We have collected a number of frequently asked questions that have been asked by our patients through the years. We are providing them here as a resource for you. If you have any questions that are not answered here, please feel free to contact us directly.
Q - Does endovenous laser ablation help venous ulcers?
A – Venous ulcers occur when the venous pressures within the leg increase to the point that the nutrition to the skin is compromised. The ulcers are typically located just above the ankles. The high venous pressures are due to malfunctioning leg veins. The malfunctioning veins are located during an ultrasound exam and are subsequently destroyed with the endovenous laser. The venous pressures within the leg then normalize and the venous ulcers typically heal within a matter of weeks and rarely recur. Patients with venous ulcers are among the most rewarding patients that we treat because they are so thankful to finally be rid of their chronic wound.
Q - How does endovenous laser ablation treat varicose veins?
A – The varicose veins seen on the skin surface are most commonly the result of a malfunction in a vein that can’t be seen. Ultrasound is used to identify the underlying source of the varicose veins and endovenous laser ablation is used to destroy it. The laser fiber is placed within the abnormal vein using ultrasound guidance and laser energy is used to seal the vein shut. The vein that is treated with the laser does not have to be removed from the leg. It is simply absorbed by the body over time. The varicose veins on the skin surface are then removed thru micro-incisions that leave little to no mark on the skin. No stitches are required. Local anesthesia and mild sedation are used to ensure a pleasant patient experience during the endovenous laser procedure.
Q - How does the blood get back to my heart if the varicose veins are removed?
A – Varicose veins are abnormal veins that no longer function as they should. Normal leg veins return blood to the heart in an orderly fashion. Varicose veins allow blood to pool in the legs which result in symptoms including leg pain, leg cramps, and leg swelling. Once the varicose veins and their underlying source are treated, the body redirects the blood thru healthy veins and the symptoms resolve. We have many miles of veins in each leg that can easily assume the load once the problematic varicose veins are treated.
Q - How is the endovenous laser procedure for varicose veins done?
A – The laser fiber is very small, about the size of a piece of spaghetti. It is placed into the abnormal vein that is the underlying cause of the varicose veins. A local anesthetic solution is then placed along the course of the laser fiber. The laser fiber is activated and is slowly pulled down the target vein. The abnormal vein is destroyed by heat generated by the laser. The vein is basically welded shut. The patient is comfortably sedated during the procedure. The endovenous laser procedure typically takes about 30 minutes.
Q - I had an endovenous laser ablation but my varicose veins never went away. Why did this happen?
A – Endovenous laser ablation is used to treat the underlying cause of varicose veins. The procedure prevents the formation of subsequent varicose veins within the treatment area. The existing varicose veins at the skin surface should then be removed thru small incisions (micro-phlebectomy). Small varicose veins may disappear following the endovenous laser procedure but large varicose veins will not. They must be removed by micro-phlebectomy. The vast majority of my varicose vein patients are treated with a combination of endovenous laser ablation, micro-phlebectomy, and sclerotherapy.
Q - I had sclerotherapy for spider veins and now have brown discolorations on my skin where the spider veins used to be. Why did this happen?
A – Sclerotherapy involves the chemical destruction of a vein. The larger the vein, the more blood is present at the time of its destruction. Blood may clot (coagulum) within a sclerosed vein and can subsequently stain the skin. The pigment (iron) within blood is responsible for the staining (hemosiderin staining). We have patients come back 1 to 2 weeks after a sclerotherapy session so we can express any coagulum. We also have our sclerotherapy patients wear compression hose for 5 days after the procedure. Both have been shown to decrease hemosiderin staining. We have a laser treatment to remove the staining should it occur.
Q - What are the risks of endovenous laser ablation for the treatment of varicose veins?
A – The risk everybody asks about is the risk of blood clot. This risk is very low, less than 1%. Bruising and redness of the skin along the course of the treated vein are more common. The bruising and redness typically disappear over 1 to 2 weeks. 50% of patients will notice a small amount of skin numbness directly above the course of the treated vein.The numbness is a temporary occurrence and usually completely resolves. Risks are significantly reduced when the procedure is performed by a physician who is highly experienced with endovenous laser ablation.
Q - What are your qualifications for performing endovenous laser ablation for varicose veins and how many have you done?
