What Are Varicose Veins and What Causes Them?

A high percentage of patients suffering from varicose veins of the legs have an associated condition known as incompetence of the saphenofemoral valve. When this valve becomes weakened, or “incompetent”, the greater saphenous vein becomes enlarged, causing normally small veins connected to it to also enlarge in predictable patterns. Common signs of greater saphenous vein reflux include clusters of varicose veins on the inner thigh and leg near the knee, multiple areas of spider veins along the thigh and leg, and dark or red discoloration of the ankles and feet.

If varicose veins are caused by reflux into and from a larger vein, known as the saphenous vein, the reflux must be stopped or the varicose veins will never be properly eliminated. Dr. Kakish utilizes both non-surgical techniques available today for proper treatment.

Endovenous Laser Ablation (EVLT™) of the Saphenous Vein

Rather than cutting the incompetent vein out as performed during vein stripping, or cutting into the groin to tie off the leaking saphenofemoral valve (which is associated with an unacceptably high rate of recurrent varicose veins), the saphenous vein may be closed by inserting a very thin laser filament through a skinny needle near the knee. EVLT™ is a quick, minimally invasive laser procedure that leaves no scar, has a short and relatively pain-free post-operative recovery period and is performed under local anesthesia in the doctor's treatment room.

The procedure requires only local anesthetic identical to the numbing medicine used to repair a laceration or to fill a tooth cavity. The treatment itself will take less than 45 minutes and initially involves both a physical and an ultrasound examination to map the vein to be treated. After carefully confirming the proper position of the laser fiber, the vein is closed by activating the laser – this process takes less than 3 minutes. Five minutes after the procedure, you will be up and walking normally. Most of our patients undergoing this procedure return to work the same day.

A compression stocking is worn for up to 7 days aftr the procedure. Walking immediately following the procedure is encouraged and normal daily activity can be continued but vigorous activity, such as gym workouts should be avoided. Discomfort during the procedure is minimal. You may have some bruising and soreness for 7-10 days after the treatment. Over-the-counter non-aspirin oral pain relieving medication can be taken as needed.

Ultrasound Guided Microfoam Ablation of the Greater Saphenous Vein

The other treatment of choice for eliminating significant varicose veins involves an injection of a very safe liquid, a process called sclerotherapy. In this technique, the solution is made into bubbly foam, and then expertly injected into the offending varicose vein, which has been first outlined precisely by an ultrasound examination. The bubbles stick to the walls of the leaking vein, injuring the veins walls, and causing the body to dissolve the vein “naturally”. The foam is contained within the bad veins under direct ultrasound visualization by compressing the leaking valve. This method requires neither general nor local anesthetic, and can be performed in less than 10 minutes. An extremely small needle is used, similar to an insulin needle. After having the foam injection technique, our patients get up off the table, and can walk home or return directly to work. Many of our patients report an immediate improvement of the pain in their legs they have experienced for years.