Treatments and Procedures for Venous Conditions

Non-Surgical Treatment for Vein Conditions

Spider and varicose vein treatment

• Compression
  Compression stockings generally help symptoms from varicose veins and are frequently required as a first step in the treatment of venous disorders. A short period of compression is usually required after any venous treatment.
• Polidocanol
  This is an FDA-approved medication administered as sclerotherapy, a series of injections. This closes and eliminates spider and varicose veins. Performed as an outpatient procedure, this therapy is delivered with a very small needle.
• Anticoagulation
  Anticoagulation is used to treat clots and deep vein thrombosis. The duration of treatment depends on the case.
• Ultrasound-guided foam sclerotherapy
  In this procedure, injections of polidocanol foam are used to close veins that are too large or too deep for regular injections.

Side effects associated with these treatments:

• Tenderness, redness, and/or hard lumps at the injection sites.
• Hemosiderin staining — a light brown discoloration of the skin over the treated vein, resulting from iron in the red blood cells moving into the skin as your body resorbs the treated vein. It typically fades and resolves over a period of time.
• Scabbing, leg swelling, or small ulcers. 
• Very small risk of deep vein thrombosis (DVT).
• Matting — a small cluster of thin, red spider veins in very close proximity to each other may develop at the injection site. This can be treated with further sclerotherapy, but may not completely resolve.

• Thrombolysis: medication is delivered through a catheter to break up a blood clot. Thrombolysis is performed in the hospital under careful monitoring.
• Vena cava (IVC) filters: small, metal devices positioned in the vena cava, near the renal (kidney) veins, in order to stop blood clots in the legs before they can travel to the heart and lungs and cause pulmonary embolism.
• Venous embolization: a procedure used to stop blood flow to problematic veins in the pelvis or abdomen. The surgeon inserts a catheter into either a groin or neck vein, injects dye to identify the problematic vein, then places a wire into the vein under x-ray guidance.
• Venous recannalization: treatments to open narrow or occluded veins. These methods include angioplasty, stenting, and bypass surgery.
• Venous lysis: an inpatient procedure used to break up acute vein blood clots and decrease leg swelling, pain, and future complications from venous hypertension; may be followed by angioplasty or stenting.

Ablation

Venous ablation: an outpatient laser (EVLT) or radiofrequency (RF) therapy performed for symptomatic reflux and dilation of superficial veins, involving the placment of an ablation fiber. Possible side effects include:

• A pulling sensation along the vein
• Bruising
• Hard lumps along the course of the vein
• Hemosiderin staining
• A small risk of DVT

Surgery

• Phlebectomy
  Occasionally, veins or parts of veins will need to be surgically removed. This may be done in conjunction with other minimally invasive procedures either in the office or the operating room. Patients go home the same day and resume regular activities immediately.
• Venous Bypass
  Very rarely, it is necessary to perform a venous bypass to restore normal venous circulation, most often needed years after large deep vein clots (DVT). These procedures are available through the Vein Center.