How Do Endovenous Ablation Procedures Treat Your Varicose Veins?

How Do Endovenous Ablation Procedures Treat Your Varicose Veins?

Endovenous ablation or closure refers to the minimally invasive Ultrasound guided procedures that have largely replaced surgical vein ligation and stripping. In these procedures, leg varicose veins are thermally ablated from inside the veins by means of the heat delivered by either a radiofrequency (RF) generating electrode (VNUS closure) or a laser fiber (EVLT). A catheter (similar to an IV catheter) inserted into the varicose vein near the knee serves as an intravenous access port for the RF electrode or the laser fiber. Endovenous ablation is administered on an out-patient basis in a physician's office with the use of local anesthesia only. A session takes less than an hour and terminates with the application of bandages to the treated leg, followed by compression hosiery. Compared to surgical vein ablation procedures, endovenous ablation techniques have been shown to have a lower risk of complications, shorter recovery period, lower costs and no scarring associated with the procedures.

Endovenous ablation, as implied from the description given above, does not actually treat the targeted varicose vein; on the contrary, the procedure leads to the thermal destruction of the targeted vein and its eventual disappearance. The loss of a varicose vein; however, is not a health concern. Once endovenous ablation is complete, the blood is rerouted through healthy vessels deeper within the tissue. In fact, published studies reveal that ablation of varicose veins improves blood circulation in the treated limb, which in turn, leads to improvement of the symptoms of fatigue and heaviness in the legs, and therefore contributes to better overall quality of life.

The key to success with endovenous ablation is the making of correct diagnosis by means of Ultrasound Duplex Imaging. In general, the larger and the straighter the varicose vein, the easier it will be to pass the RF electrode or the laser fiber across the length of the vein which requires ablation. Varicose veins that can be cauterized by endovenous ablation include incompetent saphenous veins and perforator veins. Saphenous veins are the largest and longest leg veins; perforator veins on the other hand, are short connecting veins located along the entire length of the legs. Incompetency refers to the lack of ability of veins to pump blood towards the heart due to their faulty one-way valves. Incompetent valves cause the blood to pool in the lower extremities and form varicose veins.

Varicose veins that have diameters larger than 16 mm and veins that are very tortuous generally are not suitable for endovenous ablation. Surgical intervention is the only choice for the very large varicose veins. Although it is possible to thermally ablate some segments of varicosities that branch out from the saphenous veins, these are treated best with other minimally invasive techniques, such as phlebectomy (minor surgical procedure to extract them) or foam sclerotherapy. The latter involves the injection of potent foam (prepared in a doctor’s office by mixing a medicine with a gas) directly into the diseased vein. As to the choice between radiofrequency-based of laser-based procedures, the treatment outcome is similar, except that the post-treatment pain experienced by patients in the few day following a treatment is less in patients who undergo the VNUS closure compared with EVLT patients. On the other hand, both procedures are usually covered by most private insurers and Medicare when medical necessity is established

Except minor bruising or tenderness that occurs after vein ablation, complications arising after endovenous ablation are rare. Thrombophlebitis (inflammation of the vein), which occasionally occurs following endovenous ablation, responds well to non-steroidal anti-inflammatory drugs (NSAIDs). According to Dr. R. Dishakjian, a renowned Los Angeles phlebologist, a patient needs not to worry about the potential skin injuries and burns, because the large amount of tumescent anesthesia used during the procedure pushes the saphenous vein at least 1 cm away from the skin and eliminates any potential injury and burns to surrounding soft tissue structures including nerves, other veins, arteries and skin.

Despite the few limitations of endovenous ablation procedures, these minimally invasive techniques are safe, efficient, approved by the FDA, and present many advantages over surgical ligation or stripping of varicose veins. They include the avoidance of general anesthesia, minimized recovery period, same day return to ambulation, lower rate of complications, and most importantly, durability.

Click the following links for more information on endovenous ablation, varicose veins, vein treatment options, and services offered by the Los Angeles phlebologist, Dr. R. Dishakjian.

Non-surgical Varicose Vein Treatment Is Possible

Non-surgical Varicose Vein Treatment Is Possible

Varicose veins are more common in women. It affects three in ten people at some point of time in their lives. There is no particular reason for their occurrence, but factors like age, lifestyle, heredity, obesity, and hormones are known to contribute to their appearance. For some, varicose veins are more of a cosmetic problem because symptoms associated with these veins may be absent. Vein size is often not related to the presence or severity of symptoms.



