Vein Treatment Varicose Veins Laser Lipo & Vein Care Center Ask the Doctor

Is it true that radiofrequency occlusion is associated with a higher recurrence rate of varicose veins than endovenous laser ablation? I heard that there’s a greater chance the vein would re-open with RO.

All studies show that the results are the same. There is study that shows a slightly higher recurrence rate for radiofrequency vs. laser. However the study was not adequately powered to say there is a clear superiority of the outcome.

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Perhaps most important is what other patients say about the physician, and your gut reaction to the office. Experience is also very important. You should look for a practitioner who is fully dedicated to venous disease, as opposed to one who is dabbling in veins.

Ideally the surgeon/physician should have done hundreds of the ELA he is planning to perform and be well-informed about it and research regarding it. Board certification in a specialty that relates to veins such as interventional radiology, general or vascular surgery as well as Board certification in phlebology indicates at least some degree of proficiency.

You should pay attention to your comfort level in the office, and value a clean and orderly office.

- Dr. Wright

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I have just had the endovenous laser ablation procedure. A lot of the leg discomfort I had before the procedure is gone. How long after treatment will I see an improvement in the ropey appearance of the varicose veins?

Laser ablation treats the underlying cause of varicose veins, which is venous insufficiency with reflux, typically occurring in the saphenous vein. The visible, palpable varicose veins on the skin surface are most commonly branches off of this deeper vein. Their resolution will be dependent on how they are specifically handled. If nothing further is done for them, they may well decompress and slowly diminish over time, but this depends on their size and extent, and generally only occurs about 15-20% of the time. The varicose veins usually require additional treatment, which may be done by injection sclerotherapy, over a series of treatments, usually 4 weeks apart.

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I have distended, ropey veins on the anterior surface of my left calf and have been told that my problem involves the perforator veins. How would you treat this? Would you use traditional laser or “cold” laser?

Any of the medical LASERs used for endovenous thermal ablation procedures can be utilized well for ablation of perforating veins. Other options include radiofrequency ablation with the VNUS RFS device or foam sclerotherapy. Low level or “cold” lasers are not used to treat veins.

- Dr. Wright

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How long does it take to show an improvement after the Sclerotherapy is performed?

It is variable. Most patients will see the veins looking much worse for the first 2 weeks. After that, they see some improvement.

Some patients can enjoy great results as soon as 4 weeks after injections, others might take up to 3-4 months. Things usually look worse for a month or so then fading starts, and it can take several months before significant improvement is noted. It also usually takes more than one treatment.

- Dr. Wright

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Can dermatologist perform Scleotherapy Or only Phlebologists? What kind of certification is required?

Although sclerotherapy may be performed by any type of physician, you will likely experience the best results with someone who is both highly experienced and a specialist in treating venous disease, and in the use of sclerotherapy specifically.

Look for someone who is a vein specialist, with years of experience, board certified in phlebology, vascular surgery, or vascular medicine, and one whose practice is devoted to treating veins, as well as one who has multiple treatment options available depending on the patient’s underlying issues.

- Dr. Wright

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I hade sclerotherapy yesterday, but I can still see a few of the veins that were treated. How long until all the veins disappear?

It is quite variable from patient to patient and from vein to vein. Most of the times takes at least 3-4 weeks before some results can be appreciated, however could go as long as 3 months before improvement can be noticeable. Some go away right away some look worse and slowly fade. It rarely is done in one treatment.

- Dr. Wright

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How is polidocanol related to Sclerotherapy? I’ve heard conflicting accounts. What exactly is polidocanol?

Polidocanol is a sclerosing agent, drug used to treat veins. It works quite well. Currently, it is available only from compounding pharmacies in the US, although it will be available from a manufacturer soon. The drug most commonly used in the US is Sotradecol, which works well also. This is the FDA-approved drug available here. All of these drugs work by injuring the vein well causing the vein to scar down and close off, thereby removing the varicose/spider veins.

- Dr. Wright

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Is it all right to shower the day after a Sclerotherapy treatment? When can I remove the bandages?

I use compression hose for three days to three weeks and tell patients it is fine to shower without them on.  So for my patients they can shower the day after sclerotherapy.

This will depend upon the treating physician. It may depend on what type of bandages your doctor prescribed. Typically any post-procedure dressing is removed the following morning, and patients may take their first shower at that time. You should contact your vein doctor and have them review their specific post-instructions with you. But I don’t use bandage, and only use compression stockings.

- Dr. Wright

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There is not strong data suggesting that BCP’s effect the results of sclerotherapy. The major concerns would be a possible increased incidence of DVT and increased blushing or matting, but no data to date has shown this.

- Dr. Wright

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I had the procedure 2 days ago. Today my GP prescribed MethylPrednisolne, 4mg for allergies. Is this safe to use?

Generally yes, but you should ask the MD who treated you and make sure your MD knows your medical history.

- Dr. Wright

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When will Asclera, the new Sclerotherapy treatment, be available?

