 In the past decade surgery has undergone a minimally invasive revolution, spearheaded not only by technical innovation but patient demand. There is no better example of this than the treatment of varicose vein disease.
Not long ago, the only alternative for patients with extensive varicose veins was surgery. The procedure, aptly called vein stripping, was painful and disfiguring. The operation consisted of groin and leg incisions that resulted in numerous unsightly scars. Recovery took weeks.
Since most patients with varicosities are active, it was a difficult decision on whether to undergo surgery or continue to cope with progressively unsightly and painful varicose veins.
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Endovenous Procedures were developed with the assumption that the abnormal vein need not be removed as long as the refluxing vein was closed off.
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VNUS Corporation pioneered the use of radiofrequency energy to achieve that goal. The technique involves placing a catheter into the diseased vein under local anesthesia and guiding it to the point of highest reflux under ultrasound guidance. The RF energy produces heat that seals the vein eliminating the reflux.
 VIDEO: Click here to view video on VNUS Closure®
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It was not long before laser was introduced to achieve the same effect of thermal sealing of the vein. The cost of laser fibers and simplicity of use have made this a popular choice.
Until recently, the only disadvantage of the laser procedure was the increased post operative discomfort experienced by patients in the first few days following treatment when compared to the VNUS® catheter.
The new Cool Touch ® 1320 wavelength laser now available in the Center has eliminated much of the postoperative discomfort previously experienced with lasers of other wavelengths adding yet another advantage to the noninvasive treatment of varicose vein disease!
VIDEO: Click here to view video on Cool Touch®
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Both procedures are done under local anesthesia and take a couple of hours to complete. The endovenous procedure will often be combined with a microphlebectomy to remove the prominent varicose veins. Most patients report little if any pain during the procedure other than the discomfort from the small needle used to instill the anesthesia. Perhaps the worst complaint of patients is the need to wear compression stockings for the first week after the procedure!
To get a better idea of what to expect during an endovenous procedure, read the information sheet.
The Vein & Laser Center of New England is one of the few Centers offering both VNUS Closure® and laser procedures to its patients. With both options available, we are able to tailor treatment to the individual not the other way around! |
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Microphlebectomy |
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 Is the removal of varicose veins through incisions as small as the size of a needle tip. The procedure is often undertaken in combination with an endovenous procedure or as a stand-alone procedure in patients who do not have major vein reflux. Patients are encouraged to resume walking on the day of the procedure and engage in their normal activities as soon as possible. In most patients, the incisions are barely visible several months later.
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Typical Incisions |
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Foam Sclerotherapy |
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 Foam sclerotherapy is an exciting option offered by the Vein Center for the treatment of varicose veins. It allows a noninvasive method of eliminating larger veins without the use of incisions.
When air is mixed with a sclerosant, a foam solution is created. When injected into a vein, it will displace blood inside the vessel, allowing direct contact between the vein wall and the sclerosant. The end result is sealing of the vein and eventual absorption by the body. 
 Foam sclerotherapy has been proven to be safe and effective.
Dr. Roupenian is one of the most experienced phlebologists in this therapy which should only be performed by those well trained in this technique. He frequently attends International Conferences not only on the use of foam sclerotherapy but other emerging technologies in the treatment of venous disease. Foam sclerotherapy is another example of how the Center is committed to providing the most up to date and least invasive treatment options for patients with venous disease.
Honduras Mission
Every year Dr. Roupenian participates in a mission to Honduras where hundreds of patients with advanced venous disease are treated with foam sclerotherapy. Click here to read more about the Honduras mission. |
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- Visual sclerotherapy is the “gold standard” in treating this disorder. These veins are injected with an extremely small needle that most patients report as a “pinching”. The solutions used are called sclerosants and are made specifically for the elimination of spider veins. Studies have confirmed the efficacy of the two most commonly used solutions in our Center. Our Center does not use saline injections, common with many practitioners, because it is more painful and associated with a higher incident of side effects.
The most important principle in the successful treatment of spider veins is eliminating the underlying sources of abnormal venous pressure that are responsible for the appearance of spider veins. It may be as simple as foam sclerotherapy to the underlying blue veins or eliminating reflux in the deeper veins of the leg with an endovenous procedure. For that reason, all our spider vein patients undergo both an ultrasound and Veinlite examination prior to our recommending a treatment plan.
An important rule of thumb for patients who undergo sclerotherapy to understand is that it takes an average of three to four treatments spaced 2 months apart to obtain a clearance of about 90%. How many treatments is up to the individual patient depending on the results they wish to achieve.
- Surface laser is playing an increasing role in the treatment of spider veins but should not be used indiscriminately in all patients who present with spider veins. Improper selection of patients can lead to unsatisfactory results, complications or even the proliferation of veins that may be resistant to treatment.
The role of laser therapy in spider vein treatment is best summed up in the chapter “Candidates for Laser Therapy” by Dr. Neil Sadick (a former President of the American College of Phlebology) in the recent textbook “The Vein Book".
“Laser therapy may be considered appropriate in patients who are needle phobic, cannot tolerate sclerotherapy, are plagued by leg veins that are sclero-resistant……. Ideal candidates for laser treatment of leg veins previously have undergone appropriate surgery or sclerotherapy for the treatment of varicosities, incompetent perforators and reticular veins, as well as sclerotherapy to clear the majority of superficial vessels”
*(N. Sadick and L Sorhaindo “Laser Treatment of Telangiectasias and Reticular Veins” in The Vein Book edited by Dr. John Bergan Elsevier Academic Press Copyright 2007
The two most common treatments for eliminating unsightly hand veins are sclerotherapy and microsurgical removal. Both are relatively painless and effective therapies.
Click here to read our patient instruction sheet on hand vein sclerotherapy.
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