Many of our patients come to the office complaining of painful varicose veins, swelling in their ankles, and generalized leg pain. Quite commonly, these same patients have dealt with their leg symptoms for years, not knowning that there are new techniques that can solve their vein-related leg pain. Most of these advancements have to do with laser vein therapy in which a specialized vein laser can wipe out defective vein valves in your legs and improve your circulation. These techniques have very little physical downtime and are covered by most PPO insurance carriers.
EVLT represents one of the most important advancements in vein treatment in the last decade. Vein surgeons embraced the technologic advancements in laser endovenous treatment around 2002, upon observation of the longterm outcome reported in large clinical studies on the efficacy and low risk profile of endovenous laser and endovenous radiofrequency ablation. Advancements in technology have further improved the efficacy and safety profile of endovenous vein treatment and have allowed for its application in mild to moderate venous insufficiency. Patients who have symptoms associated with their varicose veins may benefit from endovenous treatment of venous reflux localized to the greater saphenous veins. Our Los Angeles vein clinic is equipped with laser EVLT and radiofrequency VNUS systems for the treatment of medical varicose vein problems.
ALTERNATIVE TREATMENTS:
AMBULATORY PHLEBECTOMY: Some of our patients have an isolated varicose vein that is close to the surface of the skin, and that bulges while standing. These patients may benefit from a minor surgical procedure known as a microphlebectomy, or ambulatory phlebectomy. These treatments begin with very small micro-incisions that are used to tie off and remove unwanted bulging varicose veins from the legs and thighs. Unlike old-fashioned vein stripping, microphlebectomy procedures offer very low risk, have maximal improvement, and have minimal scarring and downtime.
FREQUENTLY ASKED QUESTIONS FAQ ABOUT EVLT:
What is the risk of thromboembolism after endovenous laser? The EVLT procedure is known as endovenous laser therapy and is used to treat patients with venous reflux and chronic venous disease. A study by T. King et al demonstrated that the risk of venous thromboembolism is low among patients undergoing endovenous laser therapy for veins. Out of over twenty seven thousand truncal endovenous laser treatments, only fifty four patients developed a thromboembolism. The authors note that further research is needed to identify if venous anatomy, or variations in anatomy, were responsible for these events. In turn, the incidence of VTE is very low among healthy ambulatory patients.
What does EVLT stand for? EVLT is a laser therapy that can be used to treat unhealthy veins in your circulatory system. The technology is termed EVLT, which stands for endovenous laser treatment. Dr. Raffy Karamanoukian is an expert in vein disease and utilizes the EVLT system for the treatment of venous reflux.
What should I expect during my varicose vein consultation? In our Los Angeles vein clinic, we offer consultation for varicose veins and spider veins. If you have already had a consultation with another physician, our office also offers second opinion consults for vein disease. During your appointment, Dr. Karamanoukian will examine your legs and review your medical history and relevant risk factors for varicose veins. If you have a deeper vein problem, a vein lite examination, vein ultrasound, and vein mapping procedure will be performed. These directed vein exams will help delineate whether your vein problem is medical or cosmetic. At the end of your vein consultation, we will then recommend vein treatments that are tailored for your specific problem.
Can I drive immediately after my EVLT procedure? Most patients who have undergone EVLT in our office have the procedure performed using local anesthesia while awake. Patients are able to drive home immediately after the EVLT procedure and can resume normal, non-strenuous, activities after the EVLT treatment.
Can the VNUS or EVLT treatment work for large diameter veins? A study presented by A. Petukhov demonstrated the efficacy of the ClosureFast VNUS procedure in large diameter veins. They reported a total occlusion rate of 98% and noted that radiofrequency endovenous ablation was successful irrespective of vein diameter. This allows individuals with severe varicose vein disease to be treated with endovenous therapy. Dr. Raffy Karamanoukian has validated these conclusions in practice and has found that the VNUS, Venefit, EVLT and Clarivein procedures for varicose veins are effective in the treatment of mild, moderate, and severe cases of venous reflux that are medically symptomatic. Visit our Los Angeles vein clinic to see if these treatment options are right for you.
Why do varicose veins occur in the legs and thighs? It is thought that gravity induced changes in pressure increase the risk of varicose veins and vein disease in the lower extremity, namely the legs, thighs, ankles, and feet. Because the effects of gravity on the circulation are highest in the ankles, this is the area that has the highest vein pressures, particularly if you have a condition known as venous reflux. Dr. Raffy Karamanoukian will assess your legs during your consultation and determine if indeed you have venous reflux and venous insufficiency.
Do I need to bring anything with me the day of the EVLT or Venefit procedure? We ask that you eat a light meal the morning of your procedure and avoid any moisturizing creams on the legs and thighs. Patients do not need to take any medications prior to treatment, but if you take daily medicines, please take your normal doses at the requisite times. If you are taking Aspirin or Ibuprofen, kindly inform the office during our preoperative visit. Finally, a Tylenol analgesic tablet can be taken one hour before arrival to help with the discomfort during the EVLT or Venefit treatment.
What other vein treatments are available at the Santa Monica Vein Center? Our vein clinic is located in Los Angeles and we offer a comprehensive list of vein procedures that range from cosmetic vein treatments to more medical vein therapies. We offer the EVLT, VNUS, Venefit, and Clarivein procedures. In addition, we are experts in injection sclerotherapy, ultrasound guided sclerotherapy, transilluminated sclerotherapy, laser vein treatments, pulsed dye laser, and microphlebectomy vein surgery.
