Why do I need an initial consultation?

During your first visit, Dr.Wagner and his team will assess your medial history and examine your veins. This is usually all that is required in most of the patients who present with simple spider veins. For patients with varicose veins, and in some with spider veins, a painless ultrasound evaluation will be performed in order to determine if there is another vein deeper under you skin that is causing what is visible on the surface. After this careful evaluation, Dr.Wagner will then be able to discuss the patient’s treatment options.

Are varicose veins common?

Varicose veins are a very common condition in the United States and affect approximately 15 percent of men and approximately 25 percent of women.

Are varicose veins only a cosmetic concern?

For men and women, varicose veins as well as spider veins makes them feel less attractive. However, it’s important to note that for other individuals, the varicosities may cause aching, pain and discomfort. Over time, venous disease may lead to serious problems if not treated accurately.

What causes Varicosities and Spider Veins?

The heart pumps blood filled with oxygen and nutrients to the entire body. Arteries carry blood from the heart towards the body parts. Veins carry oxygen-poor blood from the body back to the heart. The squeezing of leg muscles pumps blood back to the heart from the lower body. Veins in our bodies have valves that act as one-way flaps. These valves prevent the blood from flowing backwards as it moves up the legs. Unfortunately, if the one-way valves become weak, blood can leak back into the vein and pool there. This problem is called venous insufficiency. Pooled blood enlarges the vein and it becomes varicose (bulging). The spider veins can also be caused by the backup of blood. Varicose veins are most commonly caused by age, pregnancy, obesity, heredity and standing for long periods of time.

Why do varicose veins and spider veins usually appear on the legs?

The force of gravity, the pressure of body weight, and the task of carrying blood from the bottom of the body up to the heart make legs the primary location for varicose and spider veins. Compared with other veins in the body, the leg veins have to work the hardest in order to carry blood back to the heart. Secondary to gravitational forces, these specific veins endure the most pressure. This pressure is usually stronger than the veins' one-way valves, which eventually become dysfunctional.

Are varicose veins and spider veins painful or dangerous?

Spider veins usually do not require medical treatment. But varicose veins usually become enlarged and worsen over time. Severe varicosities may pose health problems. These may include:

Chronic venous insufficiency. The pooling of blood for long periods of time in the veins slows the return of blood to the heart. This insufficiency may cause blood clots (Thrombosis) and/or severe infections secondary to venous ulcerations. Blood clots can be very dangerous because they can move from leg veins and travel to the lungs. Once lodged in the lungs, the clot can prevent the heart and lungs from functioning correctly.
Sores or skin ulcers can occur on skin tissue around varicose veins.
Chronic irritation, swelling and painful rashes of the legs.

What are the signs and symptoms of varicose veins?

Some common symptoms of varicosities may include:

Aching leg pain
Becoming easily tired
A sense of leg heaviness
Swelling of the legs
Hyperpigmentation of the skin (Seen in chronic cases)
Itching or irritated rash on the legs

What is sclerotherapy?

Sclerotherapy is a microinjection procedure that is utilized to treat spider veins. The procedure requires injection of a sterile solution (called a sclerosing solution) into the small veins using a very fine, thin needle. The solution used irritates the vein lining causing it to undergo fibrosis and eventually disappear with time. Numerous veins can be injected during each session.

What is the best treatment for spider veins?

The best and gold standard treatment for spider veins is sclerotherapy. Even though laser vein removal is an easy, fast, and effective way to treat superficial veins, sclerotherapy has been used in the medicine for more than 30 years. Dr.Wagner believes that laser treatment is a good choice for some vein treatments. However, laser treatment for leg veins is usually more expensive, more painful and less effective than well-executed sclerotherapy for leg veins.

Where is the procedure done?

It is usually done in the doctor’s office. The procedure does not require any type of anesthesia. There is minimal pain. For those patients who are unable to tolerate the pain, a topical local anesthetic may be utilized on the skin about 30 minutes before the procedure is performed.

Can sclerotherapy be used to treat large varicose veins?

Unfortunately, sclerotherapy is generally used for the very small superficial veins next to the skin (reticular and spider veins). Sclerotherapy is usually not effective for larger veins. When large veins are treated with sclerotherapy, a stronger solution and a higher volume is usually required. After the treatment for these larger veins, compression hose stockings are usually recommended to be worn for at least 2-3 weeks.

How many sclerotherapy sessions are required?

It varies from patient to patient but typically 2-4 treatments are required for the best results. In patients with milder cases, 1-2 will suffice. The treatments may vary when there are more veins or slightly larger veins.

Is there any pain associated with sclerotherapy?

Patients may experience a little sting associated with each injection. The burning sensation lasts few seconds. Most individuals tolerate the procedure and do not require any type of anesthesia. The greater part of patients declare that the procedure is much less than painful than what they originally anticipated.

