FAQ

1. What is superficial venous reflux or venous insufficiency?

Superficial venous reflux is a condition that develops when the valves that usually keep blood flowing out of your legs become damaged or diseased. This causes blood to pool in your legs. Common symptoms(what you feel) of superficial venous reflux include leg pain and heaviness, fatigue, night time leg cramps and restless legs as well as varicose veins. Common signs(what you see) of venous insufficiency include swelling, extensive spider veins around the lower leg and ankle, varicose veins, leg skin pigmentation and thickening, as well as hemorrhage from veins and non healing ulcers.

 

 2. What is endovenous ablation?

Endovenous ablation literally means inside-vein-closure.  It is a minimally invasive treatment for superficial venous reflux. This may be accomplished with thermal(heat used) or nonthermal means(medical adhesive or sclerosants).   The thermal catheters deliver energy to the wall of the vein from within, effectively cauterizing the vein wall from the top to the bottom causing the vein to seal closed and the pressure in the leg veins to return to return to near normal.  Either radiofrequency (RF-ClosureFAST) energy or LASER energy can be used and both are very effective in achieving long term closure of the veins.  Nonthermal techniques include 1. the use of steam, 2. mechanical irritation of the vein wall combined with liquid sclerosant (Clarivein) and most recently 3. the use of a proprietary formulation of cyanoacrylate glue to close the veins without the need for more than one needle puncture(Venaseal).  Vein Specialists is proud to offer ClosureFAST, CoolTouch CTEV LASER and Venaseal at both of our offices, under local anesthesia, with return to normal activity within hours.

 

3. How does it work to treat superficial venous reflux?

When a vein is diseased and the valves are damaged, pressure in the leg veins rises to levels higher to what the veins were intended to withstand.  The high venous pressure leads to common signs of vein disease such as varicose veins, leg swelling and skin changes of the legs. Ultrasound enables the diagnosis and stratification of venous insufficiency and is critical to the treating vein specialist in terms of deciding when to treat , which vein to treat and which technique to use. Treatment of venous disease prior to 2000 when endovenous ablation was introduced and approved by the FDA, was limited to observation and occasional vein stripping, as a last resort.  The introduction of endovenous ablation with Radiofrequency energy initially, followed by LASER energy, was a quantum leap in the treatment options for patients with significant superficial venous insufficiency.  This minimally invasive technology has led to a more proactive approach for the management of patients with venous insufficiency, rather than reacting to complications of the disease.  Since 2000 we have ahd a viable alternative to vein stripping or expectant observation, and this has led to advancements in our diagnostic ultrasound investigation of venous insufficiency and furtherance of our understanding of the ultrasonic pathophysiology of venous insufficiency.   Endovenous ablation provides a less invasive alternative to vein stripping by simply closing the problem vein objectively identified on diagnostic ultrasound. Once the diseased vein is closed, venous circulation is immediately improved, venous pressure is reduced to near normal levels and signs and symptoms of venous insufficiency often improve within a very short period of time.  

 

4. How is endovenous ablation different from vein stripping?

During a vein stripping procedure, performed as an inpatient in a hospital setting, under general anesthesia, the surgeon  would makes an incision in your groin, at the knee and at the medial ankle.  The Codman stripper tool would be advanced from the vein in the ankle past the knee and up to the incision at the groin level,  The great saphenous vein would be ligated and divided at the groin and the catheter pulled up through the cut end of the vein and a plastic bullet head attached to the plastic catheter.  On the other end a handle would be attached and then the vein would very forcefully be pulled out, from the top to the bottom, shearing off the side branches as it was pulled caudally.  This left a big tunnel into which the ends of the remaining veins often oozed and filled up leaving a large hematoma in the thigh from the groin to the mid calf.  Weeks to recover, alot of pain and disability , some nerve injuries at the ankle and a 5-10% risk of deep vein thrombosis.  No wonder we very rarely treated patients with vein disease prior to the introduction of endovenous ablation! 

