How does the laser work to close the vein?

The endovenous laser is one that we put inside the vein in order to close off those big veins that are damaged and hurting the patient. This is a different laser than the skin laser which is sometimes used on spider veins. The endovenous laser creates a concentrated light that creates intense heat. The laser I use produces a wave length that targets water. Since water is the main component of the cells of the vein, the heat is distributed to these cells and permanently damages them, resulting in contraction, scarring and closing of the vein.

Why doesn’t this energy destroy or damage the tissue around the vein?

It can. However, we take precautions to prevent this. A wall of liquid anesthetic is placed 360 degrees around the targeted vein and any energy that reaches around the vein is absorbed by this one centimeter wall of fluid. There have been reported cases where tissue has been damaged when inadequate anesthetic has been delivered.

What happens to the blood that used to return to the heart when the vein is closed?

This blood still returns to the heart, it just uses an alternate route. There are many, many veins throughout the body. Imagine you were in Henderson and you wished to go to Summerlin. You would start on a route you had chosen and begin your journey. If you ran into a street that was under repair and blocked, you would choose an alternate route. In similar fashion, the blood will find an alternate vein, one that has normal valves and function, and return to the heart. There are literally thousands of patients walking around who have had vein treatments or who have had heart surgery where the veins in their legs were used as bypass grafts whose blood continues to return to the heart using alternate routes.

Then what happens to the vein once it is closed?

The vein contracts and gets smaller over time as the scarring process continues and as the body removes old tissue that is not being used. This process is so efficient that often when we examine the patients in follow up with the ultrasound, we often cannot find the previously treated vein?

Does insurance cover vein treatments?

Insurance will cover treatments they consider medically necessary. So, if you have symptoms such as pain, aching, fatigue, cramps, heaviness, restless legs, and/or signs such as swelling, sores, bleeding or blood clots in your lower extremities AND we can identify problems in the veins with a properly done ultrasound, your situation will be considered medically necessary. However, if you have only spider veins, then that condition is considered cosmetic and insurance will not pay. Patients should remember that spider veins mean that you have some form of venous disease; so if you have spider veins and you have symptoms then you need to be evaluated for a more serious underlying problem with the larger veins that supply pressure to the spider veins.

Do I have to go to the hospital to have my surgery?

No! Almost all procedures done on the venous system can be done as an outpatient. I do them in my office operating rooms.

Will I be put to sleep for my operation?

No. We do not put anyone under general anesthesia. If fact, we do not use intravenous sedation to “knock the patient out” for a while. We use a special type of local anesthesia called “tumescent anesthesia” invented by a California physician in 1984. We also offer patients some mild medicines to relax them. However, many patients choose to take no oral medicines because they wish to drive themselves home after the procedure.

I don’t like needles or any pain. Why can’t you just put me out?

We choose not to, and this is why. Every treatment method in medicine comes with its own set of complications. Every study ever done comparing general anesthesia with tumescent anesthesia methods comes down on the side of the local anesthetic with regards to complications. For example, take the most extreme complication—death. The only deaths reported in liposuction operations have been in those patients done under general anesthesia. There have been zero deaths reported doing liposuction under local tumescent anesthesia. And so it goes for the potential of other complications. If you can do the operation properly, it is best done under local. The down side is that there is occasional mild transient pain. Most of the time the patient feels a few mosquito bite needle sticks. Usually patients sleep through most of the procedure.

What is the down time after surgery? How long will I be out of work? How soon can I resume my daily activities?

The good news with proper treatment of bad veins with the endovenous (inside the vein) laser is that not only will there be a 90-95% success rate but there is essentially no down time. In fact, part of the post operative instructions includes walking daily. Most patients can return to work the next day. There can be some mild soreness in some patients but this is not significant. Narcotic medications are not needed and patients can immediately resume normal activities. The only activity restrictions are a temporary hold on aerobic activity until the treated area heals; or a 2-3 day wait on returning to work if your job entails vigorous physical activity.

Do I have to wear support stockings?

