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Sclerotherapy
What
is sclerotherapy?
Sclerotherapy is used to treat both spider veins and certain types of
varicose veins. Sclerotherapy involves the injection of a special
medication into the diseased vein which causes it to close off. Here
at our center, we use an FDA-approved drug called Sotradecol (sodium
tetradecyl sulfate). Sotradecol is not painful like saline injections,
which are used by many other clinics.
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Will
it hurt?
Most patients describe minimal itching and burning for 5-15 minutes
following sclerotherapy, but you will leave the office free of
discomfort. You will feel the prick of the needle being inserted into
the skin. However, we use the tiniest needles possible to reduce the
discomfort felt by our patients. If you are very concerned about pain,
please talk to Dr. Walrath. They will be more than willing to discuss
some possible solutions.
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Is
this treatment permanent?
Most people who have spider veins also have diseased veins which
“feed” the spider veins. Here at our center, we make every effort
to treat the underlying problem, as well as the spider veins. By
treating the underlying veins, the chances of recurrence are much
lower.
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How
many treatments will I need?
It depends on the severity of your problem. If we are able to treat
the “feeder” veins effectively, you may require only one or two
treatments. However, if you have a more severe problem, such as
numerous spider veins over a larger area, we may require 3 – 5
sessions to take care of you. These are spaced approximately 4-6 weeks
apart.
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Will
I need to take time off of work?
No. You will need to wear compression hose for at least 48 hours, but
you can resume normal activities immediately after the treatment.
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What
is the cost?
This will vary depending on the number/length of session(s) you
require, and whether you are treating spider veins or varicosities. We
charge based on the amount of time we spend treating you.
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Endovenous
Laser Treatment
What
is ELT?
ELT stands for Endovenous Laser Treatment. This is an exciting new
technique that is replacing traditional vein stripping in practices
across the nation. It is predominantly used to treat varicose veins.
ELT involves threading a laser fiber into the diseased vein and firing
it along the length of the vein. This effectively “closes” the
vein, preventing blood flow and the increased pressure associated with
varicosities. Local anesthetic (numbing medication) is used, and all
ELT procedures are done here at our facility.
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Is
the procedure painful?
As mentioned, the procedure is carried out under local anesthetic. A
dilute solution called “tumescent” is used. You will feel the
prick of the needle used to inject the anesthetic, but you will be
completely numb for the remaining part of the procedure. Many people
describe a feeling of pressure as the anesthetic is injected into the
tissue, but this only lasts for a few seconds until the medication
takes effect. Since the entire area around the vein is numb, you will
feel nothing as the laser is fired. After the procedure, the
anesthetic lasts a few hours. You will take medication at regular
intervals for at least 3-4 days to decrease pain and inflammation.
Most people find the pain-relief we recommend to be more than
sufficient. Very rarely will patients require a stronger
pain-reliever, but if they do, we are happy to prescribe something.
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How
effective is the ELT treatment?
The ELT procedure is about 98% effective in closing the vein.
Obviously, when a vein is stripped, it is impossible for it to return
as it is completely removed. However, with traditional stripping,
there is a greater chance of new veins growing. So even though the
original vein is gone, new ones may recur which require treatment in
the future. With ELT, new veins are unlikely to grow thus greatly
decreasing the likelihood that you will require additional treatment
in the future. In short, ELT is considered more effective at treating
varicosities than traditional stripping.
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Can
all varicose veins be treated with ELT?
No, unfortunately. If the vein is greater than 2cm in diameter, then
the laser will not be effective. Also, if the vein is very tortuous or
“winding”, then it may be impossible to insert the laser fiber far
enough into the vein to be helpful. If the vein is located very close
to the surface, ELT is not appropriate. In these cases, an alternative
treatment will be recommended by the surgeon.
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Stab
Phlebectomy
What
is a stab phlebectomy?
A “stab” phlebectomy, also called micro-phlebectomy, is used to
treat certain types of varicose veins. The word “phlebectomy”
literally means removing the vein. The day of the procedure, the
doctor or nurse will mark your leg where the veins bulge out. Then, a
special local anesthetic (numbing medication) called “tumescent”
is injected into the area surrounding your vein. The doctor will make
tiny incisions or “stabs” of about 2-3mm – the size of a
ball-point pen tip – and use a crochet-type hook to “grab” the
vein and remove it. This interrupts the vein, causes any remaining
portions of the vein to “clot off”, and gets rid of those
unsightly bulgy areas!
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But
don’t I NEED those veins?! What if I need bypass surgery later?
If the veins were functioning normally, then yes! But since the veins
are dilated and not working properly, they are doing more harm than
good. Heart doctors do not use varicose veins for bypass surgery for
this very reason!
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Does
it HURT?
Most patients say that the procedure does not hurt at all. You will
feel the pin prick of the needle as we inject the anesthetic, but then
the area is instantly numb. You will not feel any of the “stabs”.
You will not feel pain from the veins being removed. We will give you
some prescription-strength ibuprofen to help you for the first day or
two, but the vast majority of patients require only extra-strength
Tylenol or Motrin to keep them comfortable. Rarely will patients
require a stronger pain-killer post-operatively.
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What
about scarring?
The incisions are so tiny, that any scarring is not seen. Most
patients can barely see their incisions four to six weeks following
surgery. Compared to the “railroad tracks” associated with
traditional vein stripping, the scars are practically non-existent.
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What
is the “down” time for a stab phlebectomy?
The
“down” time for this procedure is negligible. You will need to
take it easy for the first 48 hours, but walking is encouraged to
promote healing - you will walk out of the office! After the first two
days, normal activities are resumed. Only strenuous exercise is
discouraged for the first week to ten days, as are swimming and hot
tubs. After that, it is business as usual!
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Laser
Treatment for Spider Veins
What
happens during the procedure?
During the procedure, the doctor will
take a device that looks like a large pen with a wire attached and
place the tip directly on the skin over the vein. He will then fire
the laser several times along the length of the vein. You will hear a
clicking sound as the laser fires and will feel a hot sensation. The
laser effectively closes the vein so that blood can no longer flow
through. This decreases or completely gets rid of those purple/red
veins.
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Is
it painful?
Most patients describe the “hot” sensation mentioned previously.
Others describe the feeling as “tiny pinches”. Either way, the
feeling is fleeting, lasting less than a second. Once the firing is
complete, the discomfort disappears. We will provide you with an ice
pack to minimize discomfort at your request.
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When
is laser used?
Laser is used instead of injections when veins are located on the
face. Laser may be used in addition to sclerotherapy (injections) if
the veins are larger than 1mm in diameter. This helps to shrink the
veins down so that sclerotherapy is more effective.
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Is
it dangerous?
Without special safety precautions, the laser can be dangerous.
However, we ensure patient as well as health care worker safety by: 1.
providing safety glasses for everyone in the room; 2. using the lowest
effective settings possible; and 3. only allowing the doctor to
perform the procedure as per the State Board of Medical Examiners. At
the very low energy settings we use to treat spider veins, the danger
is minimal.
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