Below is a list of some frequently asked questions, but please feel free to call our office if you need additional information. We are always pleased to assist you.
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How did I get a vein problem in the first place? |
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Sometimes it's easy to determine what causes the veins to develop. The known factors include heredity, pregnancy, female hormones (especially progesterone), obesity, and standing all day at work (hairdresser, sales, etc.) Often we don't have a clue. Varicose veins develop more frequently on the left for reasons unknown. |
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How can I tell if I have a spider vein problem or a varicose vein problem? |
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Shut your eyes while you are standing, and feel your legs. If you cannot feel the veins, you have a spider vein problem. If you can feel the veins, and they push in easily but bounce right back out, you have varicose veins. |
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Can you do anything for the ugly veins I have on my hands? Breast? Face? |
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Yes. Sclerotherapy, laser treatment, or surgery can be used to remove unwanted veins at any location. |
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Why can't lasers be used for all vein problems? |
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The laser I use is quite effective for spider veins, but lasers have a limited role when they are the sole treatment for leg veins. Lasers only destroy what they "see." To prevent new veins from forming, the deeper high-pressure veins that feed the surface veins have to be eliminated, and those veins are usually invisible to the laser. If they are not eliminated, new veins readily form around the old ones, and you're back to where you started. Laser treatment of spider veins is slightly more painful than injections and more expensive, too.
At the other end of the spectrum, lasers can be used for the same purpose as the VNUS® Closure device, namely to close the saphenous vein without open surgery. In my experience, the results are good either way.
Unfortunately, lasers cannot be used to obliterate bulging varicose veins. That takes surgery (microphlebectomy) or injections. |
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What if I don't want to be put asleep for treatment? |
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Most varicose vein procedures can be done with local anesthesia and, if needed, a little sedation by mouth. If you want to be a little more "out" than that, you may elect to have pain medicines and sedatives given into your veins (conscious sedation), but that requires the services of an anesthesiologist. Even extensive, large veins can be removed without general anesthesia. |
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How long do I need to stay off my feet? |
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All procedures are done on an outpatient basis. You are encouraged to walk and drive immediately after the procedure. Most individuals can resume work within three or four days. I believe it is prudent to avoid vigorous lower extremity workouts for about ten days. |
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What are microphlebectomies? |
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Microphlebectomies are tiny incisions (less than the width of a pencil) through which varicose veins are carefully teased out. The incisions are spaced about every 2-3 inches or so, so the procedure can be tedious and time-consuming if veins are scattered over a wide area. Stab avulsion is another name for this technique. The simplicity, minimal expense, and rarity of complications with microphlebectomies give this technique an important continuing role in varicose vein treatment. |
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Are all patients with varicose veins candidates for Endovenous Laser Closure (EVLT, ELAS) or VNUS® Closure of the saphenous vein? |
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No. Closure is used only in patients with reflux in the greater saphenous vein (the major "outside" vein in the thigh). Patients who cannot be treated with endovenous closure of the saphenous vein include those with:
- Recurrent varicose veins (after previous saphenous vein stripping);
- About half the veins that result from reflux in the short saphenous vein (behind the knee); and
- Varicose veins that are unrelated to saphenous vein reflux.
