Preparation to vein procedures

Though some young women have spider veins which can be treated by injection, most candidates for vein procedures are childbearing age and older. After pregnancy, especially a second pregnancy, veins may get worse. Vein treatments are relatively simple procedures, and there are not many situations in which a patient would be advised against it. Women who are taking birth control pills are one exception because, in rare cases, this can contribute to clotting problems. In cases where a patient already has a clotting disorder, it may not be advisable to treat the veins. Also, women should not be treated during pregnancy.

If you are being treated for large veins using vein hooking, you may need to take one to two days off from work. Plan to wear compression socks for about a week, usually with a wrap over this for the first 12 to 24 hours. You may walk normally after your procedure, but long backpacking trips are out for a while. It's a good idea to plan on having someone drive you home from the surgical center if you've had relaxation medicines. In many cases, however, no medication besides the local anesthetics is needed. Make sure you have loose comfortable clothes that will fit over any bandages.

If you're having sclerotherapy, you can return to work the same day. There are no drugs or anesthetic given, and you'll have no problem driving yourself home. You may be wearing some kind of support stocking.

How It's Done

Vein Hooking

Removing large varicose veins, back in the days when it was done in a hospital under general anesthesia, used to involve making incisions about one inch long, threading a long wire through the incision and through the vein from the groin to the knee, hooking the vein onto the wire, and pulling the whole thing out. This caused a lot of bleeding and bruising, and physicians sometimes advised one or two weeks of bed rest, which had the potential to cause circulatory problems because the patient was immobile for so long. Despite the new alternatives, this method is still commonly used.

The new methods are an entirely different story. For anesthesia, we use the same tumescent anesthetic that we use for liposuction, which numbs the area and decreases bleeding. The technique for hooking the vein is similar, but the instrument is smaller, and instead of pulling the entire vein out, we remove it in small segments of up to six inches long. Since the vein was already dysfunctional, the circulation system simply compensates for its removal by channeling the blood through the thousands of other working veins.

The leg has two major veins, either of which can be varicose and need removal. One begins at the groin and is seen on the entire inside of the leg. Another is located at the back of the knee, appearing on the upper calf. Several other leg vein systems may be dysfunctional and need to be removed as well. Tiny incisions are made wherever the veins bulge, and they are hooked out with our new tiny specialized tools. If the valves for the large groin vein are not working properly, they will frequently be tied at the groin, cutting off their connection to the rest of the system. This is called "flush ligation." The incision is sometimes made in the groin crease, where the scar is less visible. The entire procedure usually takes between one and three hours, and the patient feels little or no discomfort.

Some new procedures have been developed to destroy these veins from the inside as well. These involve threading the large veins with an instrument that can be turned on to destroy the vein internally.