Fortunately, there are many options for varicose vein treatment, often covered by health insurance plans. With todays advanced technology, varicose vein treatment does not require hospitalization and is performed in doctors office or vein clinics. The Vnus Closure procedure and EVLT (endovenous laser treatment) are the most advanced medical technologies currently available for varicose vein treatment. These procedures are endovenous in their approach; meaning that veins are accessed and treated from inside the veins. According to recent published studies, patient satisfaction with the VNUS closure system is the highest compared to others that use endovenous laser treatment approach. The main reason that some doctors use endovenous laser systems is for increasing their profit margin. The VNUS closure system uses expensive disposable catheters; whereas, the competing systems use reusable laser fibers. The catheter used in the VNUS closure procedure is a radiofrequency generating catheter, which is inserted directly into the vein near the knee and guided up the thigh using Ultrasound Duplex imaging. Ultrasound imaging helps the doctor identify the diseased sections of the vein and precisely position the catheter in diseased veins. The heat delivered by the radiofrequency generating catheter causes the vein wall to shrink and seal. Varicose vein treatment with the VNUS closure is performed with local anesthesia and takes less than one hour. Patients walk out of the clinic wearing compression stockings to resume near normal activities.



The most common side effects of the VNUS closure procedure are pain and bruising related to heating of the vein and the inflammatory reaction secondary to heating. This usually lasts 7 to 10 days and is controlled with NSAID medications. Of course, a follow up ultrasound examination is essential in order to assess the treated vein and to check for adverse outcomes. Within one week, the target varicose vein should be successfully closed. The VNUS closure procedure is most suitable for large varicose veins. According to Dr. R. Dishakjian, the vein specialist at Nu Vela Esthetica, a reputable Los Angeles vein clinic, only 10 to 15% of small branch varicose veins and spider veins regress after varicose vein treatment with the VNUS closure procedure. The doctor says that these are best treated with either sclerotherapy or foam sclerotherapy. These vein treatment techniques use a tiny needle to inject a medicine, in the fluid or foam form, directly into the diseased veins.



Nu Vela Esthetica, established in 2005, is a premier Los Angeles Vein Clinic and Cosmetic Laser Surgery Center. It is equipped with latest and most advanced technologies to treat veins of all sizes. Dr. Dishakjian, the vein specialist at the Center, uses the VNUS closure system for varicose vein treatment, IPL and lasers, specifically designed for facial veins, sclerotherapy for spider vein treatment, and foam sclerotherapy for the medium-sized leg varicose veins. Find out more by clicking on a link in this article. It will take you to Nu Vela Estheticas informative website.

Author Description :

Sue Jerdak, has graduated from University of London, UK, with a PhD degree in Chemistry. Until recently, she was an associate professor of chemistry. At present, Dr. Jerdak spends most of her time by writing and publishing articles about varicose vein treatment and aesthetic medicine. She writes regularly for Nu Vela Esthetica.

Insight Into VNUS Closure Procedure and EVLT - Two Revolutionary Vein Treatment Modalities

Minimally invasive varicose vein treatment modalities; more specifically, the VNUS closure procedure and EVLT (enovenous later treatment), both introduced at around the early years of this decade, gained such a strong foothold in the arsenal of physicians treating varicose veins, that the role of scalpel became insignificant, varicose vein treatment moved from the hospital to the office setting, and a diverse group of physicians, ranging from cardiologists to radiologists, entered into the field of varicose vein treatment. As a consequence of this revolution in the management of vein disease, the American College of Phlebology was established, having as a goal the provision of knowledge and skills required for the use of new vein treatment technologies. In the year 2005, the American Medical Association, AMA, recognized phlebology as a separate self-designated specialty, the same as dermatology, vascular surgery, or any other recognized specialty. At present, Dr. John Mauriello, an anesthesiologist by his primary training, is the president-elect of the American College of Phlebology.

The differences between the VNUS closure procedure and EVLT are subtle. Both are endovenous in nature; meaning, varicose veins are accessed and treated from inside the veins. Whereas, the former uses a disposable catheter equipped with a radiofrequency (RF) generating electrode, the latter uses a reusable laser producing fiber. RF closure was first introduced in Europe in 1998 and was cleared by the US Food and Drug Administration (FDA) in March 1999. Endovenous laser vein treatment was first described in 1999 and FDA approved in the year 2002. It should be noted that EVLT is a trademarked term and several other acronyms, such as EVLA and CTEV, are trademarked with claims that their laser fibers and wavelength result in less pain than others. Although many different radiofrequency ablation catheters are available for a variety of medical applications, the ClosureFAST catheter and ClosureRFS Stylet, manufactured by VNUS Medical Technologies, currently are the only commercially available and FDA approved systems designed for venous ablation.

