Michigan Vein Care Specialists

About 90% of people who have visible varicose veins have a problem in one of the underlying veins that are not visible from the surface. In those cases, treating just what is seen is less likely to relieve the varicose vein symptoms — the patient is more likely to have early recurrence of varicose veins. A thorough evaluation by a vein care specialist (phlebologist) combined with an ultrasound of the leg veins allows a more appropriate course of treatment to be chosen. Varicose vein treatment is less likely to be effective without the evaluation and ultrasound. Treating Varicose Veins via Lifestyle Changes In some cases, simple lifestyle changes may help relieve the symptoms. This includes things like: Elevating the Legs Periodically This treatment allows gravity to help relieve the pressure on the varicose leg veins. Walking, Rather than Sitting or Standing in One Place The contraction of your calf muscles is what provides the pump to push blood through your leg veins back toward your heart. Wearing compression stockings This treatment provides some support to the veins from the surface, preventing them from becoming as swollen. Graduated compression stockings are specially designed to be tightest at the ankle and slightly looser up the leg to promote the flow of blood the right direction through leg veins. Most insurance companies require that patients try these lifestyle changes for a period of time — typically 6 weeks to 6 months — before they will pay for a more definitive treatment option. We can help you figure out what your insurance company requires if you are unsure. You do not need to wait before coming in for a consultation. Medical Treatment of Varicose Veins Endovenous Ablation If the ultrasound shows that the problem is caused by reflux (backward flow of blood due to damaged valves) in one of the underlying veins, this needs to be corrected with an endovenous ablation. This is a procedure done in the office under local anesthetic. A special catheter or laser fiber is inserted into the malfunctioning vein through a small puncture in the skin. The vein is numbed, then heat is applied to seal it shut. This forces the blood to circulate through the healthy veins instead of pooling in the diseased ones. In many cases, this procedure alone relieves the pressure on the surface veins and no treatment is needed to directly address those veins. Medical Treatments for Surface Varicose Veins In people who have had venous disease for many years, the surface veins may not have enough elasticity left to snap back after the pressure is relieved. These people may need another procedure at the same time or subsequent to the endovenous ablation to target the surface veins. Depending on the size, location, and extent of the varicose veins, microphlebectomy or sclerotherapy may be offered. Microphlebectomy means removing a vein through a tiny puncture in the skin. This is done in our office under a local anesthetic. The punctures are small enough that no stitches are required and they typically leave no visible scar. Sclerotherapy is an option for smaller varicose veins and spider veins. It involves injecting a solution directly into a diseased vein in order to close it off. The solution causes irritation of the vein wall, causing it to collapse and seal shut. Once the vein is closed, blood reroutes through the remaining healthy veins around it. Sclerotherapy can be used for very tiny spider veins or for larger varicose veins. The concentration and amount of the solution injected is adjusted depending on the size of the vein being treated.

As with other venous disease, a layered approach to treatment is best. If a careful history and physical exam raises concern for an underlying problem in a deeper vein, an ultrasound may be ordered to evaluate. Surface vein treatments work best if all the underlying venous reflux is treated first. Sclerotherapy is still considered the “gold standard” treatment for spider veins. Sclerotherapy is injecting a solution into a diseased vein to “sclerose” or scar the vein shut. The solution irritates the vein, which makes the vein wall sticky. Over time, the veins seal shut and are reabsorbed by the body. The injections are done through very small needles and are relatively painless. Different concentrations of the sclerosing solution are used depending on the size of the vein being treated. A skilled vein specialist will target the reticular veins feeding the spider veins in order to improve the results of treatment. There are a variety of solutions available for sclerotherapy. Hypertonic saline is a concentrated salt water solution. It is FDA approved, but not specifically for sclerotherapy. It works by drawing water out of the cell, dehydrating and killing it. Advantages to hypertonic saline include that it has no risk of allergic reaction and is inexpensive. Its disadvantages include that it is painful when it is injected and has a high incidence of adverse reactions such as skin discoloration, causing new spider veins to develop (telangiectatic matting) or causing ulcers if it leaks into the tissue surrounding the vein treated. Dr. Jones does not use hypertonic saline for these reasons. Sodium Tetradecyl Sulfate (STS) is a detergent sclerosant. It works by disrupting the protein molecules in the vein cell wall. It is FDA approved for use in sclerotherapy. It is safe, reliable, and painless when injected in low concentrations. It has a much lower incidence of adverse reactions such as skin discoloration, inflammation or ulceration compared to hypertonic saline. There have been rare reports of allergic reactions to STS. Polidocanol is a local anesthetic which is effective as a sclerosant as well. It has been widely used in Europe for sclerotherapy with good results. It was recently FDA approved for use in this country. It is painless when injected. Polidocanol, like STS, has a low incidence of adverse reactions such as skin discoloration, inflammation, or ulceration. It also carries a very small risk of allergic reaction. Surface lasers are effective against some spider veins and small varicose veins. In the majority of scientific studies, however, sclerotherapy has been shown to be more effective than laser when performed by a skilled vein care specialist. Most people find sclerotherapy to be less painful than laser treatment of spider veins.

