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Vein Treatment Services

Vein Conditions | Smith Vein Institute

Treatment for Varicose Veins and Venous Reflux

Varicose Veins:

Varicose veins are abnormally swollen or enlarged blood vessels in the leg caused by the failure of the valves in the veins to normally pump blood from the limbs back to the heart. The blood can pool, or even reverse, a condition known as venous reflux, which is the cause of varicose veins and their related pain and symptoms. This treatment is often covered by insurance following a conservative trial period of wearing compression stockings.

Chronic Venous Insufficiency:

Untreated varicose veins can progress to a more serious form of venous disease called Chronic Venous Insufficiency. Also referred to as Venous Reflux, this disease will result in worsening symptoms, such as pain, swelling, restlessness and fatigue of the legs, as well as skin damage and ulceration in more severe cases. All treatments are minimally invasive, and require little to no downtime. Dr. Smith will prescribe the wearing of compression hosiery for a specific period of time following many of the procedures.

Vein disease is progressive, and if left untreated, patients may develop:

  • Blood clots
  • Large varicosities
  • Throbbing pain
  • Severe swelling (Edema)
  • Possible ulceration in extreme cases

Endovenous Laser Ablation:

The endovenous laser ablation (EVLA) procedure involves thermal ablation of incompetent varicose veins. Unlike vein stripping, EVLA permanently closes the abnormal vein, thereby leaving it in place without surgically removing the vein.

In the past few years, the use of lasers has become an excellent alternative to surgical stripping to treat varicose veins. If you have saphenous insufficiency you are a candidate for laser ablation. Using the laser we can eliminate your vein without making any incisions in the groin or stripping your vein. The laser takes the place of stripping. This procedure is very well tolerated and done through just a needle stick. A thin laser fiber is inserted into the diseased vein, through a small puncture which does not leave a scar. Under ultrasound guidance, the laser fiber is guided up into the greater saphenous vein in the thigh or the small saphenous vein in the calf. The laser energy is delivered inside the vein thereby heating it and sealing the vein closed. The procedure is done in the office with a special local anesthetic called tumescent. It numbs the area very quickly. You are typically here for about an hour. We have you walk for a period of 10-20 minutes before leaving the office and can resume normal activities that day. We ask that you wait 1 week before resuming heavy exercise and 2 weeks before swimming or using a hot tub.

Duplex Ultrasound Evaluation:

Proper diagnosis is critical to the effective treatment of vein disease. Smith Vein Institute uses advanced ultrasound testing known as Duplex Vein Scanning to identify abnormal valve function in the veins. This dignostic test takes less than an hour and is usually covered by your insurance. Our vascular lab is in the process of becoming one of the region’s premier IAC Accredited Vascular Laboratories.

Radiofrequency Ablation (Venefit™):

Formerly known as VNUS Closure™, Venefit™ is a minimally invasive procedure used for the treatment of varicose veins and Chronic Venous Insuffiency (CVI). Performed in our office using just local anesthesia, the tiny ClosureFast™ catheter is inserted into the affected leg. A tiny burst of radiofrequency energy causes the vein wall to shrink and collapse. The vein is sealed and “closed” when the physician withdraws the catheter. After the diseased vein is sealed shut, the blood is naturally re-routed to healthy veins. Because of the consistent level of heat delivered by the Venefit procedure, the patient experiences less bruising and a quicker recovery period than alternative laser energy ablations.

Ultrasound-Guided Sclerotherapy:

Ultrasound-guided sclerotherapy (UGS) is an office-based minimally-invasive procedure used to chemically ablate superficial varicose veins. Ultrasound-guided sclerotherapy and/or Ambulatory Phlebectomy are procedures completed as part of a Continuum of Therapy approach to treat any varicose veins remaining after endovenous laser ablation.

With ultrasound guidance, an FDA cleared chemical agent, sodium tetradecyl sulfate (STS), or polidocanol is precisely injected into veins targeted for chemical ablation, usually as a foam, to shrink and collapse them. This technique requires precision and expertise. The advantages of ultrasound-guided sclerotherapy are no scarring, effective shrinkage and collapse of chemically ablated varicose veins, and a powerful adjunctive tool for eliminating residual collateral varicose veins remaining after endovenous laser ablation.

