Varicose Vein Treatment Los Angeles
The appearance of bulging leg varicose veins is what prompts most patients to seek varicose vein treatment or removal. For some patients, symptoms of chronic venous insufficiency, CVI, are completely absent, and the cosmetic improvement of their legs is their primary motivator for seeking varicose vein treatment.
Interestingly, the veins that are the root cause of bulging leg varicose veins, and therefore need treatment, are often not the very superficial varicose veins for which patients may have originally sought medical attention.
In fact, patients are often surprised to learn that a huge bulging varicose vein network on a calf may have its origin at the groin level (saphenofemoral junction) or back of the knee (saphenopopliteal junction). Locations where the largest superficial veins, the saphenous veins, communicate directly with the deep vein system.
CVI and the resulting varicose veins can be managed conservatively with stockings and compression. However, definitive CVI and lasting therapy require the elimination of the saphenous veins or perforator veins.
Duplex ultrasound is an essential diagnostic test in any varicose vein treatment plan. The test is necessary prior to any treatment because it pinpoints where the damaged valves are in the veins. Accordingly, an ultrasound test can dramatically increase your chances of successful treatment.
Currently, incompetent leg veins are eliminated either by surgical removal or by one of the newer non-surgical, minimally invasive leg vein treatment procedures.
It is important to understand that in most patients, the superficial venous network, including the saphenous veins, is a secondary, redundant system. Consequently, these veins are not essential for the normal circulation of the venous blood in the legs. For this reason, patients undergoing Coronary Bypass Surgery with harvested veins (most commonly the GSV) suffer no adverse circulatory effects in the legs, unless the deep veins are non-functional.
Nu Vela for the Most Experienced Varicose Vein Specialist
Nu Vela is one of the most advanced vein treatment centers in Los Angeles, California. The vein clinic specializes in non-surgical varicose vein removal, housing the two most advanced FDA approved s systems for the treatment of varicose veins. They are called Venefit™ Targeted Endovenous Therapy (formerly known as VNUS Closure) and Endovenous Laser Treatment (EVLT).
The phlebologist of the center, Dr. Raffi Dishakjian, M.D., is a highly skilled physician in venous system treatments. In addition, he is one of the most experienced vein surgeons in the Los Angeles area. Dr. Dishakjian takes pride that over the last decade he has successfully treated hundreds of patients a year using cutting-edge technologies.
At Nu Vela Laser and Vein Center, Dr. R. Dishakjian makes sure that you always receive outstanding clinical care. To that end, the vein surgeon personally performs all the required tests, including Ultrasound Diagnosis, and other ancillary vein treatments. The treatments provided by Dr. Dishakjian for varicose veins include:
- Venefit™ Targeted Endovenous Therapy
- Varicose Vein Laser Treatment (EVLT)
- Foam sclerotherapy
Click vein treatment options to read about the treatments available at the Center. Please go to our before and after picture gallery to have an idea on the range of the veins that we treat and the treatment outcome you can expect.
Note that you should wear compression stockings for 1 to 2 weeks regardless of the procedure. Wearing these stockings improves the circulation of blood and speeds up the healing process.
lEG VARICOSE VEINS TREATED WITH EVLT
*Individual results may vary.
LEG VARICOSE VEINS TREATED WITH THE VENEFIT PROCEDURE
*Individual results may vary.
Description of the Varicose Vein Treatment Procedures
The following subsections are about a brief description of the varicose vein treatments provided by Dr. Dishakjian. Details of each of the procedures could be accessed by going to the relevant pages of our website.
Endovenous Thermal Ablation (EVLT and Venefit™)
Nowadays, endovenous thermal ablation techniques (EVLT and Venefit™) have almost put an end to painful vein removal surgeries.
These treatments are geared towards correcting the superficial venous reflux in the veins by thermally ablating the enlarged and diseased saphenous or perforator veins.
Endovenous thermal ablation refers to the minimally invasive Ultrasound guided treatment of varicose veins. During the procedure, a varicose vein, usually the saphenous or perforator vein, is entered into and shut down from inside the veins by means of controlled heat. A radiofrequency (RF) catheter or laser fiber serving as heat sources. The Venefit™ system uses a radiofrequency generating electrode, whereas the EVLT uses a laser fiber.
The doctor protects the skin and structures surrounding the targeted vein from heat injury by injecting a large volume of Tumescent anesthesia along the whole section of the vein.
Endovenous procedures commonly require about an hour of operative time. You may walk immediately after the procedure. Discomfort and recovery downtime are minimal and do not result in scarring. You may resume normal activities the next day.
