Varicose and Spider Veins Specialists in Northern California

Endovenous laser therapy is a simple, minimally invasive procedure. Performed under local anesthetic, this procedure involves inserting a thin laser fiber optic catheter into the vein and then applying heat to seal the vein shut thereby closing the source of the abnormal veins that give rise to the visible varicose veins on the skin. In sum, EVLT shuts off the source of chronic venous insufficiency symptoms, the saphenous veins.

Varithena/Ultrasound-guided foam sclerotherapy (UGFS) of varicose veins is a useful treatment option. It is a relatively safe method in the case of limited, small varicose veins. In theory, a justified concern could be raised that the injection of an active drug into the large superficial venous vessels may potentially cause life-threatening consequences.

Phlebectomy is performed through a small 1 mm needle puncture in the skin rather than the much larger scalpel incisions for veins stripping in the past. Topical anesthesia is used to numb the surface of the bulging veins, and a needle like instrument is used to remove the bad veins in the leg. After removing larger varicose veins, the puncture marks are so small, they do not require stitches or result in large scars.

It is very important to note that Ambulatory Phlebectomy is a supplemental procedure to EVLT.  Varicose veins on the skin surface arise from an underlying vein source that is refluxing diagnosed with venous ultrasound.  In other words, varicose veins that are treated by phlebectomy are only the surface manifestation of an underlying venous insufficiency.  As such, it does not make sense to simply remove the varicose veins without treating the underlying problem.  For this reason, most insurance companies cover ambulatory phlebectomy only after the EVLT procedure is performed. And as one might expect, the benefits and risks of ambulatory phlebectomy are very similar to those of EVLT. Patients are able to walk out of the office with no down time!

Phlebectomy requires total focus and concentration on the part of the surgeon while utilizing fine-tip instruments through the micropuncture skin opening. Usually only 10 to 20 vein segments can be removed at a time, in one-hour sessions.

Tiny, “feathery,” and a “blush” of spider veins (called “telangiectasia”) are too small for sclerotherapy needles to get inside the vein for injection.  Using a hand-held device with a tiny “hair-thin” probe that is attached by a cord to a machine that generates micro-bursts of high-frequency energy (4 MHz) which is released through the tip of the micro-probe and delivered to the tiny spider vein.  The heat causes the blood vessels to close as the blood coagulates.  It does not work well for the larger veins which are more amenable to Sclerotherapy, but it does work well for the tiny spider veins.  It is a complementary technology to needle-based Sclerotherapy for the full spectrum of cosmetic vein treatment.

Sclerotherapy eliminates smaller varicose and spider veins through the injection of an FDA-approved drug solution that causes closure of the veins. The solution is injected directly into the affected veins, where it causes the vein walls to seal together. The vein is eventually reabsorbed by the body while blood is rerouted through healthy veins nearby. While Sclerotherapy is covered by some insurance companies for the treatment of varicose veins, it is not covered for the treatment of spider veins by most insurance companies. Therefore, most Sclerotherapy treatments performed on the spider veins are paid by the patients themselves. Spider veins are those small and tiny veins right on the skin that are 1-2 mm or less in width, and are in shades of blue, purple, or red in color. Sclerotherapy is considered the best treatment for spider veins. No anesthetic is required prior to treatment and patients report little discomfort during and after the procedure. Most return to work and regular activities as soon as the treatment is completed.

Because Sclerotherapy is only “partially successful” among those injected spider veins, multiple sessions of injection maybe needed in some patients. Between 5 to 6 weeks of treatments are usually needed for a given area, separated by weeks to months of interval in between sessions.