The Advancement of Modern Vein Procedures
A paradigm shift occurred when a physician had the bright idea of heating up a diseased vein to destroy it rather than major surgery to remove it. This laser heat technique and other developed ancillary techniques comprise modern vein medicine (sometimes referred to as “phlebology”). Unlike the out-dated stripping procedure, the modern vein procedures are minimally invasive and do not require hospitalization, risk of general anesthesia, or a long recovery period.
Despite this being minor surgery, for many patients the words “surgery” and “needles” invokes significant anxiety or outright hysteria. For this reason, Vein Specialists of Alaska (VSA) offers patients anti-anxiety medication administered immediately before the procedure(s). We never force such medications on our patients, but we find many are happy to take us up on the offer. Such medications induce a calming state and can even induce restful sleep while the procedures are performed. A few needle sticks are the worst of the procedures, and with the medication on board, most patients don’t even recall the needles. Even if patients recall the needles, the patients comment all the time that the vein procedures were far better than going to the dentist.
We perform the minor surgical vein procedures in an outpatient surgery center in our locations where available. IV anti-anxiety/sedation can be administered in outpatient surgery centers; otherwise, the option if performing procedures in an office procedure room is oral anti-anxiety/sedative medications.
Typically, a patient will have the endovenous laser (EVLT) procedure performed, and may need additional minor procedures performed depending on the diseased vein anatomy noted from the initial consult and ultrasound evaluation. The two other commonly performed procedures include micro-phlebectomy and ultrasound guided sclerotherapy. Click here for a detailed description of these procedures.
In either procedure location, the procedures are always performed under strict sterile technique—meaning the leg to be repaired is cleaned with surgical soap, sterile drapes are placed so that only that leg is exposed in the operative field, the surgeon and any needed assistant wear sterile gowns and gloves.
Most procedures from start-to-finish last an hour plus/minus a few minutes. If sedation is given, the patient is monitored until awake/stable to be released. The patient then walks out of the office or surgery center.
Convalescence is quick. Two days are preferred off-work to mostly elevate the leg to start the healing process, but non-strenuous activity is encouraged alternating with leg elevation. During the first 48 hours following procedure(s), compression and bandaging continues uninterrupted. Then compression is worn during upright hours for 2 weeks (overnight optional). Compression worn during this healing phase greatly reduces post-procedure soreness and also significantly speeds healing. Bruising and associated bruisy soreness is common for the first 1-2 weeks following procedure(s) and responds well to as-needed dosing of OTC anti-inflammatory medications (like Ibuprofen), the compression hose, and topical arnica, so narcotic analgesics are not routinely prescribed.
If micro-phlebectomy small incisions are made to remove the lumpy varicosed vein branches, typically they do not require stitches. They scab and begin healing almost immediately. Rarely do they leave a visible scar when fully healed. While healing, they may appear darker for some time, especially in darker pigmented patients, but usually fade with time. While darker, it is important not to over-sun/sunburn the incision marks. At worst, the incisions will look like a freckle.
Severe post-procedure pain is rare, compared to significant, often severe post-op pain and restrictions following antiquated vein stripping. What is common if the Great Saphenous Vein (GSV) is lasered in the inner thigh, is a strange annoying pulling, tight sensation onset usually 5-7 days after the procedure. This is completely normal as the lasered vein scars. It lasts about a week after onset, and is most bothersome when first up and about after prolonged sleeping or sitting. Anti-inflammatory medications, moist heat, and gentle stretching help the affected person move through this phase. No matter what is done/not done to address this aggravation, it passes completely in a matter of days. Usually understanding and patience are the only recommendations needed to combat this expected “side effect.”
Once the bruisy sore and tight/pulling sensations are resolved from healing of the vein procedures performed, usually resolved by 2 weeks out, the patient can typically tell a very profound difference in the symptoms of the vein disease that led them to treatment in the first place. This is most commonly relayed as a welcome resolution of chronic heavy/tired sensations and resolution of the myriad of described pain symptoms, restless leg symptoms if experienced, and even improvement or resolution of chronic swelling in the legs if experienced. [Refer to CEAP classification] (link to that on website). If the affected treated person also had chronically severely diseased lower leg skin with/without related skin ulcers, typically the vein procedures also result in prompt improvement in skin integrity, even healing chronic venous skin ulcers in very short order.
Patients are often astounded at how much better their legs look and feel following the procedure. Link to Testimonials
Complications. No procedure is risk-free. The good news is compared to outdated vein stripping, the modern procedures performed including EVLT are significantly lower risk, mostly due to not having to be performed in the hospital, not requiring general anesthesia, and getting patients moving immediately after. Click here for a list of potential complications.