Vein Disease 
Abnormally dilated veins, otherwise known as varicose and spider veins, affect the majority of adults at some time in their lives. Associated symptoms of varicose and spider veins can include aching, throbbing, excessive fatigue, itching, burning, a restless feeling in the legs and cramping. Unaware that any non-surgical remedy is available, many vein disease sufferers resign themselves to their discomfort and altered lifestyle.

What Are the Causes?
Both spider veins and larger varicose veins are caused by abnormally high pressure within the affected vein. In most cases the cause of this high pressure is hereditary. Larger varicose veins have abnormal valves that fail to keep blood flowing toward the heart. Blood flowing downward, instead of upward, in the legs causes the vein walls to stretch out until the vein bulges from the skin surface.

Treatments
Duplex-Guided Sclerotherapy (DGS) and Foam Sclerotherapy
In the case of large varicose veins in which the sources of abnormal flow are out of sight below the skin surface (and therefore in the past only treatable by surgery), duplex ultrasound is used to identify these sources and to enable the physician to guide the tip of the injecting needle directly to these sites. The vein then gradually disintegrates within the body, just as with small spider veins. 

At Vein Specialists of Northern California, the solution used for treatment is sodium tetradecyl sulfate, or STS. Vein Specialists of Northern California prefers this solution to hypertonic saline, which is more painful and less effective on larger veins. A recent innovation in sclerotherapy for varicose veins is the use of foam STS. Foam becomes less diluted than liquid when injected into the vein allowing more high-strength solution to come into contact with the vein wall. The result is that less solution has to be injected in order to get the same effect, and the success rate is higher.

Endovenous Laser Treatment (EVLT®)
EVLT® is a relatively new procedure that takes about 45 minutes from beginning to end. EVLT® uses laser energy delivered in a thin fiber-optic probe to treat the underlying cause of the varicose veins. EVLT® is performed under ultrasound guidance and local anesthesia allowing a more gentle, minimally-invasive approach to the treatment of varicose veins. There is minimal to no pain and virtually no scarring. Initially Dr. Isaacs will consult with the patient about the procedure. During the procedure, the area of the leg affected is locally anesthetized and a thin laser fiber is inserted into the abnormal vein, delivering the laser energy. This laser energy closes off the vein to any future blood flow. Your body will naturally use other healthy veins to return blood to the heart. The fiber-optic probe is then withdrawn from the body. You should experience minimal discomfort during the procedure. Patients regain normal skin tone and can resume normal activity the next day.

Most patients will wear elastic stockings for two weeks after treatment, depending on the size of the vein treated. Vein Specialists of Northern California was one of four offices in the country involved in the FDA trials in 2000 and is one of the very few offices in which this new treatment is available.

Benefits
While ultrasound guided treatments to larger veins typically involve five to ten injections with high strength solution, superficial treatments usually involve fifty or more injections in each leg during each visit. A course of treatment can include from one to five treatment visits at bi-weekly intervals. An extremely fine needle is used so that discomfort is minimal.

How Do You Decide Which Treatment Is Right for You?
Dr. Isaacs feels strongly that an educated and informed patient achieves the most satisfactory outcome. As our patient, you are a member of the treating team and understanding your own condition is essential for getting the best results.

Before any treatment is recommended or any estimate of cost is made, we ask you to visit us for an initial evaluation. At that time you will receive educational material, have a full history taken by Dr. Isaacs, undergo a complete examination of your veins and have a duplex ultrasound evaluation of the circulation in your deep and superficial veins. After this examination has been completed, you will have a complete understanding of the nature of your vein condition and the options for treatment. If our treatment is not appropriate for you, alternative recommendations will be made. We do not believe in "selling" you on our treatment; the final decision is always yours.

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