EVLT (Endovenous Laser Treatment of the Saphenous Vein)

Endovenous Laser Treatment (EVLT) is an FDA approved treatment of varicose veins and their underlying causes, replacing a more invasive stripping.  EVLT treats the greater saphenous vein, which is located through the inner thigh continuing to the ankle, or the lesser saphenous vein, which extends down the calf. The insufficient or "leaky" vein is treated from the inside by inserting a laser fiber that emits heat energy causing the vein to seal itself off preventing blood from flowing through.  The blood then re-routes to many other normal veins of the leg.  Generally the procedure takes about 45 minutes from start to finish and is done in the office under local anesthetic. In 40% of patients who undergo EVLT the large varicose veins collapse and no other treatment is needed. If veins remain we offer Microphlebectomy and Sclerotherapy for continuing treatment.


Microphlebectomy

Some veins are too large to be treated with injections or too small and tortuous to be treated with laser ablation.  Microphlebectomy is a method of surgical removal of larger symptomatic varicose veins. Each vein is marked by Dr. Landis prior to the procedure and removed through tiny incisions in the skins.  Veins are gently removed in small sections and gradually collapse while blood re-routes to other healthy veins in the leg.  Each incision is closed with either a steri-strip or one small suture.  It is typically performed in the office under local anesthesia and usually takes about 45 minutes to one hour.  Patient can expect to return to work the following day with minimal discomfort.   

Sclerotherapy

Sclerotherapy can be used to treat both varicose and spider veins.  A small amount of solution is injected directly into each spider vein using a very tiny needle.  At Landis Vein Clinic we use Sodium Tetradecyl Sulfate (STS) because it is FDA approved and we have found it to be very effective. 

Wearing compression stockings following treatment is essential to getting the best possible results.  Most patients see good improvements; however sclerotherapy is not effective for every patient.  The number of treatments needed varies among patients, but usually takes about 3-6 treatments per site depending on the extent of the problem.  Although this treatment is very effective we can not guarantee that it will eliminate all of the veins treated and sclerotherapy cannot prevent the formation of new spider veins.   Your legs will look worse before they look better and cosmetic improvement is not immediate!  Most patietn are happy with the way their legs look about 6 months to a year after treatment. 

Photolaser Therapy

Photolaser treatments are available in our office to treat very tiny spider veins on the legs and/or face. A light beam is pulsed onto the veins in order to seal them off and cause them to dissolve. Treatments may be combined with sclerotherapy and multiple treatments are usually required. It is necessary to stay out of the sun and refrain from using sunless skin care products for 2 weeks before and 6 weeks after. The procedure is done in the office and requires no recovery time.
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SEPS (Subfacial Endoscopic Perforator Surgery)

Subfascial Endoscopic Perforator Surgery (SEPS) is a newer approach to treat chronic venous insufficiency or venous stasis ulcers.  This procedure is done for patients with existing perforator veins that are enlarged due to incompetency, or a backflow of blood, that causes increased pressure in the vein and surrounding tissue of the lower leg. This backflow can cause skin changes such as scaly patches or discoloration and the possiblity of ulcers in the ankle area. The SEPS procedure disconnects these perforator veins and helps relieve the pressure in the venous system by redirecting blood flow to healthy veins. The benefits include a higher rate of wound healing and a reduced chance of developing new ulcers. Patients who are candidates for a SEPS will also have regular appointments with a wound clinic to promote further healing.  This procedure is performed in a hospital and requires general anesthesia.

Ultrasound guided ligation

Ligation of the greater, accessory or lesser saphenous vein is performed when it has been determined that the vein cannot be treated with EVLT because of its size or anatomy. This procedure is done in an outpatient surgical center or hospital under monitored anesthesia with the aid of ultrasound.  A small incision made where the vein connects to the deep venous system. It is tied off or ligated to render it nonfunctional.  Many times a microphlebectomy is performed at the same time. 

Links: www.phlebology.org