Frequently Asked Questions
General FAQ's
Q: Will I see a doctor on my first visit?
A: Yes. Dr. Hayes will review your medical history and perform a physical examination. This, along with non-invasive ultrasound imaging, allows Dr. Hayes to determine the type of treatment required.
Q: Do I have to have an ultrasound evaluation?
A: Ultrasound is an invaluable tool used in diagnosing venous insufficiency in the deep and superficial veins, and to look for blood clots and other causes of leg swelling / pain. Ultrasound is also needed to make an accurate assessment of the level and extent of varicose veins. Treatment is individualized, however, and not all patients require an ultrasound.
Q: Does endovenous ablation require hospitalization?
A: No. Since it is minimally invasive, venous CLOSURE and the other procedures we utilize can be performed at the Vein Center or at the hospital on an outpatient basis.
Q: How long does endovenous ablation take?
A: About an hour.
Q: Once treated, will varicose veins reappear?
A: Effectively treated varicose veins do not come back. The predisposition to form varicose veins cannot be cured, however. Over time, patients may develop new varicose veins in the same or in other areas. Because we treat the “source” of these veins the progression is greatly slowed. New veins that form tend to be less severe and are more easily dealt with. Usually a “touch-up” treatment to remove new veins will be needed periodically.
Q: What type of anesthesia will I receive?
A: Most varicose vein procedures can be done with local anesthesia and conscious sedation. You will be "awake", and will remember the procedure, but you will be quite comfortable and "feeling no pain." Even extensive, large veins can be treated in a without general anesthesia.
Q: What is tumescent anesthesia?
A: Tumescent Anesthesia is a form of local anesthetic commonly used by dermatologists, plastic surgeons, and vein surgeons. It involves the use of a very low concentration of local anesthetic that is injected around the vein. It provides excellent anesthesia of prolonged duration and gives remarkably diminished post-operative discomfort. The really nice thing about tumescent anesthesia is that it eliminates the need for either a general anesthetic or a spinal anesthetic.
Q: How long do I need to stay off my feet?
A: Our procedures are done on an outpatient basis. We encourage our patients to get up and walk immediately. Most individuals can go back to work within two or three days. Vigorous lower extremity workouts should be avoided for about two weeks, as should hot baths and excessive sun exposure. You also need to wear compression stockings for about two weeks. We will perform a post-operative ultrasound a few days after the procedure to ensure healing is progressing as planned.
Q: Is a history of blood clots in the legs or lungs a reason to avoid vein treatment?
A: Not necessarily, but careful evaluation with pre-operative ultrasound is most important. Before any procedures are done in this clinical setting, deep venous insufficiency and deep venous clots must be ruled out.
Q: Can I be treated while I am pregnant?
A: Treatment is not recommended during pregnancy or while the mother is breast-feeding.
Q: Should I wait until I am through having babies before getting my veins fixed?
A: No. Early treatment of venous insufficiency prevents advanced symptoms or more serious complications from developing. Additional pregnancies may make small “touch-up” procedures necessary after delivery of your baby.
Q: Doesn’t my body need all of its veins?
A: The leg has two venous systems: The deep system, which is responsible for 90% of blood return, and the superficial system, which is responsible for the remaining 10% of blood return. Refluxing (insufficient) veins, varicose veins, and spider veins are all diseased, malfunctioning veins in the superficial venous system.
When these veins are treated or removed, the venous circulation is actually improved. This is because diseased veins allow the blood to flow in the wrong direction (reflux) rather than returning to the heart and lungs for recycling. When the diseased veins are removed, the blood is naturally diverted to the remaining healthy veins. Circulation is therefore improved immediately.
Q: Does the deep venous system ever get varicose veins?
A: While the deep venous system can develop venous insufficiency (reflux), the deep veins are supported by the leg muscles and bones and never become "varicose." The superficial system lacks this support system and is consequently prone to varicose vein formation.
Q: What if I need a heart bypass later on?
