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A varicose vein is a large, bulging vein, which can be caused by a faulty valve, weak vein wall, or combination of both. Patients with varicose veins receive an evaluation to determine the underlying cause. In addition, the evaluation determines the major leak point, which is the basic origin of a varicose vein. The non-invasive evaluation usually consists of an in-office Doppler and color Duplex ultrasound examination.
The mostly common factors in the predisposition to varicose veins are heredity, pregnancy, and hormones. Varicose veins are chronic and progressive in most cases. They can be treated with sclerotherapy and endovenous methods such as Endovenous laser (E-LAS).
Though the exact cause of varicose veins is not known, it is known that the vein walls expand and the valves could be damaged in the process. The damage happens when the blood is prevented from moving up the legs and out of them and therefore the heavy weight of the blood is exerted on the valves, which can hold for a certain limit before they start leaking blood to the lower parts of the legs. As the valves lose their grip, they become damaged and more blood seeps into the lower leg parts where it pools in the vein and forms spots visible to the human eyes. When you have this type of vein you may also have symptoms of tiredness and "heaviness."
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Treatments of Varicose Veins
Sclerotherapy Treatment
How does sclerotherapy work?
The sclerosant solution agitates the lining of the vessel, causing it to swell and stick together causing the other surround veins to fade from view. Some vessels will pressurize the other veins under treatment. Depending on the size, the blood vessel maybe injected more than once as several vessels may be injected in one treatment session. The solution varies according to the size of the vessels involved. Larger varicose veins often underlie spider veins. In such cases it is thought that it is best to treat these vessels first.
Transillumination Guided Sclerotherapy (T.G.S)
Spider veins are fed by blood leaking from an underlying feeder reticular vein. Like the root of a weed, this feeder vein is not visible to the naked eye but is the lifeline of the spider veins (weed).
In Transillumination Guided Sclerotherapy, a fiber optic light is placed on the skin, allowing us to see the feeder vein. With the feeder illuminated, the sclerosing solution is injected directly and accurately. Oftentimes the spider veins disappear and their direct injection avoided.
The best candidates for sclerotherapy
Age is not problematic for undergoing Sclerotherapy. Pregnant and breast-feeding women are advised to postpone the procedure. Most spider veins caused by pregnancy will disappear on their own after delivery. Nursing mothers are mostly not to undergo Sclerotherapy because the effects of sclerosing solutions in the blood, milk, and the woman’s system might reach the new-born.
What to expect from sclerotherapy?
Sclerotherapy will make the protruding veins disappear. In several sessions, the optimal results are reached. Should also be known that the procedure treats only those veins that are currently visible; it does nothing to permanently alter the venous system or prevent new veins from surfacing in the future.
Planning a sclerotherapy treatment
The initial consultation will be about examining the legs, where the doctor may draw as simple sketch to map out the affected areas and the zones that require work. An examination to check possible serious problems causing swelling, sores or skin changes at the ankles. Ultrasound scanning will detect blood backflow in the venous system.
Where will the sclerotherapy treatment be performed?
Sclerotherapy of spider veins is a relatively simple procedure that requires no anesthesia, so it will be performed in an outpatient setting, most likely your doctor's office.
Endovenous Laser Ablation of Saphenous Vein Treatment (E-LAS)
How does E-LAS work?
ELAS is the FDA cleared Endoluminal Laser Ablation of the Greater Saphenous Vein. It’s a one-time procedure that is very quick, minimally invasive and causes little or no side effects. it is highly effective in eliminating varicose veins and is an alternative to the traditional method of stripping the vein.
The procedure takes 35-45 minutes to perform with the patient lying flat under local anesthesia, which means she/he will be awake and fully alert. Laser fiber is threaded into the problematic vein. Laser energy is injected into the vein at very dense quantities, causing it to collapse and seal shut. Once the laser energy has been applied, the fiber is removed and a compression bandage is put on your leg. The procedure eliminates the vein and relieves all kinds of discomfort or pain the patient might have had.
Until recently, the removal of the veins required actual stripping and surgical removal of the vessel which meant an overnight stay at the hospital and painful recovery period with possible scarring from the incisions and post-operative infections.
While the name may sound complicated, the process is quick, smooth, and minimally invasive to the body, causing little or no side effects and is proven as highly eliminative of varicose veins.
The best candidates for E-LAS
Patient with bulging varicose veins who has malfunctioning valves (reflux) in one of her/his Saphenous vein.
What to expect from E-LAS treatment?
Getting rid of the cause of the varicose veins in a an incision-less, minimally invasive procedure using local anesthesia.