Despite the occasional use of the VNUS closure procedure and EVLT for cosmetic purposes, their main use is for varicose vein treatment, or the underlying cause, venous reflux (pooling of blood in the veins of lower extremities due to faulty vein valves) and alleviation of symptoms associated with enlarged nonfunctional saphenous and perforator veins. Saphenous veins are the largest and longest superficial veins; whereas perforator veins are short connecting veins located along the entire length of the legs. When diseased, these veins allow reverse flow and channel blood directly from the deep veins into the superficial ones. Leg symptoms, often not related to vein size or abundance, can include: aching pain, swelling, skin irritation or sores (ulcers), discoloration, and inflammation (phlebitis).

Varicose vein treatment, with either EVLT or VNUS closure, takes less than an hour. A treatment session starts with Ultrasound imaging to identify the diseased sections of the veins. This is followed by the injection of tumescent anesthesia all along the diseased vein and the insertion of a tiny catheter into a vein, usually near the knee. Using Ultrasound imaging, a laser fiber or a radiofrequency electrode is then inserted through an intravenous access port (similar to but larger than an IV catheter) and is guided up the thigh and positioned precisely at the very source of reverse flow. In the case of EVLT, the laser fiber generates a laser beam, which heats and boils the blood in the vessel causing it to shut. In the VNUS closure procedure, the radiofrequency generated by the electrode selectively heats and contracts the collagen in the vein wall and results in a fibrotic seal. A session terminates with the application of bandages to the treated leg, followed by compression hosiery. Compression is of vital importance after any venous procedure because its use prevents stagnation of blood in the treated leg, prevents bleeding from puncture sites, promotes faster healing of the treated veins, and reduces post-operative bruising, tenderness and clot formation. Injection of local anesthetic around the abnormal vein is the most bothersome part of the procedure because it usually requires multiple injections along the vein. Actual closure of the vein with laser or radiofrequency is usually completely painless. Of course, a follow up ultrasound examination is essential in order to assess the treated vein and to check for adverse outcomes. Although not common, a small number of EVLT patients require narcotic medications during the few days following the treatment. It is hoped that some of the newer LASER wavelengths, energy settings, and newer laser fibers will improve the technology and reduce the pain caused by the procedure.

As to the limitations of the endovenous procedures, despite some scattered reports of skin burns, the procedures can be considered quite safe. In fact, both procedures can be performed on very thin legs or very superficial veins without causing injury to neighboring tissue or the skin. The large volumes (500 cc) of dilute Lidocaine (0.1%) tumescent anesthesia, injected along the entire saphenous compartment prior to the application of radiofrequency, has the double role of compressing the vessel against the catheter (for better outcome) and providing a heat sink that absorbs the heat created by the device. According to a renowned Los Angeles phlebologist, Dr. R. Dishakjian, liberal use of tumescent anesthesia pushes the saphenous vein at least 1 cm away from the skin and eliminates any potential injury and burns to surrounding soft tissue structures including nerves, other veins, arteries and skin. It should perhaps be mentioned that the application of tumescent anesthesia for endovenous vein treatment was first patented in the United States by VNUS Medical Technologies, who have filed several patent infringement lawsuits against companies selling endovenous laser vein ablation systems. Not all litigations are settled yet.

For situations where the saphenous veins are very large, the Los Angeles phlebologist says: "despite the fact that the endovenous catheters are thin, it is possible to treat veins as large as 16 mm, because the epinephrine added into the tumescent anesthesia provides improved constriction of the vein around the heat-generating tip of the catheter, while also prolonging the analgesic effect of Lidocaine for up to 6 to 8 hours post-procedure." The doctor adds, "even significantly tortuous (curved) veins can be treated with the endovenous technique. In such cases where the catheter tip cannot be advanced through the entire length of the vein, a second catheter entry point may be used to bypass a curved part. The existence of blood clots in the veins is the only absolute contraindication to both EVLT and the VNUS closure and require surgical intervention."

Unfortunately, endovenous techniques do not often solve the problem of branch varicosities and spider veins. When left untreated, only 10% to 20% of patients will have regression of these branch varicosities to the point where no further intervention is necessary. Residual varicose veins following the procedure can be treated with a variety of techniques. Treatment options may include phlebectomy simultaneously with vein ablation or delayed treatment following the observation for spontaneous regression. If delayed treatment is selected and necessary, either phlebectomy, sclerotherapy, or foam sclerotberapy may be chosen depending on the physician's preference. Phlebectomy involves the surgical excision of a vein or part of a vein; whereas, sclerotherapy and foam sclerotherapy use a needle to inject a medicine either in the form of a fluid or foam directly into the diseased vessels.

As with other varicose vein treatment techniques, continued occlusion of the saphenous vein with either the VNUS closure procedure or EVLT does not eliminate the possibility of developing recurrent varicosities. Recurrent varicose veins from untreated vein segments or new reflux can and will occur in some patients. This, however, does not represent a failure of endovenous ablation. Varicose vein treatment with endovenous ablation techniques have proven to be as effective as conventional surgical management and have led to increased patient satisfaction.