Most people with varicose veins have a problem limited to the veins in the legs. There are, however, less common causes of leg vein problems which shouldn’t be overlooked. During your initial consultation, Dr. Jones will ask questions and do an examination designed to check for these other possible causes along with her evaluation of your legs. This typically includes: Examining the neck, lungs, and heart to see if there is any evidence of heart failure contributing to leg swelling. Feeling for abdominal masses or aneurysms which could be obstructing the outflow of your leg veins Evaluating pulses for any evidence of Peripheral Arterial Disease (PAD) which can overlap vein symptoms and could be exacerbated by wearing compression stockings Evaluating for kidney problems which could cause leg swelling Reviewing your medication list for anything which could be contributing to your symptoms or might interfere with your treatments Asking about the nature of your symptoms to make sure they’re typical for venous disease before recommending treatment Reviewing family history to see if there is any reason to suspect a hypercoagulable state (tendency to blood clots) Further testing with labs or x-rays may be recommended if anything seems suspicious on your exam.

Diagnostic Ultrasound is a non-invasive test which allows evaluation of structures below the skin surface. It is the test of choice for evaluating vein problems. The ultrasound is performed in our office by a Registered Vascular Ultrasound Technician (RVT). Warmed ultrasound gel is applied to the leg, then the ultrasound probe is moved up and down to examine the deep and superficial leg veins. Images are taken first to map out the anatomy and rule out blood clots in the veins. Note will be made of what deeper veins the surface varicose veins connect to in order to plan the best treatment approach. These images are created by sound waves and no radiation is involved in the exam. Once the anatomy has been evaluated, the function of the veins is checked. This involves squeezing the legs to force the blood forward through the veins and seeing if the valves close properly. When the valves are working, the blood simply stops after the squeeze is released. When the valves are incompetent, the blood flows back down toward the feet and refills the veins. This is called reflux.

Graduated compression stockings provide support to veins of the legs by applying compression that is firmest at the ankle and slightly less further up the leg. They improve the efficiency of blood flow through the veins, prevent venous stasis, and can relieve some of the symptoms of venous disease. They come in a variety of strengths, for example 8-15 mmHg, 20-30 mmHg, and 30-40 mmHg. They also come in a variety of styles including knee-high, thigh-high, and pantyhose style. Compression stockings have their place in both the treatment and prevention of vein problems. Before treatment, most insurance companies require that patients have had a trial of “conservative management” before they’ll pay for any definitive treatments. While they don’t correct the underlying causes of vein problems, these stockings can provide some relief from swelling, aching, and heaviness. Down sides to compression stockings are that they can be difficult to get on, difficult to keep up, and may feel uncomfortably tight or hot after they’ve been worn for a while. After treatments, compression stockings decrease bruising and soreness. We recommend wearing them for one week after endovenous ablation and phlebectomy – or for as long as they make your leg feel better. Compression stockings have been shown to improve the efficacy of sclerotherapy and diminish the risk of adverse reactions. Some vein clinics advertise “compression free” treatment of spider veins. While recommending compression stocking use after sclerotherapy may not sound as exciting in advertisements, at MVCS, we’d like you to get the best results in the fewest number of treatments. Wearing compression stockings for about 2 weeks after injections has been shown to do that. Vein disease is a chronic problem. Wearing a comfortable, light-weight compression stocking long term at times when you’re going to be up on your feet or sitting for a prolonged period of time may decrease your risk of developing recurrent varicose and spider veins. We like our patients and would enjoy seeing you back in a few years for another round of treatments, but we’re sure you have better ways to spend your time! We’d be happy to help you find a compression stocking that you can feel good in after your treatments are complete.

