Fellowship-Trained Surgeons Providing Minimally-Invasive Solutions

Surgical Associates offers a wide range of vein services and treatments to relieve the pain and embarrassment of varicose veins and spider veins. Our Vein Center has earned a reputation for offering advanced, minimally-invasive treatments tailored to the individual patient, with many procedures being performed in the comfort of our clinic’s accredited vascular lab.

Many people think of varicose veins as merely a cosmetic issue, so they delay treatment or avoid it altogether. However, if left untreated, varicose veins can lead to a more serious form of  vein (venous) disease called chronic venous insufficiency (CVI),  which can present more serious symptoms such as pain, ankle swelling, leg fatigue, and skin damage and ulcers.

Many have also heard horror stories of techniques from the past, which involved surgical vein strippings that led to lengthy hospital stays, lingering pain and extended time off work.

At Surgical Associates, we’ve perfected a wide variety of minimally-invasive procedures, many of which utilize the precision of ultrasound imaging. The benefit to patients is two-fold: recovery is less painful, and the results last longer! Many rapid-recovery varicose and spider vein treatments can be performed at Surgical Associate’s comfortable clinic and are usually covered by insurance. Most patients report reduced swelling and pain in just a few days, with veins becoming less visible in a couple of weeks. Surgical Associates vascular surgeons are fellowship-trained, and all lower peripheral interventions are performed within the comfort of our clinic’s angiography suite.

If you suffer from varicose or spider veins, contact us today for a free vein consultation to develop a treatment plan that’s right for you!

Before undergoing vein surgery, you will need to complete the following steps:

  • Consultation with Brenda Mittelsteadt, NP to evaluate the severity and necessity for treatment of varicose veins as well as to initiate the workup process
  • Color pictures of your veins (for the insurance company)
  • Ultrasound (done in the office) to evaluate the size of the veins, whether there is reflux (blood flow going in the wrong direction) in the veins
    • This helps us identify which treatment is the best option for you.
  •  “Conservative therapy” documentation (a step required by most insurance companies)
    • This may include three monthly visits with the nurse practitioner. We will help guide you through this documentation if it is needed.
  • Submission of paperwork to the insurance company for preauthorization
    • You won’t need to worry or fret about all the paperwork. Our team will take care of it for you!

Surgical Associates surgeons use the radio frequency ablation (RFA) procedure as their operation of choice for varicose veins. This procedure was chosen because it is performed through small surgical incisions, resulting in less pain and quicker recovery, while maintaining a level of results on par with more invasive procedures.

In RFA surgery, a small incision is made in the vein to be treated, and a small probe is inserted through a catheter. Then radio frequencies are emitted from the probe, and this energy heats up the vein. The probe is then drawn out of the vein, and the vein collapses behind the withdrawn probe. With the vein sealed shut, blood then naturally re-routes to healthy veins. After a year or two, the vein disappears. The results are comparable to vein surgery, but there is less risk and pain.

Unlike painful vein stripping surgery or laser ablation, the catheter delivers uniform, consistent heat to each treated segment, and temperatures do not exceed 248 degrees F. As a result, RFA causes less bruising and allows for rapid patient relief and recovery. The procedure is commonly performed in an office or an outpatient setting and is covered by most health insurance in the United States.

RFA has the following advantages over other existing treatments:

  • Minimally Invasive: RFA eliminates the need for groin surgery and general anesthesia. The procedure also results in little to no scarring and is generally performed using local anesthesia in Surgical Associates’ office.
  • Less Pain, Less Bruising, Faster Recovery: A 2009 study compared the experience of patients treated with RFA and those who received laser treatment. The study demonstrated:
    • Less pain, bruising and complications
    • Up to four times faster improvement in patients’ quality of life versus laser (based on a quality of life questionnaire)

Other studies have shown that patients receiving RFA treatment return to normal activity faster than those undergoing vein stripping.

Excellent Clinical Outcomes: RFA treatment has been shown in a prospective, international multi-center study to be 93% effective at three years using Kaplan Meier analysis.

The procedure is performed as a medical necessity as diagnosed by a trained vein specialist. It is not designed to address spider veins or cosmetic issues. However, the successful treatment can produce cosmetic improvements. As with any medical procedure, you should consult your vein specialist and review all safety information associated with any procedure.

Risks and Complications in RFA Surgery

As with any surgery, there are risks and complications associated with RFA surgery.

Complications vary from patient to patient. Talk with your surgeon about the percentage of patients who experience complications. Complications include but are not limited to:

• Pain in the incision area
• Bruising in the treatment area
• Skin discoloration in the treatment area

Sclerotherapy is a procedure used to treat varicose veins.

Sclerotherapy is one method, along with surgery, radiofrequency and laser ablation, for treatment of varicose veins and venous malformations. In ultrasound-guided sclerotherapy, ultrasound is used to visualize the underlying vein so the physician can deliver and monitor the injection. Sclerotherapy is often done under ultrasound guidance after venous abnormalities have been diagnosed with duplex ultrasound. Sclerotherapy, under ultrasound guidance and using microfoam sclerosants, has been shown to be effective in controlling reflux from the sapheno-femoral and sapheno-popliteal junctions.

Foam sclerotherapy is a technique that involves injecting “foamed sclerosant drugs” within a blood vessel using a syringe. The sclerosant drugs (Sodium Tetradecyl Sulfate or polidocanol) are mixed with air or a physiological gas (carbon dioxide) in a syringe. This increases the surface area of the drug. The foam sclerosant drug is more efficacious than the liquid one in causing sclerosis (thickening of the vessel wall and sealing off the blood flow), for it does not mix with the blood in the vessel and, in fact, displaces it, thus avoiding dilution of the drug and causing maximal sclerosant action. It is therefore useful for longer and larger veins.

