Some lasers can rupture the target vein causing swelling, bruising and significant pain. Alabama Vein & Restoration Medspa uses this specific vein laser because it has been found to be the most comfortable and effective laser treatment for varicose veins. It is a 1320 nanometer wavelength laser which requires less heat to close the vein than other lasers. It also has a 99% efficacy rate of closing the treated vein. The TVS1470 laser targets water in the vein wall, unlike older lasers that target blood, which makes the procedure much more comfortable with minimal post-op bruising or swelling.

AM I A CANDIDATE FOR ENDOVENOUS LASER THERMAL ABLATION TREATMENT?

Patients undergo a comprehensive lower extremity venous ultrasound by a Registered Vascular Technician to determine if they are a candidate for endovenous laser ablation. The endovenous laser procedure is indicated for those patients who suffer with pain, swelling and varicose veins or venous ulcerations caused by venous insufficiency (faulty valves) within a portion of the superficial venous system. It is a minimally invasive procedure that is incredibly effective. The endovenous laser treats the underlying source of varicose veins and venous ulcerations.

WHAT DOES THE PROCEDURE INVOLVE?

Patients are mildly sedated therefore; they must have a driver with them. Upon arrival for the procedure, the course of any varicose veins are marked on the skin, and an intravenous catheter is placed for the administration of sedative. Supplemental oxygen is administered and monitors for blood pressure, EKG, and pulse oximetry are applied. The leg to be treated is prepped with hibiclens and sterile draped. The access point for the introduction of the laser is identified using ultrasound guidance. The laser fiber is small, about the size of a strand of spaghetti.

The laser fiber is precisely positioned within the target vein using ultrasound guidance. Tumescent anesthesia is then carefully placed around the vein using ultrasound guidance. The tumescent anesthesia prevents any sensation of pain while the laser is firing and its presence around the vein prevents the heat of the laser from being transmitted to the skin, muscles, or nerves.
Once the tumescent anesthesia is in place, the proper position of the laser fiber is re-checked and the laser firing is initiated at a precise speed. A typical laser run takes about 10 minutes. There is no sensation while the laser is firing. Patients are comfortably sedated throughout the entire procedure. The vein that is treated with the laser is the underlying cause of the varicose veins that are seen at the skin surface. The vein that is treated with the laser is not removed, the body simply absorbs the ablated vein over time. Micro-phlebectomy (the removal of existing varicose veins thru micro-incisions) is then performed on any large and ropey varicose veins seen at the skin surface. The incisions are very, very small and leave little to no mark on the skin. No stitches are required. Sclerotherapy is then done to clear any associated veins. It is the combination of all three therapies (endovenous laser ablation to treat the underlying cause of the varicose veins, micro-phlebectomy to remove the existing varicose veins at the skin surface, and sclerotherapy to clear associated veins) done simultaneously in a single treatment session that is responsible for our fantastic results. The treated leg is then wrapped with an ace bandage for 24 hours followed by a compression hose for 2 weeks. The hose may be removed to shower and sleep. Any post-procedure pain is easily managed with Motrin or Aleve. Daily activities may be resumed on the second day. Exercise may be resumed after 2 weeks. Patients are able to return to work on the second or third day.

Some temporary skin numbness above the course of the vein treated with the laser is a common occurrence. It is not a big deal and typically resolves with time. A “pulling” sensation along the course of the vein treated with the laser is also common. The sensation is usually felt 2-3 weeks after the procedure. The “pulling” sensation is due to the healing process and typically resolves in about a month. Follow-up ultrasounds are done at 1 month and 3 months to ensure the vein treated with the laser remains closed.

VENOUS ULCERATIONS

Venous ulcers are also very effectively treated with a combination of endovenous laser ablation and ultrasound guided sclerotherapy. The abnormal veins that are causing the venous ulcer are identified with an ultrasound exam. The abnormal veins are then destroyed with a combination of endovenous laser and ultrasound guided sclerotherapy. Venous ulcers then typically heal within 3 to 4 months and they rarely recur. Patients are kept in compression hose until the venous ulcer fully heals.

Endovenous Laser Ablation is a procedure with minimal downtime, few complications, and a high success rate. However, you will experience some minor discomfort following the procedure. Over the 3-4 weeks following the procedure, you will experience several sensations that will change as time goes on. None of these should be significant enough to keep you from walking or resuming your normal activity. The sensations are part of the healing process and are to be expected.

