What are Varicose Veins?
Large, often bulging veins that have a zigzag pattern. Varicose veins always result from abnormal flow of blood in opposite the normal direction. In such cases, there is an incompetence of the one way barriers (valves) between the deep and superficial leg vein systems, leading to abnormal flow of blood from the larger deep veins into the superficial smaller veins and creation of zigzag dilated varicose veins.

What causes Varicose Veins?
Heredity is the most dominant factor for developing leg varicose veins. Other causes included higher than normal abdominal/pelvic pressure and high progesterone levels, which are both present during pregnancy. Standing for prolonged periods and on regular basis, as seen in many jobs, also aggravates varicose veins by creating stasis of blood in leg veins.

What are the symptoms of varicose veins disease?
In addition to their embarrassing, unsightly appearance, symptoms can include burning, itching, pain, leg fatigue, heaviness, throbbing, ankle swelling, muscle cramps, and even ankle open sores and bleeding. Unfortunately, many physicians do not recognize vein problems as the cause of many of these symptoms.

How is sclerotherapy compared with externally delivered laser, in treatment of
superficial reticular and spider veins?
The gold standard and most successful treatment modality is "sclerotherapy", provided it is done properly. Different laser treatment machines have not been able to offer similar results in comparison to properly done sclerotherapy. It is a fact that experience and knowledge are both necessary elements in performing good sclerotherapy. Many physicians who use laser for treatment of varicose and spider veins, may have attempted to use sclerotherapy on limited occasions and found it to be a difficult procedure. The fact is that generally sclerotherapy can deliver much more effective and better results than many laser procedures, provided it is done in the hands of an experienced and knowledgeable phlebology physician. A good treatment plan, must be based on a thorough initial evaluation and mapping of the sources of reflux/feeder veins in each individual case. Each case may have more than one option for getting rid of their varicose veins.

What is Sclerotherapy?
Sclerotherapy is injection of a tiny amount of a sclerosing solution inside the targeted vein, in an attempt to close the abnormal vein. Normal veins will pick up the flow, the pressure in the veins will be reduced and thus leg circulation will improve.

Foam Sclerotherapy, an State-Of-The-Art in Scleroptherapy:

Foam sclerotherapy is a wonderful safe treatment for medium and large varicose veins. This rapidly evolving new treatment is the result of more than 20 years of work by few European physicians; notably Dr. Frullini of Italy.

Foam sclerotherapy consists of an injection of small amounts of a sclerosing agent that has been transformed from liquid into foam by a rapid exchange of air and liquid sclerosing agent between two syringes connected by a small three-way valve.

Why does foam-sclerotherapy work better than liquid-sclerotherapy for medium & large varicose veins?
With traditional liquid sclerotherapy, once the sclerosing liquid is injected in a vein, it quickly dilutes with blood, resulting in decreased concentration of sclerosing agent within the lumen of the target vein. Therefore, an effective concentration of sclerosant is not staying in touch with the inner surface of the vein for a sufficient amount of time in many cases. While foam displaces the blood away and remains in contact with the inner layer of injected veins for a longer and more effective period. This makes foam sclerotherapy a much more effective treatment than liquid sclerotherapy. Furthermore, with foam there is much less post treatment local pain, discomfort, and pigmentation of the overlying skin. In summary, foam is much more effective and associated with fewer side effects in the treatment of varicose veins. Nowadays, many European pioneers of foam-sclerotherapy prefer foam over surgery, as presented at the latest World Congress on Vein Disease in San Diego in the summer of 2003. Obviously, physicians who lack experience in liquid-sclerotherapy and are not trained in foam-sclerotherapy should not perform sclerotherapy

What are the different treatment methods available for larger varicose vein conditions?
First, it should be emphasized that there is no single treatment that is suitable for all different varicose vein types and conditions. A vein specialist would first evaluate and map your particular condition by identifying the locations of incompetent valves. Then he/she would suggest one or more treatment modalities that fit your individual condition.