Risks and Complications in Sclerotherapy

Complications, while rare, include:

  • Venous thromboembolism
  • Visual disturbances
  • Allergic reaction
  • Thrombophlebitis
  • Skin necrosis
  • Hyperpigmentation or a red treatment area

Most complications occur due to an intense inflammatory reaction to the sclerotherapy agent in the area surrounding the injected vein. Sclerotherapy is fully FDA approved in the USA.

After your surgery, you will need a ride home. As you recover, you will need to take the following steps to achieve optimal results:

  • Visit with surgeon 1-2 weeks after your procedure.
  • Depending on the procedure done, you may need an ultrasound of the treated vein(s) to assess progression of healing.
  • You may need to come back periodically depending on continued symptoms requiring further treatment, or you may be discharged knowing you can come back any time you need us.

The following is some general information regarding the VNUS Closure® procedure. For all other questions, and to determine whether you are a candidate for the Closure procedure, please make an appointment for a consultation.

What is superficial venous reflux?
Superficial venous reflux is a condition that develops when the valves that usually keep blood flowing out of your legs become damaged or diseased. This causes blood to pool in your legs. Common symptoms of superficial venous reflux include pain, swelling, leg heaviness and fatigue, as well as varicose veins in your legs.

What is the Closure procedure? 
The Closure procedure is a minimally invasive treatment for superficial venous reflux. A thin catheter is inserted into the vein through a small opening. The catheter delivers thermal energy to the vein wall, causing it to heat, collapse, and seal shut.

How does it work to treat superficial venous reflux?
Since valves can’t be repaired, the only alternative is to re-route blood flow through healthy veins. Traditionally, this has been done by surgically removing (stripping) the troublesome vein from your leg. The Closure procedure provides a less invasive alternative to vein stripping by simply closing the problem vein instead. Once the diseased vein is closed, other healthy veins take over and empty blood from your legs.

How is the Closure procedure different from vein stripping?
During a stripping procedure, the surgeon makes an incision in your groin and ties off the vein, after which a stripper tool is threaded through the saphenous vein and used to pull the vein out of your leg through a second incision just above your calf.

In the Closure procedure, there is no need for groin surgery. Instead, the vein remains in place and is closed using a special (Closure) catheter inserted through a small puncture. This may eliminate the bruising and pain often associated with vein stripping (i.e., that may result from the tearing of side branch veins while the saphenous vein is pulled out). Vein stripping is usually performed in an operating room, Linder a general anesthetic, while the Closure procedure is performed on an outpatient basis, typically using local or regional anesthesia.

Is the Closure procedure painful?
Although some people are more sensitive than others, patients generally report little pain. Some have said they can feel a little heat when the catheter is energized.

Will the procedure require any anesthesia?
The Closure procedure can be performed under local, regional, or general anesthesia.

How quickly after treatment can I return to normal activities? 
Many patients typically return to normal activities within a day1. For a few weeks following the treatment, your doctor may recommend a regular walking regimen and suggest you refrain from very strenuous activities (heavy lifting, for example) or prolonged periods of standing.

(Note: These results were obtained using VNUS Closure and VNUS ClosurePlus; RF products with expandable electrodes)

How soon after treatment will my symptoms improve?
Most patients report a noticeable improvement in their symptoms within 1-2 weeks following the procedure.

Is there any scarring, bruising, or swelling after the Closure procedure? 
Patients report minimal to no scarring, bruising, or swelling following the Closure procedure.

Are there any potential risks and complications associated with the Closure procedure?

As with any medical intervention, potential risks and complications exist with the Closure procedure. All patients should consult their doctors to determine if their conditions present any special risks. Your physician will review potential complications of the Closure procedure at the consultation.

Potential complications can include:

  • Vessel perforation
  • Thrombosis
  • Pulmonary embolism
  • Phlebitis
  • Hematoma
  • Infection
  • Adjacent nerve injury (tingling or numbness),
  • Skin burn

Is the Closure procedure suitable for everyone? 
Only a physician can tell you if the Closure procedure is a viable option for your vein problem. Experience has shown that many patients with superficial venous reflux disease can be treated with the Closure procedure.

Is age an important consideration for the Closure procedure?
The most important step in determining whether or not the Closure procedure is appropriate for you is a complete ultrasound examination by your physician or qualified clinician. Age alone is not a factor in determining whether or not the Closure procedure is appropriate for you. The Closure procedure has been used to treat patients across a wide range of ages.

What happens to the treated vein left behind in the leg?
The vein simply becomes fibrous tissue after treatment. Over time, the vein will gradually incorporate into surrounding tissue.

Is the Closure procedure covered by my insurance?
Many insurance companies are paying for the Closure procedure in part or in full. Most insurance companies determine coverage for all treatments, including the Closure procedure, based on medical necessity. The VNUS® Closure procedure has positive coverage policies with most major health insurers. Your physician can discuss your insurance coverage further at the time of consultation.

When can I drive after surgery?
After surgery you will be sore and have some limited mobility. Once you are completely off of any narcotic pain medications and once you feel you can quickly slam on the brake if you needed to, you can drive. Your surgeon will advise you on what to expect for the timing of this.

1. Lurie F. Creton D. Eklof B. Kabnick LS. Kistner RL. Pichot O, et al. Prospective randomized study of endovenous radiofrequency ablation (Closure) versus ligation and stripping in at selected patient population (EVOLVES study). J Vasc Surg 2003;38:207-14.