Varicose Vein Procedures

New Varicose Vein Procedures

 We Fix Varicose Veins
VARICOSE VEIN
PROCEDURES
HOW VEINS WORK
REASONS TO FIX
FAILED VEINS
EDUCATIONAL CONSULT,
SCREENING, & DIAGNOSIS
THE FOUR VARICOSE
VEIN PROCEDURES
MYTHS AND THE CHANGING
STANDARD OF CARE
SEE OUR
LEARNING VIDEOS
The Four Modern Varicose Vein Procedures
  1. Endovenous Laser Treatment (EVLT):
  2. laser closure of failed vein through an IV
  3. Ultrasound Guided Sclerotherapy (UGS):
  4. injection to close hidden varicose veins
  5. Ambulatory Micro-Phlebectomy (AP):
  6. non-surgical removal of surface varicose veins
  7. Superficial Vein Sclero Therapy (SVT) and surface Medical Sclero Therapy of Smaller Varicose Veins (MST):
  8. injections to close spider veins.
1. Endovenous Ablation Varicose Vein Procedures (EVLT):
This procedure is done to close a larger, 'truncal' vein that has failed inside the leg and allow blood to follow normal pathways through competent, healthy veins. Time required for these varicose vein procedures: about 20 Minutes.
  • The leg is painted with antiseptic solution.
  • A numb spot is made over the failed vein.
  • An IV is started in the vein.
  • The laser fiber is gently inserted through the IV (the patient cannot feel this).
  • The vein is surrounded with fluid via injections at several more numbed spots.
  • The laser is fired while the fiber is withdrawn over about 3 minutes (the patient cannot feel this).
  • The heat of the laser causes these veins to collapse and be reabsorbed by the body.
  • A band aid is place over the IV puncture site.
  • The patient goes home.
    • 2. Ultrasound Guided Medical Sclerotherapy Varicose Vein Procedures (UGS):
    This procedure is done to close internal varicose veins, 'branches' off failed 'truncal' veins. Time required for these varicose vein procedures: about 20 Minutes.
  • The ultrasonographer carefully examines the leg for internal varicose veins with failed valves.
  • After identifying these veins a small amount of medication caustic to the veins is injected to close the veins.
  • These veins collapse and are reabsorbed by the body.
  • A band aid is placed over the punctures.
  • The patient goes home.
    • 3. Micro-Ambulatory Phlebectomy Varicose Vein Procedures (AP):
    This procedure is done to remove surface varicose veins, branches off a larger, internal 'truncal' vein. Time required for these varicose vein procedures: about 20 minutes.
  • With the patient standing the position of the vein is marked on the skin with a marker pen.
  • The leg is then painted with antiseptic solution.
  • Local anesthetic medication is then injected over the vein through a series of small numbed spots.
  • A puncture is made over the vein every half inch with a needle (the patient cannot feel this).
  • The vein is then removed through the puncture or interrupted so that it is closed and is eventually reabsorbed.
  • A bandage and ace wrap are applied for the patient to wear for 3 days.
  • The patient goes home.
    • 4. Spider Vein Sclerotherapy (SVT) and surface Medical Sclerotherapy of Smaller Varicose Veins (MST):
    The SVT procedure is done to close spider veins, superficial capillaries that have become dilated because of pressure resulting from failed valves in the venous tree above them. The MST is done for smaller surface varicose veins. Time required for these varicose vein procedures: about 20 minute sessions *usually three sessions over 4 months
  • The leg is cleansed with an antiseptic. And, if necessary, the skin is sprayed with an anesthetic.
  • Many tiny injections, mere extremely superficial pricking of the skin over the spider veins, are made with tiniest needle sold and a medication is injected.
  • This medication causes these tiny veins to collapse and eventually be reabsorbed by the body.
  • A cortisone cream is applied to the skin to decrease itching, the expected reaction to the medication.
  • The patient goes home.
    • Free Education Consultation
    This private, one half hour, educational consultation give each patient an opportunity to ask questions and to learn about vein disease anatomy, signs, symptoms, investigations and varicose vein procedures. Also, this appointment is an opportunity for the patient to discuss insurance coverage questions and concerns with our staff. Our staff will research your particular plans coverage, deductibles and co-payment obligations for you. Signs and symptoms of vein failure will be reviewed in the questionnaire below. If one or more of these are present, the patient will be assisted in scheduling further vein and artery evaluation, if desired.

