Treatment Options
The Vein Center of North Texas utilizes many state-of-the-art modalities to treat veins of all sizes. Dr. Hayes will carefully evaluate each patient and confer with the patient to formulate an individualized treatment plan. The goal of medical treatment is to eliminate venous insufficiency and restore proper venous circulation by eliminating any refluxing veins, varicose veins, and spider veins. The choice of medical treatment depends upon the type, size, location, and depth of the diseased veins.
Conservative Treatment
Conservative treatment refers to non-invasive options such as lifestyle changes (eating less, exercising more, losing weight, etc.) and wearing compression stockings. The objective of the conservative approach is to support the venous circulation of the legs in order to minimize symptoms and slow the development of new diseased veins. This treatment plan is not corrective and will not “heal” or “repair” any veins that have already become diseased.
Vein Stripping
Vein stripping is the surgical removal of a diseased saphenous vein (the most common cause of varicose veins). Vein stripping procedures are painful, expensive, frequently ineffective, and have recently been replaced by modern endovenous techniques. Ancient Egyptian, Greek, and Roman physicians described varicose vein stripping operations, as well as the serious complications frequently associated with them. The Roman tyrant Caius Marius, who died in 86 B.C., underwent varicose vein surgery. After the treatment on one leg he declined treatment of the other leg saying, “I see the cure is not worth the pain.” In 1905 Dr. William Keller first described inversion stripping of the saphenous vein to treat varicose veins. This rather excruciating operation has changed little over the last 100 years. It requires hospitalization, general anesthesia, and a protracted convalescence. Postoperative pain and swelling is often severe and demands 2-3 weeks leave from work. Many patients who have undergone vein stripping feel just like Caius Marius did 2000 years ago.
Despite the rather severe morbidity, vein stripping fails to relieve the patients’ venous reflux 50-65% of the time. Varicose vein recurrence is quite common after stripping. Vein stripping has earned a bad reputation, and justifiably so. Fortunately, these operations are largely of historical interest only; and have been replaced by recently developed minimally-invasive procedures including the radiofrequency “closure” procedure and endovenous laser ablation. Vein stripping is now utilized only rarely when endovenous radiofrequency and laser techniques are impossible.
Laser Treatment
Endovenous Laser Ablation
The newest technology available for the treatment of venous insufficiency or varicose veins is endovenous laser ablation. Endovenous laser ablation is minimally-invasive and performed under local anesthesia in the Vein Center (thus avoiding hospital and anesthesiology charges.) The procedure takes about an hour. Most of our patients report negligible intraoperative and postoperative pain, and do not even require the prescribed hydrocodone. Patients are up walking in 5-10 minutes and back to work or normal activities in 2-3 days.
Endovenous laser ablation is performed under ultrasound guidance. Patients are sedated (but remain awake) and given lidocaine tumescent anesthesia. A thin laser fiber is threaded into the diseased saphenous vein through a tiny (2mm) needle incision. The fiber is directed to the uppermost portion of the vein, the laser is activated, and the fiber is withdrawn. The laser gently heats the lining of the vein and safely seals it shut. The moment the diseased vein is sealed, the blood that had been refluxing within it is redirected to the healthy deep veins and thus returned to the heart. After the laser ablation, the treated vein slowly dissolves and is absorbed by your body. The varicose veins that were created by the diseased saphenous vein are then easily and permanently treated.
ACE wraps are applied when the treatment is complete. They are worn for the next 2-3 days to assist in resolution of the treated saphenous and varicose veins. A postoperative ultrasound is performed on day 2 or 3 to confirm successful ablation of the treated veins. The ACE wraps are replaced by compression stockings, which are worn daily for the next two weeks.
CoolTouch 1320 nm Endovenous Laser
The laser’s wavelength is one of the most critical components in the overall success of endovenous laser treatment. The CoolTouch CTEV™ 1320 nm laser was developed for endovenous ablation in an attempt to circumvent side effects associated with shorter hemoglobin-absorbing wavelengths. US FDA clearance was awarded in September 2004 for treatment of the Great Saphenous Vein, and in August of 2005 for treatment of the Small Saphenous Vein. Since that time, the CTEV has been used to successfully treat thousands of patients with varicose veins.
CoolTouch CTEV’s proprietary 1320 nm wavelength gives it a tremendous advantage over other endovenous lasers on the market. It has proven to be extremely effective and comfortable in the treatment of varicose veins. The unique feature of the 1320 nm wavelength is that it targets collagen in the vein wall and does not interact with hemoglobin in red blood cells. It therefore requires less heat to permanently close the vein than do competing, shorter wavelengths. This gentle, controlled heating contracts the vein, leading to closure and successful ablation of the vein.
Competing endovenous lasers are different than the CoolTouch CTEV. They use a diode, which generates shorter wavelengths (810, 940, or 980 nm) that target hemoglobin in red blood cells for laser energy absorption. This can result in extremely high temperatures. The high heat generated by the older, shorter wavelength diode lasers can actually rupture the vein - causing significant pain, swelling, and bruising.
According to endovenous expert, Dr. Robert Weiss (associate clinical professor of dermatology at Johns Hopkins University School of Medicine) “the CoolTouch CTEV 1320 nm wavelength is the ideal wavelength for this procedure. It is very safe and extremely effective, with a long-term success rate of 98%. It will be the standard to be beaten by any other technique. Physicians and patients alike will be greatly impressed when they see the difference in results between the new CoolTouch 1320 nm laser and the competing 810, 940, and 980 nm laser systems. It is truly the best technology available today.”