Planning an E-LAS treatment
No special preparation. Almost like coming to a routine doctor’s appointment. You will be fully ambulatory and resume your usual activities after the procedure.
Where will the E-LAS treatment be performed?
In office or outpatient surgical facility.
Ambulatory Phlebectomy Treatment
How does ambulatory phlebectomy work?
This is a method that involves the removal of varicose veins from the surface of the legs, it is done in the office under local anesthesia. The procedure involves puncturing or making small incisions through which the varicose vein will be pull out. Veins are very collapsible vessels that are easily deflated from blood and drawn out through the incisions. Patients are able to walk normally after undergoing the procedure.
A compression bandage or stocking are worn after the operation, some are advised to walk or bike after the procedure as to ease the pressure off the veins.
Planning an ambulatory phlebectomy treatment?
The appearance of bulging varicose veins signifies the presence of further problems in the circulatory system. For better results to be reached, the underlying veins should also be treated in addition to the surface. Ultrasound scanning is also performed to assess the status of the underlying veins and the potential problems at hand.
The best candidates for ambulatory phlebectomy
Patients with ropey, tortuous bulging veins that did not respond to Sclerotherapy.
What to expect from ambulatory phlebectomy?
Getting rid of the bulging ropey veins in a scar-less, painless in office procedure.
Where your ambulatory phlebectomy treatment will be performed?
In office at the doctor’s Centre.
What Are Unwanted Hand Veins
The network of veins on the back of the hand is covered by a layer of fat and generally thick non-transparent skin, making these veins largely invisible. Genetic factors, loss of fat around the veins, and aging of the skin, make these veins prominent and unsightly to some. While this is not a medical condition, it may be a major cosmetic nuisance to some. Just like facial wrinkles, women feel bothered by hand veins, as they tend to reveal their seniority.
Turning back the hands of time has become a reality with the rising worries concerning the appearance of protruding veins on the hands due to aging and thinning of the skin fat. Some women go to extreme measures to hide their hands; exposure to the sun, thinning of the skin, and health problem lead to the appearance of protruded veins on the hands. Just like face wrinkles, unwanted hand veins can be treated properly.
Fortunately, we now offer an innovative in-office procedure to eliminate unwanted hand veins. With the advent of cosmetic facial surgery and skin rejuvenation techniques, these unsightly veins tend to stand out more stubbornly in women who have succeeded in achieving a younger look in other parts of their body. The treatments traditionally offered are those of sclerotherapy and miniphlebectomy.
Dr. Shamma, does not recommend sclerotherapy for hand veins due to poorer results and higher complication rates. We believe that a combination of miniphlebectomy and an innovative endovenous LASER treatment provide excellent and safe results. Endovenous refers to treating the inside of the vein rather than the outer wall.
What Are Spider Veins
Small veins near the surface of the skin are called "spider" veins also known as broken capillaries. Patients with spider veins usually do not need an extensive evaluation. Using modern techniques, spider veins can be treated with sclerotherapy methods as well as Endovenous methods (Endovenous laser aka E-LAS). The two types of facial veins most often treated are the smaller spider veins and larger reticular veins.
Spider veins usually appear as fine irregular red lines on the nose, cheeks and the side of the face. The larger reticular veins appear greenish blue in color and can be 2-3 mm in diameter. They are most often found along the cheekbone under the eye and at the temple areas. Reticular veins and large spider veins are best treated by ambulatory phlebectomy or sclerotherapy, while smaller spider veins are usually treated easily with laser. Minimally invasive office surgery called ambulatory or miniphlebectomy can be performed as well. Newer diode Lasers can effectively treat spider veins.
In the medical world, they are known as telangiectasias or sunburst varicosities, small thin veins that lie close to the skin surface. They are super-fine veins connected to a larger venous system, but not an essential part of it.
Several factors lead to the development of spider veins, such as heredity, pregnancy, anything related to hormonal shifts, weight gain and activities that require a lot of sitting or standing, and the consumption of several medications.
There are 3 basic patterns for spider veins:
- They may appear in true spider shape with a group of veins entangled and radiating outward from a central, dark point;
- They may be intertwined in form and twist, looking like overcrossing branches;
- They may be simple linear shapes, appearing like separate thin lines.
Linear spider veins usually appear on the knees, while the intertwining pattern is more common on the outer thighs in sunburst or cartwheel distribution.
Not to mistake spider veins with varicose veins, where the latter are larger than the spider veins, darker in color, and tend to be more bulging outwards; they also more commonly cause pain and discomfort besides more vein disorders.
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