Treatment of Varicose Veins
VenaSeal
 
Our this link board-certified physicians use the latest procedures when treating venous disease. As a result, our patients experience higher success rates, fewer complications, and a much lower rate of recurrence. It’s no wonder hundreds of people have made MKC their first choice to eliminate their varicose veins.
Click on the links to learn more about the different procedures offered by MKC. If you still have questions, feel free to contact us.
Endovenous Thermal Ablation
ClosureFast™
 

Radiofrequency ablation is a minimally invasive treatment for varicose veins. (Ablation means a doctor uses heat to damage tissue, which makes scar tissue form. This scar tissue closes the vein.) This technique uses radiofrequency energy (instead of laser energy) to heat up and damage the wall inside a vein. This usually closes off a varicose vein in the leg.

To treat a varicose vein, radiofrequency energy is directed through a thin tube (catheter) inserted through a small incision in the vein. It can be used on large veins in the leg and can be done in an office setting using local anesthesia or a mild sedative. You will be able to walk following the treatment and recovery typically is short.

After treatment, you will wear compression stockings for 1 week or more. To follow up, your doctor will use duplex ultrasound to make sure that the vein is closed.

Is it safe?

Possible side effects of radiofrequency ablation include:

  • Skin burns.
  • Feelings of burning, pain, or prickling after recovery, from nerve damage (less likely than after vein stripping surgery).
  • Small or large blood clotting in the vein or a deep vein (less likely than after vein stripping surgery).

The more experience your doctor has had with radiofrequency, the less risk you are likely to have. Talk to your doctor about how often these side effects happen in his or her practice.

How well does it work?

Radiofrequency ablation closes off varicose veins in about 88 out of 100 people. That means it doesn't work in about 12 out of 100 people.

  • Pain after treatment is typically less after ablation than after vein surgery.
  • Veins that do not close are treated again. Choices include another ablation or another type of procedure.
ClosureFast™ Procedure
 

The ClosureFast™ procedure uses radiofrequency energy to precisely and effectively treat patients suffering from Chronic Venous Insufficiency (CVI). The ClosureFast™ catheter precisely heats a 7 cm vein segment (or 3 cm for shorter, refluxing vein lengths) in one 20-second interval.

  • The system’s controlled feedback mechanism monitors intravascular heat parameters in real time to automatically regulate therapeutic power.
  • The heat provided by the catheter shrinks and collapses the target vein, creating a fibrotic seal and occluding the vessel.
Minimally Invasive

The ClosureFast™ procedure eliminates the need for groin surgery and general anesthesia, and is generally performed using local anesthesia in a vein specialist’s office or an outpatient surgical facility. The procedure takes approximately 45-60 minutes and most patients typically spend two to three hours at the medical facility due to normal pre- and post-treatment procedures.

Less Pain, Less Bruising, Faster Recovery

Studies show that the ClosureFast™ procedure is associated with lower rates of pain, bruising and complications and a faster improvement in patients’ quality of life when compared to 980 nm laser ablation.1 The average patient typically resumes normal activities within a few days following treatment, and most patients report a noticeable improvement in their symptoms within 1-2 weeks after the ClosureFast™ procedure.2*

Clinical Outcomes

A prospective, international, multi-center study showed that 91.9% of treated veins were closed 5 years following treatment with the ClosureFast™ procedure.3,4 The study used the Kaplan Meier analysis, a common statistic used for a variety of endpoints, including effectiveness of a treatment over defined period of time.

 

References:

1. Almeida JI, Kaufman J, Goekeritz O, et al. Radiofrequency Endovenous ClosureFAST versus Laser Ablation for the Treatment of Great Saphenous Reflux: A Multicenter, Single-Blinded, Randomized Study (Recovery Study). JVIR June 2009.

