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Treatment of varicose veins should be tailored to the individual's anatomic and physiologic abnormality. In general, treatment is directed at preventing reflux in the great and/or small saphenous veins (the primary surface veins running down the leg) and at destroying the branch varicosities. Each may be accomplished by either removal or ablation.

Compression Garments
Wearing compression garments may delay progression of disease or at least provide a level of comfort. They will not reverse existing varicose veins or venous insufficiency.

EVLA
(Endovenous LASER Ablation)

If high venous pressure from an abnormal great or small saphenous vein is contributing to varicose veins, then the saphenous vein should be addressed first, which traditionally meant a vein stripping.

EVLA was developed as a less invasive way to ablate the abnormal great or small saphenous vein without a major operation. For the great saphenous vein (the most common problem), a catheter is inserted in the vein near the knee using ultrasound guidance and through a tiny punture wound. Also using ultrasound guidance, the catheter tip is positioned near the saphenofemoral junction and the LASER fiber is inserted. A specialized tumescent local anesthesia procedure is used and the LASER is activated and the fiber gradually withdrawn. The connective tissue in the wall of the vein is altered, and as a result, the vein heals shut or is ablated. This relatively non-invasive office procedure takes less than an hour and is successful in greater than 98% of cases.

Normal activities are resumed immediately, although there is often some aching and a feeling of tightness for a week or two. Deep vein thrombosis, or a clot in the deep vein, is a risk with ELVA or surgical stripping, but is exceedingly rare (less than 1% in our experience.) Also, whenever the great saphenous vein is removed or altered, one must consider that it is one conduit used for heart bypass that would no longer be available.

Endovenous Chemical Ablation
(ECA, sclerotheraphy)
A common method of treating varicose veins today is to inject a sclerosing chemical into the vein, destroying its lining. The injection is guided by direct vision, palpation, or ultrasound. The leg is then bandaged tightly for a period of time allowing the vein to heal shut. several treatments are usually necessary. The method is primarily for branch varicosities.

The injection treatment is usually not completely effective in closing the varicose vein along its entire length. Pockets may remain, trapping a bubble of blood as a tender lump. This trapped blood can be aspirated, or if left alone, the body will eventually reabsorb it and it will go away. Sometimes skin stains will appear as stagnant blood leaches out of the vein. These are simply a cosmetic problem and will fade over several months. Serious complications are very unusual.

Surgical Stripping
Both the saphenous vein and branch varicosities may be stripped, or removed, with an operative procedure. This procedure has, for the most part, been replaced by less invasive office procedures.

Ambulatory Microphlebectomy
In some cases removal of varicose veins in the office, under local anesthesia, is preferred. This procedure, also known as stab avulsion phlebectomy, utilizes a number of very small 105 mm cuts and is an alternative to sclerotherapy.

SEPS
(Subfascial Endoscopic Perforator Surgery) PAPS
Large dilated surface veins and ulcers are occasionally related to damaged valves in the veins that connect the deep and surface systems. Our vein care specialists are trained in SEPS, which is a mini-invasive procedure where these abnormal perforating veins are interrupted through small puncture wounds using videoscopic technique, and PAPS, where the abnormal veins are treated with laser through puncture wounds.