What are the non-surgical treatments for varicose veins?
If you choose not to undergo vein ablation and phlebectomy, you should consider wearing support or compression hose when you are on your feet, and elevating your legs above your heart whenever possible. These two techniques will lessen the severity of the symptoms for some people. However, the veins will continue to deteriorate as you age. There is a new FDA approved oral medication on the market to help varicose veins but the jury is still out on its effectiveness.
When can I go back to work after a treatment?
The time varies, depending on which procedure is necessary for you. If you have an office job then you should be able to return to work the next day. Even if you have physical work, you will not miss more than a few days. You can return to normal walking activities immediately after spider vein treatments. It is important that you remain active and walking immediately and in the days following your treatment.
What can I expect my leg to look and feel like after surgery?
For the first 8-12 hours following your procedure, you will have no pain, due to the anesthetic. After that, some patients have experienced soreness in the area of the ablation or vein removal. Advil, Aleve or Tylenol will relieve the discomfort. Some patients experience a pulling sensation, due to vein shrinkage where it has been sealed shut. This will usually disappear within a week. Sometimes a numbing sensation occurs in the vicinity of the ablated vein. This is due to the surface veins having been stunned, and it, too, will be gone in a week or so. If you had a phlebectomy, sometimes little pieces of veins remain behind and feel like little lumps. You may massage them with your favorite cream and they will smooth out and disappear in a few months. If you had a vein removal you will be bruised in that region. That will disappear in two weeks.
Will I develop new veins?
There is a saying in Phlebology: “Vein disease is incurable, but it can be controlled”. You don’t stop going to the dentist after he fills your cavities and cleans your teeth; you visit him regularly to control any problems that may arise. Following your specialized treatments for varicose and spider veins, you should expect to be mostly free of the vein problem. Your legs should feel lighter, less fatigued, and free of swelling and pain. It is important to remember, however, that due to gravity, the aging process, and your genetic predisposition to vein disease, you may experience some minor reappearances of varicose or spider veins. The risk of recurrence is about 9% to develop new veins in the future.
With that in mind, it is advisable that you return to the New York Skin & Vein Center annually for an ultrasound examination that will help Dr. Dohner locate any new veins that are developing. This will minimize your chances of developing recurrent vein disease and its associated problems. Of course, if you spy a new vein popping up, you should make an appointment with Dr. Dohner as soon as possible.
Am I too old, or too young, to have my veins treated?
If you can walk for 20 minutes you can have the procedure. Age is no barrier. At the Center, we have treated people of all ages — from those in their 90’s to teenagers who were already experiencing vein problems.
What about any medications, including blood thinners, I take?
There are no medications including blood thinners that would prevent you from undergoing these procedures.
Are there any pre-existing medical conditions that will prevent me from having any of these procedures?
We have treated patients with diabetes, heart disease, high blood pressure, congestive heart failure, and strokes. Very few patients probably should not have their veins treated: these include people with severe blockages in the arteries of the legs (PAD), and those who cannot walk for at least 20 minutes.
What about nighttime leg cramps, RLS, and neuropathy?
Vein disease can cause a tingling sensation in the legs, which will probably disappear after treatment. Nighttime cramps can also be a result of varicose veins. Restless Leg Syndrome (RLS) can be caused by varicose veins and we have seen many patients have their RLS cured after treating their veins. Neuropathy — numbness, burning, and tingling, especially in the feet—can frequently be improved with vein treatment.
When can I go back to the gym?
The time away from the gym varies, depending on which procedure is necessary for your leg-vein disease, but it should not be longer than a week or two. You may use the treadmill and walk immediately after your procedures—this is important to do to avoid complications.
Where can I hear of someone’s experience with the treatments?
Dr. Dohner’s office can supply you with a variety of testimonials from patients who have successfully undergone the modern, state-of-the-art, vein-disease treatments that are now available.
What are the potential complications of the treatment of varicose and spider veins?
For varicose veins, the most serious potential risk is an Endothermal Heat-Induced Thrombosis (EHIT), which sounds scary but is very rare and can be treated with a short course of oral blood thinners. If this problem occurs, it is usually noted when you return to the Center for a brief follow-up appointment one week after your treatment. At that visit, an ultrasound is performed to be sure that this kind of clot has not formed. In fact, because it is so rare, there are some medical authorities who believe screening for it after treatment is unnecessary. For patients who are at a greater risk of a blood clot, we will start a preventative blood thinner right after your vein procedure to reduce that risk.
If some of the surface nerves are tugged on when removing the surface veins you could feel a numbness in that area for a few months. If the ablated veins are close to deep nerves you could experience a numbing sensation in the inner ankle, leg, or back of the calf for several months. Sometimes this can be permanent.
In rare cases, you could develop an infection of the skin after surgery.
In very uncommon cases, removing the surface veins or lasering shut the feeder veins can actually stimulate some surface spider veins called matting. These can be treated with cosmetic sclerotherapy.
Ultrasound guided sclerotherapy risks include migraine headaches, sometimes caused by the foam. This does not occur if you have never had a migraine before. Deep vein thrombosis can be caused by the medication that is used to seal shut the surface veins. This is prevented by wearing your compression hose after the procedure and walking as per our instructions. Visual disturbances, cough, chest pain, and transient ischemic attacks have all been reported after foam sclerotherapy, but these are extremely rare.
Some of the potential complications for spider vein treatment include Deep Vein Thrombosis, but the chances of this are 1/50,000—about the same risk as getting hit by lightning. Skin ulcer: If the medication is injected mistakenly into the skin instead of the vein, an ulcer of the skin can appear. This only seems to have occurred in the past with the outdated and obsolete high-concentration salt water sclerosants. Matting: Sometimes when a vein is injected it can stimulate small veins that look like a blush or a bruise. This usually happens if we miss injecting a feeder vein. The treatment of matting is finding and treating the feeder vein. Hyperpigmentation: The most common risk, this is a brownish discoloration of the larger spider veins that have been treated. This can occur up to 50% of the time, but it will usually disappear in a few months (although some hyperpigmentation can last up to a year). This risk can be reduced by wearing compression hose, avoiding sun exposure, and keeping your follow-up appointments with Dr. Dohner. At the follow-up appointments, he will locate the trapped blood (old dead blood that remains behind in a vein that has been treated) and release it so that it won’t cause the pigmentation.