Laser and Pulsed Light treatments
Laser and Pulsed Light treatments are being used as an alternative to or to complement sclerotherapy for small veins or spider veins. They all work on the same basic principle: a light beam is pulsed onto the veins in order to seal them off, causing them to dissolve. Successful light-based treatment requires adequate heating of the veins. Several treatments are usually needed for optimal results. You should talk with a knowledgeable physician about which treatment may be best for you. For more information, please contact a physician from the Directory.
There are a variety of lasers and light sources being used to treat surface leg veins. These include, but are not limited to the long-pulse alexandrite, diode and long-pulse Nd; Yag lasers as well as intense pulsed light devices. These light devices are generally used with cooling of the top skin layer with cool gel, chilled air or other cooling methods. Cooling helps to reduce discomfort and lowers the risk of injuring the skin.
Millions of women and men are bothered by unsightly spider veins on their faces and legs. Spider veins or telangiectasias are those small red, blue and purple blood vessels that appear most frequently on the face and thighs. These spider veins are entirely asymptomatic and only of a cosmetic concern.
The best and gold standard treatment for spider veins is laser. Laser vein removal is an easy, fast, and effective way to treat superficial veins Laser therapy has been used in the medicine for more than 30 years. Advances in technology have helped developed many different lasers. The laser uses a focused beam of light. In the treatment of veins, the wavelength of light is targeted to the pigment in the blood. The laser heats up the small vein and destroys it. The laser beam is focused and does not damage the nearby skin tissue. Over a period of four to six weeks, the vein is reabsorbed by the body and disappears.
During laser therapy, light energy is delivered through a small laser hand piece to a targeted vein, in a series of brief pulses. The light energy is absorbed by the lining of the blood vessels and the blood within the blood vessels. The heat generated causes a coagulation (clotting) of the blood, which is subsequently absorbed by the body. The advanced laser treatments allow the delivery of a precise dosage of energy to each blood vessel.
All individuals are evaluated prior to laser therapy. Spider veins do not cause symptoms and are of a cosmetic concern only. For those who have symptoms, further investigation is done to ensure that they do not have varicose veins. Laser therapy is most effective for the very small spider veins and not used to treat large varicose veins.
There is no prior preparation required before laser therapy. The procedure is done in a doctor’s office or clinic and usually takes less than 10-20 minutes.
Only the very small superficial veins are treated with a laser. Generally no anesthetic is required for the procedure. The laser has a specialized chilled hand piece which acts to cool the surface of the skin while the beam from the laser penetrates the skin. Pulses of light energy are then administered in a sequential fashion.
During your treatment, you will feel a slight tingling sensation as the laser fires. If the individual feels any pain, a topical local anesthetic is applied 20 minutes before the procedure.
The majority of the treated spider veins will disappear within two to three treatments. The treatments can be spaced four to six weeks apart. If new veins appear, additional treatments are required for optimum results. The treatments may be spaced every three to four week intervals.
The skin above the veins will have a reddish, cat-scratch appearance. This generally disappears over the next two days
Patients are encouraged to resume all normal activities immediately. Final results may not be apparent for several months. Most patients are satisfied by the results in a very short time.
The risks associated with laser vein therapy are minimal. Your eyes will be shielded during the treatments. Most facilities use state-of-the-art cooling systems, thus the treatments are low risk and relatively pain-free
Depending on the size and number of veins, two to six treatments will be needed.
No, spider veins are only of cosmetic nuisance and not covered by medical insurance or Medicare.
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Surgery
Surgery was used mostly to treat very large varicose veins. With current modern techniques there is really no indication to continue treating this disorder with such an invasive method. Types of surgery for varicose veins include:
Surgical Ligation and Stripping - With this treatment, problematic veins are tied shut and completely removed from the leg. Removing the veins does not affect the circulation of blood in the leg. Veins deeper in the leg take care of the larger volumes of blood. Most varicose veins removed by surgery are surface veins and collect blood only from the skin. This surgery requires either local or general anesthesia and must be done in an operating room on an outpatient basis.
Serious side effects or problems from this surgery are uncommon.
• With general anesthesia, a risk of heart and breathing problems.
• Bleeding and congestion of blood can be a problem. But the collected blood usually settles on its own and does not require any further treatment.
• Wound infection, inflammation, swelling and redness.
• Permanent scars.
• Damage of nerve tissue around the treated vein. It is hard to avoid harming small nerve branches when veins are removed. This damage can cause numbness, burning, or a change in sensation around the surgical scar.
• A deep vein blood clot. These clots can travel to the lungs and heart. Injections of heparin, a medicine that reduces blood clotting reduce the chance of these dangerous blood clots. But, heparin also can increase the normal amount of bleeding and bruising after surgery.
