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Treatment advances for varicose, spider veins
by Dr. Paul Gaulin
Sep 25, 2011 | 1353 views | 0 0 comments | 5 5 recommendations | email to a friend | print
Dr. Paul Gaulin
Dr. Paul Gaulin
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As people age, they might become concerned about the appearance of the veins in their legs. I treat patients with a condition known generally as lower extremity venous disease. Unsightly veins can be more than a cosmetic problem; some small vein problems indicate a more significant medical concern. Once treated, advanced venous problems — i.e. venous stasis ulcers — can deliver pleasing cosmetic improvement.

Venous disease covers a spectrum of varicose and spider veins. Varicose veins develop with age and gravity. The abnormal venous valves become less able to return blood to the heart, allowing blood to pool. Varicose veins are large, up to 4 or 5 millimeters in diameter. They become dilated and twisted and can cause pain, swelling, throbbing, discoloration and even ulceration with severe vein disease. Varicose veins also are caused by genetics, obesity, prolonged standing, sedentary lifestyle and poor circulation.

Spider veins are less than 1 millimeter wide and appear near the skin’s surface. They look red or blue and take on a spidery or branching shape. Typically these veins are more cosmetically displeasing, although they have no symptoms and rarely cause a problem. Spider veins can be caused by pregnancy, prolonged standing, hormonal changes and genetics.

In the past, the main option for treating varicose veins was surgical ligation and stripping, which can be painful and require a period of recovery. The surgery is performed in a hospital under general anesthesia.

A newer procedure to eliminate varicose veins has been perfected. I perform endovenous laser treatment (EVLT) in my office. It takes about one hour and a local anesthetic is used so the patient experiences only mild discomfort during the procedure.

The technique involves passing a small laser fiber along an abnormal vein, using laser energy to damage the walls of the vein, causing it to close so blood no longer flows through it. The patient is able to walk out of the office an hour later and requires hardly any down time.

I have the patient wear a compression stocking for three days to one week after the procedure, and follow up treatment with sclerotherapy improves the cosmetic finish. Losing the vein is not a problem; blood that had flowed through the faulty vein is diverted to other, normal veins.

The success rate for EVLT is very high, based on clinical data with up to five years of follow-up. Endovenous laser treatment appears to be on the way to becoming the “gold standard,” based on its superior efficacy and lower morbidity, according to market researchers. Medicare and most insurance carriers reimburse for EVLT when it is medically necessary.

I also can treat smaller varicose veins and spider veins using injection therapy or phlebectomy. Sclerotherapy is a proven procedure and has been in use since the 1930s. The procedure involves injecting a solution directly into unsightly veins using a tiny needle. This solution occludes the spider veins over time. No anesthesia is required, and the patient has only minimal discomfort during the treatment.

Patients usually require an average of three sclerotherapy treatments, which are scheduled four weeks apart. A variety of solutions are used for injecting spider veins, and I will assess which solution is right for you.

I practice general surgery with Northern Nevada Medical Group and can distinguish between and treat both cosmetic and medically significant lower extremity venous disease. If you have questions or concerns about varicose or spider veins, call 352-5300 for an appointment.

Dr. Gaulin specializes in general and laparoscopic surgery as well as all aspects of vein disease. He completed his undergraduate and medical degree at the University of Ottawa. During his general surgery residency, Dr. Gaulin gained extensive training in management of complex venous problems. He worked as a trauma surgeon in Canada and practiced in Las Vegas for more than five years. Dr. Gaulin is a distinguished fellow of the Royal College of Surgeons and a member of the American College of Phlebology.
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