The Vein Center at St. Joseph Medical Center

At The Vein Center at St. Joseph Medical Center our physicians specialize in the comprehensive evaluation and treatment of varicose and spider veins. They are certified by the American Board of Surgery in Vascular Surgery for:

• Spider Vein Laser Ablation
• Endovenous Laser Treatment
• Sclerotherapy
• Ambulatory Phlebectomy
• Duplex Ultrasound Vein Mapping
• Other venous procedures

What are varicose veins and spider veins?

While arteries carry blood from the heart to the tissue capillaries, veins are the blood vessels that return blood to the heart. Veins deep within the legs are the main route for venous return, but superficial veins are present as well. The superficial veins are redundant and are sometimes harvested for use during bypass surgery. Valves in these veins are oriented in such a way that blood only flows to the heart as leg muscles contract. These valves can become incompetent. This causes blood in the superficial veins to pool at high pressure (reflux), stretching them and causing further valve incompetence. Heredity may be linked to the failure of the valves. Hormonal influences also contribute. Vein disorders are more common in females and are particularly associated with pregnancy. Varicose veins and spider veins arise as prominent veins just beneath the skin. While varicose veins can produce bulging deformity with standing, spider veins typically appear as blue or purple streaks or nests. Both are manifestations of the same problem congested venous blood in dilated veins caused by nonfunctioning venous valves. Approximately half of all American adults are affected by varicose and spider veins.

Are varicose veins serious?

In many people, varicose and spider veins cause no symptoms. Pain, throbbing and heaviness frequently accompany varicose veins, and these complaints are typically exacerbated by standing. Serious complications such as phlebitis (blood clots) are less common. Occasional patients develop thinning or inflammation of the skin overlying large varicose veins. The most common complaint is the unsightly appearance of the abnormal veins.

How are varicose veins and spider veins diagnosed?

Patients usually notice the protruding veins or discoloration even before symptoms occur. As boardcertified vascular surgeons, the physicians at The Vein Center at St. Joseph Medical Center are very experienced in evaluating abnormal veins. The Registered Vascular Technologists in our ISCAVL-accredited vascular laboratory utilize color-duplex ultrasound to provide a precise map of the venous system. They give particular attention to identifying the location and extent of venous reflux, which usually guides treatment options.

How are varicose veins and spider veins treated?

Stockings . Leg elevation will often relieve symptoms since standing and having the legs in a dependent position increases the pressure in the leg veins. Elastic support hose can be quite effective in counteracting the high pressure gradient in the standing position. These stockings keep the veins collapsed and prevent reflux, and may help prevent progression of varicose veins.

Cosmetic Laser treatment. This office-based modality is optimal for veins too small for phlebectomy. It treats a broad range of vessels from tiny spider veins to deep blue reticular veins quickly, safely and effectively. The laser delivers pulses of light energy which causes the blood within the vein to coagulate, eventually destroying the vessel which is later reabsorbed by your body. Blood flow will then be redirected to veins deeper below your skins surface, where it should be. Several treatment sessions are usually needed for optimal cosmetic results.

Sclerotherapy . This office-based modality is optimal for veins too small for phlebectomy, such as spider veins and reticular veins. No anesthesia is needed. Under magnification a solution containing an agent irritating to the vein lining is injected into the vein. The inflammatory response incites a localized phlebitis within the tiny veins, causing them to close. The small amounts of clotted blood may leave brownish pigment in the area, which typically resolves over a few months. Sometimes this material is drained with a small needle to accelerate healing. Several treatment sessions are usually needed for optimal cosmetic results.

EVLT (endovenous laser therapy). This newer minimally invasive procedure is an alternative to saphenous vein stripping. Rather than removing the vein, a catheter is placed into the vein under local anesthesia with ultrasound guidance. A dilute anesthetic solution is injected around the vein, which is then treated with laser energy to heat damage the inner vein lining. This causes the vein to contract and close, eliminating reflux. The procedure typically takes 30 to 40 minutes, requires no surgical incisions, and causes significantly less pain or bruising than vein stripping. Compression stockings are used for about 2 weeks, and patients can usually resume normal activities within 48 hours. As with vein stripping, symptoms from secondary veins are usually relieved. Additional treatment with ambulatory phlebectomy or sclerotherapy may improve cosmetic results. Vein stripping . The traditional treatment for reflux from the greater saphenous vein (the most common cause of large varicose veins) has been surgical removal. Under general or spinal anesthesia, incisions are made at the groin and below the knee and a wire is passed through the vein. A bullet is attached to the end of the wire and pulled back, tearing the vein from its branches and subcutaneous tissue. Bleeding into the empty space is minimized by compression, but significant bruising and swelling are common. This generally resolves within six weeks. Ace wrapping or support stockings are needed for two to six weeks.

Ambulatory phlebectomy . This office-based procedure is appropriate for secondary varicosities that persist after treating saphenous reflux or for varicosities not connected to a major refluxing vein. Using a dilute anesthetic solution, small (-3 mm) stab incisions are made over the bulging veins, then specialized hooks and clamps tease the veins out. The small incisions do not require suturing and heal with minimal scarring. Moderate bruising and discomfort is typical. Compression therapy is used for several weeks afterward.

TriVex System - Advanced Varicose Vein Treatment

Transilluminated powered phlebectomy using the TriVex System is an innovative method of removing varicosities using suction and a rotating blade. This new minimally invasive procedure is more effective than other treatments and allows people to walk out of the hospital with few scars and can be virtually pain-free within a couple of weeks. The TriVex Systems unique illumination feature enables the surgeon to quickly and accurately target and remove the veins and then visually confirm its complete extraction. This new process makes varicose vein removal more effective, thorough and less traumatic for patients by reducing the number of incisions required to perform the procedure and the duration of the surgery. Studies suggest that this method not only reduces the pain associated with varicose vein removal but also reduces the potential for post-operative infection. The procedure is performed on an outpatient basis and usually takes less than an hour.

Subfascial Endoscopic Perforator Surgery (SEPS)

SEPS is a minimally invasive surgical procedure for the treatment of chronic venous insufficiency of leg ulcers. SEPS treats the underlying condition that causes venous ulcers through a surgical approach using one to three small incisions. The benefits of SEPS may include a faster rate of wound healing and reduced chances of developing new ulcers. During the SEPS procedure, abnormal perforator veins are disconnected, thus blood flow is redirected to healthy veins. This improves circulation in the leg and leads to healing of ulcers. SEPS uses small incisions in the lower leg and a special balloon instrument to reach the perforator veins. Using a small camera, the surgeon locates the problem veins and disconnects them allowing blood to route through other veins that enable it to move freely to the heart.

Is varicose vein treatment covered by insurance?

Health insurance usually covers procedures considered medically necessary. While many insurers will cover the cost of some treatment for symptomatic veins that fail to respond to compression therapy, most will not cover treatments which are primarily cosmetic. At The Vein Center at St. Joseph Medical Center, saphenous vein stripping and radiofrequency or laser ablation for painful veins have usually been covered, while office-based procedures such as ambulatory phlebectomy and sclerotherapy generally are not. The physicians and staff at The Vein Center at St. Joseph Medical Center will assist you in ascertaining what to expect in coverage and costs.

How do I schedule an evaluation?

Please call The Vein Center for a consult with board certified vascular surgeons Dr. Sharma, Dr. Singh, or Dr. Goldenberg at 610-208-8811.