It is important to remember that every patient’s recovery is different. The following guidelines should help answer many of your questions. Please do not hesitate to contact us with any additional concerns.
- You may resume normal activities immediately, but keep in mind that you might experience discomfort and bruising along the course of the treated vein. The bruising may be extensive in the thigh, but typically resolves in 1-2 weeks. If you find that you need to take something for pain relief, we recommend starting with 400mg of Ibuprofen every 6-8 hours, taken with food. If you are unable to take non-steroidal anti-inflammatory drugs due to an allergy or other medical condition, it is acceptable to take Tylenol instead; up to 500mg every 12 hours. If the pain you are experiencing seems severe (i.e. you cannot sleep or walk due to the pain) and it is not alleviated with the aforementioned medications, please call our office or answering service for further assistance. Typically with the phlebectomy portion of treatment, lighter activity levels may be warranted due to discomfort which is most likely to be experienced for the first 48 hours following treatment.
- Activity Restrictions: we typically recommend waiting 7-10 days before resuming a routine exercise program (i.e. running, weight lifting, cycling, etc.) We also recommend that you abstain from lifting anything over 20lbs. for the same timeframe. Until then, a modified workout is recommended (ex. walking is encouraged, treadmill use is fine – avoid an incline, no running or vigorous activity, no weight bearing exercises specific to the legs and/or arms as that exerts extra force onto the lower extremities). This is recommended because the vein is in the healing process, and any additional force may cause the treated vein to reopen.
- Our procedures are performed in a sterile environment in an effort to reduce the risk of infection. The risk of developing an infection as a result of these procedures is extremely low, however to further reduce the risk, we ask that you abstain from soaking in water (i.e. pools, hot tubs, or bath tubs) for 7-10 days after the procedure as this is the span for which you are most susceptible to infection. Showering is fine, but we ask that you wait 24 hours after your procedure before you remove the ace wrap (that was applied after the procedure) to shower.
- A sensation of tightness or pulling along the length of the treated vein is normal and to be expected. Prior to treatment, the veins are very flexible. However, once treated, the vein contracts and becomes scar tissue (typically perceived as a cord-like sensation). This can develop 1-4 weeks after treatment and resolves over time.
- Areas of inflammation can be common after treatment; these areas are red, swollen, tender and typically have an associated warmth sensation. As the treated vein closes, it can cause an inflammatory reaction. This can occur within 1 week after laser or radiofrequency ablation treatment, or 3-6 weeks after foam sclerotherapy treatments.
- Feeling hardened, tender knots in the areas of treatment is also normal; especially after having an ambulatory phlebectomy performed. We typically refer to this as “trapped blood”, and it occurs when blood is trapped within the treated vein and clots. These are not usually dangerous to your health, however they can be tender and warm to the touch. To relieve discomfort and promote the healing process, we recommend applying a warm, moist compress a few times a day, along with gentle massage. This will help to assist in the natural reabsorption of these areas (without intervention this will still occur, however these recommendations will expedite the process). Dependent upon degree of discomfort, there is also the possibility of having a thrombectomy performed to produce immediate relief. This would entail local anesthesia of the area, a stab puncture in the skin to express (squeeze out) the trapped blood. If you notice warmth or redness in the leg that is associated with severe pain (particularly when walking), fever or increased swelling in one leg that is new, please call our office or answering service immediately, as this could indicate a deeper blood clot (DVT) or infection.
- Skin discoloration can occur when the treated vein lies close to the surface of the skin. Once treated, the byproducts of the blood are absorbed by the overlying skin and they possess a staining component. Throughout the healing process this will lighten, though it can take several months depending on the size of the vein.
- Surface veins referred to as spider or reticular veins may remain after treatments. This could be due to many factors. Sometimes we are unable to address them due to insurance restrictions, as they typically only allow us a certain amount of sclerotherapy sessions per treatment plan. In addition, some veins require multiple treatments (to the same vein) to completely make that vein disappear. We will reevaluate these veins at the one month follow-up to determine whether or not more treatments are warranted. Sometimes insurance companies will pay for another round of visual sclerotherapy. However, if this is not an option, the doctor will discuss other treatment options with you.
- Some patients may experience a decrease and/or a loss of sensation localized to the treatment area, especially along the shin bone and/or ankle region. This is due to nerve irritation, and will resolve gradually throughout the healing process.
- Healing is still occurring, therefore continued improvement in your symptoms will take place. It is likely that some swelling may be visible but should diminish more within the next 3-6 months.
- Some patients still continue to feel a “tight” sensation in the treated vein, which is still normal at this point in the healing process, though it should start to diminish.
- Residual knots/trapped blood areas are possible, however you may notice that the tenderness that you initially felt in the area is starting to decrease. This is still normal, and continuing with warm compresses and gentle massages is recommended, as indicated previously.
- Around this point in time you may be scheduled to come in for your one month post procedure follow-up scan. New findings may be revealed on the ultrasound study, as this is the chronic nature of venous insufficiency. Whether or not further treatments are needed will be determined based on each patient’s individual symptoms and ultrasound study findings. All of this will be discussed with you in a consultation after your scan.
- Most people find that any residual symptoms from the procedures (numbness, discoloration, hardened areas, etc.) will have resolved, or significantly reduced at this point in the healing process.
- If you notice these symptoms are worsening in any way, or if new symptoms appear (such as aching pain, swelling, heaviness, fatigue, etc.) we recommend you make a follow-up appointment, as this could indicate underlying venous disease that may need to be treated.
