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Frequently Asked Questions
Who should treat your Veins?
Venous Insufficiency can be the cause of varicose veins and, if present, needs to be corrected first. Veins of any size should be treated by a physician who understands vein anatomy and physiology, and who can offer all state-of-the-art methods of treatment. As a Board Certified Vascular Surgeon with over 22 years of experience, Dr. Bardwil understands the underlying veins and can choose among all the various techniques available to decide your best course of treatment.
Dr. Bardwil will meet with you to perform a comprehensive venous evaluation and will advise you on the best treatment option for your vein problems.
Are Varicose & Spider Veins the same?
No. Varicose Veins are dilated and ropy-appearing blue vessels that look like lumps under the skin. Spider Veins are small blue or red vessels visible within the skin, usually on the leg, face, neck or chest. Spider veins are treated as a cosmetic problem. Varicose veins are more apt to have medical implications.
What are the factors that contribute to Varicose Veins?
- Heredity (the most common cause)
- Pregnancy
- Hormone Replacement Therapy
- Birth Control Pills
- Prolonged Standing or Sitting
- Increasing Age
- Obesity (this one is more controversial)
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What is Superficial Venous Reflux?
The veins in legs have one way valves. Blood in the leg veins should flow up the leg in one direction. When the one way valves don't work, the blood flows in two directions; we use the term reflux to describe this abnormal blood flow. Because the feet are in a more gravity dependent location, blood tends to stagnate in the lower legs. When reflux occurs in the leg veins, we make the diagnosis of venous insufficiency. This is a recognized medical diagnosis and treatment is usually covered by insurance.
What is Venous Insufficiency?
When we see reflux, as described above, we use term Venous Insufficiency. This means that the veins aren't functioning properly. This creates underlying pressure problems in the veins of the legs. Venous insufficiency can give rise to varicose veins, swelling, heaviness, fatigue and aching in the legs. It is estimated that 25 million people suffer from venous insufficiency. In its most severe form, this can cause profound swelling, skin breakdown or ulceration.
What can be done to correct Varicose Veins?
Recent technology has enabled us to treat vein problems in the office rather than the operating room. In the past, the best option for treating varicose veins was with a vein stripping. This procedure involved removing the saphenous vein in the operating room. The standard of care has now become closing the saphenous vein with a laser. This is performed in the office and only requires a local anesthetic. Using the ultrasound to direct placement, a needle is placed in the vein. This allows access for a laser fiber to be placed in the vein. The laser can be advanced the length of the vein. Once the laser fiber is in position, local anesthesia is injected along the vein to be treated. The laser is activated and slowly withdrawn. Laser energy is used to seal the vein. When the vein is closed, the pressure problem is resolved and swelling and symptoms improve. The blood automatically goes to the normal veins. Since the root of the problem is eliminated, most varicose veins will subsequently become smaller or disappear.
What is the Endovenous Laser (ELAS) procedure?
The ELAS procedure is a minimally invasive treatment for superficial venous reflux. A laser fiber is inserted into the vein through a small opening. The laser delivers energy to the vein wall, damaging it and causing it to close.
How does ELAS work to treat venous insufficiency?
Abnormal veins cannot be repaired, and are therefore eliminated. After the abnormal veins are eliminated, the body re-routes blood flow through healthy veins. Traditionally, this has been done by surgically removing (stripping) the troublesome vein from your leg. The ELAS procedure provides a less-invasive alternative to vein stripping by simply closing the problem vein with a laser. Once the diseased vein is closed, other healthy veins take over and empty blood from your legs.
How is the ELAS procedure different from vein stripping?
During a stripping procedure, the surgeon makes an incision in your groin and ties off the vein, after which it is pulled out through multiple incisions along the leg. In the ELAS procedure, there is no need for surgery, the vein remains in place and is simply closed using a special laser fiber inserted through a small skin puncture. Vein stripping is usually performed in an operating room, under a general anesthetic. The ELAS procedure is performed in an office setting using local anesthesia.
How long does the procedure take?
The ELAS procedure takes approximately 30-45 minutes on average.
Where will the procedure be performed?
The ELAS procedure is usually performed in our new, comfortable, state-of-the-art vein center
Is the procedure painful?
Local anesthetic is used to numb the treatment area. Patients report feeling little or no pain from the Laser.
Will the procedure require any anesthesia?