WHAT TO EXPECT FOLLOWING ENDOVENOUS LASER ABLATION

1. You should not feel intense pain the day of surgery because you have local anesthetic in your leg. The number one cause of pain the day of your procedure is that the ace bandage is too tight. This is especially true if the pain is in your foot or heel. The pain is quickly resolved by simply loosening the ace bandage.

We rarely prescribe pain medication. We recommend that you take ibuprofen regularly following your surgery to help with the pain and swelling unless you are taking medications that prevent you from taking ibuprofen. Most patients that are experiencing symptoms before their procedure report that recovery from the procedure is less than what they were already experiencing. You will feel sensations for at least three weeks that are reported as numbness, tingling, mild pain, itching, etc. However, these feelings are not described as severe pain and are not disabling. You should be able to function at your normal activity by the third day. At about 2-3 weeks you will notice a pulling in your groin that may feel similar to a pulled muscle. This is to be expected and is part of the healing process.

2: If varicose veins were removed, some minor bleeding may occur the day of surgery. Put as little weight as possible on the treated leg the day of surgery. Keep your leg elevated on 2 to 3 pillows. If you see blood through the bandage, simply elevate your leg and apply pressure. The bleeding will stop.

3: EXPECT YOUR LEG TO LOOK BRUISED AND SWOLLEN WHEN YOU REMOVE THE BANDAGE: The bandage will be left in place for 24 hours. When you remove the bandage, you should be sitting down or reclining. Most patients are not affected by removing the bandage but if you feel dizzy or lighted headed, this will only last for a few minutes. Your leg will appear swollen due to the amount of numbing fluid placed in your leg to keep you from feeling the laser. Your leg will be bruised. If you had a vein removed, there will be white gauze pads over the incisions. These can be removed and thrown away. There will be steri-strips placed over each incision…..no stitches are used. These should stay in place until they fall off or you return for your follow up appointment. The spider veins that are treated with sclerotherapy will look worse before they look better and they may appear darker for the first few weeks. If you had a large varicose vein removed, you will have steri-strips over each incision site. Do not be alarmed by the number of steri-strips. The incisions are very, very small and leave little to no mark on the skin. Your leg will be bruised, swollen, and the steri-strips will cover the length of the vein removed.

4: Wearing your compression hose is the number one thing you can do to ensure the optimal result of your procedure and to help prevent complications. The compression hose reduce the amount of bruising and swelling and they increase the clearance of spider veins following sclerotherapy. Wearing the hose and walking as much as possible is optimal. Compression hose will be worn for two weeks after the ace bandage is removed on day 2. The hose may be removed to sleep and for showering. You may resume your normal activities once you are in the compression hose.

5: The day of surgery you will go home and elevate your leg. Going to the bathroom and kitchen are ok but generally keep your leg elevated. Once you remove the ace bandage after 24 hours and begin wearing the compression hose, you can resume your normal activity. It is fine to return to work on the second or third day. You have no limitations, except no heavy weight lifting and no hot baths until you are out of the compression hose. Once you are in the compression hose, the resumption of normal activities will accelerate your recovery.

6: There may be bruising along the course of the great saphenous vein on the inside of your leg or along the course of the small saphenous vein on the back of your leg from the knee to the ankle. There will also be bruising along the course of any varicose veins removed by micro-phlebectomy. Bruising normally resolves in 2 to 3 weeks.

7: A bag of fluid called tumescent anesthesia is used during the endovenous laser procedure to surround the target vein and to protect the rest of your leg from the heat of the endovenous laser. That extra fluid will take up to a week to be absorbed by your body. The swelling may move down your leg and cause swelling in your ankle and foot. Wearing the compression hose and walking will help the swelling resolve. However, patients that have a history of long-standing ankle swelling may take several months for their swelling to resolve. We typically keep these patients in a knee high compression hose until the swelling resolves.

8: The skin along the course of the endovenous laser in the upper thigh may become red and tender. More laser energy is purposefully put into this portion of the treated vein to ensure its closure. Expect to be a little more tender along the inner thigh from your groin to your knee. The tenderness is to be expected and typically resolves within a few weeks. If the vein to be treated with the endovenous laser is very large or if you are on coumadin, Xarelto, or Eliquis, more laser energy is used to ensure closure of the target vein. The tenderness described above is more common under these circumstances.

