The vein that is treated by EVLT remains closed for the rest of your life, and as time passes, it gets absorbed to a certain extent by the body. Sometimes, an ultrasound performed months or years later can see the vein remain closed as a “cord” without a lumen. Other times, the ultrasound cannot even locate the closed off veins.
The fact of the matter is that there are already “other veins” that are currently directing the blood flow back to the heart, because the refluxing veins are currently sending the venous blood back down the leg (when standing or sitting for long time). When the abnormal vein is shut off, these other veins will have an “easier time” carrying the blood out of the leg.
An important innovation about the EVLT is that it can be performed with the patient wide awake. It does not require general anesthesia. It only requires local anesthesia, i.e. injections with lidocaine-containing solution. You will be given “sedative pills” such as Lorazepam the night before and 2 hours before the procedure, but for most patients, even these are not necessary. You will also be prescribed an anesthetic “cream” as a way of making the skin sensitivity “dull” to minimize the discomfort associated with needle injections. But then again, for many patients, even this is not necessary. General anesthesia is a potentially dangerous undertaking for patients, and it is completely unnecessary for this procedure. In fact, in Advanced Vein Care Center, we have performed over 3,000 EVLT’s in the past several years. We have never had to use anything more than local anesthesia to perform those procedures, even in the most anxious patients prone to panic attacks.
We do all our EVLT procedures in one-hour sessions. We have learned from performing over 3,000 procedures that one hour is the optimal time for completing the procedure. Beyond one hour, there arises a greater chance of issues arising from patient’s back pain, hip pain, bladder incontinence, fatigue, etc. If you have very complex venous reflux anatomy where there are more than 2-3 veins that need to be treated, you may require two EVLT sessions.
For the same reason as above, we treat one leg at a time, one week apart. Treating both legs in the same setting takes too much time and discomfort during the procedure. There are tissue trauma, post procedural pain and discomfort that follow each EVLT procedure, such that treating both legs simultaneously can be overwhelming for most patients.
There can be mild to moderate pain associated with post-procedural inflammation. We use a low-frequency laser technology to minimize post-procedural pain. Usually most patients tolerate pain with anti-inflammatory analgesics such as Ibuprofen alone, or Ibuprofen with small amounts of opioid analgesic such as oxycodone or hydrocodone (active ingredients of Percocet and Vicodin). We seldom have patients who require re-fill of these pain medications.
The veins that we treat with EVLT will stay closed with a success rate of 95 to 98 %, long-term. If your leg pain and discomfort are caused by venous insufficiency, then EVLT will result in significant improvement in pain and discomfort in over 80% of patients. If your concern is that of leg swelling, the following is what we have observed. After EVLT, the pain and discomfort and the “pressure” associated with your swelling in the leg will improve in greater than 80% of the time. But the “disappearance” of swelling will depend on the nature of your swelling, such as the cause of your leg swelling above and beyond the refluxing veins (such as obesity, heart/liver/kidney conditions, etc.), the duration of your leg swelling, etc. In some patients, the appearance of swelling does not return to normal even though the pain and discomfort is alleviated.
In the U.S., there are only two drug solutions that are FDA-approved for sclerotherapy. One is sodium tetradecyl sulfate (Sotradecol®) and the other is polidocanol (Asclera®). Hypertonic solution used to be used widely, but no longer. We use Sotradecol®.
It is important that you have a detailed and open discussion about the true effectiveness of Sclerotherapy, so that you may develop a realistic expectation of the cosmetic outcome from the procedure. Information presented in the following paragraphs should be reviewed in detail during your initial consultation. Sclerotherapy is not magic. It is far from being 100% effective. Any physician who tells you that “Your spider veins will be all gone before the summer” is not telling you the whole truth. If you can imagine, we the clinicians inject a drug solution into these tiny veins, and we depend on a number of factors for a satisfactory outcome. One is your body’s reaction to these sclerosant agents, which is, after all, a chemical irritant. Another is the local micro-anatomy of these tiny veins, and how they are connected with the underlying larger veins. These are just a couple of factors that determine the outcome. As such, the effectiveness of Sclerotherapy to make the veins disappear is widely variable from patient to patient, and even from various parts of the leg. Because of these reasons, studies have shown that Sclerotherapy’s effectiveness ranges from 50% to 80%, and up to 10% of patients do not respond. The further down the leg the spider veins are located, the more difficult it seems to eradicate them, such as around the ankle/foot area.
It is very important that before your commence your Sclerotherapy, that there is no underlying venous insufficiency. If you have an underlying refluxing vein that is feeding the spider veins, the veins will keep coming back. You should see a vein specialist if this occurs.
The main benefit, of course, is to eliminate spider veins with sclerosing injections that will turn ugly red, purple, blue spider veins into less noticeable colors.
There are a number of potential complications with Sclerotherapy. These include skin hyperpigmentation, skin ulcer, micro-thrombus (tiny inconsequential blood clots-trapped inside the spider veins), allergic reaction, etc. During your initial consultation, the whole spectrum of risks will be discussed in detail. A particularly disappointing outcome maybe that of skin hyperpigmentation. Sometimes a segment of spider veins can appear “black” because of a small trapped blood clot inside the vein, and other times, there can be a dark brown line in place of old veins because of deposit of hemosiderin from blood in the skin. Although these complications are not common, it is important that you understand that Sclerotherapy will not magically make your veins disappear. It is very important that you consult a vein specialist who is experienced and upfront about realistic expectations before you commence your treatment.
No. Only those patients who have bumpy veins that ‘stick out’ on the skin require phlebectomy.
Phlebectomy requires total focus and concentration on the part of the surgeon while utilizing fine-tip instruments through the micropuncture skin opening. Usually only 10 to 20 vein segments can be removed at a time, in one-hour sessions. Some patients have a “plethora of veins” on their leg requiring more than one session. This will be determined during your office visit when you get to tell Dr. Lee the extent to which you want your veins removed, and that will determine the treatment sessions it will take to remove your veins.
Usually we try to schedule phlebectomy within days after EVLT, so that everything on your leg is completed within a week if possible, even if more than one phlebectomy session is required.
Before the removal of veins starts, the skin and the subcutaneous tissue over the vein will be anesthetized with a local anesthetic infusion. This part will cause transient, mild pain as all local anesthetic injections do. But this will render the skin and the vein painless during the rest of the procedure. So, the removal of the vein itself does not hurt.
For almost all patients, phlebectomy is performed within days after EVLT, and the answer to this question is the same as that given for EVLT procedure (see the Q&A on this topoic in EVLT section). Generally speaking, the day after phlebectomy, most patients can return to work, even to a moderately strenuous activity, wearing compression stockings.
Since 2013, we’ve been making one leg at a time beautiful. Healthy legs are the key to a healthy lifestyle
If you have general, non-medical questions, please use this form to contact us. If you have personal medical questions, please call the office and/or schedule an appointment.