Dr. RAFFI DISHAKJIAN USING EVLT FOR VARICOSE VEIN REMOVAL
Both procedures have very high, long term success rates at producing irreversible occlusion, fibrosis, and ultimately vein disappearance. Our success rate with Venefit™ and Sciton’s Joule EVLT systems runs at higher than 95 percent.
Once your vein doctor treats your varicose veins, most of your bulging superficial veins will shrink in a few weeks. In follow-up visits, your doctor will treat any remaining veins, usually with sclerotherapy.
Click EVLT & Venefit FAQ for answers to questions you may have about these procedures.
VENEFIT (VNUS CLOSURE)- PATIENT EDUCATION
Microphlebectomy, also known as ambulatory phlebectomy, is a common procedure for the removal of superficial varicose veins. This vein removal procedure is usually performed in an office setting using local anesthesia.
During microphlebectomy, your vein specialist doctor uses a surgical instrument resembling a sharp crochet hook to remove a superficial vein through small 1-3 mm incision in the skin overlying the veins. After the removal of veins, the doctor uses Steri-strip tapes or small sutures to close the incisions. You are discharged immediately after the treatment and can resume normal activities. However, the final cosmetic outcome, like for any surgery, may take several months or more.
Veins that may be removed by ambulatory phlebectomy include major tributaries as well as branches of the saphenous vein around and below the knee.
Foam sclerotherapy is a modified version of traditional liquid sclerotherapy used for the removal of spider veins. In foam sclerotherapy, a detergent class sclerosant (like STS) is agitated with a gas (air, oxygen or carbon dioxide) to form a foam. This foamed version of the sclerosant is then injected into a varicose vein with the aid of ultrasound imaging.
In the United States, ultrasound-guided foam sclerotherapy is most commonly used to treat branch varicosities of the saphenous veins. It is also used for superficial or very tortuous varicosities unsuitable for endovenous techniques, like EVLT or Venefit™.
Outside of the United States, however, foam sclerotherapy is used more commonly for the primary treatment of varicose veins. The main reason being the high cost of these technologies.
The long term success rate of the endovenous thermal ablation techniques is significantly higher (>95%) than foam sclerotherapy (~70-80%), necessitating repeat procedures for an optimal outcome.
In addition, heat based techniques result in less subsequent accumulation of denatured blood in the treated vein, with less inflammation, pain and brown discoloration.
Insurance Coverage for the Removal of Varicose Veins
Among minimally invasive varicose veins treatments, the Venefit™ (VNUS Closure) and EVLT procedures have the broadest and most favorable insurance coverage by most of the major PPO health insurance plans and Medicare. Eligibility of reimbursement is based on the establishment of medical necessity by your physician and health plan.
Please don’t hesitate to call our front desk to schedule an appointment to discuss your vein problems and insurance coverage eligibility.
Other Surgical and Non-Surgical Varicose Vein Treatment Options
Until the early 2000s, the only treatment for varicose veins of the legs was a painful surgery. This involved the removal of the dilated and incompetent saphenous vein segments, and simultaneously tying and cutting its connecting points with the deep venous system.
Since then, many modifications of the older treatments and new treatments have evolved. Here we present a brief description of the surgical procedures, not available at our vein center, and a few novel non-surgical treatments.
The most common surgery for removing varicose veins is called high ligation and stripping (HL/S). In this procedure, a vascular surgeon makes two incisions. One incision in the groin over the top of the Great Saphenous vein and a second one around the inside of the knee area over the same vein.
During the surgery, the vascular surgeon ties shut the vein from both ends and introduces a special wire, called the stripper, into the vein from the knee side. The surgeon then pushes the wire towards the groin, ties it to the cut end of the vein and then forcibly pulls the vein out from the knee-end. The surgeon then closes the cuts with stitches (sutures) and applies bandages and compression stockings. The operation takes about 1 to 1 1/2 hours.
Varicose vein surgery is commonly performed under a general, spinal or epidural anesthesia in a hospital setting. Generally, it requires hospital-stay of one or two days and a recovery time of one to four weeks. The risks of the procedure include sensory nerve injury resulting in pain and numbness. Bleeding, deep-vein blood clots, infection, scarring, and the anesthetic risk are other side effects.
Nowadays, vascular surgeons perform surgery instead of one of the newer, less invasive techniques, whenever there are blood clots or swelling (inflammation) in the target veins (phlebitis). The removal of very large or large and very superficial veins may also require surgical removal.
Endoscopic surgery for Varicose Vein Removal
This entirely new surgical technique for the treatment of varicose veins is derived from cardiovascular surgery.