2. L.H. Rasmussen, M. Lawaetz, L. et al, Randomized Clinical Trial Comparing Endovenous Laser Ablation, Radiofrequency Ablation, Foam Sclerotherapy and Surgical Stripping for Great Saphenous Varicose Veins. British Journal of Surgery Society Ltd., Wiley Online Library, www.bjs.co.uk, March 15, 2011.

3.Proebstle TM, Alm BJ, Gockeritz O et al. Five-year results from the prospective European multicentre cohort study on radiofrequency segmental thermal ablation forincompetent great saphenous veins. British Journal of Surgery. 2015;102:212-8.

4. Proebstle T, Alm J, Gockeritz O, et al. Three year European follow-up endovenous radiofrequency thermal ablation of the great saphenous vein with or without treatment of calf varicosities. J Vasc Surg. 2011;54(1)146-52.

*For 7cm RF catheter.

Non-Thermal Ablations
Non-Thermal Ablations
 

There are several treatment options that do not use heat for ablation. Each treatment method is uniquely designed for specific vein situations. And like thermal ablation treatments, patients can immediately return to normal activity with little or no pain.

VenaSeal™ Closure System
 

The VenaSeal™ closure system is the only non-tumescent, non-thermal, non-sclerosant procedure that uses a proprietary medical adhesive delivered endovenously to close the vein. This unique approach eliminates the risk of nerve injury when treating the small saphenous vein, which is a risk sometimes associated with certain thermal-based procedures.1,2 Clinical studies have demonstrated that the procedure is safe and effective.1-4 The procedure is administered without the use of tumescent anesthesia, avoiding patient discomfort associated with multiple needle sticks.

What to Expect

Before the VenaSeal™ Closure Procedure:

You will have an ultrasound imaging exam of the leg that is to be treated. This exam is important for assessing the diseased superficial vein and planning the procedure.

During the Procedure:

Your doctor can discuss the procedure with you. A brief summary of what to expect is below:

  • You may feel some minor pain or stinging with a needle stick to numb the site where the doctor will access your vein.
  • Once the area is numb, your doctor will insert the catheter (i.e., a small hollow tube) into your leg. You may feel some pressure from the placement of the catheter.
  • The catheter will be placed in specific areas along the diseased vein to deliver small amounts of the medical adhesive. You may feel some mild sensation of pulling or tugging. Ultrasound will be used during the procedure to guide and position the catheter.
  • After treatment, the catheter is removed and a bandage placed over the puncture site.

After the Procedure:

You will be taken to the recovery area to rest. Your doctor will discuss with you what observations will be performed following treatment.

Caution:

Federal (USA) law restricts this device to sale by or on the order of a physician.

Important:

Please reference the Instructions For Use (IFU) for a complete listing of indications, contraindications, warnings and precautions, adverse effects and suggested procedure. An electronic IFU can be accessed at: http://manuals.medtronic.com.

Potential Risks:

The VenaSeal procedure is minimally invasive and catheter-based. As such, it may involve the following risks. Your doctor can help you understand these risks.

  • Allergic reaction to the VenaSeal adhesive
  • Arteriovenous fistula (i.e., an abnormal connection between an artery and a vein)
  • Bleeding from the access site
  • Deep vein thrombosis (i.e., blood clot in the deep vein system)
  • Edema (i.e., swelling) in the treated leg
  • Hematoma (i.e., the collection of blood outside of a vessel)
  • Hyperpigmentation (i.e., darkening of the skin)
  • Infection at the access site
  • Neurological deficits including stroke and death
  • Non-specific mild inflammation of the cutaneous and subcutaneous tissue
  • Pain
  • Paresthesia (i.e., a feeling of tingling, pricking, numbness or burning)
  • Phlebitis (i.e., inflammation of a vein)
  • Pulmonary embolism (i.e., blockage of an artery in the lungs)
  • Urticaria (i.e., hives) or ulceration may occur at the site of injection
  • Vascular rupture and perforation
  • Visible scarring

References:

1. Morrison, N. Use of Cyanoacrylate adhesive for Treatment of Incompetent Great Saphenous Veins: 12-month Results of the VeClose Trial, European Venous Forum, 2015.