Can anyone undergo sclerotherapy?

Almost anyone with unsightly spider veins may be treated, except women who are pregnant or nursing. Other relative contraindications may include those patients with skin infections, uncontrolled diabetes, fever, history of deep vein thrombosis, anticoagulant therapy, and those patients taking corticosteroids.

Is there anything I have to do before sclerotherapy?

No preparation is required before the procedure. It is recommended that one stop smoking and stop taking aspirin a few day before the procedure. Patients on blood thinners are not candidates for sclerotherapy.

What will my legs look like after sclerotherapy treatment?

Some patients may experience some mild pain which can easily be overcome with Tylenol. The injected sites will appear bruised and swollen for a few days. Using the recommended compression stockings will help relieve the swelling and pain. The bruising usually disappears in 2-3 weeks.

What are some of the possible side effects of Sclerotherapy?

Patients may experience temporary stinging or painful cramps where the injection was performed.
Temporary wheals where the injection was performed.
Temporary small skin sores where the injection was performed.
Temporary bruises where the injection was performed.
Hyperpigmentation around the treated vein that usually disappears with time.
Groups of fine red blood vessels around the treated vein that usually disappear with time.
The treated vein may also become inflamed or develop lumps of clotted blood. This is not dangerous. Applying heat and taking aspirin or antibiotics can relieve inflammation. Lumps of coagulated blood can be drained.

Does insurance cover sclerotherapy?

Unfortunately, spider veins and sclerotherapy are considered cosmetic in nature and the cost of treatment is not covered by most insurance companies.

What is Endovenous laser treatment?

Endovenous laser therapy is an FDA-approved, non-surgical procedure to treat varicose veins. EVLT is a procedure which is exclusively performed in an office, requires no incisions and no hospital stay. With endovenous laser therapy, there is no need to remove the leaking saphenous vein (main superficial vein in the thigh). All steps are performed under ultrasound guidance to assure perfect positioning of the catheter. After local anesthesia is administered, a laser fiber is inserted through a small needle hole in the skin into the vein that runs along the inner thigh. Once in proper position, the laser fiber is then slowly heated, which causes the vein to collapse. The sealed vein will shrink with time and eventually disappear. This technique rapidly treats the large varicose veins in the thigh and legs and usually takes less than 1 hour to perform. Patients can resume all their normal activities soon after the procedure is performed.

How does Endovenous laser thermal ablation work?

The energy source from the laser irritates the vein wall to the point where it causes them to shrink and slowly disappear. The vein can no longer carry any blood through it. Because these veins are superficial, they are not important for transfer of blood back to the heart.

Does the procedure require any hospitalization?

No. The EVLT procedure is a minimally invasive, endovenous procedure whic can be safely performed in the comfort of a physician’s office with only a local anesthetic.

Is there a recovery after EVLT?

This procedure leaves no scars, is associated with minimal postoperative pain, a rapid recovery period and provides almost immediate relief from symptoms. Patients usually state some minor soreness and bruising, which can be treated with over-the-counter, pain medication. After the procedure, all patients are encouraged to walk and resume their normal activities. A follow up appointment is made with the doctor in usually 3 days after the procedure is performed to ensure that you are healing correctly.

Is loss of this vein a problem?

No. The saphenous vein which is destroyed is not healthy in the first place and of no use. Because the vein is engorged and thrombosed, removal has no affect on the body. The deep veins, however, are not touched by the laser as they continue to carry blood away from the legs and back to the heart.

What happens if I need to undergo a bypass and my saphenous veins are no longer available?

Usually, there are other veins that may be utilized, such as the internal mammary artery for heart bypasses.

Risks and Potential Complications

As with any invasive procedure, there are potential complications. These rare complications include:

Mild numbness around the thigh area.
Pulling sensation which may last a week or more.
Phlebitis (redness and tenderness of the skin). Most cases of phlebitis resolve in 3-7 days.
Deep venous thrombosis. This is a very rare complications following Endovenous Laser Ablation. The best way to prevent this rare complication is to wear compression bandage or compression stocking and to walk right after the procedure.
Infection at an incision site is a rare occurrence.
Bruising is a common side effect after the procedure. It usually resolves in a week.
Failure of the procedure does occur and may be related to the inability to place the probe in the vein. This does happen rarely. The majority of technical failures are related to inexperience of the physician with the procedure.

What is the difference between the endovenous laser treatment and the traditional vein stripping?

Historically, the vein stripping was and still is considered a very aggressive and traumatic procedure. The vein stripping is performed in a hospital and requires general anesthesia. It is a very painful procedure and requires a lengthy recovery time. The endovenous laser treatment is a non-surgical, minimally invasive and virtually pain-free way to treat varicose veins. Clinical studies show that recurring incidences of varicose vein disease are actually less after utilizing endovenous laser treatment than the historical, vein stripping procedure.