Medical grade, properly fitted support hose are important in the treatment of bad veins for 3 reasons:

  1. They can relieve symptoms. Many patients find that after they start wearing stockings they continue to wear them because the pain, swelling, and fatigue in the legs go away.
  2. They can slow down the progression of venous disease.
  3. They need to be worn after a procedure to maximize the quality of the results. We generally require patients to wear them during the day for 2-3 weeks after a procedure, such as sclerotherapy or laser ablation.
What about dangerous blood clots? Will I get them?

Since we are dealing with the vascular system, there is always the risk of blood clots being formed. Blood clots in the deep venous system in the lower extremities are the ones we worry about. If they get into this system they can damage the vein valves and break loose and go to the lungs as a potentially life threatening pulmonary embolus [a clot that travels to the lungs]. In experienced hands, the chance of one of these forming with laser therapy is very low. The chance of a dangerous clot forming with sclerotherapy is higher than with the laser, but is al so very low.

Someone in my family has a clotting disorder, they make clots easily. Do I have to worry?

People who make clots easily have most likely inherited this trait. If you, or someone in your family has this condition, you need to tell your physician before any surgical procedure is done. You may need to have an investigation done to find out whether you have a clotting problem. This may very well impact the treatment you receive before, during and after your operation.

Will I have much scarring?

No. Almost all treatments utilizing modern techniques for vein disorders can be delivered through a needle stick. Even the technique of ambulatory phlebectomy whereby multiple small needle stick incisions are used to remove large surface varicosities results in barely discernible small scars once they are completely healed.

Are the modern treatments for varicose veins similar to vein stripping?

NO! Ligation and vein stripping techniques for the most part can be put into the bin labeled “OBSOLETE”. There is very little place for such operations in the hands of a well trained vein specialist. Here is a list of things that vein stripping requires that laser treatment doesn’t: hospitalization, incisions up to 5cm, general anesthesia, 3 week average recovery time, massive swelling, weeks of significant pain, 50-65% recurrence rate within 5 years.

How long do these procedures take?

It varies depending on what needs to be done. Usually between 1-2 hours.

Are the procedures painful?

Most patients sleep through the majority of the operation. When the anesthetic is given through very small needles the patients will feel some stinging that is short lived. A few days after the anesthetic wears off, some patients will feel some tenderness along the course of the closed vein. More pain than this is rare.

Is the laser the only way to take care of these bad veins?

No. These veins can be removed under general anesthesia in the hospital. This is not recommended [see last week’s discussion]. The veins can be closed by a technique called radio frequency ablation. This method takes longer and has a higher recurrence rate than the laser. Its argument that there is less post operative discomfort is simply not true when it is compared to a 1320 laser, which we use all the time. The veins can be closed with sclerotherapy [injection of a chemical to close the vein]. The laser is quicker, safer, and gives a more long lasting result with less recurrence than sclerotherapy.

I started having trouble with my veins when I was pregnant with my second child. I would like to have my veins fixed, but I plan to wait until we complete our family. Should I wait?

You do not need to wait. Some patients are miserable during pregnancy because of their varicose veins. When your pregnancy is over, the hormonal levels return to normal. Unfortunately, the veins in the legs do not always follow suit. They remain enlarged and symptomatic. These veins only get worse with each successive pregnancy. The best option is to see a vein specialist and get a specific diagnosis. These problem veins can be easily treated before you get pregnant again. This will afford you a lot of relief from pain and swelling in the next pregnancy.

I’m confused about the word “laser”. My friend went to a spa and had a laser used on her skin spider veins. Is this the same laser that you are talking about?

No. The lasers that are used on the skin have a specific wave length that targets the blood in the small spider vessels in the top layer of the skin. There are several different wavelengths available and it turns out that different situations require different wavelengths to get the best results. We recommend that 1st line therapy for spider veins in the lower extremities should be sclerotherapy and not the laser. The laser that we use to close the larger veins that are the underlying cause of most vein disease is called an endovenous laser. Endovenous means “inside the vein”. The wavelength is designed to target water, and since the lining cells of veins are over 90% water, they make an excellent target for this laser. The laser fiber is put into the target vein under ultrasound guidance. The laser energy targets the lining cells of the vessel and causes it.

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