2. Morrison N, Gibson K, McEnroe S, Goldman M, King T, Weiss R, Cher D, Jones A. Randomized trial comparing cyanoacrylate embolization and radio frequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg.

3. Almeida JI, Javier JJ, Mackay EG, Bautista C, Cher DJ, Proebstle TM. Two-year follow-up of first human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. Phlebology / Venous Forum of the Royal Society of Medicine, 2014.

4. Proebstle TM, Alm J, Dimitri S et al. The European multicenter cohort study on cyanoacrylate embolization of refluxing great saphenous veins. J Vasc Surg Venous and Lymphat Disord.

Varithena® Closure System
 

Varithena® microfoam fills and treats the desired section of the malfunctioning vein. Varithena® treats a range of vein anatomies and diameters*. Varithena® can treat a range of veins, including tortuous (twisted) veins and veins above and below the knee.

Minimally invasive, nonsurgical

Treatment with Varithena® does not require any incisions or general anesthesia. It usually takes the doctor 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 talk with your doctor to see if Varithena® may be right for you.

How Varithena® works

      • The 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, and potentially serious blood clots in the leg veins. These are not all of the possible side effects of Varithena®. See Important Safety Information.

Asclera® (polidocanol)
Asclera® (polidocanol)
 

What Is Asclera® (pronounced a skler ah)?

Asclera® (polidocanol) Injection is a prescription medicine that is used in a procedure called sclerotherapy and is administered by a healthcare provider to treat two types of veins:

  • Uncomplicated spider veins (very small varicose veins = 1 mm in diameter)
  • Uncomplicated small varicose veins (1 to 3 mm in diameter) known as reticular veins

How Does Asclera® Work?

Asclera® is a sclerosing agent that is injected into the vein. It works by damaging the endothelium, the cells lining the inside of blood vessels. This causes blood platelets and cellular debris to attach to the lining of the vessels; eventually, cellular debris and platelets cause the blood vessel to clot. Over time, the clotted vein will be replaced with tissue.

How long is each Asclera® session?

A typical sclerotherapy session lasts 15 to 45 minutes. One injection is usually administered per inch with multiple injections per session. Following treatment compression stockings or support hose should be worn continuously for 2-3 days and for 2-3 weeks during the day time. Repeat sessions may be necessary. If additional treatment sessions are required they are usually reparated by 1-2 weeks.

What should I expect after being treated with Asclera®?

Maintain graduated compression
  • 2-3 days after treatment of spider veins
  • 5-7 days after treatment of reticular veins
  • For extensive varicosities, longer compression treatment is recommended
  • Post-treatment compression is necessary to reduce the risk of deep vein thrombosis.
Encourage walking
  • 15-20 minutes immediately after treatment
  • Daily for a few days

What should I avoid after receiving an Asclera® Injection?

For two to three days following the treatment, avoid (if you are uncertain, please ask your healthcare provider):

  • Heavy exercise
  • Sunbathing
  • Long plane flights
  • Hot bath or sauna

Are there any possible side effects to Asclera® treatments?

Yes, they may include:
  • Severe allergic reactions have been reported following polidocanol use, including anaphylactic reactions, some of them fatal. Severe reactions are most frequent with use of larger volumes (> 3 mL). The dose of polidocanol should therefore be minimized. A doctor should be prepared to treat anaphylaxis appropriately.
  • In rare cases, formation of small “burns” or ulcers form, usually due to leakage of Asclera®into the skin. They heal in time, but may leave a scar.
  • Inadvertent perivascular injection of Asclera® can cause pain. If pain is severe, a local anesthetic (without adrenaline) may be injected.
You should tell your doctor about all the medicines you are taking, including:
  • Prescription and nonprescription medicines, vitamins and herbal products
You should not be treated with Asclera® if you:
  • Have a known allergy to polidocanol
  • Have an acute vein or blood clotting (thromboembolic) disease
  • Are pregnant or nursing
Ambulatory Phlebectomy
 

What is Ambulatory Phlebectomy?

