LEG VEINS: AMBULATORY PHLEBECTOMY
What is ambulatory phlebectomy?
Ambulatory phlebectomy is a minimally invasive procedure used to remove superficial varicose veins. Small (2-3 mm) slit like incisions are made along the course of the vein, and the vein is removed in segments.
Who is a candidate for ambulatory phlebectomy?
Patients with unwanted varicose veins are potential candidates for this procedure. A Doppler or a duplex ultrasound examination prior to the procedure is necessary. This thoroughly evaluates a patient’s venous system to ensure that their veins are healthy and the major valves are without “leakage” (also known as reflux).
What can I expect during the procedure?
The course of the vein will be marked with ink while the patient is standing. Next, local anesthesia is injected through a small needle along the course of the vein. The numbing will be allowed to sit for a while. During the procedure, you will feel pressure but you should not feel any pain. You will be awake and may read a magazine or listen to music if desired. The procedure can take 30-90 minutes depending on the number and size of the areas being treated.
What can I expect after the procedure?
Immediately following the procedure, your legs will be wrapped. Bruising and swelling are common; these side effects are minimized by using of compression hose. The small incisions heal nicely without sutures. With this procedure, small segments of veins may be left behind. Rarely, these areas may become inflamed and lead to thrombophlebitis (in which the vein becomes tender and hard). Over-the-counter medicines, compression hose, and tincture of time usually resolve thrombophlebitis. Rarely, a sensory nerve may be injured and lead to skin numbness. If numbness occurs, it usually improves over time (months) though can be permanent. You will need to bring someone to drive you home, as the numbing can affect the use of your foot for several hours. Driving may be resumed in 12 hours.
What are my restrictions following the procedure?
You will need to keep the bandage dry for 24-48 hours. There are no restrictions on walking following ambulatory phlebectomy. In fact, it is encouraged. You may return to work the day after the procedure. Exercise and heavy lifting should be avoided for 2 weeks. Compression stockings should be worn for 2 weeks.
How do I prepare for the procedure?
To minimize the risk of bruising, avoid aspirin and nonsteroidal anti-inflammatory medications (such as ibuprofen and naproxen) for 2 weeks before treatment (unless you were placed on these medications by a physician). In addition, vitamins C, E, garlic, St John’s wort, ginseng, and/or gingko biloba are also blood thinners and should be stopped 1 week before treatment. Tylenol is NOT a blood thinner and is OKAY to take as directed. All products may be resumed 1 week after the procedure.
Where do I get the compression hose?
If you decide to pursue this procedure, please contact our office regarding a prescription for compression hose. You will begin wearing these several days after the procedure. They may be purchased at Saffa Pharmacy.
Is ambulatory phlebectomy covered by insurance?
Some insurance companies may cover this procedure if the veins are causing medical problems and/or you have failed other treatments. However, this varies considerably among insurance carriers. Please inform our office BEFORE scheduling your procedure if you want our office to pursue insurance preauthorization. It is our policy not to schedule the procedure until written prior authorization is obtained from your insurance company. Unless prior arrangements have been made, payment in full is required at the time of the procedure.
What are the fees for the procedure if it is not covered by my insurance?
Fee quotes are performed on a case by case basis depending on the number and extent of the veins being removed, though the fee for this procedure generally ranges from 1200.00- 2000.00.
LEG VEINS: SCLEROTHERAPY
What is Sclerotherapy?
Sclerotherapy is a technique in which concentrated saline is injected into superficial leg veins to improve their appearance. The solution irritates the vessel’s walls, causing them to stick together, shrivel up, and go away.
What should I expect with the procedure?
You will feel a series of tiny needle pricks and some burning as the solution is injected into each vein. Following the procedure, the usual course is to have some bruising for 1-2 weeks. Gradually over the next 2-4 months, the responsive veins slowly break apart and dissolve. Unfortunately, not all veins will respond and some will need additional therapy or may not be possible to get rid of with this method.
How many treatments will I need?
Most patients notice improvement with each treatment though require a series of at least 2 treatments. Genetics plays a significant role, and patients who get leg veins tend to slowly develop more leg veins over a period of years. Annual treatments can be helpful to keep things under control.
How do I prepare for the procedure?
We suggest avoiding sun exposure and sunless tanners for 2 weeks. Being tan makes it more difficult to see the veins and to successfully inject them. To minimize the risk of bruising, avoid aspirin and nonsteroidal anti-inflammatory medications (such as ibuprofen and naproxen) for 2 weeks before treatment (unless you were placed on these medications by a physician). In addition, vitamins C, E, garlic, St John’s wort, ginseng, and/or gingko biloba are also blood thinners and should be stopped 1 week before treatment. Tylenol is NOT a blood thinner and is OKAY to take. All products may be resumed 3 days after the procedure.
What kind of aftercare is needed?
Studies suggest that wearing compression hose for 3 weeks following the procedure increases the effectiveness of this procedure. Compression hose will be prescribed by Dr. Christian and can be purchased at most local pharmacies. Ideally, you should bring them with you to your appointment. We encourage you to wear them at least 2 weeks but preferably 3 weeks.