• Significant pain in the leg and recovery time of one to four weeks depending on the extent of surgery is typical after surgery.
Ambulatory Phlebectomy – With this minor surgery, a special light source marks the location of the vein. Tiny cuts are made in the skin, and surgical hooks pull the vein out of the leg. This surgery requires local or regional anesthesia. The vein usually is removed in one treatment. Very large varicose veins can be removed with this treatment while leaving only very small scars. Patients can return to normal activity the day after treatment.
• Slight bruising
• Temporary numbness
For the ambulatory phlebectomy it is important to recognize that bulging surface varicose veins are often due to underlying problem veins. In order to get better results, these underlying veins should be treated, in addition to treatment of the surface veins . In the case of bulging surface veins, most physicians use duplex ultrasound to evaluate the underlying veins of the leg prior to developing a treatment plan.
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The ambulatory phlebectomy is a method of removing varicose veins on the surface of the legs. It is done in the office under local anesthesia. This procedure involves making tiny punctures or incisions through which the varicose veins are removed. The incisions are so small no stitches are required. Veins are very collapsible such that even large veins may be removed through the tiny incisions used in this technique. The patient is able to walk following the procedure.
After treatment, a compression bandage and/or compression stocking are worn. Your physician will advice you how long to wear any bandages or hose. Many physicians recommend that you walk or bike after treatment. This reduces pressure in the veins, increases the flow in the veins and reduces the risk of forming a blood clot.
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Endoscopic vein surgery – With this surgery, a small video camera is used to see inside the veins. Then varicose veins are removed through small cuts. People who have this surgery must have some kind of anesthesia including epidural, spinal, or general anesthesia. Patients can return to normal activity within a few weeks.
Can varicose and spider veins return even after treatment?
Current treatments for varicose veins and spider veins have very high success rates compared to traditional surgical treatments. Over a period of years, however, more abnormal veins can develop. The major reason for this is that there is no cure for weak vein valves. So with time, pressure gradually builds up in the leg veins. Ultrasound can be used to keep track of how badly the valves are leaking (venous insufficiency). Ongoing treatment can help keep this problem under control.
The single most important thing a person can do to slow down the development of new varicose veins is to wear graduated compression support stockings as much as possible during the day.
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Laser surgery |
New technology in laser treatments can effectively treat spider veins in the legs. Laser surgery sends very strong bursts of light onto the vein. This can make the vein slowly fade and disappear. Lasers are very direct and accurate. At CIAO BELLA we have the most efficient Laser to treat spider and reticular veins that has direct effects over the vein and minimizes damage to the skin. Most skin types and colors can be safely treated with lasers.
Laser surgery is more appealing to some patients because it does not use needles or incisions. Still, when the laser hits the skin, the patient feels a heat sensation that can be quite painful. Cooling helps reduce the pain. Laser treatments last for 15 to 20 minutes. Depending on the severity of the veins, two to five treatments are generally needed to remove spider veins in the legs. Patients can return to normal activity right after treatment, just as with sclerotherapy. For spider veins larger than 3 mm, laser therapy is not very practical.
• Redness or swelling of the skin right after the treatment that disappears within a few days.
• Discolored skin that will disappear within one to two months.
Rarely burns and scars result from poorly performed laser surgery.
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These methods for treating the deeper varicose veins of the legs (the saphenous veins) have been a huge breakthrough. They have replaced surgery for the vast majority of patients with severe varicose veins. This technique is not very invasive and can be done in a doctor’s office. |
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The doctor puts a very small tube called a catheter into the vein. Once inside, the catheter sends out radio frequency or laser energy that shrinks and seals the vein wall.
Healthy veins around the closed vein restore the normal flow of blood. As this happens, symptoms from the varicose vein improve. Veins on the surface of the skin that are connected to the treated varicose vein will also usually shrink after treatment.
When needed, these connected varicose veins can be treated with sclerotherapy or other techniques. |
The VNUS® procedure is a minimally invasive treatment alternative for patients with a condition known as superficial venous reflux, often resulting in varicose veins and other painful symptoms. Varicose veins are known for their distinctive blue color and bulging appearance on the skin. They resemble large, elongated striations, and they afflict an estimated 10%-20% of the adult population, the majority of which are women.
The procedure is an outpatient procedure performed in doctors' offices, surgical centers and hospitals. Local anesthesia with moderate sedation is used to ensure comfort during treatment. Using a single needle stick or a small incision, a thin catheter is inserted into the greater saphenous vein. The catheter delivers radio frequency (RF) energy to the vein wall, causing it to heat, collapse and seal shut.