9: You may experience some skin numbness along the course of the endovenous laser. Nerves that innervate the skin can be “stunned” by the heat of the endovenous laser. Nerves may also be affected by the removal of varicose veins. The numbness typically resolves over a period of months. The sensory nerves regenerate slowly (1mm/month) and therefore, any associated numbness will resolve slowly as well. Numbness is rarely noticed and when it is, patients do not see it as big deal.

10: You may notice a few lumps that may be a bit tender. These are formed when blood is trapped in a tributary vein after the target vein has been destroyed. If you have an especially tender area, we may nick the skin overlying the area with a small needle and express the old trapped blood. These lumps are not dangerous but can be uncomfortable. They will eventually resolve on their own, but if the old blood is expressed, they will resolve much quicker.

11: The endovenous laser ablates (destroys) the target vein. The area around the vein is then absorbed by the body. The absorption process results in a “pulling” sensation along the course of the ablated vein in the upper thigh. This is typically felt 2 weeks after the procedure. The sensation resolves on its own within a week or two. Patients do not describe this as pain but do consistently describe it as a “cord-like” sensation. Patients that are very athletic and exercise frequently seem to notice this sensation more often. The sensation is to be expected and is not something to worry about.

At the Alabama Vein & Restoration Medspa, our physicians have successfully and safely performed thousands of endovenous laser ablation procedures.

Infection following endovenous laser ablation is extremely rare because the numbing fluid that is put into the leg also helps protect against infection.

To protect you from infection we do the following:

1. Give an antibiotic intravenously through your IV during surgery.
2. Prep your leg with Hibiclens and create a sterile field.
3. We encourage you to use antibacterial soap 7 days prior to your procedure and Hibiclens antiseptic wash 2 days before each surgery.
4. The tumescent anesthesia we use to numb your leg has antibacterial properties.
5. All incision sites are covered with antibiotic ointment and a sterile dressing.

Blood clots following endovenous laser ablation are extremely rare.

To help prevent blood clot formation we ask that you:

1. Take ibuprofen regularly following the procedure. You should not take ibuprofen if you are taking coumadin, Xarelto, Eliquis, or if you have a history of gastric ulcer. If you are on an aspirin regimen, you can stay on it instead of taking ibuprofen. Do not take ibuprofen and aspirin at the same time.
2. Wear compression hose as instructed and remain as active as possible. You may take the compression hose off to sleep and to shower. Compliance with the compression hose is the most important thing you can do to prevent complications and to ensure the success of your procedure.

3. Remain Active

Contact us with any questions or concerns regarding your varicose vein treatments.

Microphlebectomy is an outpatient procedure, which can be performed safely and comfortably in the office setting. There is minimal pain associated with the procedure and afterwards, if the patient was experiencing pain from the varicose vein, there is immediate relief. The cosmetic results are excellent as the bulges disappear and a smoother, aesthetically appealing leg begins to emerge. Within a short time, the minor bruising will disappear and the patient will be left with impressive results. The fatigue and pain often associated with these veins is gone!

Microphlebectomy takes less than one hour to perform. There is no preoperative laboratory testing or clearance appointments required. Patients may undergo an ultrasound examination to ensure that the veins deeper in the legs are functioning well and that they are not the cause of the varicose veins. There are few restrictions after the procedure. Many patients say they wished they had done it sooner, rather than living with ugly varicose veins for so long.

To sum up, microphlebectomy is the removal of large veins through small incisions. The procedure also helps eliminate pain and cosmetically improves appearance. The veins are permanently removed and cannot recur.

If you are suffering from varicose veins, contact us today to find out if this procedure is right for you.

Minimally invasive, nonsurgical Treatment with Varithena® does not require any incisions or general anesthesia. It usually takes less than an hour to administer Varithena®. Patients may resume some activities the same day but should avoid heavy exercise for one week.

Types of Veins Treated: Varithena® treats a wide range of varicose veins in the GSV system, including: Tortuous (twisted) veins Veins above and below the knee Veins with small, medium, and large diameters Veins previously treated with other methods Varithena® does not treat all forms of varicose veins. Please schedule your consultation with us to see if Varithena® may be right for you.

