Modern treatment innovations like endovenous laser treatment (EVLT®), radiofrequency ablation (ClosureFast™), VenaSeal™, ultrasound guided foam sclerotherapy and contemporary surface sclerotherapy have made varicose vein treatment with surgery almost obsolete. The non-surgical methods that Vein Specialists of Northern California employ for varicose vein treatment leave no scars and involve no down time. There are no incisions, no general anesthesia and no time spent in a hospital. After out-patient treatment with endovenous laser or foam sclerotherapy you can return to work, exercise and your normal daily routine immediately. Below you'll find a more in-depth account of the varicose vein removal methods and procedures that will get you on track to healthier, younger looking legs.
What are Varicose Veins?
Abnormally dilated and bulging veins, otherwise known as varicose veins, affect a surprisingly high percentage of adults at some time in their lives. Associated symptoms of varicose and spider veins can include aching, throbbing, excessive fatigue, itching, burning, restless legs syndrome and cramping. Unaware that any non-surgical remedy is available, many vein disease sufferers resign themselves to their discomfort and altered lifestyle.
Causes of Varicose Veins
Both spider veins and larger varicose veins are caused by abnormally high pressure within the affected vein. In most cases the cause of this high pressure is hereditary. Larger varicose veins have abnormal valves that fail to keep blood flowing toward the heart. Blood flowing downward instead of upward in the legs causes high pressure that makes the vein walls stretch out until the vein bulges from the skin surface.
Treatments for Varicose Veins
Elastic stockings, otherwise known as graduated compression hose, provide external support to failing varicose veins, giving temporary relief of symptoms and, to some extent, correcting the direction of flow. For many people, this simple remedy may be all that's needed. Though many insurance companies currently demand a supervised trial of prescription strength elastic stockings before other treatments are considered, it is important to understand that the corrective effect of graduated compression hose lasts only as long as the stockings are worn. There is no evidence in the medical literature that these stockings will eliminate varicose veins or have any long term curative effect.
Duplex-Guided Sclerotherapy and Foam Sclerotherapy
In the case of large varicose veins in which the sources of abnormal flow are out of sight below the skin surface (and therefore in the past only treatable by surgery), duplex ultrasound is used to identify these sources and to enable the physician to guide the tip of the injecting needle directly to these sites. After treatment the vein gradually disintegrates within the body. Similar treatment without ultrasound guidance is extremely effective for spider vein removal. At Vein Specialists of Northern California, the solution used for treatment is sodium tetradecyl sulfate, "STS" or Sotradecol®. Vein Specialists of Northern California prefers this solution to hypertonic saline (concentrated salt water, used by many dermatologists), which is more painful and less effective on larger veins. A recent innovation in sclerotherapy for varicose veins is the use of foam STS. Foam becomes less diluted than liquid when injected into the vein allowing more high-strength solution to come into contact with the vein wall. The result is that less solution has to be injected in order to get the same effect, and the long term success rate is higher. An extremely fine needle is used for all injections making anesthetic unnecessary. Even people with needle phobia find foam sclerotherapy surprisingly painless and easy.
Endovenous Laser Treatment
Endovenous laser treatment is called different names (EVLT®, EVL®) by different laser companies. EVLT® was approved by the FDA in 2001 and is an office-based procedure that takes about 30 minutes from beginning to end. Endovenous laser treatment uses laser energy delivered through a thin fiber-optic fiber to treat the underlying cause of the varicose veins. Endovenous laser treatment is performed under ultrasound guidance with local anesthesia allowing a more gentle, minimally-invasive approach to the treatment of varicose veins. There is minimal to no pain and virtually no scarring. During the procedure, the area of the leg affected is locally anesthetized and a thin laser fiber is inserted into the abnormal vein, delivering the laser energy. This laser energy closes off the vein to any future abnormal blood flow. Your body will continue to use other healthy veins to return blood to the heart. Patients often see and feel immediate improvement and can resume normal activity the next day. Most patients will wear elastic stockings for two weeks after treatment, depending on the size of the vein treated. Vein Specialists of Northern California was one of four offices in the country involved in the original FDA trials of endovenous laser treatment in 2000 and is therefore one of the most experienced offices in which this relatively new treatment is available. We have a longer period of experience with this procedure than anyone else west of the Mississippi and have served as a teaching site for other physicians learning to do endovenous laser treatment.
Radiofrequency Ablation (ClosureFast™)
Like endovenous laser treatment, radiofrequency ablation (ClosureFast) uses a thin fiber inserted through a needle under ultrasound guidance to apply heat to the internal surface of an abnormal vein. Utilizing local anesthesia, radiofrequency ablation (ClosureFast) is a come-and-go out-patient procedure that takes only 30 minutes. Because the heat is more controlled than in the endovenous laser procedure, many patients find that they have less soreness the following day. We have been using this procedure since 1998 and have seen wonderful results, especially since the introduction of the newest generation of radiofrequency catheters.
