In the last 25 years, the development of new, minimally invasive procedures has revolutionized how we treat varicose veins.
For many years, varicose veins were treated by a surgery called vein stripping. This required patients to go to the hospital and be put to sleep. The recovery from this surgery was often very long, and patients were often not happy with their results. The surgery also caused a lot of pain and bruising as the patient recovered.
About 25 years ago, a new varicose vein surgery called thermal ablation was invented, that has largely replaced vein stripping surgery. During this procedure, a small catheter is placed on the inside of the vein with the use of ultrasound. We then surround the vein with a fluid called tumescent anesthesia, which absorbs any heat that leaves the vein. This fluid has pain medicine in it, so patients feel only mild discomfort during the procedure. This anesthetic fluid also helps decrease the risk of heat around the nerves or the skin in the area of treatment. The catheter uses heat to treat the inner lining of the vein, which then causes the vein to be reabsorbed by the body. Patients generally wear compression stockings for one week after this procedure.
Our doctors at INOVIA® Vein have performed this procedure more than 4,000 times over the last decade, with excellent results. This has become one of the most widely used procedures for the treatment of varicose veins, both in Oregon and the rest of the US. Another way to treat veins with heat is called laser closure. There are a few different types of lasers that are used for this, but they all use heat to close off the leaky vein.
Non-Thermal Non-Tumescent Procedures
In the last few years, new procedures have been invented for treating varicose veins that do not require heat to close off the vein. They are referred to as non-thermal non-tumescent procedures (NTNT). Because these procedures don’t use heat to close off the varicose veins, we do not have to place fluid around the vein as an anesthetic. This means fewer pin pricks during the procedures.
Our doctors are trained to perform these procedures in the office. The procedures generally take between 30 – 60 minutes. Patients can return to work the day after the procedure and can return to regular activity, including exercise, 2 to 3 days after the procedure.
One of the new advances in the treatment of varicose veins is the use of adhesives to close off leaky veins. This procedure is called VenaSeal, which the FDA approved in 2015. The surgeons at INOVIA® participated in the study that evaluated this procedure for FDA approval. A surgical adhesive similar to super glue is used to close the vein.
Similar to the thermal procedures, a catheter is placed in the leaky vein and advanced up the superficial veins. We then place small droplets of adhesive in the vein as the catheter is removed from the body. With this technique, tumescent anesthesia is not required, nor is compression therapy after the procedure. Because we are not using heat to close the vein, there is minimal risk of skin or nerve injury as a complication of the procedure. Patients can return to work the day of the procedure, and return to regular activity a day or two after the procedure.
The surgeons at INOVIA® Vein Specialty Centers in Bend, Oregon and Portland, Oregon, are involved with teaching other doctors how to perform this procedure. During these courses, other doctors from around the world watch the surgeons at INOVIA® perform this procedure. We have doctors from South Korea, Central America, and South America come to Bend, Oregon to watch this procedure and learn the best way to treat patients using this technique.
Medicare currently covers VenaSeal, and other insurance companies around the country are starting to cover this procedure as well. We are working with our local insurance companies so all patients have the ability to have this procedure performed if they choose.
Sclerotherapy is a commonly used approach to treat small, medium and larger varicose veins. Recently, Varithena, which is a specialized sclerotherapy solution, was approved for use in the US. This is a high-quality foam sclerotherapy that retains its confirmation for a longer time and therefore is more effective at closing the varicose veins. In this procedure, a catheter is placed on the inside of the vein, and foam bubbles are injected, which causes the veins to spasm, and close off.
This approach is best for a windy vein, or patients who have had prior clots in the veins, making passage of a catheter up the vein more difficult. This procedure is also covered by Medicare, and private insurance companies will likely pay for this procedure in the near future.
Clarivein is another new procedure for treating varicose veins that does not require fluid to be placed around the vein. In this procedure, a catheter is placed in the vein and advanced up the leaky vein. A metal wire is advanced at the upper end of the varicose vein. This wire rotates at 3000 RPM’s and damages the inner lining of the vein. As the catheter is being removed, a chemical is injected into the vein that further damages the inner lining of the vein, which causes the vein to close off.
About INOVIA® Vein Specialty Centers
At INOVIA® Vein, we offer the latest techniques in the treatment of varicose veins. All of our surgeons stay current on the latest research so we can offer our patients the best varicose vein treatments available.
We perform all of these new treatments at INOVIA® Vein Specialty Centers. We are currently scheduling patients in our Central Oregon clinic at The Center next to St. Charles Medical Center (for patients from Bend, Redmond, Prineville, Madras, La Pine, Baker City, Burns, and John Day) and scheduling patients for our newest clinic opening October 1, 2018, at Bridgeport Village in Portland, Oregon (for patients from Tigard, Lake Oswego, West Linn, Hillsboro, Beaverton, Sherwood, Tualatin, Wilsonville, Clackamas, Sunnyside, and Milwaukie).