Your physician has determined that you have saphenous insufficiency will need an endoluminal ablation. Insufficiency is mainly caused by heredity. The valves in the superficial veins are not working correctly and because of this, blood is not flowing in the right direction. Over time, the blood pools causing the veins to dilate and create the bulging veins that are appearing on your leg. Spider veins are also a result. Over longer periods of time, swelling can occur and in some cases, ulcerations will form that will not heal until the saphenous vein is taken care of. Other symptoms you may be experiencing include pain, aching, itching, fatigue, restless leg, cramping, and spontaneous bleeding.
To correct the problem, we use a laser or radiofrequency catheter to close the saphenous vein. All procedures are done in the office using a local type anesthetic called tumescent. Tumescent anesthesia is a very dilute solution of lidocaine. Tumescent has bicarbonate in it which makes the solution very comfortable without the burning sensation. It is very fast acting and lasts for several hours after the procedure is over.
During the procedure, you will feel a small stick of a needle to numb the area. Through that numbed area, a small needle is inserted into the vein followed by a small guide wire, catheter and finally the laser fiber or the radiofrequency catheter. Once that is in place, you will experience a few needle sticks and some pressure while the numbing medicine is placed around your vein. Once you are numb, the laser or radiofrequency is activated while slowly pulled out. The heat from both devices causes the vessel wall to be damaged and blood is not able to flow the wrong way anymore. Over time, the vein becomes a scar. This procedure improves the circulation in the leg by ensuring that blood is traveling in the correct direction. Symptoms improve quickly and many patients state they see and feel relief in a matter of days.
After the procedure, you will be wrapped in a special wrap that can be removed the next day. Compression stockings will be worn after that for the next 2 weeks. Many times, an anti-inflammatory medication, such as Ibuprofen, is given. You may resume normal activities within 2 days. Bruising is normal and mild discomfort is common.
Your physician has determined you need a micro-phlebectomy to eliminate the large bulging varicose veins. This can be done at the same time as the endoluminal ablation but is frequently staged because sometimes these veins will get smaller after the ablation. They typically do not go completely away and therefore, the phlebectomy will give you the best cosmetic result.
The area will be marked with a pen while you are standing. The area will be numbed using a very dilute solution called tumescent with a series of very small needle sticks to inject the medication. Once you are numb, very small incisions (2mm) are made and the bulging veins are gently removed. The incisions are so small that stitches are not required. You will be wrapped in a special wrap that can be removed the next day. Compression stockings will be worn for 2 weeks. Little to no discomfort is expected after the procedure. Normal activities can be resumed in 2 days.