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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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