In the past decade surgery has undergone a minimally invasive revolution, spearheaded not only by technical innovation but patient demand. There is no better example of this than the treatment of varicose vein disease.
Not long ago, the only alternative for patients with extensive varicose veins was surgery. The procedure, aptly called vein stripping, was painful and disfiguring. The operation consisted of groin and leg incisions that resulted in numerous unsightly scars. Recovery took weeks.
Since most patients with varicosities are active, it was a difficult decision on whether to undergo surgery or continue to cope with progressively unsightly and painful varicose veins.
Endovenous Procedures
Endovenous procedures were developed with the assumption that the abnormal vein need not be removed as long as the refluxing vein was closed off.
When reflux is eliminated, varicose veins tend to fade or can be removed through small incisions. The objective was to offer patients an alternative with less pain and faster recovery.
VNUS Closure®
VNUS Corporation pioneered the use of radiofrequency energy to achieve that goal. The technique involves placing a catheter into the diseased vein under local anesthesia and guiding it to the point of highest reflux under ultrasound guidance. The RF energy produces heat that seals the vein eliminating the reflux. VNUS will soon be coming out with a new catheter “Closure Fast” which should shorten treatment times significantly in those patients who are a candidate for this particular procedure
Laser closure
It was not long before laser was introduced to achieve the same effect of thermal sealing of the vein. The cost of laser fibers and simplicity of use have made this a popular choice.
Both procedures are done under local anesthesia and take a couple of hours to complete. The endovenous procedure will often be combined with a microphlebectomy to remove the more visible varicosities. Most patients report little if any pain during the procedure other than the discomfort from the small needle used to instill the anesthesia. Perhaps the worst complaint of patients is the need to wear compression stockings for the first week after the procedure!
To get a better idea of what to expect during an endovenous procedure, read the information sheet we give to our patients.
The Vein & Laser Center of New England is one of the few Centers offering both VNUS Closure® and Laser therapy to its patients. With both options available, we are able to tailor treatment to the individual not the other way around.
Foam Sclerotherapy
Foam sclerotherapy is an exciting new option being offered by the Vein Center for the treatment of varicose veins. Until recently sclerotherapy solutions, called sclerosants, could only be used to treat small spider veins. If they were injected into larger vessels, they would be ineffective.
When air is mixed with a sclerosant, a foam solution is created. When injected into a vein, it will displace blood inside the vessel, allowing direct contact between the vein wall and the sclerosant. The end result is sealing of the vein and eventual absorption by the body eliminating it without incisions.
Dr. Roupenian has extensive experience in the use of foam sclerotherapy. He recently attended the International Symposium on Foam Sclerotherapy in Bologna, Italy where experts were able to exchange the latest information on treatment. He also was a member of a group of physicians who traveled to Honduras to treat an indigent population suffering from chronic leg ulcers with foam sclerotherapy.
Foam sclerotherapy is another example of how the center is committed to providing the most up to date and least invasive treatment options for patients with venous disease.
Microphlebectomy
Is the removal of varicose veins through incisions as small as the size of a needle tip. The procedure is often undertaken in combination with an endovenous procedure or as a stand-alone procedure in patients who do not have major vein reflux. Patients are encouraged to resume walking on the day of the procedure and engage in their normal activities as soon as possible. In most patients, the incisions are barely visible several months later.
Typical Incisions
TELANGIECTASIAS (SPIDER VEINS)
Spider veins with reticular feeding vein outlined in red
Direct injection sclerotherapy continues to be the gold standard in reducing the appearance of these unsightly fine red or blue colored vessels. The injection is done with the smallest of needles. Even patients who dislike the thought of needles are pleased with how little if any discomfort is involved with sclerotherapy. Our Center does not use saline injections, common with many practioners, because it is more painful and, we feel,associated with a higher incident of complications.
The most important principle in the successful treatment of spider veins is to eliminate the underlying sources of abnormal venous pressure that causes these veins to appear. It may be as simple as foam sclerotherapy to the surrounding reticular veins (blue veins) or the need to eliminate reflux in the deeper veins of the leg with an endovenous procedure. For that reason, all our spider vein patients undergo both an ultrasound and Veinlite examination prior to our recommending a treatment plan.
Surface laser is playing an increasing role in the treatment of spider veins but should not be used indiscriminately in all patients who present with spider veins. The Center has three wavelength lasers that are used in the treatment of spider vein patients: The Vbeam, Yag and 940 diode laser. However, improper selection of patients can lead to unsatisfactory results, complications or even the proliferation of veins that may be resistant to treatment.
The role of laser therapy in spider vein treatment is best summed up in the chapter “Candidates for Laser Therapy” by Dr. Neil Sadick (a former President of the American College of Phlebology) in the recent textbook “The Vein Book".
“Laser therapy may be considered appropriate in patients who are needle phobic, cannot tolerate sclerotherapy, are plagued by leg veins that are sclero-resistant and/or are susceptible to telangiectatic matting. Ideal candidates for laser treatment of leg veins previously have undergone appropriate surgery or sclerotherapy for the treatment of varicosities, incompetent perforators and reticular veins, as well as sclerotherapy to clear the majority of superficial vessels”
*(N. Sadick and L Sorhaindo “Laser Treatment of Telangiectasias and Reticular Veins” in The Vein Book edited by Dr. John Bergan Elsevier Academic Press Copyright 2007
HAND VEINS
The two most common treatments for eliminating unsightly hand veins are foam sclerotherapy and microsurgical removal. Both are relatively painless and effective therapies.
FACIAL VEINS
Surface laser is a very effective way to lighten those very fine thread like vessels commonly found on the nose and cheek. A significant improvement is seen after one or two treatments, which usually take less than a minute.
In the past decade surgery has undergone a minimally invasive revolution, spearheaded not only by technical innovation but patient demand. There is no better example of this than the treatment of varicose vein disease. 
Foam sclerotherapy is an exciting new option being offered by the Vein Center for the treatment of varicose veins. Until recently sclerotherapy solutions, called sclerosants, could only be used to treat small spider veins. If they were injected into larger vessels, they would be ineffective. 
Is the removal of varicose veins through incisions as small as the size of a needle tip. The procedure is often undertaken in combination with an endovenous procedure or as a stand-alone procedure in patients who do not have major vein reflux. Patients are encouraged to resume walking on the day of the procedure and engage in their normal activities as soon as possible. In most patients, the incisions are barely visible several months later. 