How Varithena Works: Our vein doctor administers a small amount of Varithena® through a catheter or by direct injection into the malfunctioning vein. The Varithena® microfoam fills and treats the desired section of the vein. The diseased vein collapses and the microfoam is deactivated. When the malfunctioning vein collapses, blood flow shifts to healthier veins nearby.

Potential Side Effects: The most common side effects seen with Varithena® are leg pain or discomfort, injection site bruising or pain. These are not all of the possible side effects of Varithena®.

If you are suffering from varicose veins, contact us today to find out if this treatment is right for you.

Sclerotherapy treatment candidate checklist:

1. Do not have treatments if you are pregnant.

2. You are not a good candidate if your blood thinning medicine must be taken everyday, for instance to protect your heart.

3. If your ability to walk is limited, you should not have treatment.

4. If you are prone to blood clots, or have a known blood clot disorder, your eligibility will be decided on an individual basis.

5. Anyone who has a severe needle fright will not do well with spider vein treatment.

6. You can have sclerotherapy if you are currently taking birth control pills.

7. Veins that could be used for heart bypass surgery later on will normally not be considered for sclerotherapy treatment, unless they are already decided not usable.

WHAT DO I NEED TO DO BEFORE SCLEROTHERAPY TREATMENT?

Before your sclerotherapy treatment, certain medications should be avoided. Talk to your doctor or certified physician assistant about all the medications you are currently taking (including herbal and dietary supplements, over-the-counter-drugs, etc) If you need to take an antibiotic before sclerotherapy, please contact your doctor and inform him. We recommend avoiding ibuprofen, aspirin, and other anti-inflammatory drugs for 2-3 days before your treatment. If you are taking Tylenol that is ok. No type of lotion should be applied to your legs before your treatment.

ARE THERE ANY POSSIBLE COMPLICATIONS WITH SCLEROTHERAPY TREATMENTS?

As with any medical treatment, complications can and do occasionally occur. At Alabama Vein & Restoration Medspa, we have worked hard to select the best treatment options available today which cause the least adverse side effects. Some of the side effects possible with sclerotherapy treatments are:

1. Pigmentation = blood pigment will often stain the skin after spider vein treatments. The vein will be eliminated, but a brown discoloration will be present where the vein once was visible. These pigments usually go away almost entirely within one year. Iron medication is thought to contribute to an increased incidence of pigment formation.

2. Bruising = common after spider vein treatments. Resolves virtually entirely within 6 to 8 weeks.

3. Skin numbness = nearby skin nerves are sometimes stunned by the treatments. This too nearly always resolves within a few months.

4. Skin ulceration = sometimes the solution will damage the skin excessively and cause a small ulcer. The ulcer will take 6 to 8 weeks to heal, and may require minor skin wound care such as ointments and light dressings.

5. Veins resistant to treatment, and new veins developing = some veins are more difficult to treat and will not disappear, and occasionally new veins will develop at treatment sites. Both of these problems are rare, and can be treated successfully by additional injections and changing solutions and compression methods.

6. Itching and redness = will develop at treatment sites on occasion. This is not serious, and can be treated with steroid creams on the skin, and anti-histamines if the itching is prolonged.

7. Ankle and leg swelling = occurs fairly commonly after injection treatments, especially if ankle and foot veins are treated. This will disappear usually within a few months. Compression hosiery may be worn in the interim.

8. Blood clots, or phlebitis, will develop in some of the larger treated veins. This is normal and is the desired result of treatment. The veins will feel lumpy or knot-like, and are often associated with tenderness and redness of the skin. This too will go away within two to four months or longer, and is treated with ibuprofen or other anti-inflammatory medication.

9. Deep vein blood clots = rarely occur after spider vein treatments. Compression hosiery and walking for about 15 minutes after your treatment will help minimize this possibility.

10. Allergic reactions = an allergic reaction to the solution injected may occur, it would occur at the time of injections, if this happens it is rarely serious. If you have a history of allergies you have an increased risk for this possibility. A minor allergic reaction would cause swelling and itching.

If you have any concerns or questions following this treatment, you should contact our office.

WHAT DO I NEED TO DO AFTER THE TREATMENT?

1. You will be asked to wear compression hosiery or compression wraps continuously for 24 hours. These will be applied before you exit the treatment table. You should then wear the hosiery daytime only for an additional 5 to 7 days. This will give you the best results with the least side effects.