Phlebectomy (also known as microphlebectomy, ambulatory phlebectomy, or stab avulsion) is a technique to remove varicose veins. In this procedure, several tiny cuts (incisions) are made in the skin through which the varicose vein is removed. Stitches usually are not required.

This procedure typically does not require a stay in the hospital. It may be done in your doctor's office under light sedation with local anesthesia.

Phlebectomy might be done along with another treatment for varicose veins, including ligation and stripping, laser treatment, or radiofrequency treatment.

Is it safe?

Phlebectomy usually does not lead to complications. Possible complications include short-term skin color change, infection, pain, and tiny red spider veins.

How well does it work?

Phlebectomy can help improve the cosmetic appearance of skin after treatment.footnote 1 But this procedure is less likely to fix varicose veins when the leg veins are not working well. Because that is the case for most varicose veins, this procedure is usually used along with other treatments, such as ligation and stripping, laser treatment, or radiofrequency treatment.

Pelvic Venous Embolization
 

How is Pelvic Venous Insufficiency (PVI) treated?

A pelvic ultrasound is generally performed prior to a venogram to rule out other potential problems with the ovaries or uterus. The diagnosis of pelvic venous insufficiency is confirmed by pelvic venography. If indicated, a treatment called Pelvic Venous Embolization can then be performed in order to relieve the abnormal pressure inside the pelvic veins. The venogram and embolization are performed on an outpatient basis and take about two hours.

The embolization procedure consists of inserting a thin, flexible, plastic catheter (or tube) into the jugular vein in the neck. A liquid contrast agent is then injected into the veins of the pelvis and special x-rays are obtained. These images allow the doctor to visualize the refluxing pelvic varicosities and seal them off using sclerosant and coils placed inside the abnormal veins. The catheter is then removed and a small dressing is then applied. After treatment, patients can often return to normal activity immediately.

Compression Stockings for Varicose Veins
Compression Stockings for Varicose Veins
 

Compression stockings help relieve the symptoms of varicose veins. They improve circulation and are a mainstay of treatment for varicose veins that are causing symptoms. (Mild varicose veins that are not causing symptoms don't need treatment.) Compression stockings are tightest at the foot. They gradually loosen as they fit higher on the leg.

Doctors often recommend that you wear stockings during the day to help relieve symptoms.

  • For very mild symptoms, you may want to start out using regular support pantyhose, knee-highs, or knee socks (which end just above the calf, below the knee). You may find that these help swelling and aching considerably. They are also less expensive than the special compression stockings a doctor prescribes, and they are available at most department stores or online.
  • For more serious symptoms, you may want to buy special compression stockings from a medical supply store (with a doctor's prescription), where you can be fitted for them.

Compression stockings can be expensive. They may be hard to put on, and it may take you a while to get used to wearing them all day. But if they fit right, they should be snug but comfortable. If you have problems wearing the stockings, be sure to talk to your doctor.

Consider any problems you may have with compression stockings compared with the chance that they may help keep your problem from getting worse and may help you avoid surgery.

Avoid elastic bandages for varicose veins unless your doctor specifically suggests them. They can cut off blood flow and may make varicose veins worse. (If this type of bandage is recommended, ask how to wrap it.)

Recovery
Vein Treatment Recovery
 

Following treatment, you will be able to resume most normal daily activities, although you should refrain from strenuous exercise or heavy lifting for one week. You will also wear a compression stocking for one-week post-procedure. Many patients experience mild discomfort, which is typically treated with Ibuprofen or Tylenol. If you choose, ice packs during the first 48 hours after treatment can help with any pain or inflammation. After 48 hours, moist warm compresses will aid the healing process.