Click on the following links for more information on the VNUS closure procedure, foam sclerotherapy, and other varicose vein treatment options offered at a modern Los Angeles vein center. Article Source: http://EzineArticles.com/?expert=Sue_Jerdak_Ph.D.

Why Do Spider Veins Sometimes Reappear Soon After Sclerotherapy Treatment?

Why Do Spider Veins Sometimes Reappear Soon After Sclerotherapy Treatment?

Sclerotherapy involves the injection of a fluid (a sclerosant) directly into a diseased vessel in order to cause irreversible damage to the vessel, while avoiding damage to normal collateral vessels and surrounding tissues. After an injection, the damaged vessel becomes non-functional and gradually fades away. Though sclerotherapy has several applications, such as treatment of small hemorrhoids and esophageal varices, the single most widely used application of sclerotherapy is for reticular and spider vein treatment. Reticular veins are superficial veins that have a cyanotic hue and are 2-4 mm in diameter. Spider veins (telangiectasias); on the other hand, are very fine, red, blue or purple superficial veins commonly appearing as thin wiggly lines on the thighs, calves and ankles.

In principal, sclerotherapy can be an effective therapy for veins of any size; however, the larger the vein and closer to the deep venous system, the greater the likelihood of treatment failure or early recurrences. Sclerotherapy of veins larger than 5 mm in diameter often requires special techniques and high potency sclerosants in larger amounts and high concentration, increasing the risk for spasm and many other undesirable adverse effects. The reason is that larger veins contain more blood, dilute the injected sclerosant, and decrease its efficacy.

Currently, the only widespread application of sclerotherapy in the United States and other Developed countries is for reticular and spider vein treatment. Although these small veins may be surgically removed, sclerotherapy presents a rapid, effective, and cosmetically acceptable alternative that is particularly attractive to patients with extensive networks of small abnormal veins. Spider veins respond quickly to this treatment and results can be seen as early as three to six weeks. Larger veins take longer to respond. Contraindications to sclerotherapy are rare and include pregnancy and allergy to the sclerosing agents. The side effects of sclerotherapy are tolerable and temporary. Patients might experience itching, tenderness, skin bruising and redness at the injected area. Sclerotherapy not only offers the possibility of remarkably good cosmetic results, but also has been reported to yield an 85% reduction in symptoms of pain, burning, and fatigue associated with these veins. It should be mentioned that vein size alone does not predict the presence of symptoms. Veins causing symptoms may be as small as 1 mm in diameter, and larger bulging varicose veins may not cause any symptoms whatsoever.

Some patients are highly responsive to sclerotherapy injections and can be treated with weak sclerosants in only a 1-2 sessions, while others are highly resistant, and may require several sessions, stronger sclerosants and/or combination of treatment techniques including laser vein treatment. When a patient has had a poor response to initial series of treatments and the veins recur, or new veins start to appear soon after the treatment, the original diagnosis must always be called into question. Failed treatment often means that a hidden source of reflux was overlooked or the underlying cause for the appearance of the small veins was not identified with Ultrasound Duplex imaging. Reflux vein disease refers to an abnormal communication with the deep vein system allowing reverse flow from the deep vein system into superficial veins. Only when diagnostic tests fail to identify a large vessel as a source of reflux, superficial dilated veins are ascribed to localized valve failure. It should be noted that even the smallest veins have valves. It is only in the latter case that the treatment plan starts with sclerotherapy.

A renowned Los Angeles vein specialist says that he owes his very high sclerotherapy success rate to his treatment plan that starts with the identification of underlying sources of reflux, like the saphenous vein, incompetent perforator veins (veins that allow communication between the superficial venous system and deep venous system of the legs), or reticular vessels. According to the same Los Angeles vein specialist, reticular or spider vein treatment must be directed at the entire system, because if the point source of reflux is not ablated first, the superficial web will rapidly recur, because the larger veins serve as "feeder" veins for the smaller veins. You may read more about sclerotherapy and spider vein treatment by visiting the website of the reputable Los Angeles vein specialist.

To learn more about spider veins and sclerotherapy, please visit the website of the Los Angeles Vein specialist.

Article Source: http://EzineArticles.com/?expert=Sossy_Dishakjian

Causes For Sclerotherapy Failure And Recurrence Of Spider Veins After Treatment By Sue Jerdak At Isnare.com Ezine Articles

Causes For Sclerotherapy Failure And Recurrence Of Spider Veins After Treatment By Sue Jerdak At Isnare.com Ezine Articles