Treatments
Treatment for Venous Disease
There are multiple options for the treatment of lower extremity venous disease, depending on the level of the problem. There are 3 basic categories of treatment; saphenous vein or truncal treatments, large secondary veins, and spider veins. Generally speaking, insurance companies consider the first 2 treatment categories as medically necessary. Treatment of very small spider veins is cosmetic, and not covered by insurance.
Treatment of Saphenous and Truncal Veins
These treatments are performed in the office under local anesthetic and are designed to seal the source of the backflow of venous blood into the lower legs. Once these veins are sealed, blood is rerouted to normal healthy veins and normal circulation is restored.
Radiofrequency ablation or Venous Closure
This is a catheter directed treatment performed through a small puncture in the vein which can be performed under local anesthetic in the office. The catheter is positioned within the vein to be treated and energy is transferred to the wall of the vein causing permanent contraction and sealing of the treated vein. Compressive dressings are then applied.
Venaseal
This is another catheter directed treatment similar to radiofrequency ablation which uses a small amount of biologic adhesive to seal the larger leaking veins and prevent backflow. The results are comparable to radiofrequency ablation. This technique does not require compressive dressings.
Treatment of Large Secondary Veins
These veins are often visible along the inside of the thigh and calf. They present as symptomatic lumps in the leg which tend to be most prominent in a standing position. Because they are very irregular and twisted, catheter directed treatment is not generally practical. Treatment of these veins is divided into surgical and nonsurgical techniques.
Ambulatory phlebectomy
This is a micro- surgical technique generally performed in an outpatient surgical setting under anesthesia. Multiple very small 2-3 mm incisions are made along the course of the vein and it is removed in segments. The advantage of this technique is that the results are immediate. Incisions are generally small enough that they do not require stitches.
Ultrasound-guided injection of foam sclerosant or Varithena
This is a nonsurgical technique performed in the office. No anesthesia is required. A prepared medication is injected into the vein using a small butterfly needle. The medication causes a disruption of the wall of the vein which then results in closure of the vein segment. The advantage is that no anesthesia is required and there is no significant recovery. Final results may take several months.
Treatment of Spider Veins, Reticular Veins, and Telangiectasias
These are the most superficial veins that can be seen in the legs. They sometimes appear as clustered webs or even as bruises and stains. These veins are not considered to be a disease process and therefore their treatment is not covered by insurance.
Cosmetic treatment of spider veins consists of injection sclerotherapy. Sclerotherapy is a nonsurgical method for treating unsightly veins. The sclerosants used at the vein center are specifically designed and FDA approved for their purpose. They cause disruption of the vein wall and closure of the treated veins. Final results are seen when the vein scars down and is reabsorbed by the body. Numbers of treatment sessions will depend on extent of presenting problem and patient preference.
Compression Garment Treatment
Compression garments are a vital part of treatment for venous disease. Although they cannot reverse the process, they mechanically help remove the blood that is trapped in the lower legs by gravity. They are also required as necessary treatment by all insurance companies which cover treatment of venous disease. There are many excellent available options for obtaining comfortable, appropriately fitting compression garments.
www.ameswalker.com is a great place to start. Our staff are available to help you with your choices. We advise that you obtain your compression garments prior to your consultation
