Varicose Veins / Venous Insufficiency
Venous Ablation
Venous ablation is a minimally-invasive treatment concept that is used to 
close and treat problematic superficial veins that are often the largest and most troublesome in a patient with symptoms of venous insufficiency. Entry to the vein is typically performed under direct ultrasound guidance. After a small amount of anesthetic is instilled, a small needle is directed into the problematic vein, allowing placement of the treatment device. A variety of options are available for ablative closure of the problematic veins.
The Vein Clinic offers the largest variety of ablative options available in Upper Michigan and is the only clinic to offer both thermal and non-thermal treatment options. Our physicians will work with you to select the best ablative option for your venous issues.
Endovenous laser ablation treatment (EVLT) with 1320nm CoolTouch or 1470nm VenaCure laser technology involves the placement of a very small laser fiber into the problematic vein under ultrasound guidance. Anesthetic numbing medication is then placed along the vein, and the fiber is gently pulled back through the vein with typically no sense of discomfort during the ablation procedure. The laser heat energy causes the vein to collapse and close. Typically the patient can return to normal daily activities in 24-48 hours.
Endovenous radiofrequency ablation (ERFA) with the Covidien ClosureFast system is in many ways identical to the EVLT procedure, except that radiofrequency energy is utilized to heat, collapse, and close the wall of the problematic vein.
Varithena foam ablation is our newest non-thermal ablation treatment option. After a needle is placed, the foam is slowly injected under ultrasound guidance and results in an irritation of the vein that results in spasm and closure of the vein. Foam injection may allow treatment of very twisted and tortuous veins that may not otherwise have been able to be treated with tradition laser or RF energy and may allow treatment without need for injection of local anesthetic for those who are intolerant or allergic.
Phlebectomy
Sclerotherapy
Sclerotherapy is typically performed for the treatment of smaller veins such as spider veins or can also be used in combination with additional treatment options such as ablation or microphlebectomy when larger veins exist in combination with spider-type varicose veins.
Sclerotherapy is a safe procedure requiring no anesthesia, often done right in our office. A very small and typically painless needle is directed into the spider vein or its feeding vein. The doctor or the nurse uses the needle to inject a small amount of sclerosing solution into the vein. This solution irritates the vein wall and results in a permanent closure of that vein. Once the vein has been closed, it will typically shrink and dissolve in the body and disappear in approximately one to three months.
Image below is our nurse performing sclerotherapy procedure for spider veins. She is using a vein light to enhance her view of the spider veins while injecting the scleroscene solution.
Take any regular medications the day of your procedure, as sclerotherapy does not require you to take any pre-operative medications. You may also eat a normal breakfast or lunch the day of this procedure; sclerotherapy does not require you to fast at all. Before the procedure our nurse will take a look and mark up your spider or varicose veins. This will determine how much sclerosing solution will be used. The nurse will then prepare you for your procedure in one of our treatment rooms.
- Please inform us if you take blood thinners such as Coumadin (Warfarin), aspirin, or Plavix, although this typically does not affect your procedure. We ask that you stop taking these medications four days prior to your procedure.
Your treated area will be wrapped in an elastic bandage, which you will need to leave on for two to three days to minimize bruising and swelling. You should elevate your legs for two to four hours following your procedure as well as take two-twenty minute walks for the next several days. While walking is strongly encouraged, we do ask that you refrain from any stressful or pounding activities such as weight lifting or aerobics for one week. You may also be asked to wear compression stockings for a short period of time.
Deep Vein Thrombolysis
Blood thinners, also called anticoagulants, remain the mainstay of treatment for deep vein thrombosis. Anticoagulants do not actually dissolve or break up clots, but rather they prevent clots from forming or getting larger once they occur. Heparin and warfarin (Coumadin) are two of the most common blood thinning medications but may require frequent testing or may not be appropriate for some clinical situations. Some newer medications such as apixaban (Eliquis) or rivaroxaban (Xarelto) can be given orally or less frequently and do not require frequent blood testing. Some patients may require anticoagulant therapy for only a few months, while others may require life-long treatment if risk of new or worsening clot formation is considered too high to tolerate.
Venous Thrombolysis
Venous Thrombolysis utilizes the well-proven and time-tested clot-busting agents, already proven useful in the treatment of clots, stroke, heart attack, and arterial thrombosis. The most common drug currently utilized is tissue plasminogen activator (t-PA). With this technique, a small catheter is placed into the vein behind the knee under ultrasound guidance, through a very tiny nick in the skin. The catheter is then actually directed into the clot under X-ray guidance and the clot-busting drug is slowly infused through the catheter. Depending on the age of the clot, the infusion and clot dissolution may be completed in a couple of hours or may take as long as a day or two. If there is an underlying blockage in the vein that may have caused the clot to form or would act as a stimulus for new clot to form, this may be able to be treated with angioplasty right at the time of the thrombolysis procedure.
Venous Stenting
Stenting may be used in combination with thrombolysis to fix and improve narrowing within a vein after a clot is dissolved. It may also be used by itself if a narrowing is found that has contributed to the development of deep vein thrombosis or perhaps chronic leg swelling and pain. The most common example of this situation is May-Thurner Syndrome, where the main vein that drains the left leg (common iliac vein) is compressed and narrowed by an adjacent artery, limiting venous blood flow. May-Thurner is known to be present in many patients with deep vein insufficiency and has been shown to increase the likelihood of developing deep vein thrombosis.
Inferior Vena Cava Filter Placement
In some individuals, thrombolysis or stenting may not be possible. Likewise, some standard blood-thinning medications may have previously failed or be contraindicated due to risk of bleeding complications. In these patients, a vena cava filter may present the best option for treatment. The vena cava is the large vein in the abdomen that collects the venous blood from the legs and returns it to the heart. The filter is a small, umbrella-shaped device that is easily and painlessly deployed under X-ray guidance through a small needle hole in the vein in the neck or top of the leg. Almost all modern filters can now be easily removed once a blood clot has been treated and/or the risk of clot development has passed.
All about Compression Hose/Conservative Treatment
Graduated compression stockings have a long and well-proven role in the treatment and prevention of both venous insufficiency and deep vein thrombosis. The unique construction of these specialized stockings allows the greatest degree of compression to be delivered at the level of the foot withlesser degrees of pressure applied as the stocking moves further up the leg. This progressive, or graduated, compression:
- Helps improve blood flow and keeps blood and fluid from pooling in the lower portion of the legs
- May help prevent blood clots from forming
- Helps relieve and heal skin changes and symptoms associated with venous insufficiency and varicose veins, such as itching and venous ulceration
Specially-fitted compression stockings are typically tighter at the foot with a gradually looser fit higher on the leg. There are varying types and compression gradients, and our specialists at the Vein Clinic will work with you to provide the best solution for your problem. The stockings should be snug but comfortable and ultimately work best when worn daily and while awake and on your feet. Stockings are not typically worn at night or while bathing.
Tips for stocking use:
- Put stockings on early in the day when swelling is at a minimum. Sitting in a chair with a back allows you something to lean against.
- Put your toes in the stocking and gently roll and slide it back over the heel. Then use your fingers or palms to slowly roll and slide the stocking further up the leg. Do not grab or pull at the top of the stocking as this may cause it to tear or rip.
- If you have trouble, rubber gloves may help grip the fabric. Assist devices such as a slip sock or stocking butler are also available. Our nurses or your certified fitting expert can provide further help.
- If you experience numbness, or the toes turn dark or painful while wearing compression hosiery, call your doctor immediately.