Vein Specialists of Northern California would proudly like to announce that we were chosen to be the first office in the Bay Area to treat patients suffering from venous reflux disease with the VenaSeal™ closure system. This new, minimally invasive procedure uses an advanced medical adhesive to coapt (close) the diseased vein in patients with symptomatic venous reflux disease. The VenaSeal™ closure system is the only procedure to use adhesive to coapt and close the vein with high closure rates across three clinical trials. Patients treated with the VenaSeal™ closure system usually have minimal to no bruising, and are able to quickly resume normal daily activities. Unlike other heat based treatments, VenaSeal™ does not require the use of injected tumescent anesthesia, and eliminates the risk of nerve injury associated with thermal based procedures. In most cases, patients do not need to use compression stockings post procedure. The VenaSeal™ closure system is the only non-thermal, non-tumescent, non-sclerosant procedure approved for use in the U.S. that uses an advanced medical adhesive that closes the diseased vein. This procedure is office based and done in under an hour.
How Do You Decide Which Treatment Is Right for You?
Dr. Isaacs feels strongly that an educated and informed patient achieves the most satisfactory outcome. As our patient, you are a member of the treating team and understanding your own condition is essential for getting the best results. Before any treatment is recommended or any estimate of cost is made, we ask you to visit us for an initial evaluation. At that time you will receive educational material, have a full history taken by Dr. Isaacs, undergo a complete examination of your veins and have a duplex ultrasound evaluation of the circulation in your deep and superficial veins. After this examination has been completed and the results explained, you will have a complete understanding of the nature of your vein condition and the options for treatment. If our treatment is not appropriate for you, alternative recommendations will be made. We do not believe in "selling" you on our treatment; the final decision is always yours.
Spider Vein Treatments
Spider vein treatment eliminates abnormally dilated small veins, otherwise known as spider veins, that affect the majority of woman and many men at some time in their lives. Spider vein removal eliminates ugly purple and red “broken” veins along with associated symptoms like aching, throbbing, excessive fatigue, itching, burning, and cramping. Unaware that any non-surgical remedy is available, many spider vein sufferers resign themselves to covering their legs at all times, even in the heat of summer. With modern refinements in available solutions and techniques, sclerotherapy is a safe and effective spider vein treatment. For larger varicose veins, Endovenous Laser Treatment (EVLT®) and duplex-guided foam sclerotherapy have been proven to be extremely powerful treatment tools.
What are Spider Veins?
Spider veins are most commonly found on the face and legs (although they can be found on other parts of the body). Spider veins are formed by the dilation of smaller blood vessels close to the skin surface. Spider veins usually do not pose a health threat, but can produce a dull ache in the legs after longer periods of standing.
Causes of Spider Veins
Both spider veins and larger varicose veins are caused by abnormally high pressure within the affected vein. In most cases the cause of this high pressure is hereditary. Larger varicose veins have abnormal valves that fail to keep blood flowing toward the heart. Blood flowing downward in the legs instead of upward causes the vein walls to stretch out until the vein bulges from the skin surface. A combination of high pressure and hormonal influences causes most cases of spider veins.
Spider Vein Removal
Spider veins – also known as telangiectasias or sunburst varicosities – are small, thin veins that lie close to the surface of the skin. These veins are connected to deeper veins, and only a careful duplex ultasound examination can determine whether spider veins are being caused by a deeper abnormality. This type of ultrasound evaluation is done on every new patient in our office, even if there are only a few spider veins to be treated. Vein Specialists of Northern California employs sclerotherapy and foam sclerotherapy to remedy these damaged veins. Laser can be used to treat the smallest spider veins following sclerotherapy, but usually is not effective as a first-line treatment for spider veins on the legs. Sclerotherapy uses the body’s natural healing abilities to close off abnormal veins. After being injected with a liquid that irritates and slightly damages the lining of the vein, the body responds by filling the vein with scar tissue. Once flow is eliminated, the vein disintegrates. Sclerotherapy can enhance your appearance and your self-confidence, but it’s unrealistic to believe that 100% of the visible veins will disappear completely as a result of treatment. After each sclerotherapy session, the veins will appear lighter. Two or more sessions are usually required to achieve optimal results. Serious medical complications as a result of sclerotherapy or foam sclerotherapy are extremely rare.
Restless Leg Syndrome
What Are Symptoms of Restless Leg Syndrome?
Many people have become aware of a condition commonly known as Restless Leg Syndrome (RLS). The condition of restless leg syndrome is often associated with the following conditions and symptomatic criteria including: Feeling and sensation resulting in an urge to move limbs, especially legs Worsening of symptoms at rest. Some patients report symptoms are worse when lying down, or sitting for long periods of time. Worsening of symptoms during end of day or at night. Improvement of symptomatic conditions with activity and movement. If you are having a hard time describing the sensations that you think might be restless leg syndrome, you are not alone! Many other patients have a hard time describing the condition. The general feeling associated with Restless Leg Syndrome is often described by patients as “something feels just antsy, creepy, or uncomfortable”. While most have these feeling in their legs, the syndrome can occur in arms as well. An urge to move while experiencing these symptoms is also common.
