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The foundation of treatment is to make an accurate assessment of the cause and extent of your problem. That is best done with a physician's personal examination, and usually includes mapping your veins with Color Duplex Ultrasound. This is a painless test done at your first visit to the Vein Center.
Diagnosis Cosmetic leg vein problems fall into two broad categories (with plenty of overlap):
Spider veins are small, highly colored red or blue veins on the surface of the skin. They are treated with injections, lasers, or a combination of both.
Varicose veins most commonly arise from an abnormal connection between the veins deep in the leg and the surface veins. This allows blood to spill out (reflux) from the deeper veins to the surface, usually into either the long saphenous vein (starting in the groin) or the short saphenous vein (starting behind the knee).
Treatment Treatment consists of two equally important steps:
Spider Veins and Telangiectasias
Sclerotherapy The mainstay treatment for spider or small varicose veins. A mild detergent solution is injected to collapse the veins. A promising variation of treatment, foam sclerotherapy, is to create foam from the basic solution. This allows for a reduced concentration of solution and a more durable, effective result. Laser treatment Beverly Hills Vein Center's state-of-the-art Dornier 940 laser was designed specifically for the treatment of vascular lesions.
Reflux in the Saphenous Vein
Laser closure of the saphenous vein (ELAS, EVLT, or ELVeS) is the latest minimally invasive alternative to stripping of the saphenous vein. A laser fiber is threaded up the vein to the source of the problem (usually to the groin or behind the knee.) As the fiber is withdrawn, laser energy heats the inside of the saphenous vein, causing it to collapse and seal shut. This procedure, usually done under local anesthesia, is readily combined with microphlebectomy. The combined treatment eliminates both the source of the vein problem and the veins themselves. VNUS® Closure The VNUS Company introduced the original minimally invasive technique to shrivel up the saphenous vein. The devise uses radiofrequency (electricity). Although today I close more saphenous veins with a laser than radiofrequency, both techniques are quite effective. Each technique has its pros and cons, so I do use radiofrequency in selected patients if I think I can achieve a better result with it.
This was the traditional treatment for reflux in the saphenous vein for over a hundred years. With today's new technologies for closing the saphenous vein internally, stripping is necessary only when the saphenous vein is unusually large (fewer than 3% of patients).
Elimination of Large Varicose Veins Multiple small incisions "tease" the varicose veins out of the leg. This is often the surest, quickest and most cosmetically gratifying way to remove large veins. The procedure is usually done at the same time as endovascular closure of the saphenous vein.
Sclerotherapy A strong detergent solution is injected in the veins. Large veins may require more than one treatment session, and treatment may result in a slowly healing lump where the vein was located. ("Sclero" means "hard.")
Transilluminated vein extraction, a variation of liposuction, removes large and extensive varicose veins. A powerful light directs suction only to the affected veins, reducing the number of incisions and taking less time than microphlebectomy. This procedure is best done with the help of an anesthesiologist. Trivex® is a promising technology, but the results are somewhat less reliable than microphlebectomy. There is a small but real risk of localized permanent skin staining, which is often of less concern to men than women.
Find a Vein Specialist Near You 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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