Endovenous ablation procedures have revolutionized the treatment of varicose veins. These use chemical, laser or radiofrequency energy to seal a vein shut from the inside, and can be performed in a vein specialist’s office rather than in a hospital operating room. How is Endovenous Ablation Different from Vein Stripping? In the past, to treat saphenous vein reflux, ligation and stripping procedures were performed in a hospital, under general anesthesia. This involved making an incision in the groin, dissecting down to where the damaged vein joins the deep vein, tying it off, and then pulling it out through another incision lower in the leg. It was painful, expensive (because of the O.R. costs), left scars, and usually required a couple of weeks for recovery. Since the development of Endovenous Ablation, vein stripping and ligation are things of the past Endovenous Ablation: Defined “Ablation” means sealing off the vein. “Endovenous” means working from inside the vein. Endovenous Ablation is a term used to describe a variety of minimally invasive treatment techniques which uses chemical, radiofrequency or laser energy to cauterize and close malfunctioning veins in the legs. This treatment closes off the problem veins but leaves them in place so there is minimal bleeding and bruising. This is a procedure done in the office under a local anesthetic. Forms of Endovenous Ablation The most common approach to treatment of an incompetent great saphenous vein is Endovenous Thermal Ablation. Either laser or (RF) radiofrequency energy can be used as the heat source. Under certain circumstances, particularly when incompetent veins are tortuously convoluted, Endovenous Chemical Ablation results in superior results with significantly less discomfort to the patient. Specific forms of Endovenous Ablation Endovenous Thermal Ablation Radio Frequency Ablation (RF) (Venefit™) Laser Ablation (EVLT™) Endovenous Chemical Ablation Foam (Varithena™) Physical Assessment Examination At Michigan Vein Care Specialists, all prospective new patients meet with Dr. Jones first for a thirty-minute “in depth” Physical Assessment Examination and if anything seems suspicious from your exam we may conduct further testing by recommending labs or X-rays. Diagnostic Ultrasound As part of providing you with complete, comprehensive care, it is critical that we perform a thorough evaluation of your entire venous system, so that poorly functioning veins can be treated at the source. Failing to find and treat the root problem means that symptoms and varicose veins will quickly return. The Diagnostic Ultrasound is a non-invasive test which makes it possible for physicians to evaluate the structures below the skin’s surface. It is the test of choice for evaluating vein problems. Customized Plan and Treatment Despite what you might read on the Internet or in magazines, there is no single best treatment for varicose veins—simply because not all cases are the same. The best course of treatment for you depends on many factors, including your underlying vein anatomy, which particular veins are damaged, the severity of your symptoms, and your personal reasons for seeking treatment. Contact Dr. Jones To contact Dr. Jones, or to schedule an Initial Vein Care Consultation, please call us toll-free (866) DR VEINS or (866) 378 3467.

“Phlebectomy” means to remove a vein. “Microphlebectomy” simply means to remove it through a tiny puncture in the skin. For patients with large, bulging veins, especially those that have been present for a long time, microphlebectomy may be a good treatment option. This is a procedure done in the office under a local anesthetic. The area around the diseased veins is numbed, then tiny punctures are made in the skin along the course of the varicose veins. The veins are removed through those punctures using specialized instruments. No stitches are needed and there is no scarring. The only activity restriction after microphlebectomy is avoiding extremely heavy lifting for the first few days. Normal light activities and walking can be resumed immediately.

Sclerotherapy is injecting a solution into a diseased vein to sclerose or seal the vein closed. The solution causes irritation of the vein wall which makes it sticky. Over time, the veins seal shut and are reabsorbed by the body. The injections are done through very small needles and are relatively painless. Different concentrations of the sclerosing solution are used depending on the size of the vein being treated. Ultrasound guided sclerotherapy, as the name implies, is injecting a sclerosing solution into a vein using ultrasound to direct the injection. This is done to treat veins which are not visible from the skin surface. It is helpful to eliminate veins which are feeding spider veins, to treat incompetent perforater veins which are contributing to chronic venous insufficiency/venous ulcers, or to seal off the origin of a varicose vein.