Catheter-directed Sclerotherapy using Duplex Ultrasound: Catheter-directed foam sclerotherapy (CDFS) is a safe and more effective method to treat incompetent saphenous veins.
Duplex Guided Compression Sclerotherapy: With this procedure, a chemical irritant, called a sclerosing agent is injected into the vein while Dr. Strauts observes the injection process on an ultrasound screen.
This allows incompetent veins that are below the surface of the skin to be treated. This technique causes the vein to collapse and seal shut. Afterwards a leg wrap is applied for compression, patients are able to walk immediately after the procedure.
Surgical Microphlebectomy: is a method of surgical removal of varicose veins at the surface of the skin. Small incisions are made next to the vein and sections of vein are removed through these small incisions. Afterwards, a leg wrap and medical compression stocking is worn. Patients are able to walk immediately after the procedure.
Sclerotherapy: is used to treat both varicose and spider veins. A small needle is used to inject the veins with a chemical irritant, or sclerosant, that irritates the lining of the vein. The veins collapse, seal shut, and are reabsorbed by the body. Afterwards, a leg wrap is applied and patients are able to walk immediately.
Laser for spider veins: uses a high intensity laser beam to destroy spider veins that are too small to be injected. After this cosmetic spider vein treatment is done a leg wrap is applied and patients are able to walk immediately.
Classifying Venous Disease
A commonly used classification system know as CEAP has been developed by leading phlebologists basing the class according to presentation, severity and cause of venous disease. This classification system improves the diagnosis accuracy and treatment options for vein specialists and their patients.
- Etiology or cause
Because venous disease and it’s presentation can vary the CEAP system has simplified the criteria for comparing venous disease into 7 categories based on observation and increased severity.
CEAP Categories and Description
C0 No evidence of venous disease
C1 Reticular and superficial spider veins
C2 Simple varicose veins only
C3 Varicose veins with edema (swelling)
C4 Varicose veins with venous stasis skin changes (pigmentation)
C5 Varicose vein with healed venous ulcer
C6 Varicose vein with open venous ulcer
Most patients referred to a vein clinic fall in to category 2 (simple varicose veins). This is a crucial time for treatment to avoid or delay further complications and severity in venous disease.
Patients in categories C 3-6 disease demonstrate an increasing severity of chronic venous insufficiency, and have a functional abnormality of the venous system. Without treatment these patients have increased risk of developing chronic ulceration.
Recommendations for new patients with venous disease
CEAP 1 no urgent need to refer for medical treatment, usually a cosmetic problem (however, could be early sign of underlying venous disease)
CEAP 2 refer routinely to vein specialist for Doppler and duplex ultrasound assessment
CEAP 3-5 quick referral to vein specialist for Doppler and duplex ultrasound assessment
CEAP 6 – urgent referral to vein specialist for full venous ulcer assessment and wound care