Venous Ultrasound is the best test for venous disease. It assesses the venous circulation, including the deep system and the superficial. Venous ultrasound can rule out clots, or deep vein thrombosis (DVT), in addition to measuring valve closure times or demonstrating venous insufficiency which is the hallmark of venous reflux. Venous ultrasound can also identify veins that feed directly to ulcers as well as diagnose other non-vascular conditions, such as a Baker’s cyst, that may be the source of the patient’s discomfort.

It’s inexpensive, not painful but is dependent on the skill of the technologist. That is why it is important to go to certified centers.

Once the vein doctor completes mapping out the patient’s veins, a tiny amount of anesthetic is injected under the skin. A catheter (plastic coated needle) is placed in the vein. This procedure is generally painless since the area is numb from the local anesthetic. When the catheter is in place, a medication is gently injected into the vein. This medication (sclerosant) closes the incompetent vein. A bandage is placed over the area. This provides compression to assist in collapsing the vein network. The bandage remains on for 5 days. Following the procedure, the patient should also wear medium strength compression stockings. Learn more about sclerotherapy vein treatment.

Veinwave is a procedure which uses thermocoagulation to safely and effectively treat spider veins anywhere on the body. The procedure is used to treat very tiny veins that cannot be treated with sclerotherapy.

Hook / Ambulatory Phlebectomy is a minimally invasive procedure performed via a pinhole puncture. With this technique, vein doctors can remove nearly all larger veins as an office procedure with local anesthesia. The Ambulatory Phlebectomy procedure is frequently used in conjunction with sclerotherapy. This reduces the pressure in the spider veins and smaller telangiectasias. Ambulatory Phlebectomy allows vein doctors to remove almost all the varicose veins in the leg. This procedure is much less invasive because only large surface veins are removed.

The vein doctor uses ultrasound to map the vein being treated. The doctor guides a thin tube (catheter) through a tiny incision into the vein. This catheter is threaded through the blood vessel and into the groin. The vein doctor delivers electricity in 20-second pulses to a heating element. This heats and contracts the collagen within the vein’s walls. The walls will shrink and then shut down. Veins are treated in segments while the catheter is slowly brought down towards the incision site. Once the entire vein is ablated, the blood flow automatically reroutes through the healthier veins nearby. This restores healthy circulation and reduces swelling. The ablated vein turns into scar tissue, which is then absorbed by the body.

MOCA or mechanical chemical ablation is a newer technique that can ablate a vein with mechanical trauma and a sclerosing agent. It is particularly useful in smaller veins, and segments beneath wounds.

Direct ultrasound guided sclerotherapy can also be used to ablate symptomatic veins that are too tortuous or too short for catheter based techniques.  The sclerosing agents are detergents that can be injected either straight or as a foam (combined with gas/air).