During the surgery, a special endoscope (tiny video camera) is introduced under the skin through an incision just above the knee. The varicose veins are then removed through small cuts. A further small incision must be performed in the groin area.
People who have this surgery must have some kind of anesthesia, such as epidural or general anesthesia.
Because this treatment puts high demands on technical equipment and requires surgical/endoscopic experience, the procedure is performed in a hospital. For that reason, it is usually applied during cardiovascular surgery, or when varicose veins are causing skin ulcers.
Patients can resume their normal activities within a few weeks. A recovery period much longer than that needed after endovenous thermal ablation.
Transilluminated Powered Phlebectomy (TIPP)
This technique is a variant of ambulatory phlebectomy using the TriVex System.
Varicose vein removal with this modality is carried out in a darkened operating room. A vascular doctor uses an external transillumination light source device, much like a flashlight, to accurately pinpoint veins for removal.
During the procedure, the surgeon uses a tumescent anesthetic solution and loosens the veins and releases them from the surrounding. Similar to a liposuction procedure, the surgeon then uses a special cannula to cut and remove a vein by sucking it through a small hole at the tip of the cannula.
This technique is only applied to the very superficial veins, the incisions usually do not require stitches, and patients can return to normal activities in 2 to 3 days.
ClariVein is another emerging minimally invasive endovenous varicose vein treatment system. ClariVein relies on mechanical agitation and an infused chemical to destroy a diseased vein.
The ClariVein device is a hand-held single-use device equipped with a catheter that contains a rotating wire driven by a motor situated inside the device. The procedure starts by introducing the catheter, under Ultrasound guidance, into the targeted vein.
After positioning the tip of the wire precisely, the phlebologist turns on the device, causing the wire to rotate and scrape the inner walls of the vein while simultaneously dispersing a chemical solution. This combined mechano-chemical technique aims at efficiently sealing the vein with the smallest possible amount of infused chemical.
The main advantage of this treatment over heat-based endovenous techniques is the elimination of the need for the sometimes uncomfortable step of local anesthetic injection, as well as lack of the residual leg numbness after the procedure.
However, currently, there are no long term studies documenting the effectiveness and safety of this system. In time, ClariVein may become a viable mainstream treatment modality. This system is currently FDA-approved as a non-specific vascular infusion device, but not specifically for varicose veins.
The VenaSeal Closure system is the latest FDA-approved, in-office procedure to permanently treat varicose veins. VenaSeal delivers immediate results that are comparable to EVLT and Venefit procedure. The system uses a catheter, dispenser gun, and guidewire to introduce an adhesive agent into an affected superficial vein and subsequently treat varicose veins and clinically symptomatic venous reflux.
Because VenaSeal is a non-thermal procedure, it is administered without the injection of tumescent anesthesia (dilute numbing medicine). This minimizes the need for multiple needle sticks and hence minimizes bruising and recovery time and makes compression stockings unnecessary. Accordingly, the VenaSeal Closure system may be most attractive to those who do not tolerate wearing compression socks. But this convenience comes with an additional price tag as the system utilizes a single-use kit. Moreover, it is not a commonly covered method of treating venous insufficiency disease by insurances and there is no long term data yet on the durability of results.
The SEPS procedure
SEP (subfascial Endoscopic Perforator Surgery) is an endoscopic procedure for removing incompetent perforator veins in the legs. These are the perforator veins that often cause venous ulcers due to chronic venous congestion.
During this procedure, your vascular doctor makes several small skin cuts through which he/she inserts a special cannula equipped with a balloon tip. Similar to a laparoscopic procedure.
The balloon helps identify the veins by separating them from the surrounding tissues. Surgical clips are then used to occlude these defective perforator veins under direct endoscopic view. The SEPS procedure typically requires about 2 to 3 hours of operative time and 2-3 weeks for a full recovery.
Although this procedure is sometimes described as minimally invasive in nature, it is more traumatic than EVLT and Venefit. Moreover, it results in some scarring and often requires general anesthesia.
Questions About Cost of Treatment of Varicose Veins?
Consultations with the vein doctor are free with the purchase of any service. We charge a nominal refundable consultation fee for the first office visit only. This fee is fully credited towards a subsequently purchased service. Note that Consultation does not include the charge for venous Duplex Ultrasound test when indicated. However, most of the fee for the ultrasound test is reimbursed to you with a follow-up endovenous treatment procedure.
Call 818-832-4500 for any inquiries regarding treatment cost, insurance coverage, procedure details, or scheduling an appointment. Click the “Contact ” button at the top for directions.