A – Dr. Adams and myself are Diplomats of the American Board of Phlebology and the American Board of Anesthesiolgy. We have performed over 5,000 endovenous laser procedures. I founded Mississippi Vein Institute in 2008 with the intent of creating a medical practice that specialized exclusively in the treatment of spider veins, varicose veins, and venous ulcerations. I wanted to create a center of excellence for the treatment of those particular conditions. We have now treated thousands of patients from all over Mississippi and have earned a reputation for exceptional treatment results. What makes Mississippi Vein special is the fantastic team that supports Dr. Adams and myself. We are all dedicated to achieving the absolute best possible treatment result for our patients. Dr. Manning.
Q - What is the recovery time following the endovenous laser procedure for varicose veins?
A – The majority of patients will undergo a combination of endovenous laser ablation to treat the source of their varicose veins, micro-phlebectomy to remove the varicose veins themselves, and sclerotherapy to clear associated spider veins. In this case, patients are able to return to work and full activities within 2 days. Occasionally, the endovenous laser is used alone and, in this case, patients are able to return to work and full activities the next day. Patients wear a compression hose for 1 week after the procedure.
Q - What will happen if I don’t treat my varicose veins?
A – Varicose veins are a component of a disease process called chronic venous insufficiency. The disease process is relentlessly progressive and will worsen over time. The number of varicose veins and their associated symptoms will increase. The speed of progression will be dictated by many factors including genetics, occupation (prolonged standing and sitting), pregnancy, body weight, and use of compression hose. Compression hose treat the symptoms but do nothing for the underlying cause of varicose veins. The underlying cause of varicose veins is best treated with endovenous laser ablation.
Q - Will I develop new varicose veins after my existing ones are treated?
A – The most common cause of varicose veins is an inherited disorder that affects the ability of leg veins to return blood to the heart. Varicose vein disease is a chronic disorder that can recur in another location following successful treatment in a previous location. The most effective treatment is a combination of endovenous laser ablation to treat the underlying cause of varicose veins and micro-phlebectomy to remove the varicosities themselves. The recurrence rate within the treated area using this treatment combination is less than 1%.
Q - I only have spider veins. Does this mean I will eventually develop varicose veins?
A – Spider veins can exist without varicose veins and are not a reliable predictor of varicose vein formation in the future. The tendency for spider vein formation, like varicose veins, is inherited. Spider veins can exist as an isolated anomaly or they can be a precursor of more severe venous disease to come. The experience of your parents will, to a large degree, predict your chances of eventually forming varicose veins. Foam sclerotherapy is the most effective treatment for spider veins. Maintaining a healthy weight and routine exercise are your best defense.
Q - I have varicose veins and my legs frequently ache and cramp. Why is this happening?
A – Varicose veins are due to a malfunction in how leg veins transport blood back to the heart. Blood abnormally pools in the leg veins as a result and causes them to significantly distend. The engorged leg veins push against surrounding nerves and leg pain can be the result. Blood is returned to the heart from the legs by the power of muscle contraction. The calf muscle does most of the work. Abnormally engorged leg veins signal the leg muscles to forcefully contract in an attempt to empty the veins and this is often felt as leg cramps.
Q - Is there anything I can do to prevent the occurrence of varicose veins?
A – The most common cause of varicose veins is an inherited defect in a portion of the venous system in the legs. Therefore, not all varicose veins can be prevented. However, there are some things you can do to keep your leg veins in the best shape possible: exercise your legs (walking or running), maintain a healthy weight, avoid prolonged standing and sitting when possible, elevate your legs when resting, and wear compression hose if you have an occupation that requires you to spend much of the day on your feet.
Q - My legs swell and the skin above my ankles is discoloring. Why is this happening?
A – When certain leg veins malfunction, blood begins to pool within the legs. This “pooling” increases the venous pressures within the legs and swelling ensues. In extreme cases, red blood cells are forced out of the circulation by the ever increasing venous pressures. Red blood cells contain a pigment (iron) that discolors the skin under these circumstances. Once the malfunctioning veins are treated, the swelling and discoloration begin to resolve. A duplex ultrasound exam is needed to reveal the source of the problem.
Q - My parents have varicose veins. What are the chances that I will have them too?
A – The most common cause of varicose veins is an inherited disorder that affects the ability of leg veins to return blood to the heart. The chance of developing varicose veins is 90% if both parents have them and 35% if only one parent has them. The chance of developing varicose veins is 27% if neither parent has them. Varicose veins are more common in women. This is thought to be due to pregnancy and hormonal factors. The average age of patients seeking treatment for varicose veins is 45.