A: Diseased varicose veins make poor bypass conduits, and are generally rejected by heart surgeons as donor grafts. There are many other arm and leg veins available, as well as the internal mammary arteries that are quite superior to dilated, tortuous, or diseased leg veins.
Q: What if I leave my varicose veins alone?
A: Untreated venous insufficiency and varicose veins tend to worsen over time. The appearance will almost certainly continue to deteriorate. You can expect to develop worsening symptoms including leg tiredness, heaviness, aching, throbbing, tingling, burning, itching, numbness, swelling, “restless legs”, etc. More serious complications such as phlebitis, blood clots, dermatitis, hemorrhage, and open non-healing sores (venous stasis ulcers) can occur if symptomatic veins are left untreated too long.
Q: What are the risks of endovenous ablation?
A: Potential complications include, but are not limited to bleeding, infection or inflammation, damage to adjacent structures, pulmonary embolism, hematoma, paresthesia.
Q: Does insurance cover my treatments?
A: All medically necessary (non-cosmetic) treatments and procedures are covered by Medicare and most insurance plans. Venous insufficiency and large varicose veins typically qualify due to the debilitating symptoms they cause. Spider veins are considered cosmetic and are not covered. Dr. Hayes will make a determination of medical necessity, usually at the initial consultation.
Q: What is Restless Leg Syndrome?
A: Restless leg syndrome (RLS) is a very common problem in which patients feel an irresistible urge to move their legs in order to relieve the “heaviness” they have in their legs – especially the calfs. It is our experience that many patients with RLS symptoms and venous disease will experience significant improvement in their discomfort with comprehensive treatment of their venous disease.
Q: What are Venous Stasis Ulcers?
A: When venous insufficiency is left untreated over many years, the constant pressure backup causes worsening edema and poor oxygen supply to the skin. This poor circulation is known as venous stasis. When venous stasis becomes severe, the tissues actually break down, forming an open sore or ulcer. These ulcers are painful, very difficult to treat, and can be present for months or years at a time. Venous stasis ulcers are quite difficult to heal using conventional measures. They usually occur in the lower leg and can range from the size of a penny to completely encircling the leg. They do not occur in all patients with varicose veins. It is impossible to predict which patients will go on to develop this complication.
Venus Ablation FAQ's
Sclerotherapy FAQ's
Q: How effective is sclerothrapy?
A: You can generally anticipate a 50-90% improvement in the appearance of your veins. It is important to remember that things get worse before they get better, and fading is gradual. We do expect noticeable improvement after three treatments (if you need that many). The overall process takes months, but complete disappearance of spider veins is often achieved.
Q: Is the injection painful?
A: Most patients report only a slight stinging or burning sensation, similar to an insect bite. Many patients experience no pain at all.
Q: When will I see changes in the appearance?
A: You will begin to see a change in color in approximately 2-3 weeks. The veins will turn from dark blue or purple to pink, and gradually fade away. The exact length of time varies with the type of veins treated and from patient to patient.
Q: How many treatments will I need?
A: For most varicose veins and refluxing saphenous veins, one treatment is all that is needed. Spider and reticular veins do require several treatments. The number of sessions varies with the number, size, and location of the veins to be treated. In addition, a patient’s desired level of cosmetic results will have an impact on the number and extent of treatments. We can usually achieve the desired results in 3-5 sessions spaced 4-6 weeks apart.
Q: Is sclerotherapy safe for anyone?
A: The contraindications for sclerotherapy include: pregnancy, breast-feeding, non-ambulatory status, allergy to the sclerosant agent, pre-existing blood clotting tendencies, and the inability to follow the pre-op or post-op instructions.
Q: Do you use saline for injection?
A: No. Although effective for small spider veins, hypertonic saline (salt) solutions are quite painful. We at the Vein Center use FDA approved STS (sodium tetradecyl sulfate) in various concentrations as our sclerosant of choice. This solution is effective on different sized veins and cause very little discomfort.