I heard that Asclera (Polidocanol) was recently FDA approved. When can patients expect this sclerant to be widely available in the US?

Not sure about when the FDA will approve this. I have been told it is expected soon. Possibly it will be available in a few months.

– UPDATED: It was approved and is now available. –

- Dr. Wright

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I haven’t had it evaluated by a doctor, but I do bruise extremely easily and the bruise usually stays for at least three weeks, even for a minor bump. Is this something I should have checked before undergoing sclerotherapy?

Sclerotherapy is generally safe for the vast majority of patients, even for those who may bruise easily. Obviously, there are multiple injections performed with treatment, so bruising is not at all uncommon, and may last for variable amounts of time afterward. However, in your specific case, if you bruise with even minor trauma, and it lasts for an extended period of time, you may want to have your physician evaluate you for any potential bleeding disorders, just to make sure there is not something significant going on.

- Dr. Wright

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Can Restless Leg Syndrome be treated by treating Venous Insufficiency?

According to MEDLINE:

The cause of restless leg syndrome (RLS) is unknown but it appears to have multiple causes. Symptoms of RLS include abnormal sensations of creepiness only relieved by moving the legs, irresistible urge to move legs, persistent leg movements during sleep, sleep difficulty, tingling, burning, aching, and numbness. Venous insufficiency can also cause very similar symptoms. Recent medical research shows that 22% of patients with RLS also have venous insufficiency.

Most RLS is treated with dopamine agonist medication such as mirapex. Approximately 80% of patients have long lasting relief of symptoms by taking a medication everyday such as mirapex or similar medications. However, a small percentage has worsening of their symptoms (augmentation of their symptoms). There can be other side effects related to the medication such as blood pressure dropping upon standing, drowsiness, hallucinations, voluntary movement difficulties, double vision, and compulsive behaviors. Most patients would much rather have a single intervention that could relieve their symptoms for the rest of their lives.

Venous insufficiency, which is caused by back flow in the veins in the legs, is also a common cause of restlessness in the legs. Venous insufficiency can be well treated with a laser to close the backward flowing veins. New medical research has shown that the treatment of venous insufficiency can cure the symptoms of RLS. In fact in patient with RLS and venous insufficiency, 98% had relief of their symptoms of RLS by treating their venous insufficiency and 80% of patients’ relief was long term. In light of this new information it makes sense for patients who have symptoms of restlessness in their legs to be evaluated for venous insufficiency with a simple ultrasound test. If found, the treatment of venous insufficiency has the best chance of complete relief of symptoms.

- Dr. Wright

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Can Vein Disease Cause Restless Leg Syndrome (RLS)?

Symptoms of RLS and Venous Insufficiency

The symptoms of venous insufficiency are almost identical to the symptoms of restless leg syndrome. RLS is common. Up to 3-10% of the population has symptoms of RLS[1]; whereas, venous insufficiency is also common occurs in 25% of the US population[2]. Both cause symptoms which include: abnormal sensations of crawling which is only relieved by moving the legs, irresistible urge to move legs, persistent leg movements during sleep, sleep difficulty, tingling, burning, aching, and numbness. The symptoms of both RLS and vein problems are relieved by movement of the legs. RLS and vein disease are usually noticed with change in position, such as lying down and standing. RLS symptoms tend to be more noticed when first lying down; where as, vein disease symptoms tend to be more noticed when standing.

Restless Leg Syndrome and Venous Insufficiency

Restless leg syndrome (RLS) is considered a sleep disorder. Venous insufficiency is a circulatory disorder. The cause of RLS is unknown but it appears to have multiple causes. Some cases are associated with iron deficiency, peripheral neuropathy, Parkinson’s disease, and other neurological disorders. However, it is clear that some RLS is caused by venous insufficiency. Recent medical research shows that 22% of patients with RLS also have venous insufficiency[3]. In addition, the treatment of venous insufficiency can cure the symptoms of RLS. In fact in patient with RLS and venous insufficiency, 98% had relief of their symptoms of RLS by treating their venous insufficiency and 80% of patients the relief was long term[4] [> 2ys].

Fulda S, Stalla Wetter TC.

J Neurol. 2007 Dec;254(12):1748-9. Epub 2007 Nov. 9. No abstract available.

PMID: 17990060 [PubMed – indexed for MEDLINE]

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[2] Langer RD, Ho E. Denenbery JO, Fronek A, Allison M, Criqui MH. Relationships Between Symptoms and Venous Disease: The San Diego population study, Arch Intern Med.2005.165:1420-1424.

[3]  The effect of sclerotherapy on restless legs syndrome.

Kanter AH.

Dermatol Surg. 1995 Apr;21(4):328-32.

PMID: 7728485 [PubMed - indexed for MEDLINE]

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[4] The effect of endovenous laser ablation on restless legs syndrome.

Hayes CA, Kingsley JR, Hamby KR, Carlow J.

Phlebology. 2008;23(3):112-7.

PMID: 18467618 [PubMed - indexed for MEDLINE]

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