Who should NOT undergo Sclerotherapy?
Patients who are pregnant should not be treated.
- Avoid aspirin and non-steroidal anti-inflammatory products (such as ibuprofen or aleve) for 1 week before and after treatment (unless you were placed on these by a physician for medical purposes). Other commonly used blood thinners to discontinue before therapy include fish oil, vitamin E, and gingko biloba. Tylenol is okay.
- Avoid consuming alcohol 24 hours before and after treatment.
- Do not have legs waxed 24-48 hours before or after treatment.
- It is best if you are not tan (including self-tanner) in order to see the veins as well as possible.
- Bring your compression stockings (20-30 mm Hg) to the treatment session. You will need to put them on immediately after treatment.
- If you prefer, you may bring a pair of shorts to wear during treatment.
- Wear a long skirt or loose slacks on the day of your appointment. This makes it easier to carry on your activities with your temporary dressings and compression stockings.
- Compression stockings (Support Hose) should be worn daily for 2-3 weeks after treatment.
- After treatment, there is no restriction on activity, but try not to bump the areas during exercise. Weight lifting with the legs should be minimized for two weeks.
- Leg elevation is not necessary.
- Re-treatment is often necessary. It may be scheduled at 12 week intervals for previously treated areas. New areas may be treated weekly. Sometimes veins take a full 16 weeks to respond. Unfortunately, some veins may not respond despite adequate time.
- Expect the treated areas to appear red and swollen. It is not unusual for the sites to look worse before they look better.
LASER TREAMENT OF LEG VEINS
Who is a good candidate for laser leg vein treatment?
In general, sclerotherapy (injections) is the best first option for leg veins (which is a service also offered at the Dermatology and Laser Center of Oklahoma). However, if this treatment fails or if the veins are too small to inject, or if you are needle phobic, laser therapy is a good alternative. The best veins for laser therapy are small veins (1-2 mm in diameter) which are clearly visible on the surface of the skin. In general, the higher up on the leg a vein is, the better it responds to laser therapy. Ankle veins are very difficult to treat with a laser.
What should I expect?
You will be given goggles for eye protection prior to the procedure. Cold gel will be applied to your skin. During the treatment, cold air is also blown on your skin. This makes the treatment more comfortable and also protects your skin. You will feel some stinging as the laser is pulsed but most patients find this procedure very tolerable. Because the beam of the laser is small (1.5 mm), each vessel is traced out individually. Most treatments take 15-30 minutes, depending on the number of vessels being treated. Following the procedure, the treated veins may disappear; alternatively, they may appear gray in color and then disappear over weeks to months. Unfortunately, some veins may not respond as well as others. Your skin will be pink for several hours, and rarely, scabs may occur. Uncommon side effects include but are not limited to scarring and depression like grooves on the skin.
How many treatments will I need?
Most patients notice improvement with each treatment but are happiest with a series of 2-3 treatments. Genetics plays a significant role, and patients who get leg veins tend to slowly develop more leg veins over a period of years. Annual treatments can be helpful to keep things under good control.
How should I prepare for the treatment?
We suggest avoiding any sun exposure for 4 weeks prior to each treatment and sunless tanners for 2 weeks. Being tan (for your skin type) increases the risk of side effects. It is okay to shave your legs as usual. Compression hose following treatment may be worn but are not essential.
LASER TREATMENT OF FACIAL VEINS
How does the laser work?
The long pulsed Nd-Yag laser is composed of a single wavelength of light (1064 nm). The laser passes through the skin and is absorbed by the unwanted vessels. Because this laser goes deeper than other lasers often used to treat facial veins (such as the Versapulse laser), it is helpful in treating resistant or deeper veins (which appear maroon, blue or violet color).
How many treatments will I need?
This depends of the location, depth, and density of the vessels being treated. In general, however, if a vessel is going to respond to this wavelength, improvement will occur with 1 treatment. Because this laser creates heat within the skin, if many veins are present and close to each other, several (2-3) treatments are necessary to reduce the risk of complications. While we will make every effort to get rid of your veins, we cannot guarantee your results.
What should I expect?
You will be given goggles for eye protection prior to the procedure. Cold gel will be applied to your skin. During the treatment, cold air is also blown on your skin. You will feel some stinging as the laser is pulsed but most patients find this procedure very tolerable. Because the beam of the laser is small (1.5 mm), each vessel is traced out individually. Most treatments take 10-30 minutes, depending on the number of vessels being treated. Following the procedure, the treated veins may disappear; alternatively, they may appear gray in color and then disappear over weeks. Your skin will be pink for several hours, though makeup may be applied if desired. Rarely, scabs may occur.
How do I prepare for treatments?
We suggest avoiding any sun exposure for 4 weeks prior to each treatment. If possible, come into the clinic without any makeup or creams on the areas to be treated. Alternatively, we will have you wash your skin prior to treatment. If the treatment site is near your hair, avoid an alcohol based hair products/spray the day of the procedure. If desired, bring makeup with you to the appointment to apply when finished.