    VEIN SCREENING QUESTIONNAIRE
    THIS PATIENT NOTES ONE OR MORE OF THE SIGNS AND SYMPTOMS BELOW:
  • Leg Pain: Aching, tired, or 'heavy' legs; painful calves....legs that feel 'older' than they should.
  • Leg Cramps: night cramps, 'Charley horses', nocturnal muscle cramping.
  • Blue Feet: Blue veins at the foot and ankle (a physical sign called 'corona phlebectasia').
  • Swollen Ankles: Swelling, increasing at the end of the day or when traveling.
  • Leg Skin Changes: Red/brown discoloration, ulceration, eczema, itching & burning.
  • 'Secondary' Restless Leg Symptoms: Night-time aching, restlessness, movement, or cramping.
  • Varicose Veins: Bulging surface veins. *Fact: Most varicose veins are hidden, below the surface.
  • Spider and Reticular Veins: Small red veins and larger purple veins visible on the surface.
  • Exertional Pain: Muscle pain, cramping on walking - possible arterial 'claudication'.
  • Neuropathy vs. Vascular Symptoms: Numbness, painful, tingling, burning and/or cold feet.
    • Costs of Varicose Vein Procedures
    Contrary to popular perception, most vein work is medically necessary, not 'cosmetic'. While the cosmetic benefits are tremendous, the main purpose is to help you have healthier legs and stop the deterioration of the legs that results from vein valve failure. Most varicose vein procedures are paid for by most insurance companies and by Medicare.

    Also, contrary to popular perception, varicose vein procedures are not horribly expensive. Many comment that the fees are somewhat equivalent to prevailing dental fees…the EVLT cost is similar to a crown and the other costs are similar to major fillings down to dental cleaning with x-rays. For example, the Medicare Fee Schedule is as below:

    CPT CODE Description Medicare Fee Schedule
    36478 EVLT $1,418.57
    37766 AP $617.30
    93970 Ultrasound Bilateral $239.91
    76942 UGS $181.76
    36471 MST $175.17
    93971 Ultrasound Unilateral $158.27
    93922 ABI Artery Screening with US $116.00
    99203 1st New Patient Office Visit $101.28
    99213 Established Patient Office Visit $67.20
    36468 SVT (Cosmetic, our fee $200) $0.00

    Medicare will pay the office of a 'Participating Provider' 80% of these fees for medical necessary varicose vein procedures and evaluations. The patient or the patient's secondary insurance is responsible for the remainder.

    Plan of Treatment for Varicose Vein Procedures
    Evaluation and varicose vein procedures are done in a progression generally spread out over about six months. This is necessary for several reasons including:
    1. observation time and ultrasounds to evaluate the results of treatments,
    2. the 'global periods' for waiting between treatments required by insurance companies,
    3. the recommended staging of varicose vein procedures:
    4. First close failed truncal veins (EVLT)
    5. Next close internal varicose vein branches (UGS)
    6. Next close external varicose vein branches (AP)
    7. Lastly close surface spider veins, reticular veins and small varicose veins (SVT, MST)
    8. some procedures must be done and repeated once or twice to take advantage of the body's natural healing, for example, give time for the closed spider veins to reabsorb, time to observe results of the first UGS, etc.
    9. patient comfort…….simple ½ hour visits, no more than one a week
    All varicose vein procedures plans can be interrupted for any amount of time necessary, for example, a one week holiday, a two week cruise or 6 months until returning from the north.

    Week Type of Visit Reason for Visit
    1 Free Educational Consultation Education
    2 Bilateral Venous US, Initial Diagnostic Ultrasound (US)Testing
    3 Exam and Review of US by Physician Physician Exam
    4 Arterial Screening ABI Evaluation Diagnostic Testing
    5 EVLT Procedure #1 Right Leg Close Failed Truncal Vein
    6 Recheck - Unilateral US Evaluation Recheck of above procedure
    7 EVLT Procedure #2 Left Leg Close Failed Truncal Vein
    8 Recheck - Unilateral USEvaluation Recheck of above
    9 UGS- Right #1 Close Internal Varicose Veins (Right)
    10 UGS- Left #1 Close Internal Varicose Veins (Left)
    11 Bilateral Venous US, 3 months 3rd Month Diagnostic Testing
    12 Recheck Established Patient Exam Physician Exam
    13 UGS - Right #2 Close Internal Varicose Veins
    14 UGS - Left #2 Close Internal Varicose Veins
    15 AP -Right #1 Close Internal Varicose Veins
    16 AP -Left #1 Close Internal Varicose Veins
    17 No treatment No treatment
    17 SVT Right #1 Close Surface Spider Veins
    18 SVT Left #1 Close Surface Spider Veins
    19-23 No treatment No treatment
    24 Bilateral Venous US , 6 month 6th month Diagnostic Evaluation
    25 Physician Exam 6th month Physician Evaluation
    26 SVT Right #2 Close Surface Spider Veins
    27 SVT Left #2 Close Surface Spider Veins
    28-34 No treatment No treatment
    35 SVT Right #3 Close Surface Spider Veins
    36 SVT Left #3 Close Surface Spider Veins
    37-50 No treatment No treatment
    51 Bilateral Venous US , One Year  
    52 Physician Exam  

    Vein disease progresses.
    A yearly Ultrasound and Exam are recommended.

    VARICOSE VEIN PROCEDURES | HOW VEINS WORK | REASONS TO FIX FAILED VEINS
    EDUCATIONAL CONSULT, SCREENING, AND DIAGNOSIS | THE FOUR VARICOSE VEIN PROCEDURES
    MYTHS AND THE CHANGING STANDARD OF CARE | SEE OUR LEARNING VIDEOS

    Varicose Vein Procedures