| Vein Treatment | ||
Overview: The following information will provide a brief summary of venous problems and treatment options. Normal Anatomy and Function: Veins are the blood vessels that return blood from the legs to the heart. All veins have valves that allow blood to flow out of the leg but not “back up”. If a vein’s valves don’t work, the vein is said to be incompetent. Leg veins are divided into the deep veins that are within the muscle part of the leg and superficial veins that are between the skin and muscle layer. Deep veins are the most important veins and cannot be removed. Superficial veins can safely be removed or obliterated. The main superficial vein in the leg is the saphenous vein. It runs from the inner ankle up the lower leg and thigh on the inner side and empties into the femoral vein in the groin. An incompetent saphenous vein is frequently the source of significant varicose veins. Abnormal Veins: Varicose veins range from large ropey bulging veins to very small bluish or red spider veins and come in all sizes in between. They are not dangerous and frequently cause no symptoms. They occur because of poor valve function that results in enlargement of the normal vein. Some varicose veins cause discomfort, and many are unsightly. Treatment: Many veins can be treated with injection sclerotherapy, which is the simplest vein treatment we offer. It works well for spider veins and small to moderate varicose veins (up to 6mm in diameter). The procedure is done in the office, and recovery is minimal. Each sclerotherapy session lasts 5 to 10 minutes, and numerous veins are treated in each session. However, most patients will require more than one session if they have many veins. If a patient has significant symptoms and large varicosities in the inner leg or thigh, they are likely to have an incompetent saphenous vein. This is best treated with vein stripping or EVLT (endovenous laser therapy) to remove or obliterate the saphenous vein. EVLT is only used to treat the saphenous vein. Some varicosities are too large for sclerotherapy and don’t require saphenous vein removal or ablation. These veins are best treated with ambulatory phlebectomy or varicose vein excision. This procedure involves removal of vein through very small incisions under local anesthesia. Recovery from this procedure is very short. Evaluation and Testing: Office evaluation by one of our physicians is needed before a specific treatment can be recommended. Frequently a venous duplex exam (ultrasound) will be necessary to plan treatment, particularly if the patient has large veins and significant symptoms. The venous duplex is done here in our office in The Vascular Lab. Insurance: All of the above treatments may be covered by insurance if the veins are causing lifestyle altering symptoms or other problems such as superficial phlebitis, bleeding of ulcerations. Insurance is much more likely to pay if the patient has had a trial of conservative treatment with compression stockings. Insurance will not pay for cosmetic vein treatment. We will send a letter to your insurance carrier after appropriate evaluation if the patient has significant symptoms. We will need to wait until the “predetermination of benefits” is answered before treatment can be done. We do not pursue insurance coverage beyond the initial letter. Sclerotherapy can be done at the same time as the initial evaluation but only if treatment is cosmetic or on a “self pay” basis, and insurance will not be billed. http://www.venousdiseasecoalition.org/ http://www.phlebology.org/patientinfo/index.html http://www.evlt.com/content/patients/about-evlt/info.jsp
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