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Frequent Questions

GENERAL INFORMATION ABOUT OPTIMA VEIN CARE

What services are offered at Optima Vein Care?
Optima Vein Care is a full service diagnostic and treatment medical facility specializing in the evaluation and management of all types of vein disease. We treat cosmetically important spider veins to large painful varicose veins. We also treat complications of venous disease such as venous ulcers.

GENERAL INFORMATION ABOUT VEIN DISORDERS

What are the symptoms of a vein disorder?
Several symptoms can indicate the possibility of vein failure.

What are varicose veins?
Varicose veins are abnormally enlarged blood vessels in which blood has pooled. Most varicose veins are the result of "valve failure" or a "leaking" vein. They usually are bluish in color, and may appear twisted. They are very common on the legs, especially among women. The tendency to develop varicose veins is thought to be linked with heredity and occasionally trauma. Women, especially those who have had children, and men and women who spend a lot of time standing seem to be most susceptible to developing varicose veins.

What are spider veins?
Spider veins are small varicose veins that appear as bluish or reddish lines just under the surface of the skin. More than half of patients with spider veins can experience aching, tingling and pain in the legs.

What causes varicose and spider veins?
Veins are the blood vessels through which blood flows back to the heart. Blood that flows into the legs must circulate and then return to the heart. Because the blood needs to flow uphill and against gravity, several mechanisms play a role to move the blood back to the heart. One way valves in the veins normally allow the blood to flow towards the heart and prevent the backflow of blood. If these valves weaken and cannot perform their job, blood may pool in the legs, causing veins to bulge and dilate. When blood pools in the larger surface veins, the result can be the blue, bulging type of varicose vein. When this happens to the tiny veins just below the skin surface, the result can be spider veins.

Is failure of the valves the only reason varicose veins develop?
Besides failure of the valves, several other problems can lead to varicose veins. The blood in the veins is actually squeezed by the leg muscles when an individual walks. This 'calf pump" can weaken or falter leading to pooling of blood and increased pressure in the veins. There is some evidence that weakening of the vein walls leads to varicose veins. The walls dilate and the valves are pulled apart and can no longer close allowing blood to reflux backwards down the leg.

Are varicose veins dangerous?
Varicose veins are usually not dangerous however varicose veins are often associated with pain, aching, itching, burning, a heavy or tired feeling in the legs, swelling, or cramps. In rare cases, varicose veins may signify a serious underlying disease of the deeper veins. If this is a possibility, it may be recommended that you undergo further evaluation. Some individuals will have little or no symptoms or will see there symptoms attenuated with time.

Who develops varicose veins?
Varicose vein disorders are very frequent in the general population. Studies reveal that 40% of American women may have varicose vein disorders by their forties or fifties. Studies also demonstrate, that if one or both of your parents has varicose veins, your chances for developing varicose veins are increased. Besides heredity, the two major risk factors towards developing varicose veins are gender and age. Females have a higher incidence of varicose veins and this is likely related to hormonal factors during puberty, pregnancy and menopause. Aging also coincides with an increase in the incidence of venous disorders.

DIAGNOSIS

How is vein failure diagnosed?
In most cases imaging with duplex ultrasound can furnish the information necessary to locate the areas in the veins where there is reflux. This is a simple exam where a probe is placed on the patients' skin. Not only are the veins visualized but the flow of blood can be assessed to determine abnormalities.

TREATMENTS

What are the treatments for varicose veins?
Treatment for varicose veins strives to relieve the symptoms and/or eliminate the troublesome veins. Regular exercise, such as walking is important to pump the venous blood through the veins. The legs can also be elevated episodically to relieve the pressure in the veins and to provide them with a "rest". Graduated compression hose can provide support for the veins and reduce reflux by improving venous flow. These treatments can reduce the symptoms of varicose veins. Methods to eliminate poorly functioning veins include sclerotherapy, ambulatory phlebectomy and endovenous laser therapy.

What is sclerotherapy?
Sclerotherapy is a procedure where a sclerosing solution is injected into the vein. The solution damages the internal lining of the vein causing the walls of the vein to stick together thereby ablating (closing) the vein. Sclerotherapy is considered to be the gold standard for the treatment of spider veins and recent improvements have extended its therapeutic indications to larger veins.

What is ultrasound guided sclerotherapy?
Very often the visible surface varicose veins and spider veins originate from reflux in deeper veins located beneath the surface of the skin. Over time the pressure causes the surface veins to dilate and become varicose or spider veins. To successfully eliminate the origin of reflux, the injections can be guided by monitoring the target with ultrasound imaging.