Ambulatory Phlebectomy:

Ambulatory Phlebectomy (AP) involves the surgical removal of surface varicose veins using a special local anesthetic called tumescent, which numbs the area very quickly. Then tiny, 1-2 mm incisions are made to gently remove the bulging veins. The incisions are so small that no stitches are required. Since veins are very collapsible, even large varicose veins may be removed through the tiny incisions using this technique. In general, ambulatory phlebectomy does not fix the root or cause of the underlying vein problem. AP is an office-based procedure done in conjunction with or after endovenous laser ablationas part of a Continuum of Therapy approach to treat any varicose veins remaining after endovenous laser ablation. Since visible surface veins are surgically removed, the results are usually immediate, and recurrence is unlikely. Following an AP procedure, a compression stocking is worn for 2 weeks. We ask you to take it easy for the first 2 days and then you can resume normal activities on the third day. Wait 1 week before resuming heavy exercise and 2 weeks before swimming or using a hot tub.

Conservative Vein Therapy:

Conservative vein therapy refers to a non-invasive form of treatment whereby medications and surgical options are not used to treat varicose veins. Patients with varicose veins may increase their daily walking & exercise, achieve weight loss, avoid high heels and wear compression stockings. Historically, both health care providers and insurers have recommended a trial period of conservative vein therapy ranging from 6 weeks to 3 months before proceeding with definitive vein care. Conservative vein therapy is beneficial in reducing varicose vein symptoms and slowing the progression of chronic venous disease. However, conservative vein therapy will neither prevent nor eliminate the condition of varicose veins.

Treatment for Spider Veins

Also known as “roadmap veins” or telangiectasias, spider veins are tiny superficial blood vessels often found on the calves, thighs and ankles. Typically cosmetic in nature, spider veins are generally not considered a health risk; however, patients can experience symptoms such as itching, burning and achiness in the affected area, and they will worsen if left untreated. Factors like heredity, pregnancy, prolonged standing or sitting, trauma or pressure, and hormonal changes all contribute to the development of spider veins. If deemed a cosmetic procedure, this treatment may not be covered by insurance.

Usually we use a combination of treatments depending on the size and location of the spider veins. We combine injection therapy, laser, and VeinGogh therapy. Most spider veins require 3-5 sessions spaced 1 month apart for maximal clearing. If a laser or VeinGogh treatment is required, it is often done at the same time. The laser can treat many skin types but you cannot to be tanning while we do the treatments. Tanning and skin color typically do not interfere with injection therapy. Once the treatments are complete, tanning can be resumed as normal.


Sclerotherapy is a vein treatment procedure used to chemically ablate superficial veins. This procedure uses tiny needles to inject a liquid or foam chemical agent into visible surface veins. The injected chemical solution causes the treated veins to shrink and collapse over time.

In most cases, multiple treatment sessions are needed. Side effects are rare, with the most common being staining. Following a sclerotherapy procedure, compression stockings are worn to prevent the treated veins from carrying blood. Approximately 70% of veins treated by sclerotherapy will disappear with each treatment, unless their underlying cause is not treated. This is why Smith Vein Institute recommends a non-invasive evaluation first be performed to evaluate for underlying venous disease. Despite all the advancements in laser technology, sclerotherapy still remains the overwhelming choice of patients and their doctors for spider vein treatment. Why, because sclerotherapy is more effective and less painful than any other treatment available for spider veins.

Non-Invasive Evaluation:

Non-invasive evaluation is essential for making the correct diagnosis and for determining vein treatment options for patients with varicose veins. Duplex ultrasound allows for visualization of veins and their venous flow assessment, along with determination of the status of the deep, superficial, and perforator veins. At Smith Vein Institute, we are committed to remaining the regional leader in Vein Care. In addition to the expert clinical services and advanced physician training offered, Smith Vein Institute has an experienced ultrasound technologist perform the non-invasive evaluations which will dictate which of the therapeutic vein care options are most appropriate for our patients.