This still leaves over four out of five patients with large varicose veins as candidates for laser or VNUS® closure of the saphenous vein. |
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What's to choose between EVLT and VNUS closure of the saphenous vein? |
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VNUS closure got to market about two years before the first vein laser. Some insurance companies approve both technologies, some only VNUS (as of now). The VNUS device is more complicated and considerably more expensive to use. Both technologies are FDA approved. I have found that the laser is
almost 100% successful in closing average-sized saphenous veins, and it
is definitely more effective than the VNUS device for closing large
saphenous veins. |
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What is the difference between ELAS, EVLT, and ELVeS? |
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Not much. Lasers that can close the saphenous vein are diode lasers that fall in the narrow ranges 810 to 980nM of the infrared electromagnetic spectrum. Each company that has developed a laser for this purpose has tacked its own acronym on the procedure. From what I can tell, they all work about the same. The only difference comes when you take the same laser and aim it at spiders and other tiny veins. Here a difference of only 20nM can make a huge difference in the relative absorption of energy by hemoglobin, water, and other skin pigments. The Dornier 940 laser is more powerful than the other two lasers, and has superior results on small spider veins. |
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Where will my treatment be provided? |
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Treatment of major varicose vein problems is possible in any facility that has the appropriate equipment. The Triangle Surgery Center (in the suite immediately adjacent to the Beverly Hills Vein Center) was established to provide the very latest and best equipment possible for treatment of a wide range of venous disorders. The center has received licensure from the California Department of Health Services (DHS), AAAHC accreditation and Medicare certification, each entity enforcing the highest possible standards of patient care and safety. Cedars-Sinai Medical Center is available for patients who insist on hospital care. For some patients, it is preferable to perform laser closure of the saphenous vein in the office, followed by microphlebectomy at Triangle Surgery Center at a later date. Spider and small vein problems are treated in the Beverly Hills Vein Center. |
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Will insurance pay for my treatment? |
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Blue Cross, Blue Shield, Aetna, Cigna, and other PPO insurance companies usually cover varicose vein treatments (including laser closure of the saphenous vein and microphlebectomy), but each has a different pre-approval process, and each has a different reimbursement policy. I have chosen to contract with several PPOs (including Medicare), so my professional fee reimbursement follows their contractual obligations. I am a non-participating provider for all remaining PPOs, which means those patients must pay my surgical fee at the time of service, and they will be reimbursed a variable amount by their insurance company. I am not contracted with any HMOs, so those patients are in a difficult position, because they must first persuade their gatekeeper (physician or nurse) that their problem is worthy of treatment. HMOs may authorize treatment, but seldom with any of the newer techniques, or in the surgicenters or hospitals in my community. Some insurance companies pay a small amount for treatment of spider veins (telangiectasias), even though they are fundamentally a cosmetic problem. I do sclerotherapy exclusively on a cash basis, although you are welcome to persuade your insurance company to reimburse you. Take lots of pictures. Within reason, our office will assist patients in researching their insurance benefits. |
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My PPO covers treatment for varicose veins, but you are not on my list of providers. Why should I pay more for your services? |
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Doctors, patients, and insurance companies know that varicose vein problems are one-third medical disorder and two-thirds cosmetic. PPOs reluctantly acknowledge their obligation to treat varicose veins, but often grossly underpay the provider to discourage treatment (think Blue Cross.) The contracted physician has no incentive to learn the latest minimally invasive techniques and/or invest in the equipment needed to perform these procedures outside a hospital. She often relies on the easiest and quickest treatment (saphenous vein stripping). Why should she care about the size of your scars or how long it will take you to resume your normal activities?
Two benchmarks to tell if your PPO doctor is up to speed are:
1. Does the doctor do a color flow (Duplex) ultrasound study in the office by either herself personally (best) or a technician (a close second), or does she send you out to a vascular laboratory and discuss the findings later? Innumerable variations and subtleties of varicose vein disease often get lost if the doctor provides treatment based solely on an outside report, without the benefit of a hands-on look at the actual anatomy and behavior (reflux) of the veins. Walk away if the doctor proposes treatment without the benefit of a color flow test. This borders on substandard care.
2. Does she belong to the one society that is dedicated to the treatment of varicose vein disorders, namely the American College of Phlebology ( www.phlebology.org )? Their annual meeting, newsletters, and journals will keep any physician up to date on the latest in varicose veins (and this is a surprisingly rapid moving field). If the doctor bothers to learn the latest minimally invasive techniques, he may try to recoup her investment with various ploys, such as charging cash (typically $1000 to $2000) for the actual removal of the varicose veins. This is perfectly legal if you sign a waiver acknowledging that this portion of the procedure is "cosmetic".
Finally, a contracted physician working exclusively at a hospital remains unfazed by hospital, anesthesiologist and laboratory co-pays. They can really add up (20%-30% of a lot of money is still a lot of money!)
Bottom line: As a dedicated phlebologist, I believe I can provide superior results at a competitive price. |
If you are not from the Beverly Hills or Los Angeles area and would like to find a vein specialist near you, please click on VEINSonline.com.
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