiofrequency. In this country, laser and radiofrequency are the most popular methods. In our vein center, we offer all three modalities but prefer either laser or radiofrequency. The procedure is done in the office under minimal sedation (you will be awake or may dose off briefly) along with local anesthetic. Most procedures last around an hour and you can usually expect to return to work the next day. You are asked to remove your bandage and ace wrap 48 hours after the procedure and then wear your stockings during the day for 2 weeks. We ask that you avoid strenuous exercise and hot tubs for an additional 2 weeks. You will be given a prescription for an anti-inflammatory agent to take for 10 days post procedure. Any additional discomfort can be managed with only Ibuprofen.
Your initial office visit will include an interview and physical exam followed by an ultrasound examination of your lower extremities. The development of ultrasound techniques to evaluate leg veins has made the science of treating venous disease what it is today. After the ultrasound exam a recommendation will be made as to the best way to treat your individual problem based on the ultrasound findings. All procedures as well as physical and ultrasound exams are performed by Dr. Barr.