VEIN
DISEASE

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Arrival For Vein
Pocedures

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

Vein disease is a blood flow problem. When blood flows from the heart to the foot, it flows through the arteries. When it flows from foot back to the heart, it flows through the veins. Hence, In the veins, blood flows from the foot back to the heart against gravity. Blood, being a heavy liquid, has a tThere are three kinds of ablation procedures performed in our office based on what is most suitable for you. As explained in another section of this website (hyperlink to vein disease segment, “What Causes Vein Disease?”), vein pathology is caused by backward flow of blood in the veins due to valve dysfunction. When the backward flow is in the superficial veins (veins that are under the skin), such veins can be ablated. By ablating the veins we close and rendered non-functional and 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 minimally invasive approach, we close the veins from within and accomplish the same results. Laser, radiofrequency, or Venaseal procedures accomplish the same result in different ways

Radiofrequency Procedures

During the procedure, you are lay on your back on the stretcher in the procedure 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 probe or the 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 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.

VenaSeal procedure

In VenaSeal procedure, 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 thereby closing it. In Venaseal procedure, other than a small dose of numbing medication in the calf, you do not need any additional doses of numbing medication through the length of the vein. Currently, VenaSeal procedure is covered only by a limited number of insurance companies. In future, we anticipate this procedure to become the most popular procedure.
After 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. The patients should not drive themselves back home.

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 a desk job, 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 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. Most patients complain of a pulling sensation in the thigh at the most. We typically recommend Motrin (on full stomach only) or Tylenol. You may even use warm compresses with 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 conditions contributing to the swelling. The varicose veins are expected to flatten out. If the varicose veins do not go down after one month vein ablation procedure, most insurance companies cover a procedure called stab phlebectomies wherein small cuts are made directly over the varicose veins and the unsightly disfiguring varicose veins are removed. This is also an office-based procedure performed .

Stab Phlebectomies:

Stab 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 stab phlebectomies if the veins do not become smaller in size after a month after the ablation procedure. This is also an office-based procedure. It is done similar to the ablation procedures 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. In out experience , patients are happy with the removal of varicose veins and the results

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.