Vein Services
& Treatment

Premier Veins Michigan staff includes a board-certified vascular surgeon, Dr. Ajith Kadakol, and a board-certified dedicated vascular ultrasonographer.  Be rest assured that you will get the best possible care in a stress-free environment. Above all, all services are covered by insurance in most cases.

Initial Consultation

When you make an appointment and come to see Dr. Kadakol for the first time, you will have a consultation with him. During this clinical evaluation, he will talk to you and learn about your symptoms and examine you. At this time, a determination is made whether your symptom-complex fits vein pathology. If so, as per insurance rules, you will be asked to start your compression stocking trial. You will also be scheduled for an ultrasound test.  Most vein consultations, ultrasound tests, and treatments are covered by insurance companies. You may have a conversation with Dr. Kadakol and his staff about insurance coverage issues and any questions you may have.

Compression Stockings Trial

Conservative management trial including wearing Compression Stockings is a requirement of insurance companies for most patients. Typically a period of three months of trial with conservative management is required by insurance. Compression stockings are manufactured with graded elasticity so that they apply higher pressure at the ankle with progressively lesser pressure towards the top of the stockings. This helps in preventing the pooling of blood in the legs. We typically ask patients to wear compression stockings from morning to evening, during waking hours. Patients may take the stockings off when they go to bed at night. We also recommend patients elevate their legs whenever they are in a bed or a chair and avoid periods of prolonged standing or sitting. After three months of trial, if compression stockings are not helpful and if the ultrasound shows backward flow in superficial veins, such patients are eligible for ablation treatment.
You may note that patients with certain symptoms are exempted by insurance from the compression stocking trial requirement. These symptoms include change of skin color or texture, bleeding from varicose veins, recurrent clotting of varicose veins, and current or healed ulcers.

Vascular Ultrasound Testing

Typically after the initial consultation if you are noted to have symptoms suggestive of venous insufficiency you start the compression stocking trial. You will be scheduled for an ultrasound test to look at the functioning of the valves in your veins. (Certain patients are exempted from compression stocking trials-see the section above on compression stockings to understand if those exemptions apply to you). This ultrasound test is done on a scheduled date in our office by our board-certified vascular-trained skilled and experienced ultrasonographer. We ask patients to hydrate themselves well starting from the day prior and, avoid Coffee and Cigarettes on the day of the ultrasound. Dr. Kadakol reviews the results of the test and typically sees you in follow-up on the same day, immediately after the ultrasound. At this time a determination is made whether you have valve dysfunction in veins and the pattern and distribution of valve dysfunction in your leg are noted. If you have valve dysfunction in superficial veins and associated symptoms, you are generally eligible for laser, radiofrequency or Venaseal ablation procedures. However, you have to complete the Compression stocking trial period to determine if you can be helped by stockings alone.

Insurance coverage determination and prior authorization:

Most insurance companies cover vein ablation procedures when patients have appropriate symptoms that cannot be treated with compression stockings and ultrasound test proves valve incompetence. Our office spares no effort in obtaining prior authorization for these procedures from insurance companies so that patients are not liable for any insurance-covered services. However, you may note that if you have not met deductibles, you will be liable for that amount. 

Scheduling For Procedures:

Once prior authorizations are obtained, the patients are scheduled for the procedures that are most appropriate for them. These include Laser, Radiofrequency or Venaseal ablation of veins, depending on what procedures are covered by insurance companies. Patients may also be eligible for Micro-phlebectomy of disfiguring large varicose veins after the ablation procedure(s).

Vein Treatment

Arrival For Vein
Procedures

We ask patients to hydrate themselves well starting from the day prior and, avoid Coffee and Cigarettes on the day of the procedure. On the day of the procedure, we ask you to avoid breakfast if you are scheduled before 12noon. If your procedure is scheduled after noontime, you may have a light and simple breakfast before 8 am. Again, on the day you are scheduled for your vein procedure, we typically have you take two 5 mg tablets of Valium at home about an hour before the time of the procedure. You need to be accompanied by a person who drives you in and out of the office; you cannot drive yourself after taking Valium. On arrival at the office, if you are anxious, you may be asked to take an additional tablet of 5mg of Valium. After that, you will be taken to the procedure room where vein procedures are done under local anesthesia

Ablation procedures

As explained in another section of the is web-site(Vein Disease), vein pathology is caused by the backward flow of blood in the veins due to valve dysfunction. When the backward flow is in superficial veins (veins that are under the skin), such veins can be ablated. By ablating the veins, we close and render the veins non-functional and, hence, take the bad veins “out of the circuit”. This allows blood to flow smoothly back to the heart in the other normal veins. In the past, these veins were removed in a procedure called Vein-stripping. With modern technology and a minimally invasive approach, we close the veins from within and accomplish the same results. There are three kinds of ablation procedures performed in our office based on what is most suitable for you. Laser, radiofrequency, or Venaseal procedures accomplish the same result in different ways. All these procedures are done under local anesthesia using a numbing medication. At the end of the procedure, all that you will have is a small cut in the calf!