- Venous insufficiency is considered a chronic and progressive disease process, therefore we have eliminated those veins that were initially seen to be refluxing, or not moving the blood properly. In time other veins may become dysfunctional, which is why we provide a surveillance service to our patients. We recommend reevaluation at the one month, six month, and one year mark post-procedure. After the first year is complete, you will need annual follow-up appointments. If at any time throughout the process you develop new or worsening symptoms, you should contact the office to make an appointment for evaluation.
In each of these similar procedures, a catheter is fed through the skin and into the area of the vein requiring treatment. In the case of the radiofrequency treatment, the catheter emits high-frequency radio waves that heat the vein tissue and collapse it. The body then naturally “re-routes” the blood supply around the closed vein, which later is reabsorbed into the body. In the case of laser treatment, the catheter emits light that heats the vein and collapses it. Both of these treatments are used to treat varicose veins but not spider veins.
Catheter Procedures Consist Of Four Principal Steps:
- Mapping the Saphenous Vein
A typical procedure begins with noninvasive ultrasound imaging of the varicose vein to trace its location. This allows our physician to determine the site where the ablation catheter will be inserted and to mark the desired position of the catheter tip to begin treatment.
- Inserting the Closure/Laser Catheter
Our physician then typically injects a volume of diluted anesthetic fluid into the area surrounding the vein. This numbs the leg, helps squeeze blood out of the vein and provides a fluid layer outside the vein to protect surrounding tissue. Then our physician accesses the saphenous vein or the appropriate vein. The Closure or Laser catheter is inserted into the vein and advanced to the uppermost segment of the vein.
- Delivery of Radiofrequency or Laser Energy and Withdrawal of the Catheter
Noninvasive ultrasound is used to confirm the catheter tip position and the physician then activates the RF generator, causing the electrodes at the tip of the catheter to heat the vein wall to a target temperature. As the vein wall is heated, the vein shrinks and the catheter is gradually withdrawn. During catheter pullback, which typically occurs over 1 to 2 minutes, the RF generator adjusts the power level to maintain the target temperature to effectively shrink collagen in the vein wall and close the vein over an extended length. The laser procedure is performed much the same way, using a different type of catheter. After local anesthesia is administered, a laser fiber is inserted through a catheter into the vein. The laser delivers short bursts of energy and the vein collapses around it. The collapsed vein soon shrinks and disappears. This technique rapidly treats the veins and takes 10–20 seconds to perform.
- Follow Up with Ultrasound Study
24–72 hours after your treatment, ultrasound imaging is used to check for a DVT (deep vein thrombosis).
Ambulatory phlebectomy is a minor surgical procedure aimed at removing unsightly and symptomatic superficial varicose veins. This procedure is performed in an office-based, outpatient setting using local anesthesia. Complete surgical removal of varicose veins segments may be achieved in a single session or in separate sessions depending on the location and how extensive the network of veins to be removed. Often, ambulatory phlebectomies are routinely performed at the same time as a laser or radiofrequency ablation. The technique is performed through tiny stab incisions that usually do not require skin sutures to heal. The bulging vein is extracted through these small incisions. The small slit-like incisions heal quickly and after 6-12 months, they are practically imperceptible. Temporary bruising or swelling may occur after the procedure. Recovery time is immediate and ambulation after this surgery is encouraged. A post-operative bandage is kept in place for 24 hours then replaced with daytime compression stockings for 1-2 weeks. The use of compression stockings aids in healing and reduces postoperative pain.
Each of these treatments is administered by syringe. Spider veins are treated by a safe and quick procedure called visual sclerotherapy. A chemical called a sclerosant is injected into the problem vein, filling it and initiating a reaction that results in vein closure. Blood is then naturally re-routed to other healthier veins around the affected area. The body eventually reabsorbs the treated veins.
Ultrasound guided foam sclerotherapy is designed for treatment of varicose veins. The sclerosant foams to fill the veins, which are often larger in diameter than normal veins due to pooling of blood; this is what causes the “ropey” or bumpy look associated with varicose veins. The physician administering the treatment uses ultrasonography—sound waves—to guide the procedure for maximum accuracy and safety. The foam solution has the consistency of shaving cream, which improves treatment in two distinct ways: First, the foam displaces blood within the vein, permitting the full strength of the sclerosing agent to be in direct contact with the vein wall for an extended period of time without any dilution effects. Second, the foam is visible via ultrasound imaging and can be easily tracked and guided to the source of the venous problem.
Visual sclerotherapy is used only for smaller, spider veins. It is administered “visually,” meaning your doctor does not require the use of ultrasound the guide the procedure. Sclerotherapy, or “injection therapy,” is the most common treatment for spider and varicose veins on the legs. During treatment, a mild chemical solution is injected into the incompetent vein or small vessel. The sclerosing agent irritates the walls of the vessel, causing it to collapse. The body then absorbs the vein and blood is re-routed to a healthy vein, restoring proper venous circulation in the area. A single sclerotherapy treatment session involves multiple injections. Patients describe the injections as feeling like a pinprick or mosquito bite. The number of treatment sessions needed will vary from patient to patient, depending on the number of veins treated, healing time, and the level of cosmetic perfection desired. Following injections, a compression stocking needs to be worn to help keep the vein closed. Normal daily activities can commence immediately after treatment.
- We realize that most patients do not like to wear compression stockings. One of the benefits to having the venous closure procedures performed is that you don’t have to wear compression stockings daily to find relief from your symptoms. However, due to the chronic nature of venous disease, continued compression stocking use is recommended, particularly during prolonged periods of standing or sitting. This is particularly important to remember if you are travelling in a plane or car for an extended period of time, as the stockings help reduce the risk of developing a blood clot (or DVT). Unless previously indicated by your physician, a knee high length stocking is suitable for long term use as opposed to the thigh high or panty hose style.