What are the different types of Varicose and Spider Vein treatments? Why would you use one method over another?
Minimally Invasive Vein Ablation Treatment
This minimally invasive treatment is an outpatient procedure performed using imaging guidance. After
applying local anesthetic to the vein, the interventional radiologist inserts a thin catheter, about the size of a
strand of spaghetti, into the vein and guides it up the great saphenous vein in the thigh. Then laser or radio
frequency energy is applied to the inside of the vein. This heats the vein and seals the vein closed.
Endovenous Laser Treatment (ELT)
Endovenous Laser Treatment (ELT, or sometimes referred to as EVLT) is a quick, minimally invasive
laser treatment that requires no hospitalization and no complicated surgery. The entire procedure, from
start to finish, takes about 1 hour and there is very minimal to no pain. After applying local anesthetic to
the vein, the interventional radiologist inserts a laser fiber, about the size of a strand of spaghetti, into the
vein and guides it up the greater saphenous vein in the thigh. Then laser energy is applied to the inside of the
vein. This heats the vein and seals the vein closed. Once the vein is closed, the blood that was circulating
through the vein is naturally re-routed to other healthy veins. Over time, the varicose vein is absorbed by
the body.
Ambulatory Phlebectomy
Ambulatory phlebectomy (also called microphlebectomy) is a technique used for vein removal of large,
bulging varicose veins. Small incisions are made and the veins directly removed. Phlebectomy is done in
the office with local anesthesia.
Sclerotherapy is the accepted gold standard for spider vein treatment. A tiny needle is injected
directly into the vein, introducing a small amount of an FDA-approved chemical solution. This solution
causes vein wall irritation, collapsing and shutting down the vein. The non-functional vein is eventually
absorbed by the body. Sclerotherapy can be completed in a matter of minutes, although multiple
sclerotherapy sessions may be required to achieve full clearance. Successful sclerotherapy requires
skilled physician technique with a solid understanding of venous anatomy.
Ultrasound-Guided Sclerotherapy
For certain larger, deeper varicose veins and feeder veins (those not visible on the surface of the skin),
ultrasound-guided sclerotherapy may be used. Generally a foamed (air-mixed) solution is used to allow
greater surface contact in these larger veins.
Do health care insurance companies cover all of these procedures?
Varicose vein treatment is often covered by insurance. We will work with you to maximize your
insurance benefits. Call us at to learn more.
If patients don’t get covered, can you estimate their final cost?
Yes. We have price lists for all vein procedures.
What are some of the symptoms of true Varicose Veins?
Common symptoms of varicose veins include: pain, fatigue, itching, burning, swelling, cramping,
restlessness and throbbing.
Varicose veins often become large and ropelike. Overly distended varicose veins, especially near the
ankle, can rupture and cause bleeding. In some cases, varicose veins can cause serious health issues
such as venous leg ulcers.
What is the downtime after endovenous ablation or phlebectomy?
Treatment is on an outpatient basis during convenient office visits. You can resume most activities
shortly after each session.
What is required for preauthorization by the patients from the insurance companies? Stockings?
Requirements for vein procedure coverage include approved medical necessity, and thorough
trial at conservative treatment regimen (i.e. leg elevation, NSAID medications, and prescription
medical grade compression hose use for up to 3-6 months, depending on insurance provider).
All patients are seen again after a conservative treatment regimen to assess for change in
clinical status.
Does vein disease affect women and men equally?
Women account for approximately 85-90% of varicose vein cases, mainly because of the unique
additional risk factors for females, including estrogen levels and pregnancy. Women are particularly
afflicted with reticular veins. These light blue veins usually appear in a lattice framework, giving a
marbled appearance to the skin. They are the most harmless looking veins, but they are usually the
most symptomatic of all. Reticular veins are the cause of the high rate of Restless Leg Syndrome (RLS) in
women. When these veins are effectively treated, the discomfort and automatic movements diminish.
In men, the pathophysiology is similar, but instead of reticular veins, the culprits are multiple, small-
branching varices and “high pressured small vein disease” (hpsvd). The varices, unfortunately, are often
mistaken for “cosmetic” telangiectasia (spider veins). The difference is important because the treatment
is different. The association between RLS and vein disease has been overlooked, most likely because
of the innocent appearance of the reticular veins. We see dozens of cases each day with RLS, and we
expect improvement after only a few treatment sessions.
Please visit our website at triangleinterventional.com for further information. Questions in March and April will be focused on Pain Management followed by Central Venous Access and Oncology. Please submit your questions to lpritchett@aac-llc.com or call 919.677.9729 for referral information.