You may note that patients with certain symptoms are exempted by insurance from compression stocking trial requirement. These symptoms include change of skin color or texture, bleeding from varicose veins, recurrent clotting of varicose veins and current or healed ulcers.

Laser and Radiofrequency Procedures

During the procedure, you lay on your back on the procedure-bed in the operating room. After giving numbing medication in the calf, we enter the vein through a needle. A laser or radiofrequency probe is then inserted through the needle and advanced close to the groin, but not into groin. The entire procedure is done through the needle. When the laser or radiofrequency probe is in the right position, additional doses of numbing medication is administered through the entire length of the vein from the calf to the groin. The entire vein is made numb. After confirming the correct position of the laser or radiofrequency probe, the laser or radiofrequency machine is switched on and the vein is closed from inside. Then, the laser and radiofrequency probes are removed. This way the vein that was causing the backward flow and pooling of blood in the leg is closed allowing the other good veins in the leg to take the blood smoothly back to the heart in an unhindered fashion. At the end of the procedure, all that you will have is a needle hole or a small cut in the calf. After laser or radiofrequency procedure, an ACE wrap dressing is applied from the ankle to the groin and the patient is discharged home.

Watch the procedure video on the left

 

VenaSeal Procedure

In the VenaSeal procedure, after accessing the vein in question with a needle using a numbing medication, instead of the laser or radiofrequency probe, a small catheter is inserted into the vein and a medical glue is injected into the bad vein through its length thereby closing it. In the Venaseal procedure, other than a small dose of numbing medication in the calf, patients do not need any additional doses of numbing medication through the length of the vein. Currently, the VenaSeal procedure is covered only by a limited number of insurance companies including Medicare, Bluecross Blueshield of Michigan, Blue Care Network, Bluecross Blueshield-Federal, Priority Health, Paramount, and Medicaid. Only patients with these insurances are eligible for this procedure. In the future, we anticipate this procedure to become the most popular procedure.
After the VenaSeal procedure, all that the patient needs is a small Band-Aid in the calf. Most patients are able to tolerate the procedure very well and they are discharged home with the escort they came with. Patients should not drive themselves back home.

Watch the procedure video on the right

 

After care

After discharge home, we typically instruct the patients to go home and lie down or sit in a chair for a few hours with their leg elevated. Subsequently, they are allowed to walk around the same day. The day after, most patients can resume their normal activities. We typically tell patients not to indulge in any strenuous activity or excessive walking. People who work in sedentary jobs, such as desk jobs, can even return to work the next day. People who work in more physically intense professions involving standing and walking may need to be off for a couple of days. We typically do the vein procedures on a Friday so that patients can be back to work on Monday without having to take time off.
Most patients have minimal or no pain. At the most, some people may feel a pulling sensation in the thigh. We typically recommend Motrin (on full stomach only) or Tylenol. You may even use warm compresses with a heating pad at the site of pain. More than 95% of patients do not need any narcotic pain medications.

What Can You Expect After Vein Ablation Procedure?

Most patients notice that their legs do not feel heavy and achy. Their swelling goes down as long as they do not have any other condition contributing to the swelling. The varicose veins are expected to flatten out. If the varicose veins do not go down after the vein ablation procedure, most insurance companies cover a procedure called Micro-phlebectomies (see below for details).

Micro-Phlebectomies

Micro-phlebectomies are meant to treat large varicosities. Even though this is usually cosmetic and it is not necessary to remove the varicose veins, most insurance companies do cover Micro-phlebectomies if the veins do not become smaller in size after the ablation procedure. This is also an office-based procedure done under valium and local anesthesia. We do offer this procedure in our office. Small cuts are made over the prominent varicose veins under local anesthesia. Depending upon the number of prominent varicose veins a patient has, one may need up to 10 or 20 small cuts to remove the large varicose veins. After the procedure, the patient is discharged with a bandage from the ankle to the groin similar to the ablation procedure. Most patients tolerate this procedure very well. 

Long-term Care After Vein Ablation and Removal of Varicose Veins

People who develop venous insufficiency due to valve incompetence in the veins should work towards reducing the risk factors such as prolonged standing, obesity, etc. However, when certain risk factors cannot be mitigated, the most important intervention that helps prevent long-term recurrence is continued wearing of compression stockings. We recommend continued wearing of compression stockings during waking hours to help prevent long-term recurrence of venous insufficiency.