Once the diseased vein is closed, other healthy veins take over and empty blood from your legs. As normal return flow is re-established, your symptoms should improve noticeably.
Following the procedure, the catheter is removed, a bandage is placed over the insertion site and your leg may be wrapped typically for 1 day to aid healing. Your doctor may ask you to walk, wear compression stockings, and to refrain from standing for long periods of time following the procedure to help speed your recovery. Many patients resume normal activity within 1-2 days.
Patient benefits of the VNUS Closure include minimally invasiveness, requiring no general anesthesia and the ability for most patients to walk out of the medical facility within hours. Stripping is often performed under general anesthesia which necessitates a longer time within the medical facility. Convalescence following stripping can take weeks and involve significant pain.
The VNUS Closure procedure is an alternative treatment option to the older more traditional vein stripping surgery . The Closure procedure is a new minimally invasive treatment for superficial varicose veins. The procedure involves placement of a thin catheter into the vein through a small opening in the skin and radio frequency waves are applied to the vein. This energy released from the radio frequency catheter causes the vein to heat and collapse, eventually causing disappearance of the vein.
When the valves in the vein become incompetent or defective, blood starts to pool in the leg instead of going forward to the heart. With time, the varicose veins increase in size and get engorged with blood. With the Closure procedure, the defective vein is treated with energy and there is no need for surgery. Once the diseased vein is treated, no more blood returns back to the leg and the varicosity disappears.
The Closure procedure is performed on an outpatient basis. The entire procedure is done under ultrasound visualization. The leg is cleaned and a local anesthetic injected in to the thigh area just above the knee. Then a small needle is placed into the vein and through it is guided a Closure Cather. When the catheter is in position, Radio frequency energy is applied to the vein and the catheter is withdrawn. The radio frequency energy heats up the vein and causes it to collapse. This leads to eventual closure of the vein
Following the procedure, a bandage is placed over the insertion site, and additional compression is provided to keep the area clean. One is encouraged to walk and resume all normal activities
The Closure procedure does not require general anesthesia and is a less extensive procedure than vein stripping . The recovery period is also much shorter than surgery. Patients treated with the Closure procedure have less postoperative pain, less bruising, faster recovery and fewer overall complications.
The Closure procedure takes approximately 45-60 minutes. After the procedure, patients are observed for an 1hour and then discharged home.
Some patients report mild pain during the Closure procedure. For those who feel any pain, a local anesthetic can be given to numb the skin.
The majority of individuals resume their normal activities in a day. Continued walking and a resumption of normal activities is highly encouraged. For those into sports and heavy lifting, a delay of 5-7 days should be appropriate.
Most patients report marked improvement in their symptoms within 1-2 weeks following the procedure. The cosmetic appearance usually takes a few more months.
Patients report minimal to no scarring, bruising, or swelling following the Closure procedure. Most of these disappear in 1-2 weeks.
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. Potential complications include:
1. vessel perforation
2. thrombosis
3. pulmonary embolism
4. phlebitis
5. hematoma
6. infection
7. paresthesia (numbness or tingling)
8. Skin burn.
The Closure procedure is only for large varicose veins. It is not suitable for spider veins. Veins which do not have leaky valves and which are normal should not be removed, because future open heart surgery may require the use of these veins. The Closure procedure has been used to treat patients across a wide range of ages.
Current data indicates that two years after treatment, the majority of treated veins remain closed and free from reflux. When the Closure procedure fails it is usually the fault of the device or the lack of experience of the physician.
The treated vein collapses and becomes fibrous tissue. Over time, the vein disappears.
Is the Closure treatment covered by my insurance?
If the patient with varicose vein has symptoms, many insurance companies cover the cost of the Closure procedure in part or in full. However, most insurance companies want a trial of stockings and exercise before surgery is undertaken.
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EVLT® uses targeted laser energy to close the vein shut and helps in making you look and feel better fast. The benefits of the procedure are relief from heaviness in the legs, in addition to an overall wellness of being. You will have the confidence to show off your legs, regardless of the weather or season.
The EVLT® procedure is a minimally invasive laser procedure in treating varicose veins without scarring. The laser energy minimizes the vein walls, shrinking them and closing the faulty vein so that the blood cannot flow through it. This eliminates the bulging of the vein at its source. After the treatment, the blood in the faulty veins will be diverted to the many normal veins in the leg.
The procedure takes about 45 minutes with local anesthetic and is done on an outpatient procedure basis.
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Less than 1 percent of patients develop deep vein thrombosis (DVT) from the laser ablation. Numbness has been known to occur in a small number of cases and on rare occasions can be permanent.