2. Immediately after treatment, with your compression wraps or hosiery on your legs, please walk around for about 15 minutes. This helps distribute the solutions, and dilute any solution in the deep veins.

3. You may drive and otherwise participate in all normal activities, with your hosiery on your legs.

4. Please avoid high impact sports and activities for 2 days after treatment. Sometimes you will be asked to wait a longer interval, depending upon the size of veins treated.

5. You should avoid Direct exposure to sunlight, whirlpools, hot baths or hot compresses for 48 hours. Showers are ok but keep the water as cool as possible. The site of injection can be washed clean with mild soap and room temperature water.

WHAT IS THE EFFECTIVENESS OF SCLEROTHERAPY TREATMENTS, WHAT ARE MY EXPECTED RESULTS?

We ultimately hope to achieve a minimum 50% of injected veins to be eliminated with each sclerotherapy session. Fewer than 10% do not respond to the injected solutions. If this happens, we have alternate solutions that can be tried. More commonly spider veins respond in 6-8 weeks and larger veins respond in 3-4 months. If the veins do respond to treatment they will not come back. But new veins may appear at the same rate as before treatment. If there are scattered spider veins, these usually can be eliminated within 6 months or less. For blue spider veins, treatments may take 1 year or longer to achieve desired results. You will be advised of your and our expectations at the time of your consultation.

HOW MUCH WILL THE SCLEROTHERAPY TREATMENT COST ME?

1. Spider vein treatments are considered cosmetic and are not covered by insurance.

2. Each spider vein treatment is $225 per leg. A treatment includes sclerotherapy (injection) of spider veins on one leg, front and back, and including the ankles and feet.

3. The number of treatments required is difficult to estimate. Our staff will provide for you our best judgment regarding the number of treatments. Usually, the interval between treatments is two to three months.

4. Please note our policy regarding appointment cancellations. Except for true emergencies, we respectfully request you notify us 72 hours prior to an appointment cancellation.

Thank you for seeking consultation and treatment with the Alabama Vein & Restoration Medspa. Our efforts are to offer you the best and safest treatment options available today. If you have questions, please call or e-mail for answers and we will be pleased to respond. Be patient as we observe the results of treatment, for often several months must pass before we see the results we all desire. We look forward to working with you as we provide this specialty care for your vein problems.

Immediately after the treatment you can resume everyday activities. Avoid the sun for a couple of days or use sun block. After a few days very small micro-crusts like the marks from a cat scratch can appear where Veinwave has been applied. This is normal and no special care is needed. These will disappear on their own. After 2 weeks, your practitioner is able to see if any small veins remain. Most people will need 2-3 treatments to eradicate unsightly veins. Once a thread vein has been successfully treated it cannot come back. It is possible to make more thread veins but these too can be treated. If you are interested in our Veinwave treatment please contact our office for more information and to schedule your consultation.

HOW COMPRESSION THERAPY STOCKINGS WORK

Compression stockings are designed to provide support to the legs and veins, assist with circulation, and minimize swelling. The compression is graduated, with the strongest support starting at the ankles and gradually decreasing towards the top of the garment. This gradual support works in conjunction with the pumping action of the calf muscles, which also assist with circulation. A common myth is that compression stockings will cut off circulation. When fitted and worn properly, compression stockings help with your circulation, not reduce or restrict it. Compression garments are categorized by classes. These classes consist of compression ranges, which are measured in mmHg---meaning millimeters of mercury, the universal form of measurement used for this type of garment. There are designated medical indications for each compression class.

WILL I FEEL COMFORTABLE WEARING COMPRESSION THERAPY GARMENTS IN PUBLIC?

Today’s compression stockings are very fashionable – most of them look just like regular hosiery or dress socks. No one will know the difference! Since we use Juzo as our primary compression hose supplier, we can offer garments in various styles and colors.

ARE COMPRESSION THERAPY GARMENTS COMFORTABLE?

Compression stockings compliment your legs naturally and beautifully. Juzo specifically uses Exclusive FiberSoft™ technology which adds softness and comfort, leaving your legs feeling energized all day long!

HOW SHOULD I WEAR MY COMPRESSION STOCKINGS?

Consult your primary care provider for specific instructions. If you need to wear your garment every day, you may want to consider purchasing a second pair so you will always have one pair to wear while the other is being washed.