Rule Out Vein Problems, Treatment Options
Various treatment options for RLS are available including iron supplements, pharmacological treatment (drugs), and lifestyle changes including exercise. In addition to consulting with your primary care Physician on the best course of treatment, a consult with a venous disease specialist (Vein Doctor), should be part of a comprehensive diagnosis and treatment plan. Consulting with a venous specialist is important to rule out venous disease as a possible underlying cause of RLS before embarking on a course of therapy. Treatment and diagnoses for restless leg syndrome should be sought if your discomfort is consistent.
Restless Leg Syndrome Diagnoses
The Vein Specialists of Vein Northern California offers diagnoses and treatment (if underlying cause is vein related) for restless leg syndrome. If your RLS is caused by varicose veins, or other venous insufficiency, our clinic specializes in the treatment of these conditions. Please schedule a consult with us if you are concerned about restless leg syndrome.
Dr. Mark N. Isaacs, MD
Diplomate American Board of Phlebology.Dr. Isaacs has specialized in the treatment of vein disease since 1990.
Dr. Mark Isaacs received his medical training at the University of California San Francisco School of Medicine.
He completed his residency training at an affiliated hospital of the University of Minnesota, has been Board Certified in Family Medicine since 1979 and is a Fellow of the American College of Phlebology and the American Academy of Family Practice. In 2008 the American Board of Phlebology offered it’s Board Certification examination for the first time, and Dr. Isaacs was in the first group to pass. He is on the hospital staff of John Muir Medical Center and is a member in good standing of both the California Medical Association and the California Academy of Family Physicians. He has been a clinical faculty member at both U.C.S.F. and the University of Minnesota. He is also a Diplomate of the American Board of Phlebology.
Dr. Isaacs has specialized in the treatment of vein disease since 1990.
He has served on the faculty of the American College of Phlebology and the Union Internationale de Phlebologie. As an early proponent of the use of duplex ultrasound to guide the treatment of varicose veins, Dr. Isaacs was asked to join in the original FDA trial study of endovenous laser, a method of treatment that has now become the gold standard for non-surgical treatment of large varicose veins. Dr. Isaacs is very enthusiastic about the effectiveness of sclerotherapy and other non-surgical modalities for the entire spectrum of vein disease. It is very rare that a physician has the opportunity to use a treatment that gives both prompt relief of symptoms and cosmetic improvement. The impact on a patients self-image and daily functioning can be incredibly positive.
The following is a list of different types of insurance plans that might help you in determining your benefits:
This kind of health plan is best suited for people who want a lot of options and are willing to pay for it. In other words, it allows you to select any physician or hospital your heart desires. The other good thing about it is that it allows you to self-refer.
PPO (Preferred Provider Organization)
If you use the doctors and hospitals on your list you'll greatly reduce deductible and co-payment costs and there won't be as much claims paperwork. However, you may also select your own physician and self-refer (at higher cost). Currently, Dr. Isaacs is a member of Anthem BC, Blue Shield, Cigna, Healthnet, Pacificare and United Healthcare PPO's. Our office will bill directly for medically necessary and authorized treatments. Patients will be responsible for co-pays and any deductible. Any cosmetic treatment will be the responsibility of the patient.
EPO (Exclusive Provider Organization)
Similar to a PPO except that the coverage for non-listed physicians and services may be less, and there are more rigorous utilization review requirements.
HMO (Health Maintenance Organization)
Your selection of doctors and hospitals is strictly limited to those on the HMO list. You also have to choose a primary care physician with whom you have to consult for all referrals regarding specialized care or hospitalization, including a referral for vein treatment. If you receive treatment without authorization from a non-HMO physician you will not be covered. Currently, Dr. Isaacs is not a member of any HMO.
Point of Service
This is a combination of HMO, PPO and Fee-for-service.
Medicare covers those treatments that are considered medically necessary. Our office will bill directly. Patients are responsible for co-pays and for the full cost of any treatments that are cosmetic. A waiver must be signed by each Medicare patient prior to any cosmetic treatment.
Available to Medicare-eligible individuals, this plan puts you in an HMO (see above) in return for lower rates. The restrictions are the same as in an HMO.
This policy is added on to Medicare to cover additional costs not included in the standard Medicare policy. Restrictions depend on the plan you choose.
Will Your Insurance Plan Cover Vein Removal?
Most insurance companies do not pay for sclerotherapy or any other treatment if it is performed for cosmetic reasons. Some insurance companies do pay benefits if there is pain or discomfort that impedes activity. However, each insurance carrier is different and it is recommended that individuals check with their own insurance carriers to determine if there is coverage. Each patient is given a complete evaluation summary of their proposed plan of treatment at their consultation detailing medically necessary treatment(s) which may be billable to insurance and non-medically necessary treatment(s) which would not be billable to insurance and completely out of pocket.
Dr. Mark N. Isaacs, Board Certified in Phlebology, has specialized in venous disease since 1990. He provides the most advanced treatments including EVLT endovenous ablation, ClosureFast RF ablation and sclerotherapy for all types of venous insufficiency.