In a recent study by Dr. Thomas Proebstle (Professor of Dermatology and Phlebology, University of Heidelberg, Germany), fewer patients complained of postoperative pain, patients used less postoperative pain medications, and less postoperative ecchymosis (bruising) and redness was noted in those who underwent treatment with the CoolTouch 1320 laser than in those who underwent treatment with a shorter wavelength diode laser.1 Dr. Proebstle felt the lower side-effect profile of the CoolTouch 1320 laser was due to the absorption properties, which cause an inability of the laser to produce vein wall perforations during Endovenous Laser Therapy. 100% of the patients treated with the CoolTouch 1320 nm CTEV were successfully occluded.
Mitchel P. Goldman, M.D. (Associate Clinical Professor of Dermatology University of California, San Diego, School of Medicine) demonstrated that treatment with the CoolTouch 1320 nm laser resulted in 100% occlusion of the great saphenous vein without evidence of recurrence at 6 to 12 month follow-up. "In fact”, reports Dr. Goldman, “The treated vein was not identifiable by duplex examination six months after treatment, and there was no recurrence of any varicose veins at any time during our follow-up.” He found treatment with the CoolTouch laser was not complicated by postoperative pain or bruising that occurs when the shorter wavelength diode lasers are used for intravascular treatment of the great saphenous vein. He felt this was due to the lack of interaction of the 1320 wavelength with hemoglobin in red blood cells and the extreme heat this creates.2 According to Dr. Goldman, “Having helped develop the radiofrequency Closure® procedure and treating dozens of patients with the 810 nm EVLT™, I have found that the Cool Touch CTEV™ 1320 nm procedure produces the best results in the quickest, most affordable and patient-friendly manner.”
- Proebstle, Thomas M., Moehler, Thomas, Gül, Doendue & Herdemann, Sylvia (2005) Endovenous Treatment of the Great Saphenous Vein Using a 1,320 nm Nd:YAG Laser Causes Fewer Side Effects than Using a 940 nm Diode Laser. Dermatologic Surgery 31 (12), 1678-1684.
- Goldman, Mitchel P., Mauricio, Maritess & Rao, Jaggi (2004) Intravascular 1320-nm Laser Closure of the Great Saphenous Vein:
A 6- to 12-Month Follow-up Study. Dermatologic Surgery 30 (11), 1380-1385.
VNUS Closure®
VNUS Closure® is a revolutionary new technique that has virtually replaced the traditional “ligation and stripping” operations practiced in years past. This highly-effective FDA-approved procedure has been used on thousands of patients over the last several years in the U.S. and around the world with excellent results.
VNUS Closure® is an outpatient procedure performed under ultrasound guidance by placing the VNUS RadioFrequency (RF) catheter into the diseased vein and advancing it to the uppermost segment of the vein. The RF generator is then activated and the catheter is pulled back, slowly heating the vein from inside. The radiofrequency energy destroys the vein lining and causes the vein to shrink and seal shut.
After the procedure, the narrowed vein gradually becomes fibrous and eventually dissolves. Flow is naturally redirected to the healthy remaining veins, restoring normal circulation. Unlike stripping operations, this outpatient treatment requires no sutures. It is quick, relatively painless, and offers superior results. The procedure is performed in the Vein Center or in the hospital under local anesthetic with or without sedation.
When the treatment is completed, ACE wraps are applied and worn for three days to assist in the resolution of the veins. A follow-up ultrasound is performed within a few days. We then replace the ACE wraps with light compression stockings for approximately two weeks. Patients generally return to normal activity within two or three days.
VNUS Closure® offers many benefits over vein stripping:
- Less invasive
- Faster recovery
- Same day, outpatient procedure
- Only local anesthesia with or without sedation
- Little or no scarring
- Rapid relief of symptoms
Sclerotherapy
Sclerotherapy is a safe and effective method of treating small to medium sized varicose veins as well as spider veins and reticular veins. A tiny needle is used to inject the diseased vein with a solution that causes irritation of the lining of the vein. The veins collapse and are gradually reabsorbed by the body and disappear. Blood flow is re-routed to the remaining healthy veins and normal circulation is restored. Because no incisions are created, sclerotherapy usually does not leave a scar.
A single sclerotherapy treatment session may involve one to many injections. The number of treatment sessions needed varies greatly and depends on the type and number of veins treated, as well as the level of cosmetic perfection desired.
This procedure is performed in the Vein Center and usually causes only minimal discomfort. No anesthesia is used. The sensation is similar to a pinprick or mosquito bite. Bruising and pigmentation sometimes occurs after sclerotherapy. Bruising usually disappears in one to two weeks. Although pigmentation almost always fades completely, it can last for several months. Scarring and other complications have been reported, but are quite rare.
After the treatment is completed, light compression stockings are applied. These are worn from one to three days to assist in the resolution of the veins. Normal activities can be resumed upon leaving the Vein Center.
Ambulatory Micro-Phlebectomy
Ambulatory micro -phlebectomy utilizes minimally invasive techniques developed in Europe to eliminate large, bulging varicose veins. Affected veins are delicately pulled up and gently removed through tiny 2mm incisions that do not require sutures. The incisions are so small that, after normal healing, one can scarcely find them on the leg. This procedure is safely performed in the Vein Center under local anesthesia, usually with some sedation. It can be employed when the saphenous vein is not diseased or has been previously dealt with.
Recovery is almost immediate; patients can walk right out of the office. Postoperative pain is minimal and can be controlled with a mild pain reliever. Mild bruising will appear, but usually resolves within a few weeks. Most patients are back to work and their normal activities in two days.
Following this procedure, the legs are elevated for the first day. Light compression stockings are worn for two weeks. This minimizes swelling and discomfort and allows for quick healing.