Vein Surgery

What are spider veins?

Spider veins, commonly found on the face and legs, are caused by the dilation of a small group of blood vessels near the skin's surface. They often look like red or purple sunbursts or web patterns and are more common in women.

What are varicose veins?

Varicose veins are caused by swollen or enlarged blood vessels. The blood vessels have enlarged due to a weakening in the vein's wall or valves. Located deeper in the skin than spider veins, they may appear raised and often are blue.

Varicose veins can be serious because they may be associated with the development of one or more of the following conditions:

• Phlebitis. Inflammation of the vein.

• Thromboses. This occurs when blood clots form in the enlarged vein.

• Venous stasis ulcers. An ulcer is formed when there is not proper drainage in the enlarged vein.

Although the exact causes for varicose and spider veins are unknown, pregnancy, heredity, prolonged standing, increased age, heavy lifting, and hormonal changes seem to be contributing factors.

Treatment for spider and varicose veins

Specific treatment for spider and varicose veins will be determined by your doctor based on:

• Your age, overall health, and medical history

• Extent of the condition

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Treatment may include:

• Sclerotherapy. This procedure involves the injection of a concentrated saline or specially-developed solution into the spider or varicose vein. The solution then hardens, causing the vein to close up or collapse. Healthier blood vessels located nearby absorb the blood flow of the collapsed vein.

• Ambulatory phlebectomy. Ambulatory phlebectomy involves the removal of the vein by tiny punctures or incisions along the path of the enlarged vein. Through these tiny holes, the surgeon uses a surgical hook to remove the varicose vein.

• Electrodesiccation. This procedure involves the sealing of the veins with the use of an electrical current.

• Laser surgery and intense pulsed light therapy. Abnormal veins are destroyed by high-intensity laser beams or intense pulsating light.

• Surgical ligation and stripping. This procedure involves the surgeon making an incision in the skin and removing or tying off the blood vessel.

 

If you experience discomfort, swelling and varicose veins in your legs, you may be suffering from superficial venous reflux disease. Traditionally patients diagnosed with venous reflux would undergo varicose vein stripping surgery. Now, patients can be treated with the Closure procedure - a minimally invasive alternative to painful vein stripping surgery.

The closure procedure can be performed on an outpatient basis using local anesthesia in which the physician numbs the leg before treatment. This procedure can be done in our office, allowing the patient to avoid an inpatient hospital stay. The procedure consists of four principal steps. 

Map the Saphenous Vein

A typical procedure begins with noninvasive ultrasound imaging of the varicose vein to trace its location. This allows the physician to determine the site where the Closure catheter will be inserted and to mark the desired position of the catheter tip to begin treatment.

Insert the Closure Catheter

After the physician accesses the saphenous vein, the Closure catheter is inserted in to the vein and advanced to the uppermost segment of the vein. The physician then typically injects a volume of dilute anesthetic fluid into the area surrounding the vein. This numbs the leg, helps squeeze blood out of the vein and provides a fluid layer outside the vein from the tip of the catheter to further create a near-bloodless filed inside the vein, allowing the catheter to preferentially heat the vein wall, rather than the blood.

Deliver RF Energy and Withdraw Catheter

Noninvasive ultrasound is used to confirm the catheter tip position and the physician activates the RF generator, causing the electrodes at the tip of the catheter to heat the vein wall to a target temperature of typically 85 degrees Centigrade or 185 degrees Fahrenheit. As the vein wall is heated, the vein shrinks and the catheter is gradually withdrawn. During catheter pullback, which typically occurs over 15 to 18 minutes, the RF generator regularly adjusts the power level to maintain target temperature to effectively shrink collagen in the vein wall and close the vein over an extended length.

Confirm Closing of Vein

After treatment, ultrasound imaging is used to confirm closing of the vein. If a portion of the vein is not closed, the catheter can be reinserted and energy reapplied. After the procedure, the narrowed vein gradually becomes fibrous, sealing the interior of the vein walls and naturally redirecting blood flow to healthy veins. This procedure is often completed the in 45 to 60 minutes.

Please call our office if you have any additional questions or would like more information about venous Closure.

Possible complications associated with the treatment of spider or varicose veins

Possible complications associated with the treatment of spider or varicose veins may include, but are not limited to, the following:

• Pigmentation changes. Brownish splotches near the treated area may appear, and may take several months (or even up to a year) to fade.

• Allergic reaction and scarring. Allergic reactions from the injected chemical solution, as well as permanent scarring, may result.

• Telangiectatic matting. This reaction involves the appearance of fine, reddish blood vessels near the treated area. Treatment for this condition may require further injections.

• Blood clots. Treatment could cause blood clots in the veins.

Who are candidates for sclerotherapy?

Women and men of any age may be candidates for sclerotherapy, but most are 30 to 60 years in age. Spider veins are more common in women. Men do have spider veins, but often do not consider them to be a cosmetic problem because the veins are usually concealed by hair on the leg.

Pregnant or breastfeeding women should postpone sclerotherapy treatment. Further, it is not known how sclerosing solutions may affect breast milk.

About the procedure

Although each procedure varies, generally, vein removal surgeries follow this process:

• Location options may include:

  • Surgeon's office-based surgical facility
  • Outpatient surgery center
  • Hospital outpatient
  • Hospital inpatient

• Anesthetic options may include:

  • Local anesthesia with intravenous sedation, or epidural or spinal anesthesia
  • General anesthesia

• Recuperation period:
  A compression bandage may be applied on the treated area following the procedure. Support hose may be recommended for a while.