How does the EVLT laser work to treat unhealthy veins? The EVLT laser is specially designed to treat unhealthy veins that are causing injury to the venous circulation. The treatment is carried out with ultrasound guidance. Once the EVLT treatment is initiated, the laser light targets the vein wall and causes them to shrink up and shrivel. Once the unhealthy vein is damaged, the body begins the normal process of absorbing the vein and rerouting the blood using a healthier vein circuit.
What is the success rate with EVLT? Long term studies with EVLT and endovenous laser vein treatments have shown an efficacy of about 95% to 98% at the one year interval. Our office has examined and followed patients for several years and has found the longterm results with EVLT to be outstanding.
Can I shower the day of the EVLT or Venefit procedure? We recommend that you remove bandages the evening of your EVLT or Venefit procedure and either bathe or shower that evening or the next morning. It is alright to get the treated area wet, especially with lukewarm to warm water. If you have any concerns about the treated area, please call the office and speak to one of our vein experts. The most common complaint is from the mild bruising that may occur along the inner thigh. The bruising usually resolves quickly after the procedure.
Why does pregnancy increase my risk for developing varicose veins? If you already have occupational and family risk factors for varicose vein disease, pregnancy can make the situation worse. During pregnancy, the amount of circulating blood increases and the weight of the fetus increases intraabdominal pressure and may even put extra strain on the vein valves in your groin. Thus, the nine months of pregnancy can put severe stress on your veins, leading to the development of venous reflux. If you have had multiple pregnancies, our office can examine your veins and determine the best course of action to relieve leg pain, leg vein problems, and varicose veins.
Will EVLT repair by damaged veins? Unfortunately, once a delicate vein valve is damaged, it is almost impossible for them to be repaired. Vein valves work well under constant pressure, but once they are damaged, the injury is often permanent. The EVLT and Venefit procedures work around the vein problem by closing off unhealthy and damaged veins and helping the body reroute the blood supply using a more healthier network. The veins that are targeted are usually unhealthy and the body does not need them to function properly.
Does your office provide second opinions for EVLT and VNUS? Our office is a multidisciplinary center dedicated to all types of vein problems. If you have a vein problem and are being considered for EVLT or VNUS or Venefit procedures, give us a call and we can help you with your decision. Our expert clinician can provide you with a second opinion and guide you through the process of selecting the right vein procedure for you.
What preventive measures can I take to prevent varicose veins? There are many small things you can due to decrease the rate of varicose vein progression. Reguar aerobic exercise can help your legs; as can occupational changes such as the avoidance of long periods of sitting or standing. If you work for long hours, you may want to take frequent breaks and even wear compression stockings if necessary. Elevate your legs at the end of the day, and do not cross your legs for extended periods of time. Chances are that you will decrease your rate of varicose vein progression using these small steps, but if you have a strong family history of vein problems, early intervention is usually the key. Our office can help you minimize varicose veins and help you lead a healthy life by improving your veins.
How long does the EVLT vein procedure take to perform? Most unilateral cases using the EVLT system take about 30 minutes to perform. The procedure is completed under local anesthesia and patients are awake and comfortable during the entire procedure. The benefits of performing EVLT with a board certified vein surgeon is that the procedure will be performed with utmost concern for safety and efficacy. Dr. Karamanoukian has vast experience in vein disorders and utilizes RF and laser vein ablation techniques.
Can I undergo sclerotherapy for my smaller spider veins after EVLT? Sclerotherapy is a wonderful and very effective solution for unsightly spider veins. If you are undergoing EVLT or Venefit procedures, you may initiate treatment with sclerotherapy once the endovenous treatment is complete. Sclerotherapy will help treat cosmetic spider veins on the legs and thighs.
Do I need a vein ultrasound if I only have spider veins? The answer to the question about the necessity of ultrasound in vein treatment is tricky. It is believed that some spider veins are an early warning sign for a more serious vein problem. If this is the case, then an ultrasound will help pick up those subtle clues towards a more serious medical vein problem. If you only have a cosmetic spider vein problem, then an ultrasound is not necessary unless you have undergone multiple sessions and the veins seem to return every single time.
Does Dr. Karamanoukian offer second opinions for vein problems? Our office is a multispecialty vein clinic and we are a secondary and tertiary referral center for complex vein problems, including varicose veins. If you have recently visited a vein clinic in the Los Angeles area and now would like a second opinion for your vein problems, our staff can help schedule an appointment for you.
I also have facial spider veins, what are my treatment options? Our Los Angeles vein clinic also offers treatment for facial spider veins, facial thread veins, and facial blushing. The three lasers we offer target the blood vessels and cause them to vanish without significant downtime or recovery. These vascular lasers are great for veins on the face, neck, legs, arms, ankles, knees, and feet.
What should I do after my EVLT treatment? After the EVLT procedure is complete, we will place an appropriate dressing on the procedure site and make sure you are well before we discharge you from our clinic. We advise patients to not overly exert themselves after surgery, but to remain active throughout the day. Walk as much as you can, but no heavy lifting or straining. Showers and bathing is recommended the evening of the procedure, and you may call our office if you have any specific concerns. Within several days of your procedure, our office will schedule a follow up visit to make sure you are recovering well and that the treated vein is responding normally.
