What are varicose veins?

Blood travels in your legs through the veins leading to the heart.  There are valves in the veins that prevent blood from flowing backwards by gravity, which prevent dilation of the veins (varices/varicose veins). When the valves inside the veins do not work properly (usually a hereditary condition), the blood does not circulate well and veins dilate progressively.  Over time they become visible and palpable, leading to cosmetic consequences such as changes in skin color,  as well as medical issues including swelling, pain, inflammation, infection and ulcers.

When the dilation is only at the level of the capillaries and small veins of the skin it will manifest as small red vessels less than 1 millimeter called ” spider veins”.  While usually only a cosmetic problem, they may also cause some symptoms.

Who is affected?

Women are more frequently affected than men, and there is a genetic component. Risk factors include standing for long hours, maintaining a sedentary lifestyle and being over-weight. Twenty to thirty percent of our patients are men and they may suffer similar symptoms necessitating treatment.

What problems may occur with varicose veins?

The problems of varicose veins are highly variable depending on the extent of the disease, ranging from only cosmetic to serious ulcers that do not heal easily.

Chronic venous insufficiency can result from delayed treatment of varicose veins, or as a result of deep vein thrombosis (blood clots in the leg veins)

Chronic venous reflux can occur in veins with damaged valves as a result of clot formation, venous thrombosis, or genetically dilated veins.  The valve damage generates venous stasis (slow circulation in the veins). The permanence of blood in the veins and poor circulation causes swelling or edema of the legs, which eventually darkens the skin. Although chronic venous insufficiency is not curable, its complications can be prevented or limited, and symptoms significantly improved with a simple non-surgical treatment

You should learn to recognize the early symptoms of chronic venous insufficiency. Prolonged sitting can cause edema or swelling in the legs.  The most common symptom of chronic venous insufficiency is edema or swelling of the ankles. If swelling increases and persists for a long time, the skin darkens; one may experience itching, and if left untreated may result in non-healing ulcers.

To reduce the risk of developing venous ulcers, venous circulation should be improved. Treatment options include elevating the legs, exercising, and wearing elastic compression stockings. If overweight, then one should consider a weight loss program. Compression stockings may relieve symptoms; however, in most cases the underlying cause should be treated. Venous laser ablation can be performed in the office with outstanding results.



Endovenous Laser Ablation

Your physician may determine that you have venous insufficiency requiring an endoluminal laser ablation. All procedures are done in the office using a local anesthetic called tumescent. Tumescent anesthesia is a very dilute solution of lidocaine with bicarbonate, which makes the solution very comfortable without the burning sensation.  It is very fast acting and lasts for several hours after the procedure is over.

During the procedure, you will feel a small needle stick to numb the area. Another small needle is then inserted into the vein followed by a small guide wire, catheter and finally the laser fiber.  Once in place, you will feel a few small needle sticks and some pressure while the numbing medicine is injected around your vein. Once numb, the laser is activated while being slowly pulled out. The heat from the laser causes the vessel wall to close and blood is no longer able to flow through the faulty vein. Over time, the vein becomes absorbed by the body. The procedure improves the circulation in the leg by ensuring that blood is traveling in the correct direction. Symptoms improve quickly and many patients state they see and feel relief in a matter of days.

After the procedure, your leg will be wrapped in a special bandage that can be removed the next day. Compression stockings should then be worn for the next 2 weeks. Many times, an anti-inflammatory medication, such as Ibuprofen, is given.  You may resume normal activities within 2 days. Short-term bruising is normal and mild discomfort is common.


Your physician may determine you need a micro-phlebectomy to eliminate the large bulging varicose veins. This can be done at the same time as the laser ablation but is frequently staged because sometimes these veins will get smaller after the ablation. Typically they do not go away completely, and therefore, the phlebectomy helps to achieve the best cosmetic result.

The area to be treated will be marked with a pen while you are standing.  The area is numbed with tumescent, a numbing solution, with a series of very small needle sticks. Once numb, very small incisions (2mm) are made and the bulging veins are gently removed with a device similar to a small crochet hook. The incisions are so small that stitches are not required. Your leg will be bandaged in a special wrap that can be removed the next day. Compression stockings should then be worn for 2 weeks. Little to no discomfort is expected after the procedure. Normal activities can be resumed in 2 days.