This procedure is well-tolerated using local tumescent anesthesia. Tumescent anesthesia is a diluted form of local anesthesia. It is injected along the length of the treated vein. This form of anesthesia serves three purposes. It is an anesthetic. It also creates a barrier between the treated vein and surrounding tissue to protect the surrounding tissue from the laser energy. It also squeezes blood out of the vein so that more laser energy can be directed to the vein wall. Once this is injected, patients rarely feel any pain.
How soon may I resume normal activity?
With our 1470 Wavelength Laser, you should resume normal activity immediately. This is a true advantage over the other lasers. This newer technology became available about 2 years ago and we were one of the first vein practices to use this wavelength laser. We encourage walking and place no limitation on distance. You should be able to return to most jobs the next day. Avoid heavy or strenuous exercise for 2 weeks.
How soon will my symptoms improve?
Many patients report a noticeable improvement in their symptoms immediately after the procedure.
Are there any potential risks or complications?
As with any medical intervention, potential risks and complications exist with the ELAS procedure. Dr. Bardwil will review potential complications of the ELAS procedure at the consultation. Risks for serious complications are considered rare for this procedure when performed by an experienced surgeon.
Is there any scarring, bruising, or swelling after the treatment?
Patients report minimal to no scarring following the ELAS procedure. Bruising will usually resolve in one to two weeks. There may be slight tenderness or numbness during the weeks after treatment.
Is the ELAS procedure suitable for everyone?
Dr. Bardwil can tell you if the procedure is an option for your vein problem.
How long will the treated vein remain shut?
When using the laser to close the vein, the vein should remain closed permanently more than 95% of the time.
What happens to the treated vein left behind in the leg?
The vein simply becomes a fibrous tissue after treatment. Over time, the body will probably re-absorb this fibrous tissue. The treated vein is indistinguishable from other body tissue one year after the procedure was performed.
Is the ELAS treatment covered by my insurance?
Insurance coverage is determined by your particular plan. Coverage is based on medical necessity. Most insurance companies use Medicare guidelines to determine coverage. That is to say that if Medicare covers a procedure, then most insurances will do likewise. Medicare does cover ELAS procedures for treatment of venous insufficiency. Dr. Bardwil's staff will discuss your insurance coverage further at the time of consultation.
What is the Endovenous Radio Frequency (Closure®) procedure?
The Closure procedure is a minimally invasive treatment for superficial venous reflux. VNUS, the company that developed this device, got FDA approval in 1999. Although they like to credit themselves with being the first to use heat to close the saphenous vein, in Europe a surgeon presented a paper on the use of laser to close the saphenous vein in 1989.
How does VNUS Closure work to treat venous insufficiency?
The mechanism of action is similar to the laser, in that it is placed in the vein and uses heat to close the vein. The device is cumbersome. The reported long-term results are inferior to laser, and the reported complication rate is higher.
How is the VNUS Closure procedure different than laser?
The technique is similar. The ultrasound is used to guide placement of each device. Both laser and VNUS Dlosure involve closing the vein as opposed to removing it. The original Closure device was awkward, and failure rates were much higher than laser. Improvements were made. Although the procedure is less cumbersome, failure rates remain high, and reported risk for complications such as blood clots are higher than laser. Although we have the VNUS Closure device, we no longer use it, as we feel that laser technology is now far superior.
What is Ultrasound Guided Sclerotherapy?
Ultrasound Guided Sclerotherapy is a very effective method of treating varicose veins. Utilizing ultrasound, the varicose vein is visualized on a screen as Dr. Bardwil precisely guides the placement of a needle directly into the diseased vein. A sclerosing agent is injected into the veins. This causes an irritation to the inner lining of the vein, resulting in closure of the vein. The number of treatments varies depending on the severity of your condition.
The majority of persons who have Ultrasound Guided Sclerotherapy performed have satisfying results. Dr. Bardwil will determine if this procedure will be appropriate, effective and safe for you.
What are Venous Stasis Ulcers?
When reflux is left untreated over many years, the constant pressure backup may cause a leaking of inflammatory cells into the tissues. This process causes inflammation, resulting in brown stains on the skin. This is known as stasis skin changes which are an indication that the process has become more serious.
In cases where the stasis is severe, a breakdown of the tissue may result in a chronic venous stasis ulcer. Venous stasis ulcers are very difficult to treat and are chronic in nature, with the ulcer reopening just when you thought it was healed.
Venous stasis ulcers do not occur in all patients with varicose veins. Unfortunately, we cannot definitively predict who will go on to develop this complication. When skin changes begin to appear, the likelihood of an ulcer increases.
