Ask the Doctor is a blog where Dr. Thomas Wright, MD answers your questions with his blog posts and your comments to this blog.
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VeinWave is an entirely different treatment than laser ablation. Ablation is done for patients with varicose veins, and is used to seal closed the underlying main vein that is causing the problem that leads to the superficial varicose veins. VeinWave is a new treatment, specifically for spider veins only, and is limited to just the smallest, fine, tiny veins that cannot be treated by injection sclerotherapy. It uses tiny pulse of radiowaves to treat these tiny little vessels, but cannot be used on larger veins.
The idea of a laser in my leg sounds a little scary.
There is a very small risk of getting a burn, however using tumescent anesthesia this risk is reduced greatly. Tumescent anesthesia is essentially a mixture of salt water and numbing medicine that surrounds the entire length of the vein. This mixture will absorb the stray heat of the laser and protect the surrounding soft tissue. In my practice we have never had a patient get burned however I suppose like anything else it is possible.
Will it take care of varicose veins that are closer to my ankles?
Endovenous laser ablation (ELA) will treat other that the saphenous. However, most veins lower in the leg must be treated with sclerotherapy or vein stripping. The ELA treats the larger sources of the problem, but is often impractical when dealing with twisty, small veins, especially on the very low leg or ankle.
Mapping of a vein is done prior to any EVLT procedure. Ultrasound is done prior to even minor procedures such as sclerotherapy, this eliminates the possibility of missing an important refluxing vein. The EVLT procedure is done entirely under ultrasound guidance.
Spider veins do not lead to skin cancer. Spider veins are one sign of venous insufficiency. Venous insufficiency can lead to leg ulcers, however spider veins themselves do not turn into leg ulcers.
Is that bad for the body to have dead tissue laying around?
No, ELA does not remove veins. The cells of the veins or tissue are replaced with healing tissue. Think about a scratch on your skin. A scab develops then as the healing process continues the scab cells are replaced with healthy new tissue over the following weeks. The same healing process goes on with your veins. So after a year it is usually impossible to tell where the treated veins were.
There are no age restrictions to laser ablation. Because the procedure is done under local anesthesia, it is extremely safe and can be done at any age. I have done this procedure on patients as young as 22, and as old as 85 without any problems.
It seems like the laser would hurt.
It is true that properly performed Endovenous Laser Ablation is associated with minimal discomfort. Patients typically require either no analgesic or an over the counter analgesic after the procedure. As with many procedures, there is frequently a mild peak of discomfort at days 3 to5 days after the procedure, and is described as a “pulling” occasionally burning sensation. The heat energy generated by the laser is not felt by the patient due to the type of local anesthesia used which surrounds the vein in a “halo” of fluid. This is one reason that the procedure is safer without heavy sedation or general anesthesia.
No. The Saphenous vein which is destroyed is not healthy in the first place and of no use. Because the vein is engorged and thrombosed, removal has no affect on the body. The deep system continues to carry blood away from the legs.
There are potential complications with any procedure. These are rare complications that include:
-mild numbness
-pulling sensation
-Phlebitis
-Deep venous thrombosis
-infection at an incision site
-Bruising
No. One is usually given a pair of special glasses to protect the eyes.
For symptomatic patients the procedure is normally covered by medical insurance and Medicare. For patients who are getting treated for cosmetic reasons the cost is about $2-4000 per leg. Most insurance companies require a trial of support or compression stockings and the need to take pain medication during the last six months. We will work with you and your insurance through the predetermination process to determine medical necessity.
My mother is 82 and she has varicose veins that have gotten progressively worse in the past 2 years. She complains that they are painful and make her legs feel heavy. She’s in good health and active, but is there an upper age limit with ELA?
NO there is no age limit. In general, like all elective procedures your mother’s general health should be taken into consideration when deciding whether to have the procedure. ELA, Endovenous Laser Ablation is a pretty low risk procedure so if your mother is healthy there is no reason not to have her varicose veins treated.
Laser ablation is very successful at treating varicose veins, with excellent long term results. The likelihood of veins coming back from the vein that’s been treated is exceptionally low. However, there is no guarantee that you could not develop varicose veins from some other source, or other vein, in your leg. This would be more determined by your genetics than anything else.
No, they are completely different than Vein Ligation, or Vein Stripping.
EVLT and RF are minimally invasive catheter based procedure which use laser or RF energy to seal the involved vein closed. Thes procedure have minimal downtime or discomfort associated with them. Ligation or Stripping are surgeries which require open incisions, dissection, and sutures, and involve either tying off and dividing the vein, or surgically removing it from the length of the leg. They are much more painful, and have a much longer post-op course and recovery. See a qualified vein specialist to see what is most appropriate for you.
