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• Endovenous Laser Therapy (ELVT). Inland Vascular Institute is making available ELVT for its patients with Greater Saphenous vein varicosities, and insufficiency. Endovenous Laser Treatment is a treatment alternative to surgical stripping of the greater saphenous vein. A small laser fiber is inserted, usually through a needle stick in the skin, into the damaged vein. Pulses of laser light are delivered inside the vein, which causes the vein to collapse and seal shut. The procedure is done in-office under local anesthesia. Following the procedure a bandage or compression hose is placed on the treated leg. Not all patients with varicose veins are candidates for ELVT. Proper diagnosis and consultation with a vascular surgeon or interventional radiologist are essential in successful treatment of venous conditions.
The most common treatment procedures involve surgery or sclerotherapy. They may be used either alone or in combination. These procedures remove the bad veins and force the blood to flow through the remaining healthy veins. Depending on the extent of the problem, surgery can be done using local, partial or general anesthesia. Sclerotherapy does not require an anesthetic.
• Surgery. The most common procedure—"stripping"—usually is done under local or partial anesthesia and performed on an outpatient basis. A flexible device is passed into the vein at knee level and removed through an incision at the groin. Smaller tributaries of these veins may be either stripped or removed, using the vein-hook crochet technique through multiple tiny incisions about 1/8 of an inch long. These incisions cause minimal scarring.
While spider veins cannot be treated surgically, they sometimes fade when the larger veins feeding them are removed. The residual spider veins can be treated with sclerotherapy. The benefit of vitamin K-based cream or horse chestnut seed extract in the treatment of spider veins has not been scientifically documented.
• Sclerotherapy. Used to treat spider and varicose veins, this procedure usually requires several treatment sessions. To treat spider veins, a fine needle is used to inject a sclerosing agent— hypertonic saline (salt solution) or other agents such as Sotradecol (sodium tetradecyl sulfate)— into the vein. The solution irritates the lining of the vein, causing it to swell and stopping the blood from flowing. The vein turns into scar tissue that is gradually absorbed by the body. Larger veins may be treated with higher concentrations of the sclerosing agent.
Following the procedure, the leg must be supported to allow the vein walls to stick together. This is done by using compression bandages or graduated support stockings.
• Laser and pulsed light treatments are used to treat smaller spider veins, especially on the face and the upper body. Red spider veins, also called telangiectasias, respond well to laser treatment on the face. Even though there are promising newer lasers in development, at the present time, this procedure is of limited value for the treatment of the lower extremity spider veins.
Your treatment should be based on several factors, including:
• Your physician's diagnosis
• The size of the veins to be treated
• Your treatment history
• Your age
• Your history of allergies
• Your ability to tolerate anesthesia and surgery
How much pain you will experience depends on your tolerance for pain, how extensive the treatment is, the part of the body to be treated, and whether complications arise. You won't feel any pain under anesthesia, but once the anesthetic wears off, you may feel some discomfort near the incisions.
If you are undergoing sclerotherapy, the degree of pain will depend on the size of the needle, the type of solution used and the doctor's experience. Sclerotherapy is relatively painless, although hypertonic saline often causes burning or cramping for several minutes after it is injected. To ease the discomfort, some doctors mix a local anesthetic in with the solution.
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