An Expert Approach to the Treatment of Varicose Veins

leg-painNew vein patients walk through our doors daily wondering what to expect from their spider or varicose vein treatment. We hope this blog post gives you a better understanding of our process and also eases any anxiety you may have with regards to the treatment of your vein disease.

Our physicians, Drs. Michael Nguyen and Shaun Patel, are Board certified and Harvard trained with experience in the treatment of varicose veins. They approach each vein patient in a similar way, going through the steps below while simultaneously accounting for the differences that make each patient and their disease aspects unique. Here are the steps involved in the Miami Skin and Vein approach to the treatment of varicose veins or spider veins.

Step 1 – Note any symptoms of vein disease

You may see visible veins on your legs, but you may not be sure whether they are varicose veins or spider veins. We’ll first take a complete medical history and then perform a physical exam, noting any symptoms you may be experiencing such as:

  • Leg heaviness
  • Leg fatigue
  • Leg or ankle swelling
  • Restless legs
  • Leg pain, aching or cramping particularly later in the day or at night
  • Varicose veins
  • Spider veins
  • Skin changes or rashes
  • Leg ulcers

Step 2 – Assess your vein disease risk factors

Next, we will assess your risk for vein disease and more importantly for risk of the progression of vein disease including:

  • Increasing age: With time, veins lose elasticity, valves deteriorate and the veins simply stop functioning properly.
  • Genetics: Just like hair color and eye color, varicose veins can be passed from one generation to the next.
  • Gender: Although we commonly treat men with vein disease, venous disease is more commonly seen in women than in men particularly with pregnancy.
  • Obesity: Excess weight causes increased pressure in the veins resulting in venous disease.
  • Occupation: Standing or sitting for long periods of time can prevent normal blood in the veins resulting in vein disease.
  • Trauma: Prior injury can increase the likelihood of venous disease.

Step 3 – Classify you as a cosmetic vein patient or medical vein patient.

Based on the results from our first two steps, we’re now ready for your ultrasound to look at the deeper veins that are feeding the smaller and more superficial veins.

If these deeper veins check out okay, you are classified as having cosmetic venous disease. If this is the case, we will recommend either liquid sclerotherapy, laser sclerotherapy or a combination of liquid and laser sclerotherapy. It’s important to remember that spider veins usually require multiple treatments – it usually takes 3 laser treatment to see an approximate 70% reduction in spider veins as well as maintenance appointments every 1 to 2 years for any new spider veins that may appear. Combining treatments (liquid sclerotherapy and laser sclerotherapy) can sometimes reduce the number of treatments required. Spider vein and cosmetic vein treatments are explained below:

  • Liquid injection sclerotherapy offers precision and minimal side effects. During the procedure, a medication called Asclera (polidocanol) is injected into the spider vein with a small needle. The medication causes the vein to contract and eventually disappear. For optimal results, our patients are advised to wear compression stockings for 3-7 days after the procedure.
  • Laser sclerotherapy using the Cutera Excel V vascular laser is also a great way to treat spider veins. It uses a unique and high power laser that is absorbed by blood inside of spider veins without affecting the skin. The laser’s precise and effective treatment of spider veins and the system’s innovative skin cooling technology ensures patient comfort and treatment success. Compression stockings are not usually required after laser sclerotherapy.

If the ultrasound shows us that there are in fact problems with your deeper veins, we will discuss the following safe and successful treatments for medical venous disease:

  • Conservative vein treatment is, in many cases, explored first in the hopes that the problem corrects itself through measures such as:
  • Avoidance of prolonged standing
  • Leg elevation
  • Exercise
  • Loosening of restrictive clothing
  • Compression stockings (20-30 mm Hg and graded pressure)
  • Weight loss

If conservative vein treatments fail, there are several options for the treatment of varicose veins:

  • Ultrasound guided sclerotherapy is very useful for treating the feeder veins that are both difficult to see and therefore difficult to treat with simple injection or laser sclerotherapy. During the procedure, a reticular vein or varicose vein is identified using ultrasound and a solution called Asclera (polidocanol), usually a higher concentration then that which is used for spider veins, is injected into the vessel ensuring precise delivery of the medication. The medication causes the vein to contract and eventually disappear.
  • Radiofrequency ablation (also called the Venefit procedure) is a minimally invasive treatment option offered to our patients who suffer from varicose veins. The Venefit procedure eliminates need for surgery or general anesthesia and is also performed in our office. It’s known for excellent results and lower rates of bruising, pain and other complications when compared to laser ablation and the older surgical “vein stripping” procedure. For this reason, the radio frequency ablation is our doctors’ preferred option when it comes to the treatment of varicose veins.
  • Endovenous laser treatment (EVLT) is also a minimally invasive option for treatment of varicose veins and has become known as the gold standard among many physicians. It offers high success rates, impressive clinical results and requires no surgery or general anesthesia. During the procedure, a thin laser fiber is inserted into the damaged varicose vein after making a small incision in the leg. Laser light is emitted by the tip of the fiber and this light heats the vein wall causing it to contract and close off. The body reroutes blood through the healthier deep veins in the leg, allowing the varicose vein to remain closed. Ambulatory phlebectomy is a minimally invasive outpatient procedure for treatment of varicose veins during which superficial varicose veins are removed through small incisions in the skin.
  • Ambulatory phlebectomy is different from and far safer than surgical vein stripping which was commonly used in the past. There is little to no scarring and only local anesthetic is needed.

After each of these varicose vein procedures, patients are expected to remain active and also to wear compression stockings. Follow up visits are scheduled a week after the procedure and then again at 1 month and 3 months post procedure.

More than 30 million Americans suffer from varicose veins or venous insufficiency and the majority remain untreated and unaware that such advanced options exist for the treatment of varicose veins and spider veins. Dr. Shaun Patel and Dr. Michael Nguyen are committed to using the latest in medical technology to treat vein disease. They offer an expert approach to treating both spider and varicose veins as detailed above. Many of their Miami and Coral Gables patients are delighted to find that their vein treatment does not require surgery or general anesthesia and, in the case of medical vein disease, is often covered by their health insurance.

Schedule a vein treatment consultation today at our beautiful Coral Gables location by calling 786-618-5039 or by completing this form.

Miami Skin and Vein
2020 Ponce De Leon Blvd, Suite 103
Coral Gables, Florida 33134
Phone: 786-618-5039


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