The procedure leaves no visible scarring, there is minimal postoperative pain, and a quick recovery period gains immediate relief from symptoms. Walking immediately after the procedure is encouraged. Minor soreness and bruising can be treated with over-the-counter, non-aspirin pain relievers as needed. It is well documented that EVLT® has a 98% initial success rate with excellent long-term results.
There are no risks from the laser treatment but just as a precaution against accidental firing of laser energy outside the body, you will be given a pair of special glasses to protect your eyes.
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EVLT is a procedure performed in an office/clinic, requires no incisions and no hospital stay is required. After local anesthesia is administered, a laser fiber is inserted through a small needle hole in the skin into the vein that runs along the inner thigh. The laser is then slowly heated and the vein collapses around it. The collapsed vein soon shrinks and disappears. This technique rapidly treats the large varicose veins in the thigh and takes less than 30 min's to perform. Patients can resume all their normal activities soon after the procedure.
The energy source from the laser irritates the vein walls, causes them to shrink and slowly disappear. The vein can no longer carry any blood through it. Because these veins are superficial, they are not important for transfer of blood to the heart.
No. The saphenous vein which is destroyed is not healthy in the first place and of no use. Because the vein is engorged and thrombosed, removal has no affect on the body. The deep veins, however, are not touched by the laser as they continue to carry blood away from the legs.
Surgery has been the traditional treatment for varicose veins, and is moderately painful and has a slightly longer recovery period. Surgery requires the use of anesthesia, leaves a scar and a few incisions. Sclerotherapy is not used to treat large varicose veins. Sclerotherapy for the saphenous vein has a high recurrence rate frequently requiring multiple treatments Other alternatives include ultrasound-guided mini sclerotherapy to destroy small branched veins and radio frequency electrosurgery.. Radio frequency electro surgery is similar to EVLT and is more of a physician choice and availability. So far the results are good and patients are satisfied
The vein is identified just above the knee and the entire leg area is cleaned with an anti septic ointment. The entire procedure is performed with ultrasound visualization of the vein. A small amount of local anesthetic is applied and a needle is place in the vein. Through this vein is inserted a small laser probe. The probe is then identified with Ultrasound to verify its position and then the laser is slowly heated with low energy. The laser energy damages the vein walls causing it to shrink and eventually leading to closure of the vein. The vein becomes fibrosed and does not carry any blood in it.The procedure is painless and takes about 30-45 minutes. Once the vein is burnt, the probe is removed and a small dressing is applied. A compression bandage is applied and worn for 1 week. The patient is usually discharged home in an hour.
The procedure leaves no scars, is associated with minimal postoperative pain, a rapid recovery period and provides almost immediate relief from symptoms. Minor soreness and bruising can be treated with over-the-counter, pain medication. After the procedure, all patients are encouraged to walk and resume their normal activities. A follow up appointment is made with the doctor in 1-2 weeks.
No. Generally the saphenous vein is only destroyed when it is thick and thrombosed. The vein in this state is almost useless and non- functioning and there is no harm in removing it. However, a normally functioning saphenous vein with no leaky valves should not be treated. A normal saphenous vein should always be preserved because it may be required in the future for open heart surgery.
As with any invasive procedure, there are potential complications. These rare complications include:
• there may be mild numbness around the thigh area
• there may be a pulling sensation which may last a week
• Phlebitis (redness and tenderness of the skin is quite common but is mild in nature and easily treated with over the counter pain medications. Most cases of phlebitis resolve in 3-7 days.
• Deep venous thrombosis. This is a very rare complications following Endovenous Laser Ablation. The best way to prevent this rare complication is to wear compression bandage or compression stocking and to walk right after the procedure.
• Infection at an incision site is a rare occurrence and usually resolves on its own.
• Bruising is a common feature after the procedure. The bruising is mild and resolves in a week.
Failure of the procedure does occur and may be related to the inability to place the probe in the vein. This does happen rarely. Other causes of failure are the inability of the laser to destroy the vein. The majority of technical failures are related to inexperience of the physician with the procedure.
No. One is usually given a pair of special glasses to protect the eyes. There are no other harmful effects from the v laser.
All data indicate that EVLT is a safe and effective procedure. The procedure does not involve any incisions and is relatively painless and has minimal complications.
The technique does not treat spider veins nor does it treat veins in the lower leg. Today, with an increased emphasis of preserving the veins for future use for either coronary artery bypass or some vascular procedure, EVLT completely destroys the vein and makes it unusable for future use.
EVLT when done in a symptomatic patient is a procedure which is reimbursed by most medical insurance and Medicare. Most insurance carriers require a trial of support or compression stockings and the need to take pain medication during the last six months. All Vein Centers will work with you and your insurance carrier through the predetermination process to determine medical necessity.
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