What causes spider veins and varicose veins?
Your legs are made up of a network of veins. A healthy vein contains valves that open and close to assist the return of blood to the heart. Varicose veins are caused by damaged or diseased valves that result in backward flow of blood in your legs, a condition known as venous reflux. This can cause blood to pool in your legs and can lead to symptoms such as pain, swelling, and varicose veins. Untreated symptoms will worsen and can progress to inflammation, blood clots, sores, ulcers or bleeding. Spider veins are very tiny varicose veins that typically appear as red or purple threadlike lines on the surface of the skin.

Normal vein valves open and close to prevent backflow as blood must work against gravity to return up to the heart. Leaky valves cause backward flow.

Risk Factors and Varicose Vein Prevention
Some factors that may contribute to varicose veins include:

• Heredity
• Pregnancy or treatments that have hormonal effects
• Age
• Prolonged standing
• Obesity
• Leg injuries

Measures that may help prevent new varicose veins or relieve discomfort from existing ones include:

• Regular exercise
• Avoid long periods of standing
• Avoid long periods of sitting
• Weight control and a healthy diet

Treatments

Sclerotherapy for Spider Veins
Sclerotherapy involves a series of injections into the varicose veins or spider veins. These injections cause the blood in the enlarged vein to clot, and within a short time, is absorbed so that is no longer able to be seen at the surface of the skin. The benefits to this procedure are that it is performed in the doctor’s office, involves no incisions, requires only a topical anesthetic, and has a short recovery period.

EVLT® and Microphlebectomy for Varicose Veins
Microphlebectomy involves tiny incisions that allow the surgeon to access the diseased veins in small portions and remove them. Removal of these veins in this way only requires a local anesthestic, and the incisions are so tiny that there is typically no scarring.

EVLT is a minimally invasive treatment alternative for patients with a condition known as venous reflux, which often results in varicose veins and other painful symptoms. It is an alternative treatment option to traditional varicose vein stripping and can be performed as an outpatient in the doctor’s office. Local anesthesia is typically used to numb the treatment area. A thin catheter is inserted into the vein through a small opening. A laser fiber is then threaded inside the catheter that is already in the vein. The laser fiber delivers energy to the vein wall, causing it to heat, collapse, and seal shut. As the laser applies heat to the vein, it is slowly pulled out and the vein closes behind it. Once the diseased vein is closed, other healthy veins take over and empty blood from your legs. As normal return flow is re-established, your symptoms should improve

Once the diseased vein is closed, other healthy veins take over and empty blood from your legs. As normal return flow is re-established, your symptoms should improve. After the procedure, the blood that would flow through the faulty veins will be diverted to the many other normal veins in the leg.

After the procedure
Following the procedure, gauze is placed over the insertion site and your leg is wrapped with ace wraps. Your leg may have a tendency to swell and bruise. This usually occurs the day after the procedure and may last for about 2-4 days. In addition, you may experience some discomfort from the needle punctures made during the procedure. Following the procedure, you will go home and return to normal activities as much as you can tolerate. Any pain can be alleviated with pain medication. Elevating your leg above the level of your heart when you are sleeping and resting helps reduce any swelling. You will need to restrain from vigorous activities for about 4 days, and if you are employed, you might consider taking 2-3 days off work to recuperate.

Follow up
After the procedure, you will return in 2-3 days to have a venous duplex exam on the leg that was treated. This test will tell us that the EVLT successfully closed the treated veins, and it will check for any clot in the deep venous system. You will also be seen by the doctor or nurse at that time.

Highlights of EVLT

• Relief of symptoms
• Short recovery
• Same day procedure
• Local anesthetic
• No incisions

Common Questions and Answers About EVLT

1. How does EVLT work?
   The laser energy damages the vein walls, shrinking them and closing the faulty vein so that the blood cannot flow through it. This eliminates vein bulging at its source.


2. Is loss of this vein a problem?
   No. After treatment, the blood that would flow through the faulty veins will be diverted to the many other normal veins in the leg.


3. How does EVLT compare to vein stripping?
   Vein stripping (removal of the diseased vein) is performed in the hospital, requires general anesthesia, involves two large incisions at the knee and groin, and has a long recovery time. EVLT has no incisions, is performed in the doctor’s office, only requires local anesthesia, and has a short recovery period.


4. How successful is EVLT?
   Published clinical studies show that EVLT has a 98% initial success rate with excellent long-term results.


5. Is EVLT covered by my insurance?
   Insurance coverage is determined on a per case basis. Most insurance companies determine coverage for all treatments, including EVLT, based on medical necessity. On occasion, we are asked to send all records and test results along with photos of your legs to the insurance company for predetermination.

Potential Risks and Complications
Potential complications include, but are not limited to the following: vessel perforation, thrombosis, pulmonary embolism, phlebitis, hematoma, infection, paresthesia, and skin burn.