Is sclerotherapy effective for all spider veins?
About 20% of spider veins are the result of underlying venous reflux. Duplex scanning is indicated if this is clinically suspected upon evaluation. By eliminating the source, the pressure is reduced and the superficial dilated veins can then be treated

How is sclerotherapy planned?
Most people can undergo sclerotherapy safely and easily. Before you undergo the procedure, a history will be taken, and a physical examination will be given. Circulation and vein structure in your legs will be assessed using sophisticated noninvasive diagnostic techniques. The most important of these technologies is ultrasound duplex scanning. The anatomy and function of each vein is mapped out to determine the best treatment option for the best result. Conditions that exclude the use of sclerotherapy include pregnancy, breast-feeding or being bed-ridden amongst others.

How many treatments are required?
Regardless of the type of treatments needed, the number of treatment sessions varies depending upon the extent of vein disease, patient compliance with the post-treatment instructions and types of veins present. People usually have a spectrum of diseased veins which may require different treatment options. Spider veins and larger reticular and varicose veins may require a variable number of treatments.

How long does the procedure take?
The initial assessment usually takes about an hour. In most cases the actual sclerotherapy injections take approximately 15 minutes. The length and number of treatments needed to complete the therapy depend, however, on the number and size of veins to be injected. In most cases, treatment requires several sessions and their number will vary according to the results obtained at each session.

Are there any side effects from the treatment?
Side effects from sclerotherapy are rare and are almost always mild. Possible side effects may include slight itching, skin discoloration at the injection site, firm areas beneath the skin where large veins have been injected, and slightly tender and red skin over the varicose vein. All these side effects tend to clear up spontaneously. 
There are a few rare potentially serious complications. These include deep vein thrombosis, a severe allergic reaction to the sclerosing agents and an inadvertent arterial injection.

Do I need to wear compression hose with the treatment?
Opinions vary concerning this question. We feel the best results are obtained when compression hose is worn after the treatments. When spider veins are treated using sclerotherapy, we recommend wearing support stockings daily for one week. For larger varicose veins, we recommend wearing support stockings for a minimum of 3 weeks while the vein is healing. You will be able to resume your normal work and recreational activities immediately.

How long will it take for the treated vein to disappear?
Veins that are injected progress through several phases including some initial inflammation before they will gradually fade as the solution causes them to shrink, harden, and then disappear. Veins often appear worse initially as the solution damages the internal lining. The length of time necessary to see results will depend on the size of the vein and the pigmentation of the skin. Large varicose veins may require multiple treatments before the reflux is curbed, and they may take three or four months before they have completely disappeared.

Is sclerotherapy expensive?
Visual sclerotherapy is the usual treatment for spider veins, reticular veins and/or varicose veins which have no underlying source. A typical treatment session is 15 to 30 minutes. One or several veins maybe injected depending on the treatment strategy. It is not the number of injections which count nor the time! Correctly treating one feeder vein can have better results than treating several spider veins. Visual sclerotherapy for varicose veins may or may not be covered by health insurance.
Visual sclerotherapy for spider veins is not covered by health insurance, as these treatments are considered cosmetic. At Optima Vein Care, sclerotherapy is performed by a physician and a treatment session for spider veins is usually billed $400.00. Ultrasound sclerotherapy is employed to treat underlying veins, which are not visible on the skins surface. If these veins have reflux, which is responsible for dilated superficial varicose veins or even spider veins, they must be treated first to obtain the best and longest lasting results. A variable number of injections may be necessary in function of the vein to be treated and especially how it responds to treatment. Ultrasound guided injections are often covered by health insurance.
At Optima Vein Care we make all treatment costs as clear as possible to allow you to make an informed decision. Patient responses to treatment are variable and determining in advance the exact number of treatments to obtain the patients goal is always an educated estimate.

Wiil my insurance pay for the treatment?
Sclerotherapy for cosmetic reasons in not covered by health insurance. If your heath insurance judges that your condition qualifies as being ”medically necessary” they may participate in the costs, and more so if ultrasound guided sclerotherapy is indicated. We accept Medicare and most major insurance policies.

What is the goal of sclerotherapy?
The goal is to eliminate the source(s) of venous hypertension which are responsible for the symptoms in the legs which will also lead to an improvement in the appearance of the legs.

Can spider veins and varicose veins reappear?
Once a varicose vein or spider vein has been adequately treated, there is little chance it could reappear. Venous insufficiency is however an evolving condition and leads to the development of new varicose veins and spider veins in other locations or even in areas that have been treated.

What is mini-phlebectomy?
With this technique larger surface veins can be extracted manually through very small incisions.

What is endovenous laser therapy?
Endovenous laser therapy is a minimally invasive procedure done under local anesthesia at our office. Laser energy is used to damage and destroy the diseased vein. This procedure takes about 60 minutes and patients rapidly return to their normal activities.