 

Endovenous ablation does not involve a hospital, general anesthesia, incisions or bleeding.   Instead, the vein remains in place and is closed using a catheter inserted through a small skin puncture. This eliminates all but a very small amount of bruising and pain previously associated with vein stripping

 

Forget your mother's or grandmother's vein procedure and the pain they suffered.  You owe it to yourself to consider evaluation and possible minimally invasive, scientifically directed (ultrasound) predictably definitive therapy.

 

5. How long does the Closure procedure take?

The Closure procedure takes approximately 20-45 minutes, though patients normally spend 1-2 hours at the medical facility due to normal pre and post-treatment procedures.

 

6. Is the Closure or EVLT procedure painful?

Dr. Magnant has treated thousands of patients and has perfected techniques that leave patients feeling little, if any, pain during the procedure.

 

7. Will the procedure require any anesthesia?

The Closure and EVLT procedures are performed under local, regional, or general anesthesia.

 

8. How quickly after treatment can I return to normal activities?

Many patients can resume normal activities immediately.2 For a few weeks following the treatment, your doctor may recommend a regular walking regimen and suggest you refrain from very strenuous activities (heavy lifting, for example) or prolonged periods of standing.

 

9. How soon after treatment will my symptoms improve?

Most patients report a noticeable improvement in their symptoms within 1-2 weeks following the procedure.

 

10. Is there any scarring, bruising, or swelling after the Closure procedure?

Patients report minimal to no scarring, bruising, or swelling following the Closure procedure.

 

11. Are there any potential risks and complications associated with the Closure procedure?

As with any medical intervention, potential risks and complications exist with the Closure procedure. All patients should consult their doctors to determine if their conditions present any special risks. Your physician will review potential complications of the Closure procedure at the consultation , and can be reviewed in the safety summary. Potential complications can include: vessel perforation, thrombosis, pulmonary embolism, phlebitis, hematoma, infection, paresthesia (numbness or tingling) and/or skin burn.

 

12. What procedure is the best for my condition?

The Vein Specialists staffs experienced registered vascular technologist who are highly skilled at venous insufficiency testing. A diagnostic evaluation of your entire lower extremity venous system will determine the extent and location of the venous disease, the root cause of your symptoms.  Dr. Magnant will talk to you about the results and together you can choose the best option for you.

 

13. Is age an important consideration for the Closure procedure?

The most important step in determining whether or not the Closure procedure is appropriate for you is a complete ultrasound examination by your physician or qualified clinician. Age alone is not a factor in determining whether or not the Closure procedure is appropriate for you. The Closure procedure has been used to treat patients across a wide range of ages.

 

14. How effective is the Closure procedure?

Data from a prospective multi-center study have shown 97.4% vein occlusion 1 year post-treatment.

 

15. What happens to the treated vein left behind in the leg?

The vein simply becomes fibrous tissue after treatment. Over time, the vein will gradually incorporate into surrounding tissue. One study reported that 89% of treated veins are indistinguishable from other body tissue one year after the Closure procedure was performed.

 

16. Is the Closure treatment covered by my insurance?

Many insurance companies are paying for the Closure procedure in part or in full. Most insurance companies determine coverage for all treatments, including the Closure procedure, based on medical necessity. The VNUS Closure procedure has positive coverage policies with most major health insurers. Your physician can discuss your insurance coverage further at the time of consultation.

 

17. What are patients saying about the Closure procedure?

98% of patients who have undergone the Closure procedure are willing to recommend it to a friend or family member with similar leg vein problems.

 

18. How can I keep new veins from coming?

Lifestyle changes often are the first treatment for varicose veins. These changes can prevent varicose veins from getting worse, reduce pain, and delay other varicose veins from forming. Lifestyle changes include the following:

 

• Avoid standing or sitting for long periods without taking a break. When sitting, avoid crossing your legs. Keep your legs raised when sitting, resting, or sleeping. When you can, raise your legs above the level of your heart.
• Do physical activities to get your legs moving and improve muscle tone. This helps blood move through your veins.
• If you're overweight or obese, try to lose weight. This will improve blood flow and ease the pressure on your veins.
• Avoid wearing tight clothes, especially those that are tight around your waist, groin (upper thighs), and legs. Tight clothes can make varicose veins worse.
• Avoid wearing high heels for long periods. Lower heeled shoes can help tone your calf muscles. Toned muscles help blood move through the veins.