The old treatment for large varicose veins is ligation & stripping surgery of great saphenous veins, which requires general anesthesia and involves multiple incisions and a long recovery period. In addition, many patients with varicose veins do not have a problem with the great saphenous veins to begin with. Phlebectomy, which consists of pulling out of small segments of varicose veins through micropunctures, is another treatment that is suitable for some. Thanks to modern phlebology, most patients may be successfully treated using other effective non-surgical treatment methods: Use of radiofrequency energy to close varicose veins, VNUS Closure is one of the new treatments. Dr. Fattahi is the first physician in Northern California to use VNUS Closure procedure. Echo-sclerotherapy, in which injection of the sclerotherapy solution is guided under ultrasonography, is another great treatment modality for incompetent perforating veins.

Aside from Faom Sclerotherapy as described above, the latest major breakthrough in this field, a successful safe treatment for varicose vein disease is endovenous laser occlusion of varicose vein, known as EVLT (EndoVenous Laser Treatment) and ELVeS (Endo Laser Vein Treatment). This scar free treatment is performed in the office and without the need for general anesthesia. The patient can return to work the next day in most cases. This procedure consists of insertion of a thin laser fiber optic catheter in the varicose vein and positioning the catheter tip near the region of the incompetent valve. Then, while pulling out the fiber optic catheter, laser is delivered to the lumen of the varicose vein. Results of this form of treatment have been very promising. This treatment modality is considered to be a major breakthrough in phlebology that we have been awaiting.

Before After

This scar-free treatment is performed in the office and without the need for general anesthesia. Patients can return to work on the same or next day in most cases. This procedure consists of insertion of a thin laser fiber optic catheter, under local anesthesia, in the varicose vein and positioning the catheter tip near the region of the incompetent valve under ultrasound imaging. Then, while pulling out the fiberoptic catheter, laser is delivered to the lumen of the varicose vein. Results of this form of treatment have been outstanding.

In my opinion, ELVeS / EVLT is a major breakthrough in phlebology that we have been awaiting for decades. During 2002-2005, I performed more than 400 cases of ELVeS with 100% success rate, no important complications, and great patient satisfaction.

One other treatment that you may have heard of is VNUS Closure (using radiofrequency energy to close varicose veins). This treatment was approved by the FDA in 1999. Many doctors and patients are confused about choosing between EVLT/ELVeS and VNUS Closure. As one of the few physicians in the Bay Area who have experienced with both VNUS Closure and ELVeS, and based on my own experience with both treatment methods, I can mention the following:

Both of these treatments modalities can work well and are designed to be done at office setting and without the need to place the patient under general anesthesia. Thus, eliminating risks associated with general anesthesia and hefty costs associated with the use of operating rooms. Patients should be able to return to routine activities immediately after the procedure in most cases. As such, a great majority of my patients drive themselves back to work or home after their treatment and do not loose any work days.

The end result is that in majority of cases both ELVeS/EVLT and VNUS Closure work well for the treatment of great saphenous varicosities associated with SFJ incompetence. But, in my opinion, there are some differences between the two that deserve attention. I should add that while in my office I use ELVeS method (using 980nm laser generator), I believe that all current endovenous laser systems produce very similar clinical outcomes. When I personally compare ELVeS to VNUS Closure, there are differences between the two treatment methods that have
convinced me to choose ELVeS over VNUS Closure:

1- ELVeS (using a laser fiberoptic) is easier and faster than VNUS Closure.
2- ELVeS has a better success rate, especially when treating larger veins.
3- Varicose vein size is practically not an issue with ELVeS, while especially large varicose veins seem not to be a good candidate for treatment by VNUS Closure.
4- Intravenous Heparin (a strong blood thinning medication) is not necessary with ELVeS. However, Heparin use is an integral part of VNUS Closure.
5- Cost of ELVeS catheter and ancillary products is at least three times less than VNUS Closure. A cost saving that can be passed on to patients.

What type of doctor should I see for my vein problems?
Many physicians in different specialties attempt to treat varicose and/or spider veins. A physician with a vast experience in the field of phlebology is preferable in most cases. Dr. Fattahi suggests, among other factors, to use a clinic that is experienced and equipped with Color Ultrasound (duplex scanner) which is the best tool to map your varicose vein problem source. Ask the doctor to present "before & after" photos of his work on problems similar to yours. The doctor should be willing to answer all your questions and explain the nature of your problem and different treatment options.

Can unsightly veins of face, arms hands, and chest be treated by sclerotherapy?
An experienced sclerotherapist can eliminate unsightly veins from these areas in most cases.